Practice Management & Revenue Cycle Management for Radiology

PRACTICE MANAGEMENT & REVENUE CYCLE MANAGEMENT

FOR RADIOLOGY & IMAGING

Sun Knowledge 41 Madison Avenue, 25th Floor, New York, NY 10010

SUN KNOWLEDGE OVERVIEW

Key Facts Awards, Affiliations & Certifications

2Sun Knowledge © 2015-16 Private & Confidential

‘Onshore /Offshore’ KPO & BPO Services Serving US healthcare industry since 2007 Robust & scalable infrastructure State-of-the-art technology and systems Highly skilled and trained staff with good

communication skills and in-depth knowledge of process

Structured training, feedback and coaching HIPAA-HITECH compliant State-of-the-art office inbuilt with all redundancies –

power, infrastructure and others

ISO 27001:2013 and ISO 9001:2008 certified CMMi-SVC implementation in progress under KPMG

guidance Member of NASSCOM, the Governing Industry body for

IT/ITES in India Awarded ‘Best Emerging BPO Company of the year 2010’

by The Economic Times, India Recognized as one of the foremost 'Emerging companies in

Eastern India' by NASSCOM in 2011 Awarded Asia-wide ‘Healthcare BPO Provider of the Year’

at the Asia BPO Excellence Awards ceremony hosted by Asia BPO Summit on 14th February 2013 in Mumbai, India

Awarded the prestigious ‘Outsourcing Service Provider of the Year’ award in the Asian Outsourcing Excellence Awards ceremony hosted by CMO Asia on 1st August 2013 in Singapore

Awarded ‘Highest New Job Creator (IT/ITES)’ by STPI (Software Technology Parks of India) on 3rd December 2015

41 Madison Avenue, 25th Floor, New York, NY 10010, USA

Office at 41 Madison Avenue, 25th Floor, New York, NY 10010

SUN KNOWLEDGE SERVICE PORTFOLIO

Provider SupportMember SupportMember Retention ProgramClinical Help Desk

Contact Center

Utilization ManagementMedication Therapy ManagementHospital Re-admission

ManagementTherapeutic InterchangeFormulary Management

Clinical Services

Medical Coding & BillingClaims AdministrationEnrollment Processing &

MemberFulfillmentCredentialing Premium billing and collections

Administrative Services

Analytics

Telemedicine ServicesRemote Patient MonitoringApplication Development & SupportTechnical SupportTechnical Documentation

IT Services

Claims /Drug Utilization AnalysisPDE AnalysisRAF AnalysisPayment Reconciliation

We provide services toPROVIDERS – Physicians, Hospitals, DME, P&O, Home Health Care and Pharmacies

PAYORS – Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs

3Sun Knowledge © 2015-16 Private & Confidential41 Madison Avenue, 25th Floor, New York, NY 10010, USA

HIPAA COMPLIANCE SUMMARY


SL. COMPLIANCE ASPECT HIGHLIGHTS

1 Physical Access Authorized access only | Bio-metric access | Proximity card system | Photo ID cards | Access log review

2 General Security 24 hour security personnel | Logging of visitor details | Physical register retained for 10 years

3 Monitoring CCTV monitoring (with recording) of production area | Daily review of recording

4 Vendor Access Signing confidentiality agreement before accessing sensitive areas | Accompanied by security personnel/employee during all times

5 Mobile Phones All employees (except managers) are required to deposit mobile phones in the locker box before entering facility

6 Personal Baggage No backpacks or other bags allowed | All baggage to be deposited in locker box before entering facility

7 Network & Application Usage

Unique user IDs created using Microsoft Active Directory | Access to storage devices, shared drives, USB/mass storage devices, printers – controlled by Domain Group Policy | No wireless access points

8 Firewall Unified Threat Management System | Internet traffic regulation using multiple filters | Network Address Translation (NAT) | Intrusion Prevention Systems (IPS) | Port-mapping for traffic between Virtual LANs | Default setting to deny all traffic

9 VPN (Virtual Private Network)

Site-to-site IPSec VPN tunnels | Authorized access via client-to-site VPN connections | Access authorization controlled by Active Directory's authentication service

10 Redundancy Management

Fully redundant network stack | Two ISP links configured in active-active mode | Power backup supplied by 130 KVA UPS and 750 KVA generator | 22 KVA UPS backup for server and network systems

