Interview with physician(s) and staff to understand the clinical and operational scope of the practice and data procurement of the following:
Charges, adjustments and payments for each specialty, physician and payor
Customary and prevailing charge schedule
Service mix ratio by physician
CPT-4 code frequency utilization YTD by physician
Physical production of needed data from client’s system
Detailed aging of A/R
Financial statements
Managed care and capitated contracts
EOBs
Analyze fee schedule and make recommendations
Compare a random sampling of charts with the original billing (HCFA 1500 claim form) and with the insurance carriers explanation of determining procedures, billed amounts and reimbursements
Review EOB’s for denials and reduced payments
Conduct Levels of Service Utilization Coding Analysis
Review reimbursement by payor mix
Identify income lost because of coding errors and omissions
Review practice operating indicators and analyze variances from market standards
Improve the staff’s ability to identify Medicare as primary or secondary insurance
Validate ICD-9-CM and CPT-4 codes to increase reimbursement and reduce liability and denials
Evaluation for level of proficiency of the following components of the practice:
Financial Screening Program
Patient Registration System
Charge Control System
Cash Control System
Third Party Billing Program
Patient Collections
Processing of Credit Balances
Record Retention
Personnel Administration
Physical Set-Up
Financial Operations
Review Staffing
General Operations
Human Resources
Telephone Techniques
Current Financial Statements
EOD (End of Day), Close Out Reconciliation Integrity
Peak Performance Physicians, LLC creates customized training programs that address CPT coding and reimbursement issues that affect practice income
Review accounting and internal control procedures
Generate a final report that will identify the current situation and practice and make recommendations for solutions, with prioritized action steps to achieve pre-determined goals. This report will also include a Physician Reimbursement and Coding Summary and a Practice Operating Indicators Analysis