Healthcare Consultants

Providing the tools that will help make your practice thrive.

 

Compliance

If your practice is one of the many that thinks it does not have time or a compliance plan does not apply, think again.  The HHS office of Inspector General suggests that every practice develop a plan for dealing with Standards and Procedures and Claims Submission Auditing.  You also must determine a disclosure protocol for voluntarily reporting irregularities.

 

The four risk areas are applicable to individual and small group physician practices are: 

· Coding and billing  

· Reasonable and necessary services

· Documentation

· Improper inducements, kickbacks, and self-referrals

 

Coding and Documentation

Documentation is as important as the care you provide to your patients.  Documentation must not only outline what level of services you provide but must support that they were reasonable and necessary services.  Increasing your reimbursements may be as easy as refining your documentation skills.

 

Coding is a juggling act involving three components:  CPT coding, ICD9 coding, and documentation.  They must be combined to show what services were performed and why.  Statistics show that the average physician loses $35,000 a year by improper coding. 

 

What could you do with the lost revenue?

 

Contract Review and Negotiations

Yes, it is possible to negotiate contracts with insurance carriers.  You must first define what profitable means to your practice.  Your conversion factor tells you what you need to collect per Relative Value Unite (RVU) in order to cover your costs.  We have the tools to simplify this process and will help you negotiate your next contract with confidence. 

 

 

 

Practice Compliance