11 Virus & Malware Protection

Central anti-malware system | Automatic updates | Extra protection by gateway firewall | Centralized OS patch management system (using Microsoft's WSUS server)

12 Other Measures Fire extinguishers at key areas | Half-yearly fire drills

REVENUE CYCLE MANAGEMENTSERVICE OVERVIEW


SUMMARY OF SERVICES


PRACTICE MANAGEMENT

Scheduling

Eligibility & Authorization Verification

Prior Authorization

Customer Care

REVENUE CYCLE MANAGEMENT SERVICES


360° Revenue Cycle Management

Services

REVENUE CYCLE MANAGEMENT – SERVICE SNIPPETS


Eligibility checking and obtaining prior authorization Credentialing as per the carrier’s guidelines

Inpatient/Outpatient Hospital Coding Physician Coding

Patient entry demographics & insurance information Fee Schedule / Charge Entry Scrubbing all entries for correctness and completeness with appropriate billing edits Submission of claims to Payers, e.g. EDI or paper Creation and mailing of patient statements Posting of payments received from patient and Payer Reconciliation of charges, payments received and adjustments made

Denial Management (understanding denials and making corrections) Resubmission of claims A/R calls as follow-up on outstanding issues Closure of a claim once the balance is zero

CODING

BILLING

A/R FOLLOW-UP

PRE-SERVICE CHECKS

AREAS OF OPERATION


We provide turnkey revenue cycle management services in the following areas:

Radiology / Imaging Prosthetics & Orthotics Urgent Care

Pathology Critical Care Durable Medical Equipment

Internal Medicine EKG Compounding Pharmacies

Cardiology ENT Orthopedic Surgery

Anesthesia Family Practice Specialty Clinics

Rehab Centers Pharmacy Physicians, and more…

SERVICE HIGHLIGHTS


Up to 97% collection rate in accounts receivable

FREE medical billing software, EMR & setup

Real-time eligibility checks & fast authorization

100% HIPAA-HITECH compliance

Rapid Automation Technology® for lightning fast claim status analysis in denial management

Turnaround time less than 48 hours max.

Low service fees with no hidden cost

Zero lockup service contract that can be cancelled anytime

Excellent references from reputed clients across the US

Real-time audits and custom reporting

PRACTICE MANAGEMENT SERVICES


ELIGIBILITY VERIFICATION


Full range of verification services

Fast 24-hour turnaround time

Above 99.9% accuracy

Detailed documentation

100% HIPAA compliance

Experience with national and private carriers

We have the experience, training and resources to complete quick verification checks, a feature that Urgent Care Centers love us for. In some cases, such services can even be rendered in real-time (with the help of fast, software-assisted database enquiries)

AUTHORIZATION VERIFICATION


Diligent follow-up till resolution and closure

Uniform importance given to every account irrespective of size, age or claim value

Fast completion of authorization process

Periodic follow-ups to maintain authorization validity

Years of experience in working at claims adjudication for major insurance companies in the US have given us a unique understanding of the authorization process, allowing us to complete the process faster than others!

PRIOR AUTHORIZATION


Full range service, comprising Authorization Request Follow-up Approval

100% HIPAA-HITECH Compliance

Low prices with no hidden cost

Highly streamlined, fast and accurate service

• Radiology / Imaging• DME• Hospitalization• Outpatient Surgery requiring general anesthesia• Skilled Nursing • Organ, Bone Marrow, Stem Cell Transplants and other similar procedures• Inpatient rehabilitation – Treatment for alcohol or drug abuse• Other conditions

We cater to

PRIOR AUTHORIZATION – KEY STEPS


Tasks involved in carrying out this Pre Authorization service include the following steps:

Gathering relevant medical documents from the Providers

Calling up insurance to find the authorization filing procedure and turnaround time

Initiation of authorization request (fax/online/calling)

Follow up with the Payer to check the auth. status as per the TAT set for each Payer

Acknowledgement of authorization approval/denial

Updating the authorization details (authorization number / duration / quantity) in the Provider’s billing system

CODING


Service Offerings

• Place of Service Based Coding – Inpatient, Outpatient Coding

• Provider Specialty Based Coding– E/M, Cardiology, Orthopedics, Physical Medicine etc.

