is a healthcare consulting and education firm providing services such as: IRO services, practice management and assessment services, A/R management and oversight, new practice set up that includes lease negotiation and facility design, auditing and training to physicians and their staff. Practicing quality medicine while maintaining and managing the bottom line is a balancing act that provider s face daily. For over 20 years, our consultants have helped healthcare providers across the country streamline their A/R process, improve patient flow, practice management and compliance, and keep current with ever-changing state and federal guidelines. To date, we have worked with thousands of physicians in virtually every specialty. Not only have we positioned ourselves in the market as objective, technically proficient advisers but we also understand the unique economic and clinical aspects of medical practices. Additionally, we ve oriented our services to fill the gap between what is typically provided by the practice s accountants and attorneys by focusing on the day to day operations of medical practices, marketing and branding. Our services are available on a one time consulting basis, as well as on an ongoing continuing advisory basis. Whether you're preparing for a Federal, State, or Insurance company audit, searching for opportunities to expand your business or need educational or management services our consultants can provide the tools, service and/or training you need. Our Services Include *Practice Assessments/Management * ICD-10 training *Practice Start Up *Baseline Chart Audits * IRO Services *HIPAA, OIG Compliance Documentation, Planning and Implementation * Lease Negotiation *Facility Design *Patient Flow *CME/CEU Seminars, Workshops and Education * Coding and Practice Management Certification Courses * A/R Management and Oversight * Forms and Publications * Speaker Presentation *Staff Development Our Credentials Over 20 Years in Experience Certified Medical Practice Managers Certified Professional Coders and Trainers Approved AAPC and AHIMA ICD-10 Trainers Certified Medical Billing Specialists Member of American Academy of Professional Coders (AAPC)
Baseline Medical Records Review Service Baseline medical records reviews/audits are preliminary assessments to develop a reference point. By performing a review in advance, your practice can identify improper billing and coding practices and make necessary corrective actions prior to any government or third-party payer audit. This can help you save both time and money. Our company is an approved government IRO (Independent Review Organization) which means we have been given the seal of approval from the government (CMS/OIG) as a compliance auditor. What Does the Baseline Medical Records Review/Audit Service Include? When we review/audit your records, we look at the level of service billed as well as the diagnosis, and other procedure codes used. We will then provide you with a detailed report as to what we found and give any recommendation as to what may need to happen moving forward. In some cases, we may recommend onsite group education and/or one-on-one provider training in which we may round/observe the visit with the provider and then guide/answer any questions after the patient visit. Our process is easy and turn-around time is quick. After receiving the necessary information, a report will be delivered within 15 business days. What We Need: - 20-25 randomly selected records/progress notes per physician - Copy of the printed CMS 1500 Form that goes with that day s progress note - Progress notes that are pulled should be from a range of services (i.e. new, established office visit, consults and hospital visits) - Include all applicable lab and/or diagnostic test results Send Records Via: - UPS or FedEx only (consultants must be provided with tracking information) - Fax to our secure Fax server
Compliance Planning and Implementation A risk-based compliance program both prevents and detects risk and potential risk. For the level of effectiveness to remain high, the program must be routinely evaluated and updated. Every organization must have established compliance standards and procedures to be followed by its employees and other agents that are reasonably capable of reducing the prospect of criminal or wrongful conduct. compliance services include help with those areas set forth in the 7 Federal Sentencing Guidelines. Reasonable Compliance Standards and Procedures Appointment of a Corporate Compliance Officer or Committee Exercise of Due Care in Delegation of Discretionary Authority Employee Education and Compliance Training Ongoing Monitoring and Reporting Systems Consistent and Continuous Enforcement of Compliance Standards Response of Offenses; Prevention of Reoccurrences Our consultants can assist you in evaluating your compliance status. Guided by our comprehensive array of compliance tools and services, the process begins with a thorough review of your current operations and processes. The result is the information you need to facilitate a focused, streamlined HIPAA compliance effort. We help you identify the significant changes required of your organization to achieve compliance. 1. Risk evaluation through assessment, auditing and monitoring - Assessment - Review of processes to proactively identify risk areas - Auditing - Independent review of specific business practices within a predetermined scope - Monitoring - Review and evaluation of key controls and risk areas 2. During the risk evaluation, the following areas will be evaluated: - Scope through risk planning activities - Risk with respect to exposure, probability and severity - Areas impacted by the risk - Documentation of risks - Risk plans
