Maximize Your Revenue
Incorrect coding and documentation can result in thousands of dollars in lost revenue
- Is your practice at risk of an audit?
- Are you leaving money on the table?
- Are you maximizing revenue by capturing all “codeable events?”
- Do you have trouble finding qualified resources and personnel to perform coding duties?
Stop losing money and putting yourself at risk for regulatory intervention by using incorrect coding and documentation in your practice. Physician’s services, and their billing and coding practices are increasingly being scrutinized. Medicare RAC Audits, CERT letters, and other payer correspondence requesting medical record reviews are on the rise. In 2011, Medicare RAC auditors recovered just under $935 million dollars in overpayments! In today’s healthcare environment, no physician, practice or hospital can afford to pay the insurance companies back!
Our complete coding services can help you navigate through the complicated coding maze to maximize your revenue and stay current with the constantly changing coding rules and guidelines. To stay ahead of the game, we constantly monitor coding rules, updates and changes, Medicare guidelines and the annual OIG Work Plan.
All of our coding specialists are certified and credentialed through AHIMA (American Health Information Management Association) and AAPC (American Academy of Professional Coders) and act as our clients’ subject matter experts on issues related to compliant coding, documentation, and billing practices. RTW Coding Specialists not only assist with improved reimbursement, but also serve as an added layer of protection against payer audits since coding violations can easily cost a practice tens or even hundreds of thousands of dollars. Our coding specialists pride themselves on real-time access, objectivity, integrity, confidentiality, credibility, expertise, superior customer service, strong client relationships and adaptability to any situation! You will see the VALUE and ROI in our services immediately!
Our coding specialists provide abstract coding services for all specialties and provider types. We will dissect your note and extract all billable opportunities and capture medical necessity to substantiate each service. If a provider’s documentation represents at-risk revenue, we communicate and provide feedback to our client’s well in advance. We make it our business to become intimately familiar with our client’s major payers, patient mix, ancillary services, bundled services, etc.—we know the particulars and anticipate changes that affect a client’s reimbursement. An added layer of protection and expertise!
Let us find the answers to your toughest and most challenging issues/questions! We will go to the ends of the earth to solve your coding conundrums!
We all know insurance companies deny claims for every reason under the sun! Denied claims represent outstanding revenue owed to your practice, now you just have to fight for it! Let our experts take on your denial backlogs and improve your bottom line!
Whether you are facing reimbursement challenges or uncertain of the quality of your provider’s clinic documentation, we partner with our clients to design roadmaps and workflows that ensure success in the areas of coding and compliance.
There are many challenges coding and billing specialists face with regards to keeping your practices financially viable. We offer expert mentoring to your staff in all areas, including (but not limited to) – provider communication techniques, new coder development, effective process improvement strategies, how to escalate compliance issues, team-building, etc.
Starting a new practice?
Adding providers or practice locations?
Having reimbursement or credentialing issues with Medicare, Medicaid or commercial payers?
Having claims or payment problems due to credentialing issues, like incorrect copays, incorrect payments, etc.?
In today’s busy healthcare world, maintaining and completing credentialing information for physicians and allied health professionals can be extremely cumbersome and distracting to practice managers and staff. Incomplete applications or a failure to respond to requests can create a domino effect of negative actions, including disruptions in your cash flow, that your practice simply cannot afford.
Whether it’s for payers or facility privileges, we provide complete credentialing management services. Outsourcing your credentialing needs will not only prevent things from falling through the cracks, but free up valuable time to complete other important tasks within your office. Our proactive approach and continuous communications with payers and facilities (hospitals), ensures the most efficient processing of applications and reduces the need for physician and staff involvement.
Like a complicated puzzle, putting together a practice from the ground up is no easy task. Whether a physician is starting a new practice, opening a satellite office or relocating the current practice, our start-up services will get the practice up and running successfully and on time. Our three-phase approach to practice start-up will give physician(s) and practices the best chance at success and profitability.
Phase 1: Pre-Planning: Strategic Business and Financial Planning
Successful practices start with a well thought out plan that describes the strategic goals of the organization, its financial and other resource needs. A strategic plan is the road map to the future and should identify the goals of the practice and how it intends to achieve those goals. We will assist you in the pre-planning of the practice, including:
- Strategic planning – preliminary planning and assessment; communications and meetings with the physician.
- Development of pro forma – revenue and expense projections including start-up budget and projections for the first year of practice (banks require this to obtain capital/credit).
- Preliminary development of organizational structure – number of employees, office space set up, etc.
Phase 2: Practice Development and Set-Up
Turnkey Success! The complete set up of your practice will take, on average, three to six months once Phase 1 is complete. Our goal is to set up the practice to maximize reimbursement, minimize expenses, maximize patient volume, and to develop an efficient and well organized practice. We will facilitate and coordinate all aspects of the practice set up including, but not limited to:
- Project management – ensure deadlines, timelines, delivery dates, etc. are met for a successful practice opening.
- Reimbursement – initial acquisition, or re-assignment, of your managed care contracts.
- Billing office set up – in-house or outsourced
- EMR implementation
- Marketing – create awareness, announcements, practice materials, identification of referral sources, etc.
- Human resources – staff hiring and training, policies and procedures, job descriptions, etc.
- Physical practice set up – IT, telecom, office and clinical furniture, equipment and supplies, etc.
Phase 3: Practice Management Support
We understand that the long-term success of the practice depends on solid management of all aspects of the practice. Based on the anticipated needs, we can customize a package of services for the ongoing support of the new practice including, but not limited to, general practice management advisement, monthly oversight of billing and accounts receivable, H/R and operations assistance and ongoing credentialing.
It is not just about fee-for-service anymore. Managed care contracts can have many components and some can be very helpful to your practice, when it is done strategically.
Contracts are not “one and done” any longer. They should be worked and examined and maneuvered constantly. Strategy needs to be developed and deployed to maximize return, maximize volume and make the practice most efficient.
Increasingly it is NOT as much about what you’re paid as it is the global cost of a member’s care. Health plans would love their provider network to lower the cost of care. We believe you should be paid to do it by getting a portion of the savings. We believe the choices providers make (site of service, frequency, ancillary services, etc.) affect the cost of care and your ultimate reimbursement opportunities.
- What contracts do you hold and what is your reimbursement rate with each?
- What patient volume are you receiving in return for any discount of billed charges?
- Do you know what is a good contract relative to the services you provide?
- Are you being paid correctly?
- Are you maximizing your potential?