New government regulatory factors. Need to improve cost and quality outcomes. Inefficient billing processes.
For millions of Americans living in rural and urban areas that are underserved by health care professionals, Federally Qualified Health Centers (FQHC) and Community Health Centers (CHC) are their main source for patient health care. Every FQHC and CHC must meet federally mandated performance and accountability requirements for administrative, clinical and financial operations.
We have hands-on experience and a proven record within this sector.
Advantage has worked within the FQHC/CHC sector and we specialize in revenue cycle management and clinical turn-around. We are “boutique” specialists who identify workflow efficiency opportunities AND help management, physicians and staff implement process improvements in your billing and clinical departments.
Billing and Collection Efficiency
One of the greatest challenges in healthcare is collecting the revenue you generate each day. According to recent studies, approximately 25% of all medical practice income is lost due to incorrect coding, underpricing, missed or never submitted charges, and nonexistent or improper follow-up.
Capabilities For Improvement
Our capabilities range from simple revisions to your billing processes to a full-blown ‘cleanup’ of your entire billing department.
Our billing consultants bring a broad range of expertise and hands-on experience to your practice and focus on reducing your days in accounts receivable and write-offs.
While other consultants may be able to give you strategy and recommendations, they will not implement and execute like we do. That’s the Advantage difference. We pride ourselves in not only providing solutions, but we also assist you in implementing and executing our key recommendations.
According to a recent Medical Group Management Association (MGMA) survey, 82% of respondents reported that they had worked for a medical practice that was the victim of employee theft or embezzlement — totaling more than $94.6 million.
Question: Are the internal controls of your billing processes tight and consistent?
Answer: Refine and customize your internal controls to help mitigate the risk of theft and embezzlement. Our consultants can help!
Billing process and clean claims begin at the front desk. The front desk is an integral division in the success of your billing effectiveness and is a primary focus of our consultants and implementation.
Eligibility and benefit verification is the single most important function to ensure accurate patient registration and subsequent claim payment. It is essential that the practice verifies the correct insurance information on each visit.
Does your practice meet the “best practice” standards in claims submission? Electronic submission ensures proof of timely filing as well as faster payment from the carrier.
It is critical to ensure all possible carriers are properly set up to electronically deposit insurance payments directly into the practice bank account. Electronic payment posting is also essential for efficient, accurate payment and adjustment posting.
The accounts receivable is the practice’s greatest asset. Our focus is to ensure payment for all services rendered in the shortest possible time.
Financial reporting, benchmarks and trending analysis are essential to monitoring the current status of all billing functions. Daily, weekly and monthly monitors must be in place to ensure all processes are timely and consistent.
Internal controls are paramount to ensure accurate checks and balances are in place for all accounting procedures. Cash controls, reconciliation and segregation of duties are potential deterrents to theft and embezzlement.
We believe that patient satisfaction is paramount to creating a successful and profitable practice. Our analysis of the patient throughput process is unique – we strictly use a clinical team that has worked with hundreds of medical and surgical practices. Each clinical consultant brings extensive hands-on experience and expertise to your practice.
Our Review Process
We conduct a thorough review of your current clinical policies, procedures and scheduling templates as well as follow the patient flow from the minute the patient enters the practice through check-out.
Once we fully understand your clinical needs, we re-engineer the patient flow patterns and work in conjunction with your management and staff to increase productivity and decrease patient wait times. Whether you are a solo practitioner or a large multi-specialty practice, we will design and implement solutions tailored specific for you.
It is our goal to create a smooth and efficient patient flow resulting in satisfied patients and a productive and efficient clinical staff.
STAT: According to a survey conducted on behalf of The Physicians Foundation by Merritt Hawkins:
Over 62 percent of physicians estimate they provide $25,000 or more each year in uncompensated care.
Physicians spend over 22 percent of their time on non-clinical paperwork.
Question: How does Advantage reduce patient waiting time and allow providers to end their days earlier?
Answer: Advantage has developed a proprietary patient flow system for every practice type to ensure that your time is used efficiently. Contact us to learn more.
Current patient scheduling templates are reviewed and redesigned to ensure maximum patient capacity and appointment availability for your clinic.
Call intake and the reception/registration processes are analyzed and recommendations are made to improve patient capture and customer service.
Patient Flow Analysis and Redesign
The entire current patient flow process is observed and mapped to make recommendations on decreasing patient wait times, improving customer service and maximizing physician’s time.
Clinical Staff Utilization and Productivity
Is your staffing at optimal ratios for efficiency and productivity? “Best Practices” methodologies are applied to determine appropriate staffing levels and assignment of duties.
Current utilization of exam lanes/rooms and testing areas are evaluated to determine potential improvements to maximize available space.
If it is not documented, it was not done! Documentation must be appropriate and accurate in order to meet the necessary medical documentation and reimbursement requirements.
Existing clinical operations must be analyzed and redesigned to ensure EMR changes have minimal impact on patient care, workflow processes and your bottom line!
EPM/EHR Selection and Implementation Efficiency
It is not only a daunting decision in choosing your EPM and EHR software vendor, but the implementation can be even more overwhelming and potentially disastrous. It is essential that you have a full-time qualified Project Manager to coordinate all the EPM and EHR activities between the practice and the software vendor. The Project Manager provides the skill and expertise to guide or lead the implementation process.