Compliance Policies and Plans: OIG Compliance Program This compliance program guidance focuses on your documentation, coding and billing designed for individual or group practices and contains seven components that provide a solid basis upon which a physician practice can create a solid compliance program: Conducting internal monitoring and auditing Implementing compliance and practice standards Designating a compliance officer or contact Conducting appropriate training and education Responding appropriately to detected offenses and developing corrective action Developing open lines of communication Enforcing disciplinary standards through well-publicized guidelines HIPAA Privacy and Security Compliance This compliance program contains all of the documents and processes you need to get your organization into compliance with the requirements of the HIPAA Privacy and Security regulations, including customizable template documents such as: Authorization Form Business Associate Agreement Complaint Form Consent Form Designation of Personal Representative Notice of Privacy Practices Request for Amendment Request for Disclosure Accounting Request for Inspection
Educational Services Education can be provided for a number of reasons to a group or on a one-on-one basis. We offer several programs that are already developed or if you have a particular need or topic that you would like for us to develop for your office we can customize one to fit your needs. Educational Programs Include: Ask A Consultant - One-on-One, Group or Webinar Based Education Customized educational programs designed to fit your practice needs. Some of our educational programs are both CME and CEU approved. Developed Programs include: - Chart Auditing - Coding Boot Camp - Compliance - E/M Documentation - ICD-10 - MACRA: MIPS/APMS - Specialty Coding Workshop One-on-One or Group Education following a Baseline Records Review In most cases once a records review has been done your office will want to have a comprehensive training program this type of education allows for the opportunity to review the report and can discuss the errors and suggestions for compliance measures with your consultant. It s our goal to not only make you aware of practice errors but to help you better understand why there are errors and what necessary steps are needed to correct them.
Follow-Up Medical Records Review Service Baseline records reviews are preliminary assessments to develop a reference point. This service is available if we provided an initial records review for your practice in the last 90 days and we ve either identified improper billing, coding, or documentation practices and our goal is to continue to assist physicians with compliance even after the initial review. It has been recommended by the Centers for Medicare & Medicaid Services (CMS) that an audit be performed annually. It is also common for physicians to fall back into their old ways and again, this may lead to loss revenue and government or third-party payor audits. This situation can be avoided by adhering to the recommendation by CMS. We perform follow-up services to ensure your practice s continued compliance. Feel confident in the service we provide as our company is an approved government Independent Review Organization (IRO) which means we have been given the seal of approval from the government (CMS/OIG) as a compliance auditor. What Does the Audit/Review Service Include? When we audit/review your records we look at the level of service billed as well as the diagnosis, and other procedure codes used. We will then provide you with a detailed report as to what was found. A comparison from the previous audit is made along with any recommendation as to what may need to happen moving forward. In some cases, we may recommend onsite group re-education and/or one-on-one provider retraining in which we may round/observe the visit with the provider. We will then answer any questions after the patient visit. Our process is easy and turn-around time is quick. After receiving the necessary information, a report will be delivered within 15 business days. What We Need: - 10-15 randomly selected records/progress notes per physician - Copy of the printed CMS 1500 Form that goes with that day s progress note - Progress notes that are pulled should be from a range of services (i.e. new, established office visit, consults and hospital visits) - Include all applicable lab and/or diagnostic test results Send Records Via: - UPS or FedEx only (consultants should be provided with tracking information) - Fax to our secure efax Server *Follow-Up Audits/Reviews are only available after for the first 3 months following the initial Baseline Review
