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1 Experts in Revenue Cycle Management For Medical Practices and Imaging Centers For over 20 years, we have forged successful partnerships with medical practices and imaging centers to improve their revenue streams through higher net collections and lower days in A/R. What sets us apart? Our expertise, attention to detail, and our processes and practices that deliver results. Among our unique skills: Expert coding Denial mitigation Aggressive billing and collections Payor contracting Our clients count on us, and we deliver. We know our billing and collections are in good hands with First Professional Services. They achieve results for us in an ever-changing reimbursement environment. Plus, not having to take on the payors ourselves makes life easier with more time for patients. -- B. Wahl, MD
2 Our Top Priority: The Financial Health of Your Practice In today s complex and ever-changing healthcare environment, new challenges threaten your practice s financial health. Difficult payors Slower collections Claim denials Increasing write-offs Higher deductibles Declining net collections More uninsured and self-pay patients We are experts in revenue cycle management and pros at effectively dealing with these challenges. We work on your behalf everyday to: Increase your revenue stream Collect payments faster Monitor key indicators of your practice performance Outsourcing Revenue Cycle Management Choosing to outsource revenue cycle management is an important business decision. Examine its advantages Stay up to date In today s ever-changing reimbursement environment, it s impractical for individual practices to remain up to date and proactive. Are your in-house processes and people staying current with changes in coding, Medicare, Medicaid, managed care plans and insurance companies? Stay consistent What happens to your cash flow when someone is out sick or on vacation? Are they billing accurately per your fee schedule and getting paid per your contracts? Are they diligently following up on patient balances? Reduce costs An in-house billing and collections department can be costly. Not only do you incur the expense of salaries, benefits, office space, technology, printing and postage, but also the hidden costs of lost revenue can mean the difference between a financially healthy practice and a struggling one. We remove the day-to-day worries of managing a billing and collections staff, typically at less cost than an in-house operation. Even if your current practice management system or EHR software has billing capabilities, we can help.
3 Expertise You Can Count On In our 20+ years of serving physicians in several specialties, we ve gained the experience, stability, and wisdom to progress ahead in an uncertain healthcare environment. Our clients came to us for our expertise, and have stayed with us for our excellent performance and service. They count on us for quality work and solid commitment. Coding and reimbursement rules We understand the complex and ever-changing rules of the game and how to play. The rules, each with their own coding and reimbursement quirks, differ by specialty: emergency medicine, radiology, imaging centers, pathology, etc. We know them all, and have the expertise to anticipate change and proactively adapt on your behalf. This means we deliver consistent results. Even with the hurdles of timely payment from insurance companies, government programs, and patients, we know how to improve your revenue stream and secure faster payment. Coding know-how Proper and thorough coding directly influences your entitled level of payment per your payor contracts. The American Academy of Procedural Coders certifies our coding professionals. Radiology Business Management Association certifies our specialty coding team as Radiology Certified Coders. These professionals ensure your claims are properly coded and documented for full and timely payment. Plus, our coding professionals provide feedback on documentation issues to keep you compliant with ever-changing regulations, and help your processes continuously improve. Managed Care We simplify the complexity of managing payor contracts, fee schedules, and reimbursement rates. Our sophisticated managed care tracking technology ensures proper payment from your payor contracts. After recognizing a patient s managed care plan, the correct reimbursement amount is calculated and later cross-checked against payments. Any exceptions are flagged for immediate follow up with the insurance company. Information technology Behind our payment speed is sophisticated technology. We work closely with your IT vendor or medical facility to establish a smoothly running electronic data exchange. We receive almost any electronic format for patient demographics, insurance, and procedural information. Plus, we are equipped to scan EOB s and medical reports for attachment to patient accounts. The resulting workflow expedites payments and reduces denials. In most situations, we submit claims within two business days of receiving electronic data. We also maintain a fiber optic connection between our corporate headquarters and the internet. This connection provides highly scalable performance along with exceptional data security and network reliability.