• Review medical notes and clinical documents

• Assign ICD-10 codes for the diagnosis identified by the physician and procedure codes (CPT/ ICD 10 PCS)

• Assign modifiers as applicable

• Code review and quality assurance

• Communication with Physician’s office for additional medical documentation and clarification

Key Tasks

MEDICAL BILLING SYSTEM


We use KAREO for coding and billing services that covers the complete billing cycle:

SOAP notes review

Superbill generation and coding

Claims edit checking and correction

Claims submission through EDI clearing house at a scheduled time

Rejection management

ERA/EOB posting and reconciliation

Automatic secondary payer billing

Denial Management

Patient statement generation and mailing

Sun Knowledge handles medical billing - promptly, perfectly and professionally – using KAREO® or other billing systems as preferred by the client.

PAYMENT/DENIAL POSTING PROCESS


Payment posting is crucial to the billing process. Due to the sensitivity of this process, accurate and efficient payment posting process is indispensable.

Our billers are known to be highly efficient and analytical in the payment posting process.

Payment Entry Process

Select Patient Account

Select EncounterSelect Encounter If not found

Refer Client SpecifiesDenial

Denial Code

Hold Transfer BalanceTransfer BalanceWrite-off

Post Payment

Payment

PRODUCTIVITY EFFICIENCY TRACKING


Employee Name Note Count Days Worked Hours Worked Notes Per Hour Max Note Time Avg. Note Time

John Smith 977 23 203.55 4.8 1:29:52 0:07:15

Jane Doe 1025 23 214.97 4.77 0:55:14 0:04:56

Rick Williams 913 21 207.07 4.06 1:27:08 0:07:14

Robert Frost 870 21 187.35 4.64 0:42:54 0:04:05

Dan Chesser 910 23 216.47 4.2 3:50:55 0:06:18

Derek Malia 823 23 210.37 3.91 7:01:30 0:04:37

Our clients depend on transparency.

We provide our clients with the ability to maintain detailed tracking for increased productivity and efficiency.

A Sample Report

ACCOUNTS RECEIVABLE


Reduction in accounts receivable

by up to 30% within 1 month

Accounts Receivable recovery cost starts from

1% of collections

Expert handling of accounts receivable by highly experienced staff

Same attention to every cash amount regardless of

its size or source

Demonstrated expertise in working on difficult-to-recover aging A/R

Over 7 years’ experience in claim adjudication for

major US insurance plans

ACCOUNTS RECEIVABLE - STEPS IN FOLLOW-UP


A/R Analysis 14% of all claims submitted to the payers are denied and have to be resubmitted, appealed

or written off by providers

50% of denied claims are never re-filed

50-70% of denied claims have higher chance of being recovered

Follow-up with payer Aggressive follow up with the insurance company's on all accounts at any

stage of the aging bucket plays an important part in A/R follow up activities. Closure of claim

Reducing days in A/R, claims submission and improving collection ratio with an increase in the probability of payment through timely follow-up is the responsibility of our A/R team

DENIAL MANAGEMENT


Auth Related14%

Coding Error5%

OON Issue8%

COB Issues10%Patient info missing

6%

Exceeds Timely Filing8%

Duplicate Claim5%

Service Not Covered6%

Primary Paid Max7%

Pre-Existing Condition5%

Others26%

Distribution of Denied Claims

TRANSITION, OPERATIONS AND COMPLIANCE

FRAMEWORK


The key resources of the customer are available during the transition phase.

All documents and process materials like P&Ps and SOPs are available to the Service Provider Transition team before the start of transition.

Any change in the Scope of Work will require re-planning.

All data files are made available for data migration work.

Any other assumptions made in the “Statement of Work” are applicable here.

A more accurate plan will be given at the time of transition

Transition plan tasks may vary depending on specific project

ASSUMPTIONSSr. No. Phase / Task Description Start

WeekEnd

Week Remarks

1. Project Initiation W + 0 W + 0

2. Transition Planning and Solution Identification W + 1 W + 1

ABC to provide existing SOPs/P&Ps/Flowcharts/Reports before this phase starts.