ICD-10 Training ICD-10 training is available in various formats to meet physicians and their staff needs. While we have developed programs, we can tailor the course this that best fits the needs of your practice. Face to Face - Class Room Style or Webinar Based Training This expert-led, interactive program covers all aspects of ICD-10-CM ranging from the fundamentals to the complex. A wide array of educational tracks focusses on advanced and specialty settings, ICD-10 training, applying guidelines to coding scenarios, analyzing the impact of ICD-10 on data management and documentation, and your coding workforce. Coding and billing staff need to not only learn ICD-10-CM, know the increased clinical specificity required by the code set guidelines. Whatever your training needs, this program will help you be well prepared to take your ICD-10 skills to the next level. This training is led by a certified/approved ICD-10 instructor: - ICD-10 format and structure Code Set Training - Complete in-depth review of ICD-10 guidelines - Nuances found in the coding system with coding tips - Hands-on ICD-10 coding exercises - Specialty Specific Code Set Training Physicians and Midlevel Training One of the largest problems following the October 1, 2015 implementation for ICD-10 is that documentation s insufficient to support the specificity required for the ICD-10 code sets. A recent study noted 62 percent of physicians cited managing ICD-10 documentation as a "major concern". Additional Services Available Include evaluating your current documentation and identifies the deficiencies and education needed to improve. This service will consist of: - Review of case examples, you provide - Review top 20 codes for your practice/specialty - Application of the ICD-10 structure and guidelines as they pertain to your specialty
IRO - Independent Review Organization Service The number of fraud and abuse allegations continues to rise each year. As a result of these allegations and the corresponding corporate integrity agreement (CIA/IA), providers are required to engage an Independent Review Organization (IRO). Bad things happen to good people primarily because poor documentation and the lack of knowledge can have a serious impact on your practice. Payor reviews happen for a number of reasons including but not limited to data mining, suspicious billing patterns, disgruntled employees, or during other investigations. The medical record should provide sufficient and accurate clinical data for correct coding and billing for all services provided to the patient, when those things are missing it will lead to payment back to the payor, fines and penalties and if the OIG is involved the practice and physicians are place under a Corporate Integrity Agreement (CIA). Why Choose Us? adheres to the independence standards set forth by the Office of Inspector General. We are an approved IRO by the Office of Inspector General (OIG); which means we have received the seal of approval by the government agency. What We Provide: As your independent review organization, we provide the following services: Conducts an independent review specific to the CIA/IA Evaluates compliance with the CIA/IA Derives a statistically valid sample consistent with the Office of the Inspector General s methodology Performs specific review procedures listed in provider s CIA/IA What We Focus On: Many of the "risk areas" identified by the OIG depend on the level of documentation. We can assist in obtaining clear, complete, pertinent and accurate documentation. Our documentation reviews focus on: As defined by your Corporate Integrity Agreement (CIA/IA) we will perform: - Discovery and Full Sample with Description of Source Data and Narrative Results - Systems Reviews - Claims review report to the OIG Analysis of documentation for content and validity/medical necessity relationship Analysis of documentation in relationship to coding and billing Identification of patterns and trends in documentation Identification of risk areas in documentation, i.e. illegibility or improper use of symbols and abbreviations Analysis of documentation for compliance issues Education and training on documentation improvement opportunities
Practice Assessment Service Measuring your practice s performance and effectiveness is a critical component of effective and successful practices. will provide a tailored assessment of your practice s finances and/or operational performance and provide you with a blue print for achieving a greater efficiency and profitability. Because each medical practice is unique with different consulting needs, our assessment projects are tailored to focus on those specific areas of concern to the client. A practice assessment checklist tailored to the client's specific consulting needs is the primary tool utilized for assessing the operational areas included in the project. Our practice assessment report explains how the identified problem or deficiency affects operations, practice cash flow and/or profitability; offers recommendations for changes or improvements that should be implemented to resolve the identified problems; and discusses options on how to implement the recommended action(s). Our Practice Assessment Service reviews the following areas: - Assessment of Accounts Receivable - Staff Productivity, Capacity & Staffing - Scheduling, Patient Access & Patient Satisfaction - Patient Flow, Operational Efficiency & Office Organization - Coding, Reimbursement & Medical Records - Patient Billing, Insurance Processing & Collections - Compliance (HIPAA, OSHA) - Personnel Interviews and Surveys of Physicians, Nurses & Staff - Assessment of Facility & Equipment - Information Systems & Technology Needs and Performances for such
