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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.
It’s all about the adults!!!
The primary goal of internal medicine practice is to provide comprehensive treatment to adult patients, focusing predominantly on disease prevention, early diagnosis and treatment.
Though internists treat chronic conditions like hypertension, diabetes, chronic lung diseases, and heart related disorders, they are also involved in addressing preventive healthcare needs for patients such as performing periodic examinations, risk factor reductions, lifestyle issues, and many others to list.
s obvious as it gets, getting paid is a major challenge for internal medicine practitioners due to the vast nature of illnesses they treat and the various subspecialties of health care they deliver. Often the physicians feel burnt out because of the overwhelming responsibilities they handle.
CMS has developed a value-based payment program which has been mandated by the Affordable Care Act. This model of payment drives reimbursement towards more of a performance comparison between physicians, thus enhancing the efficiency and quality of care provided to the patients.
In an effort to keep up with the changes in the payment models and avoid stacking up monies with the insurances, internal medicine providers need to focus on multiple aspects of billing, coding and claim submission guidelines.
We at Rely On Us healthcare services handle end to end operations of revenue cycle management which would ease the practice management and help physicians focus better on the patient care.
Incident to Billing: Knowledge of incident to billing is very essential for internal 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 where in 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 internal 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 payors, we must always keep an eye on the reimbursement of these services.
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 internal 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. Internal 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 provide a comprehensive report on your practice health and help understanding areas where the practice would need to improve processes to enhance revenue.