The Perfect Revenue Cycle

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The Perfect Revenue Cycle. Presenter: Fred Melroy. Good Billing Is Just Process. Great Book is Check List Manifesto by Atul Gawande, MD. Good Billing is Like Good Surgery or Any Activity in Life that Requires Organization! - PowerPoint PPT Presentation

Text of The Perfect Revenue Cycle

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The Perfect Revenue CyclePresenter: Fred Melroy

This presentation provides an overview of CureMD product and service offerings in an effort to establish relevance with the YAI requirements Good Billing Is Just ProcessGreat Book is Check List Manifesto by Atul Gawande, MD.Good Billing is Like Good Surgery or Any Activity in Life that Requires Organization!Life and Billing is Complicated but Steps in an Organized Manner Make it Easy.Someone Asked Why We Keep Track of All Scheduled Patients.

2Create an easily accessed, integrated, web-based EHR system specifically designed to address the needs of your practice and the demands of the practitioner.

Use technology to develop an electronic medical home.

Reduce errors.Improve quality and safety.Increase revenue.Create performance measurement tools.Increase patient education.Enhance communication among service providers. Commercial Billing vendors.

Try and meet all of these complex needs in one, comprehensive EHR solution and avoid the excess cost and lack of continuity associated with multiple technology

Create a Process

The DilemmaPatient SchedulingPatient Demo Entry & Eligibility VerificationMedical Necessity EditsMedical Necessity EditsClaims ScrubbingPaper & Electronic RemittanceDenied ClaimsCompliance SystemClaims ManagementEMR/EHRRegistration SystemDistributed environment lead towards inefficient, complex system results in increased operating cost and important of all LOST REVENUE

The Revenue Cycle: Critical Billing Tasks

CureMD - Integrated All-in-One SolutionCureMDEMRPMS & RCMRegistration & SchedulingClean Claim & medical necessity EditsDenial ManagementPatient SchedulingPatient demo entry & Eligibility Verification Medical Necessity Edits Claims scrubbingPaper & Electronic Remittance Denied Claims

What makes us stand apart in billing?One system that ensures integrated clinical and improved communication for the complete revenue cycle management.

All in one solution that works with your existing billing and financial system ensuring:

HIPAA Compliance

Efficiency improvement

Maximum effectiveness

Ensuring clean claims for denials prevention

State of the art rejection and denial management

Reports that make sense and Monitor activity.

Poor Revenue Cycle ManagementMore Income is Lost in Poor RCM Than You Can Achieve in Rate Increases

Why Outsource Billing?Straight 60 % reductions in operational and administrative cost in comparison to in-house billing

Staying up to date with financial health of your practice by having access to multiple financial reports (24/7) in comparison to manual in-house reporting

Losing 2% of total Medicare revenue on e-prescribing and PQRS incentives

Losing 17% of all claims denied for timely filing, caused by delays in the billing (Source AMA)

Efficient Denial Management enables you to track denied claims and what is being or can be done to get them paid. (MGMA reports that 7%-14% of all claims are denied because of easily correctable inoffice errors)

9Its More Than Just TimeYou still need to document the visit!Does you System Check Codes or Prompt Needed Items.Codes 99201-99215 should be used depending on the complexity of the visitFor level 5 make sure the history meets the definition of comprehensive.A new patient is a patient who has not received any professional services (face to face) in the last three years.This time includes those you see for a different Dx.

10What is a Medicare Consult?conventional medical practice is physicians making a referral and physicians accepting a referral will document the request in the patients record. The results of the referral must be communicated.For in hospital cases the principle physician of record will append modifier AI on codes. Coordinate with Hospitalist!If physician is requested to see a patient in the ED, the emergency visit code should be used unless patient is admitted and then initial hospital care code should be used.

11How do you Bill?If the service is secondary to a primary service must use modifier 25 on the primary service.Smoking cessation requires a separate diagnosis code as does nutritional counseling.You dont have to be a PCP but annual visits are limited by type, smoking for example is 8.Make sure you are familiar with the coding instructions and as a guideline CMS for the first time has published time indicators. For example: 99213=15 minutes, 99214=25, 99215 =40 minutes, 99204 = 45 minutes.Dont forget the AI for your admitted patients.

12Make Sure to Use the Right Codes Manhattan AllowableInitial Wellness = G0402$169EKGs (no waiver) G0403-G0405 (G0403 price)$24Annual Wellness = G0438 & G0439$186 & $125Ultrasound for aneurysm = G0389$137Medical Nutritional Therapy = 97802- 97803 $34 & $30Medical Nutritional Therapy Group = 97804 $28Medical Nutrition Therapy Additional = G0270 $32Medical Nutrition Therapy add on Group = G0271 $16Screening Pelvic Exam = G0101 $43

13Financial Reports CureMDs 24/7 access to different reports helps to stay updated with your practices financial health

Some Numbers That Matter!

CureMD Healthcare55 Broad Street, New York, NY 10004 Ph: 212.509.6200www.curemd.comThank you