Practice Management Oversight The struggle between being successful in a medical office practice and enjoying a personal life can be hard. The practice s performance and effectiveness is a critical component of effective and successful practices. can provide practice management oversight on temporary or a permanent basis. Some practices have either lost a manager or think that their current manager has reached a level of management beyond their capability. Knowing each medical practice is unique with different consulting needs, our management oversight is tailored to focus on those specific areas of concern to the client. We recommend a minimum of 6 months of oversight in order for you to see significant changes in how your practice will run. Depending on your needs your package would include onsite presence weekly, phone and email access during normal business hours of Monday-Thursday 9-4 availability and access to consultant outside of stated hours to include, 1 hour prior to office hours and 2 hours after office hours along with the following as requested: Our Practice Management Service can include any of the following: - Accounts Receivable Management/Oversight - Staff Productivity, Capacity and Staffing - Patient Flow, Operational Efficiency and Office Organization - Coding, Reimbursement and Medical Records - Patient Billing, Insurance Processing and Collections - Implementation, planning and monitoring of Compliance - (HIPAA, OSHA) - Personnel Management - Facility and Equipment to include ordering and supplies management - Information Systems and Technology Needs and Performances for such What We Need: Log in/password assigned to our team for computer systems A designated area to work within your office Copies/Access to all policies and procedures currently in place Copies/Access to any contracts for equipment/supplies Copies/Access to personnel files and job descriptions * As part of our management oversight we will make suggestion to improve the practice but ultimately it is your decision.
Practice Start-Up Service Starting up a practice is ideally performed at least seven to nine months in advance of the start date, but, the earlier the better. Some practices even come to us months after starting up! The process involves meetings with the providers/owners and making as many decisions as possible regarding practice start-up and operations. The initial consultation for starting up a practice can be in-person or over the phone. If you have no private-practice experience and are starting from scratch, we can do it all for you. If you have some private practice experience or have a lot of the preparation already completed, we may be able to reduce the projected timeline. Every practice set up is customized to the needs of the client. What Does the Practice Start-Up Service Include? Once your contract is signed, our work includes but not limited to: A 250+ point checklist and calendar of pre-start-up activities are prepared and reviewed in detail. The doctor is referred to our partnering bank for business loans, if needed. Easy-qualifying loans are available for up to 100% financing. The check list points are broken into categories of: o Site Selection o Facilities/Operational opportunities o Legal, Financial and Insurance opportunities and needs o Permits and Licenses o Staff Hiring and On-boarding o Marketing and Business Development o Billing/Coding/Collections protocols o Supplies and Office/Medical Equipment Preliminary marketing strategies are discussed and planned in addition to fee setting, practice budget, and tax/legal requirements. Customization of: o EMR Templates o Employee handbook o Compliance policies o Financial policies o General ledger/accounting for Quick books Selection of: o EMR/EHR and/or billing service On-going medical practice oversight and compliance training, as needed. We are available by phone, email, or office visit for further support.
Other Services Through our partnership and/or co-ownership we also offer these other services. Commercial Real Estate Leasing Services: Often time physicians sign a lease and the only person they have worked with is the agent from the building they want to move into. That agent is really working on behalf of their client the building owner. That s why we took the extra steps to become licensed we did not want our clients to be taken advantage of. Our firm specializes in commercial real estate for healthcare providers. We re here to help create and deliver real value through commercial real estate for our clients. In a complex world that is constantly changing, we are committed to helping you understand and navigate the intricacies of commercial real estate whether you re an investor or occupier of space. Because we understand the unique needs of physicians we ve been able to develop an enduring client relationships built on quality service, collaboration and trust. Our commitment to your business success goes beyond the bottom line as our leasing services also include help to design your space layout and décor. Medical Office Equipment: Our clients find that with one point of contact, for all their practice needs it is a much more efficient and pleasant process, it is because of that we can offer through our partnership with Innovative Business Source a select line of nationally recognized medical equipment which offers a value to doctors by providing the features and reliability they need while still fitting within their budget.