How You Get Started
Advantage’s proprietary systems start with an EHR clinical readiness program and incorporate the necessary steps for full implementation of EPM and EHR. The proper management of your implementation makes or breaks its success and/or its failure.
Failure not only means not having met “meaningful use” with loss of incentive payments, but it also means disruptions in patient flow, increased patient wait times and a decrease in physician and staff productivity and efficiency. Our consulting team specializes in the comprehensive and seamless coordination of EPM and EHR implementation and has a positive track record of making it work.
STAT: According to CMS and national surveys, the percent of physicians using an advanced EHR system was just 17% in 2008. In 2013, more than 50% of eligible providers have adopted EPM and EHR, have demonstrated meaningful use and have received an incentive payment. The other 50% of the eligible providers that have not qualified for meaningful use have failed to achieve bonus incentive payments for a wide variety of reasons. Our consultants can assist your practice with any or all aspects of the EPM and EHR selection and implementation process.
Time Is Of The Essence
It is very important for you to prepare for achieving meaningful use as soon as possible. As time passes, you will continue to lose incentive payments and the process of meaningful use attestation will become more rigorous and burdensome.
The last year to be eligible for any incentive payments is 2014. If you have waited until 2014, the qualification standards will be harder and you will lose payments from the original qualification of $44,000 per provider. If a practice is not meaningful use certified by 2015, Medicare currently plans to impose a payment reduction of 1%. Reduction in payments will increase to 2% in 2016 and 3% respectively in 2017. It has been postulated that penalties could reach as high as 5% after the year 2017.
Strategic EPM/EHR Planning
Realign your current technology with your EPM/EHR needs, improving operational efficiency without compromising the patient flow process.
Needs / Readiness Assesment
Analyze existing clinical and business operations and processes to ensure that the EPM or EHR changes in your IT infrastructure and business functions have minimal impact on patient care.
Assist with third party research to assess the strengths and weaknesses of different software vendors and IT systems and identify cost-effective deployment measures.
Provide analytical insight, technical expertise and implementation support for EPM and EHR systems by reducing risks and business disruptions.
Provide expert clinical, technical and tactical resources to facilitate the installation and deployment of new software applications and IT systems.
Organizational Structure & Management Effectiveness
It is often said, “Companies don’t plan to fail, they merely fail to plan adequately.” This is now especially true for all of healthcare and its many providers. Your responsibility is not only to take great care of your patients, but it is also about successfully running a complex business in an ever-changing economy. Does your practice have a roadmap of where you are, where you are going and where you eventually will end up with your business? Advantage consultants start all our management projects with a thorough understanding of your needs which allows for collaborative brainstorming and decision making between shareholders, physicians and the management team.
Fiscal Management Is Essential
Fiscal management is an essential component to the success of every medical and surgical practice – no matter what size. Reduction in reimbursements, increased costs of labor and benefits and ineffective billing practices are the most significant reasons for decreased profitability. Advantage consultants use their comprehensive expertise and implementation strategies to help you realize your maximum profitability through careful fiscal monitoring and effective human resource management. Your employees can be one of your greatest assets – IF they are managed effectively and held accountable for their job descriptions.
Audit Your Strategy
This is where our strategy consultants can help you identify the strengths, weaknesses, opportunities and threats to your practice and implement key initiatives to help you maintain viability, expand your market share and develop succession plans.
You Benefit From Our Experience
Are you having difficulty finding a qualified administrator/CEO for your practice? Advantage provides interim management services where we place a highly experienced and knowledgeable individual in your practice on a short, intermediate and/or long-term basis while we recruit an ideal candidate for you – all depending upon the needs of your practice.
Or are you a small or medium sized practice who needs access to a highly skilled CEO to advise you on business matters? Advantage provides CEO Advisory Services on a monthly retainer basis at a fraction of the cost of a full-time employee.
Our clients range from solo practitioners to large multi-specialty physician practices and academic medical centers. We customize our projects to your needs – no two projects are alike. Our projects can be as small/short as a budget development to as large/extensive as taking over as the CEO of your practice. We are experts in all phases of physician practice management.
STAT: If Advantage has the opportunity to implement key recommendations from our assessments, we are confident that we can not only pay for our services, but we can also increase your net income. Through our programs and services, if you are able to enhance your annual net take-home pay by $10,000/year over 20 years at an interest rate of 8%, you could produce an internal rate of return of approximately $450,000.
Core values and a mission statement must be identified,as well as the organizational structure and the practice’s ability to effectively govern in an efficient and timely manner.
Human Resource Management
Your employees represent your greatest expense and one of the practice’s greatest assets. Day-to-day management effectiveness is imperative for practice viability.
When was the last time someone evaluated your revenues, expenses, net profitability and overhead and benchmarked the “best practice” standards for your practice?
A highly effective and efficient interim administrator or CEO can quickly implement systems to improve efficiency, profitability and grow your practice on a short or long term basis.
Collegial working relationships can turn into contentious, lengthy and expensive conflicts without proper succession planning. Plan today to ensure a physician leaving your practice tomorrow doesn’t leave the practice in jeopardy.
Goals of the practice should include key initiatives to assist you in maintaining viability and market share in the current economic environment.
Employee appraisal systems are needed to remain competitive and viable. We have developed a pay for performance appraisal system for medical personnel that has received praise within the industry.
Small and medium sized practices often need intermittent “CEO advice” on business matters for their particular practice but do not need or cannot afford a highly compensated CEO position.