3. Knowledge transfer and detailed As-Is Process Mapping W + 2 W + 3 Onshore activity at ABC

4. Validation of process mapping document / SOPs / training materials W + 3 W + 4 Onshore activity at ABC

5. Validation of solution customization requirements W + 3 W + 4 Onshore activity at ABC

6. Finalize SLA & reporting requirements W + 4 W + 4 Onshore activity at ABC

7. Staffing & Training W + 4 W + 78. Solution customization W + 4 W + 7

9. Solution testing and verify operation Readiness W + 7 W + 8

ABC to provide sample data and participate in testing exercise.

10. Conduct Pilot W + 9 W + 9

11. Evaluate Pilot results and finalize critical Quality parameters W + 9 W + 9

12. Handover to Operations & start “Go Live” W + 10 Transition work ends and

operations ramp-up

TYPICAL TRANSITION SCHEDULE

Sun Knowledge © 2015-16 Private & Confidential 2441 Madison Avenue, 25th Floor, New York, NY 10010, USA

TRANSITION SUCCESS FACTORS

Executive buy-in

Foster win-win partnership relationship

Strong project leadership for both companies

Client’s involvement in approving key deliverables (i.e. project plan, process documents, etc.)

Maintain key current subject matter experts until knowledge is transferred and the key processes are stable

Availability of key client personnel for training

Accurate identification of desk procedures and processes is critical

Effective governance structure

Communicate, Communicate, Communicate


OPERATIONAL FRAMEWORK

TRANSITION

Project scoping & planning

Knowledge transfer – Process training and assessment

Process documentation

Solution customization

Infrastructure set up

Pilot/Transition period

TRAINING

Training Need Identification

Customized training program as per client’s requirement

Pre-process & process training

Voice & accent and cultural training

Refresher training

PRODUCTION

Project management approach

Exception handling and reporting

Effective coaching & monitoring practices

Periodic review and evaluation

Service level management and reporting

QUALITY

Regular audit for process and deliverables

Identify and analyze errors to take corrective measures

Flowcharting and root cause analysis for process improvement measures

Management reporting of quality assurance activities

Capacity planning

Forecasting, staffing & scheduling

Real time reporting

Billing and revenue management

MIS / WFM

Ensure 100% adherence to federal / data protection laws

Governance & compliance audits

Organization preparedness for client & third party audits

HIPAA compliance

CONTROL & COMPLIANCE

PROJECT MANAGEMENT & OVERSIGHT

IT INFRASTRUCTURE– TOOLS & TECHNOLOGY


Sun Knowledge Governance

Structure

Steering Committee

Program Management Office

Project Delivery Team

Executive sponsorship

Management oversight

Ensure business goals and engagement goals alignment

Ensure tangible results and demonstrable value

Continuously educate &

report executive leadership on the critical success factors of engagement

Plan and implement change; define, establish performance, metrics aligned to goal

Review project scope, timeline and budget and monitor project progress

Communication, status reporting & escalation to steering committee

Manage cross team dependencies

Identify, initiate & institutionalize process improvements

Oversee knowledge repository building

Project Management

Scope Management

Knowledge Management

Change Management

Ensure successful engagement startup

Quality Management

Resource Management

Communication & Status Reporting

Issue Management

Monitor & measure knowledge transfer process

Incorporate industry best practices


GOVERNANCE MODEL


QUALITY ASSURANCE & CONTROL

Quality Control & Assurance processes at Sun Knowledge help us meet our client’s expectations and SLA target. We use Quality Assurance program to set production and quality goals. Our daily

quality audit activities ensure that we evaluate our agents’ work on all relevant criteria. We ensure quality by carrying out rigorous quality assurance and control activities.

Periodic process review

Process audit

Testing deliverables and root cause analysis

Process improvement / re-engineering

Incorporating customer feedback

N% internal quality audit of client deliverables & review reporting

Weekly/monthly monitoring of productivity reports


• Regular process test and appraisals

• Work in-sync with Operations & QA

• Preparation of training Modules

• Preparation of training Plan in ‘Knowledge Net’ training module

• Process training and refreshers

• Availability of training documents in ‘Knowledge Net’ portal

• V&A, Soft skills training

• Post-training assessment• Training feedback• Review of training program

Training Need Identification

Training Program Planning

Conduct TrainingTraining Evaluation

TRAINING METHODOLOGY


COMPLIANCE – KEY FACTS

Well defined policies to cover compliance aspects

Written procedures covering compliance aspects

Proactive compliance reporting and issue escalation

Action list for changes in rules and regulations by regulatory authorities

Compliance evaluation framework

Periodical training on compliance issues and update

Periodic audit and review mechanism to address potential compliance risks

Implementation of data privacy and security standards like HIPAA-HITECH and ISO 27001