4 Processes and Practices You Can Count On Expertise alone is not enough. It must be applied everyday through processes and procedures that achieve proven results. We do it with highly trained people, efficient workflow, solid contracting relationships, tight controls, and compliance procedures all designed to expedite payment and increase revenue. Mitigate Denials Denials are the number one reason payments are delayed. Clean claims reduce denials. Our claim scrubber technology ensures that 98% of claims submitted are complete and accurate the first time, producing consistently faster payments. Some billing companies and in-house services simply adjust off denied claims, leaving your money on the table. We promptly and vigilantly challenge all denials and investigate delays. Ensure Compliance Because of our code of ethics, proven procedures and tight controls, our clients can count on protection against fraud and abuse, maximum reimbursement from payors per contract terms, and HIPAA-compliant transactions. We have passed all external audits. To ensure quality and accuracy, we train our employees in compliance and conduct routine internal audits of all logs, data entry, payments and correspondence. Maintain positive patient relationships When balances resulting from deductibles and co-payments are not paid within 30 days, we are assertive in collecting patient responsibilities, but we communicate on your behalf in a respectful and compassionate manner. We send out statements that are clear and easy to understand. We accept Visa, MasterCard, American Express, Discover and checks for patient balances and, when necessary, work out individual payment plans. When patients don t respond to our statements and phone calls, we outsource collection to a licensed agency to ensure compliance with federal and state law. Improve payor contracts Each time your payor contracts come up for renewal or you contemplate a new payor contract, we thoroughly analyze the impact of the terms on your revenue. We ll make recommendations to you and even negotiate with the payor on your behalf to secure optimal reimbursement terms. Bilingual customer service Many practices are experiencing growth in the number of Spanishspeaking patients. Our bilingual capability is a vital link for discussing benefits and patient financial responsibility.
5 Inform with key metrics Our detailed reports reveal key metrics that drive cash flow in your practice and give you insight to make important business decisions. GROSS CHARGES $241, ADJUSTMENTS $72, NET CHARGES $169, Professional affiliations We are members and active participants in key industry associations and have an affiliation with a leading provider of radiology IT solutions. We stay informed on the latest in federal legislation, economic stimulus initiatives, technology, best practices and how these issues affect our clients. GROSS COLLECTIONS $163, REFUNDS $ RETURNED CHECKS $0.00 NET COLLECTIONS $163, GROSS COLLECTION RATE 67.63% NET COLLECTION RATE 96.49% ACCOUNTS REC 09/01/08 $371, NET CHARGES $169, BAD DEBT $8, NET COLLECTIONS $163, ACCOUNTS REC 09/30/08 $368, DAYS IN A/R Track charges, adjustments, net collections, days in A/R, and more. Get the details on payor mix, procedure counts, physician productivity, and other data that helps you manage your practice. With our extensive IT capabilities, we can customize reports to suit your needs and preferences. Transition smoothly We take the worry and stress out of changing billing arrangements. We manage all details like establishing the IT data exchange, workflow, credentialing and banking everything necessary to manage your revenue cycle. If needed, we can take over existing aging accounts receivable. Go beyond We also provide services and expertise in the following: Practice management Credentialing Payroll Accounting. 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% ABC ER Group PHYSICIAN ACUITY DISTRIBUTION - MARCH 2008 LEVEL 2 LEVEL 3 LEVEL 4 LEVEL 5 CC
6 Results You Can Count On We are compensated on the results we achieve for you, so you are assured that our top priority is the financial health of your practice. Our all-inclusive, pay-for-performance fee structure has no add-ons or hidden charges for postage, statements, etc. Move funds quickly to your account Payments are processed and posted daily and deposited directly to your bank account. Almost half of all payments are now received by Electronic Remittance Advice (ERA), which means payments that previously took weeks are now deposited in days. All payments are crosschecked, balanced and periodically audited to ensure the integrity of our processes. By accepting credit cards by phone and online, we speed payments and increase net collections. Achieve quantifiable outcomes Increased revenue and faster payments set us apart from other billing services and revenue cycle management companies. Our write-offs to collections, as a percentage of gross charges, consistently outperform industry benchmarks which nets you more at a lower cost. We combine unsurpassed reimbursement expertise and sophisticated IT know-how with our passion for client satisfaction. We do these things every day with diligence, persistence, and integrity. Contact Us for a Free Confidential Consultation To find out how First Professional Services can improve the financial health of your practice, please contact us today. Toll Free info@1stprofessional.com
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