1. Monthly Audit Management for ACCOUNTS RECEIVABLE

2. Evidence based Recalls and performing Diagnostic

Tests/Procedures and Annual Wellness Visits for better patient

care and risk management.

3. Streamlining office workflow with the use of technology and daily

reporting for all administrative tasks. Implementing

accountability at all levels in the practice, improving productivity

and cost optimization.

1. Monthly Audit Management for ACCOUNTS RECEIVABLE (First Step for Revenue Growth up to 10%)

• Streamlining office workflow with the use of EHR and back-office

services for following up OUTSTANDING claims every 6-7 weeks.

This process alone with increase collections by 10% or more

• EHR’s Claim Follow up Management provides a comprehensive

list of claims that are outstanding by PRIMARY payer, Secondary

Payer, and Patients.

• CS’s AR Follow up Team can conduct Monthly Audits for all

claims that need a phone call. Our team would make that call and

add remarks into EHR for future tracking.

• CS would also compile a list of claims that need CORRECTION

and forward it to Billing Team in practice.

• Cost per call is $1.25 compared to $4.00 in office

• Builds up knowledge base for Denials by payers for an active

Denials/Appeals Management.

• Enables team members to finds the status of outstanding claims

and document it with time/date and reference #.

• Question Insurance companies’ rep if previous (last) call status

and current (this) call status is identical for that particular claim,

as this indicates that no further action was taken on the claim.

• Ensures competency as the AR teams are familiar with all

medical policy and guidelines for claims.

• Team Members question payers if protocols regarding following

clean claim act (OR) Adjudicating claim, as per company’s claim

adjudication policy, are not followed.

1. Monthly Audit Management (continued)

2. Evidence based Recalls

Performing Clinically Necessary Tests/Procedures

Annual Wellness Program

PRE-VISIT PREPARATIONS

Working on Clinical Decision before Patient’s Arrival

TO BE COMPLETED BY THE CLINICAL TEAM, 24 HOURS IN

ADVANCE OF PATIENT’S VISIT

• Look at Problem List

• Last Test and Procedures

• Last Lab Results

• Last Annual Well Visit

• Identify Plan of Care

• Make a List of Clinically Necessary Procedures Based

on Current Problem list and Previous Assessment.

CS’s back-office physicians panel can help you with above process.

PNO Name CPT CPT Description Last performed Due Date ICD code

329 Wertz, Alfred 93000 ELECTROCARDIOGRAM 5/10/2010 10/25/2013 401.1,443.9,786.51,V72.84

93922

Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral 5/10/2010 10/25/2013 443.9

SUGGESTED 78452

Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection 786.51

93224 HOLTER ANALYSIS 786.51

93306 Echocardiography 786.51

2. Evidence based Recalls

Performing Clinically Necessary Tests/Procedures

Annual Wellness Program

Patient Name : Wilfred October

Insurance : BCBS

Active Problems : PVD, Chest Pain, Hypertension, SOB

Recommended Primary Diagnostic Procedures for Risk Management

EKG, PFT, ABI

Yearly Annual Wellcare Covered and Recommended

Based on 24 Hours or 48 Hours CHART PREPARATION

EKG last done on 05/10/2010 and ABI last done 05/10/2010 and PFT never

done. Patient didn’t have Annual Wellcare Visit as well.

Plan of Care : Recommended EKG + PFT + ABI

To be scheduled : Annual Well Visit

Check InsuranceCheck Registration

(Including Address &

Phone Numbers)

Collect Co-pay

Schedule appointment Upon Check out (OR)

depending Upon Clinical Alerts

Keeps patients ready for Pre-Exam

(OR) Triage post above functions

Ask For balance, Co-Insurance &

Deductible

3. Streamline Office Workflow through Technology and Back-office Team members.

Receptionist’s CHECKLIST

• Verify the date & time of last office visit.

• Makes Sure that Demographic Information is up to date.

• Address any system Alerts for Financial/Insurance Issues.

• Collects patient balances due to co-Insurance/Co-pay (OR)

Deductible

• Review any Alerts for clinical reasons, such as preventive test (OR)

recall based on conditions and previous treatments (OR)

Procedures.

• Distribute Pre-Visit and/or Medical Necessity Questionnaire for

Diagnostic Tests and Procedures

• If Patient was ordered an outside Test/Procedure/Referral, were

those completed and are reports available?

• Appointment Scheduling upon patient’s check-out

3. Streamline Office Workflow (continued)

3. Streamline Office Workflow (continued)

Make a comprehensive list of all OPERATIONS by

department that can be potentially streamlined using

AUTOMATION OR BACK-OFFICE team at $6.5/Hour.

Front Desk

No Show Rescheduling

-EHR’s Automated Engine can set-up calls / text messages / email

notification for No Show Rescheduling.

-CS Team can call all patients that didn’t show up and schedule

them in EHR so that there is no opportunity loss.

Precertification / Prior Authorization / Referral

-CS Precert Team can obtain Precert/Authorization /Referral for

various office based Procedures at $6.5/Hour instead of $16-

18/Hour. Our team can request Medical Records if necessary or

bring your clinical team on 3-Way Conference call as needed.

3. Make a comprehensive list of all OPERATIONS by

department that can be potentially streamlined using back-

office team at $6.5/Hour.

Front Desk

Eligibility

-EHR’s Direct B2B Connection can check upto 70% of Eligibility

-CS Team can provide Eligibility Services for remaining 30%

patients that need a Representative Call.

So combined HYBRID service can provide 100% verification for all

patients.

Appointment Confirmation

-EHR’s Automated Engine can schedule calls / text messages /

email notification for Appointment Confirmation.

-CS Team can provide appointment confirmation

for those HIGH VALUE PROCEDURES through

Representative Calls.

3. Make a comprehensive list of all OPERATIONS by

department that can be potentially streamlined using back-

office team at $6.5/Hour.

Medical Records

Scanning/Indexing Services

-EHR’s Document Management Module allows you to route IN

BOUND FAXES or Scanned Images to correct patients’ chart

however that process of INDEXING could be time consuming for

practice. Indexing process can be simplified with CS back-office

team and reduce cost of indexing by 40% or more.

Average cost of Indexing per page / file while done with OFFICE

SECRETARIES is 50 cents whereas same level of accurate services

done with CS’s back-office team would cost practice around

10 to 25 cents per image / file.