Incident reporting for data security violation

Compliance awareness among the employees and reward on compliance reporting

Compliance violation by employees leads to employee retraining and reassessment

Sun Knowledge has defined and established a process and system to avoid compliance risks while carrying out operations and encourage employees to proactively report compliance issues

to the higher management

Sun Knowledge has defined and established a process and system to avoid compliance risks while carrying out operations and encourages employees to proactively report compliance issues to the

higher management.


COMPLIANCE - ESCALATION STRUCTURE

Service DeliveryService Delivery Mgr

(Service Delivery POC)

Head of Operations

(1st Level Escalation POC)

Operations

CEO & MD

(Final Escalation POC)

Executive Board

Board of Directors

ComplianceCompliance Mgr

(Compliance Escalation POC)

Head of ComplianceCompliance

Team LeadProcess Team Lead

(Service Delivery POC)

TechnologyTechnology Mgr

QualityQuality Mgr

HR/TrainingHR/Training Mgr

Compliance Issue

Trigger Point

Process Team Leader will inform Service Delivery Manager and Compliance Manager immediately after occurrence of the event

Compliance Manager/ Service Delivery Manager will assign the severity of the compliance issue

Compliance Escalation Path

Severe Compliance Escalation Path


IT INFRASTRUCTURE

Service continuity supported by BCP and disaster management mechanisms 100% redundancy in all IT assets, providing high-availability and reliability 40 Mbps leased line internet connectivity provided by two ISPs in load sharing and automatic failover

configuration Data protection and security provided by Fortigate 300D firewall combined with other physical and logical

access controls Voice telephony infrastructure built using E1 lines provided by two IPLC providers IP Network-based PBX system with IVR, ACD and CTI functionalities and 100% call recording & reporting

features Data center with over 20 IBM servers with dedicated UPS Polycom VSX 7000A video conference system for remote training and client communication 24/7/365 IT-Infrastructure support personnel for user support, using ticket management system 120 KVA on-line UPS power backup systems and additional backup provided by 180 KVA power generator


DATA SECURITY AND END USER PRIVACY

Information security management system is aligned with ISO 27001:2013 standard Implementation of policies and procedures with respect to PHI comply with HIPAA-HITECH regulations Data replication between Sun Knowledge’s servers in NY and India via site-to-site IPsec VPN tunnels helps strong

business continuity management Daily off-site backup process to mitigate data loss risk in case of disaster Implementation of physical access control system in office premises restricts access to sensitive areas housing

application and database Physical and logical segregation of internal network into VLAN segments to control and protect data storage and

transmission between business/process units Implementation of perimeter security devices, like firewall and segregation of sensitive information systems Access to all information systems through two levels of authorization Implementation of two levels of end point malware protection network and system level anti-malware systems Use of secure e-mail system for e-mails with sensitive PHI information Implementation of access restrictions to prevent unauthorized deletion or movement of data using external storage

devices like optical discs, pen drives, etc. Security incident monitoring, reporting and resolution system Periodic employee awareness training on data privacy & protection and HIPAA regulations


CHALLENGES & RESPONSESAND BENEFITS


CHALLENGES & OUR APPROACH


Assignment of adequate staff Completion of secondary verification Rigorous audit

Time consuming with limited staff Documentation collection requires

continuous follow-up Increased TAT

Time consuming with limited staff Secondary verification not carried out

Checking Authorization Requirement and Obtaining Authorization

Eligibility Verification

Patient Demographics / Insurance / Charge Entry

Transaction audit to minimize errors; reduces denial due to missing patient information

TASK DESCRIPTION CHALLENGES APPROACH

Missing information / Key-in errors Increased denial rate Increased TAT

Assignment of adequate staff Systematic and regular follow-up with

physicians’ offices & payors to collect documentation and obtain authorization

Proper tracking mechanism



Defining KPI for rejection management process and assigning responsibility

Claims reconciliation and exception report generation

Unapplied balance Accumulation of backlog Manual posting Denials not posted

Delayed correction and resubmission Possible loss of payment

Payment Posting

Rejection Management

Paper Claim Submission

Proper tracking of every submission of paper claims

Moving to EDI based submission whenever possible will reduce cost of manual work and faster payment cycle


