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We are experts in helping family medicine practices explore and enhance additional revenue opportunities. Apart from focusing on regular office visits, immunizations, and routine health check-ups, we help your practice in extending your services to patients in the form of transitional care management, chronic care management, and telemedicine services.
We, at Rely On Us, provide a comprehensive model, covering a broad spectrum of services, starting from eligibility verification to projecting practice health with a wide variety of reporting tools.
✔ Precise and upfront determination of patient responsibility for payment of services.
✔ Reducing the burden of administrative tasks, for the practice to focus on patient care.
✔ Compliant and accurate coding standards, reducing denials for medical necessity.
✔ Verifying local coverage determinations for all claims prior to submission.
✔ Maintaining 100% HIPAA compliance across all processes.
✔ Reducing revenue loss by enhancing processes in terms of billing, coding, or administrative tasks.
✔ Increasing profitability and improving collections by 5-15%.
✔ Maintaining a healthy A/R days 35-40.
✔ Maintaining a faster turnaround time of less than 24 hours, for both billing and coding services.
✔ Monthly review of all the processes and reporting overall practice health utilizing various billing, coding, and audit reports.
Family medicine is best defined by the term “comprehensive care” for patients of all ages irrespective of gender, disease entity or organ system treated. Family medicine practitioners are the first point of contact for patients, and provide comprehensive and continuing care for all age groups. Building a strong patient-provider relationship is another key factor which defines family medicine. While delivering care to patients with acute, chronic and routine healthcare services, family medicine practitioners also cover a broad spectrum of services including but not limited to routine check-ups, immunizations, screening tests, counselling services, disease prevention interventions.
New payment methodologies are being implemented by CMS as part of The Affordable Care Act, and the focus has gradually shifted from a fee-for-service model to more of value/outcome based methodology. As part of this makeover, physicians need to focus on expanding their services to include new areas of patient care such as chronic care management and transitional care management services.
hile understanding the rules of proper documentation, billing, and coding is essential for the practice to maintain a healthy financial status, it is imperative that they also focus on providing additional services to enhance practice revenue.
Understanding E&M Guidelines for Reporting Routine Office Visits: : A routine mistake many of the family practitioners make is billing level 3 and level 4 codes consistently for majority of their patients just to avoid scrutinization. Proper knowledge of documentation and coding guidelines is essential to report the right set of codes based on the level of service provided to the patient, rather than a standard benchmarking approach.
Incident to Billing: Knowledge of incident to billing is very essential for family medicine practice. The billing is dependent on the insurance guidelines and practice regulations which differ from state to state. The practices are usually managed with non physician practitioners (NPPs) such as nurse practitioners and physician assistants. When the patients are seen by the NPPs, the claims are submitted to the insurance companies and as per Medicare; these claims get paid at 85% of the fee schedule. But many are unaware that if the encounter is supervised by the physician, the claim can be billed under the physician’s NPI which would fetch 100% of the fee schedule payment. However, there are limitations to this type of billing as it is not applicable for new patients and also when the physician is not available in the suite. There are also exceptions to this concept wherein we can bill under the physician for transitional care management and chronic care coordination services.
Billing for Immunizations: Immunizations and vaccinations are common services that are rendered by the family medicine practitioners. While billing for these services, care must be taken that the practices review all the state and the insurance guidelines before submitting the claims. Since the coverage guidelines are different for both the commercials and the federal payers, we must always keep an eye on the reimbursement of these services.
Chronic Care Management Services: This is an evolving area of revenue generation for providers. Providing CCM services to patients requires an initial process setup:
✔ Identification of patients with chronic conditions and enrolling them into the program.
✔ Categorizing patients by the highest risk of being hospitalized and the number of specialities involved in care.
✔ Setting up documentation standards, and identifying specific billing guidelines pertaining to reporting limitations.
Preventive, Screening & Assessment Services: Medicare continues to cover preventive visits along with certain screening services. Understanding what services are paid and what is not paid by CMS is a critical aspect. Services such as screening for cancer, diabetes, glaucoma, HIV, adult immunizations, initial preventive physical examinations, behavioral counseling and interventions, depression, tobacco usage and cessation are all covered services and carry a huge potential for revenue enhancement. Each set of these services carry their own documentation and billing guidelines for reporting.
Time Based Coding: Importance of documenting time spent with the patient has been a point of emphasis. Services such as counseling and risk factor reductions, smoking cessation counseling, behavioral and lifestyle modification counseling require time to be documented for proper payments. Prolonged care services codes (99354, 99355, 99356, 99357, 99358, and 99359) are used to report additional time spent by the provider during routine office visits and require proper documentation for medical necessity.
Patient eligibility and coverage determinations: Verifying patient’s eligibility and having the right set of practices in place should be of top most priority for the family medicine practices. Determination of coverage will ensure timely payments from the insurance for services rendered and avoid the headaches of collecting money from the patients for unpaid/ineligible claims. Rely On Us helps physician to stay ahead by checking the eligibility and coverage determination.
Accurate Reporting of Codes: Coding accuracy plays a significant role in determining whether a claim will be paid in a timely manner or not. Incomplete or incorrect codes, lead to claims being denied and loss of time and revenue. Our Certified coders ensure accurate reporting of place of service codes, procedural codes, and diagnostic codes.
Proper usage of modifiers on claims: Modifiers are essential elements which impact billing and reimbursement of the services rendered. Incorrect usage may lead to underpayment or non-payment of the services billed. Our billers’ pre-check all the claims before submission to make sure all modifiers that are applicable are appended to the procedure codes.
The Up-coding and Down-coding risks and pitfalls: Up-coding refers to reporting higher level of codes for patients with relatively less complicated problems which may not warrant the level of services reported. Conversely, down-coding refers to reporting lower level codes for services rendered, either unknowingly or deliberately. In either of these cases, proper documentation and reporting of services must be a day to day practice to avoid the compliance risks and avoid penalties.
Bundling and unbundling: Knowledge of CPT codes and the rules is of utmost importance for the practice to avoid denials and get the monies paid on time. Family medicine practices need to know which procedures/codes can be reported separately when performed, and what services are paid in a packaged manner. This will avoid loss of revenue and help the practice stay healthy in terms of revenues.
We would be glad to evaluate and provide a comprehensive report on your practice health, and help you understand areas where the practice can focus on adding/improving services to enhance revenue.