Additional work for printing and faxing/mailing

Delayed filing leading to denials Lack of information about the actual

status

Defining guidelines

Review of patient payments

Define KPI – TAT & Accuracy

Denial posting and review



Proper documentation – process manual, guidelines & checklists

Defining proper tracking mechanism through various reports -Ageing, Status, Daily, Exception

Generate exception reports and regular audit of every process tasks

Defining KPIs and assigning responsibility

Lack of clarity of claims volume and current status affects management decision making process

Impact on overall billing process performance and improvement

Decreased productive efficiencyProcess Administration and Reporting

AR Follow-up & Denial Management

Regular analysis, follow-up and review

Transaction audit


Accumulation of backlog Denials not posted Claims reconciliation issue

CLIENT BENEFITS


Significant decrease in operational expenses We charge as low as $10 per hour per employee! Our clients save on other associated costs for employees including Health Insurance Premiums, Payroll Costs,

Medicare Tax, Human Resources, Employee Attrition, additional Real Estate and Infrastructure Costs We guarantee > 50% operational savings effective immediately; e.g. one of our clients reported a $2.1 million

operational savings in Y1 alone!

Heightened collection and increased Accounts Receivables 30% of DME Rx are incomplete when first received. We excel in completing the Rx claim quickly.

Cyclical Data Reporting Data reporting interval customized to meet the needs of the customer Productivity Efficiency Tracking allows for quantifying the team workload

Demonstrated experience handling DME claims Medicare, Medicaid and Commercial Plans Fee for Service and Capitated Plans

SUMMARY OF BENEFITS


Very Little Risk• Proven track record in providing healthcare BPO/KPO services

• Experienced in providing services to both payers and providers

• Experienced working with various software platforms

• Quick and efficient resource for special projects requiring technical and process expertise

Significant Upside Potential• Great understanding of the Healthcare Industry. Operation scale-up with a short notice

• Extremely competitive rates, greater productivity, improved quality, increased member and provider satisfaction

Proven Process Performance• Low denial rate reduced collection time increase in revenue collection

• Billing & Coding Accuracy > 99.9%; TAT: 24 – 48 hours

• Adherence to CMS billing requirements

Clear Communication and Quick Response Time at All Times

ISO 27001:2013 & HIPAA Compliance for End-user Data Privacy and Protection


TESTIMONIALS


CLIENTSPEAK


“We have had the pleasure of working with the Sun Knowledge team throughout the few months utilizing their services for patient data entry and eligibility verification. They are a devoted and responsible team that is highly experience in what they do. They are always concerned about the client’s needs and are always there to help. I highly recommend the services offered by Sun Knowledge.”

COO of a leading medical billing and credentialing company in New York

“Your team amazed me with the manual and the amount of info you provided with that short training session.”

Practice Manager of a major Dermatology group in New York and New Jersey


CLIENTSPEAK


“My firm has evaluated an outsourcing transaction with Sun Knowledge. They provide superior service at a very attractive rate and have demonstrated to us their commitment to this partnership. Their expertise across various process areas in the PDP/MAPD domain and unique cost structure puts them in an incredible position to work with plans throughout the healthcare industry.”

Chairman, President and CEO of a major New York based Health Plan

“Our company is very pleased with the administrative, and business analytical solutions which Sun Knowledge delivers to our company from a quality & cost perspective. They have been a true partner in bringing industry expertise, and innovative solutions to the table. Their ability to grow with our evolving needs for higher end services such as clinical services is a significant differentiator among healthcare business process outsourcing firms.”

Executive Vice President of Operations of a leading MSO


CLIENTSPEAK


“I was always against the idea of outsourcing our back end claims processing work but I was wrong. Sun Knowledge provided extraordinary deliverables on a timely basis which led to cost cutting considerably for us.”

CEO of a leading MA-PD Plan

Ronnie Hastings(646) 661-7853Email: [email protected]

Sun Knowledge41 Madison Ave., Suite 2511, 25th Floor

New York, NY 11001, USA

For Additional Information, Please Contact…


Documents

Practice Management & Revenue Cycle Management for Radiology