The interrelationship between a sound Medical Practice Operation, clearly defined standards and benchmarks, and a sound Billing & Collections process is critical to the Medical Practice’s efficiency and profitability. ProMD looks to improve an Office Manager’s ability to establish objectives and work with the Staff to create operational improvements.

This service includes two major components: (A) Operations Oversight; and, (B) Billing & Collections. 

• ProMD conducts a complete Practice Assessment.
• ProMD implements the recommendations needed to facilitate financial success

The intent of the practice Operations Oversight, one of ProMD’s core services, is to identify opportunities that will maximize results. As the Account Executive perform weekly on-site visits, he will evaluate every aspect of the practice to help determine what your practice are doing well and what areas can improve to achieve goals of having a successful practice. The Account Executive will provide process improvement in the following areas:

1. Supervision, management and personnel training/development of practice operations, to include but not limited to;

   a)    Insurance verification process

   b)    Patient check-in process (e.g. forms used, collection of demographic information)

   c)    Check-out process (collection of patient's financial responsibility based on policy benefits & provider reimbursement agreement with payer

   d)    Scheduling (knowledge base of appointment types, confirmation of appointments, etc.)

   e)    Tracking of lab orders

2. Payer contracting (identify insurance contracting opportunities & procure contracts as necessary)
3. Office fee schedule analysis (determine how charges compare to peers in order to establish accurate pricing)
4. Accounts receivable management (billing/collections) - measure performance in key areas to industry benchmarks (e.g. collection rate; average days in A/R, % of A/R > 120 days, charge posting turn-around times, billing cycle, payment posting, insurance collections)
5. On-going training/development of Office Manager to assure business plan goals are met
6. On-going review of referral patterns by referring physicians; conduct on-site visits to targeted referring physicians in efforts to retain & procure business
7. Advising of compliance with HIPPA & OSHA regulations
8. Advising of personnel matters, including compensation to be paid, performance reviews, recruitment of necessary personnel, vacation/sick leave tracking, development of employee manual, etc.
9. Act as liaison between practice & current billing company to monitor the overall billing performance
10. Review & implement cash control measures (daily closing, reconciliation of cash collected vs system)
11. Develop monthly practice performance reports that will outline operation accomplishments & track/trend certain key performance factors that might result in negative financial outcomes in order to implement the necessary corrective actions to secure desired outcomes

Practice Assessment - Full Operational audit and Medical Practice improvement assessment of all areas of Practice. Complete Practice Audit, Financial, Account Payables and bookkeeping, Practice Management System, Contracting Audit, Office Fee Schedule Analysis, Account Receivable Management, Staffing and Salary Analysis. 

Insurance Contract Negotiations - Negotiated Fee per success (completed and executed agreement with Insurance Company)

Start-ups, Relocations or Practice Expansions - Practice Location Selection, Practice Management/Billing System selection, Vendor agreements (medical/office supplies, office equipment/furniture, phone/internet services, etc.) Contract Negotiation & Credentialing, acquisition of Hospital privileges, compliance planning (OSHA, HIPPA, Occupational, State/County Licensure, accounting software selection and implementation, Staffing, office policies and procedures.

IT and PMS Assessment and Analysis - Review of current infrastructure and analysis and recommendations of future needs. Troubleshooting and implementation of PMS.

Human Resources - Staffing & Salary Analysis, Employee Placement, Payroll Benefits Coordination, Staff Training and Development.

Expense Analysis/Purchasing Alliances - Medical Supplies, Equipment, Office Equipment, Furniture, IT and PMS. An analysis of your medical supply expenses will be performed and a report with annualized savings to the Medical Practice presented. 

IT problems can seriously disrupt your operations and affect your bottom line.  A down computer or server?  Can't print?  Want to install new software or hardware?  These and other (seemingly minor issues) can interrupt the operations of a Medical Practice and affect your ability to see patients.  Most of us wait until there's a real problem before we ask for help.  With IT, you need to be proactive and be ahead of the game.  You patients, your Practice, your Staff, and YOU depend on it. 

• Hardware installation (Printers, scanners, etc) 
• Software installation(Windows, MS Office, virus protection, etc)
• Assess practice computer/system needs
• Install and/or assist in the installation of Practice Management Systems
• Trouble shoot computer and printer problems
• Networking
• Configuring VPN tunnels : Sonicwalls, firewall devices, etc
• System threat assessment (viruses)

A. MEDICAL PRACTICE MARKETING PLAN

Marketing Strategy: To differentiate Medical Practice quality services and core values from competitors' through targeted, well-defined presentation and promotion.

Marketing Service:To conduct an assessment of the Medical Practice and develop a customized Marketing Plan.

Project Management (Project scope based fee)

B. MEDICAL PRACTICE STRATEGIC PLANNING

Strategic/Business Plan Development: Strategic planning is creating a vision of the future and managing toward that expectancy. It's operating under a vision, mission, strategy umbrella that focuses the organization's effort. It's an effective process for aligning your short-term decisions with your long-term goals. A business plan describes the vision and the future of the Medical Practice. It defines key performance variables that will affect results and helps establish parameters and benchmarks to measure against.

Fundamentals:

1. Establish a VISION
2. Define and understand market conditions (landscape)
3. Define variables and establish benchmarks and how they will be addressed.

Where are we today?
Where do we want to be in the future?
What should we be focused on today, in order to make it more likely we will be where we want to be in the future?

Strategic Planning Service: To engage Medical Practice in the definition and creation of a Vision, a Mission and a Plan of Action to achieve such Vision and Mission.

Project Management (Project scope based fee)

The Net Collection Rate lets you know how much money you collected of the money you could have collected. It is a ratio of cash to the net charges (net charges are gross charges minus contractual adjustments agreed to as part of the practices' contracts with insurance carriers). For example, if the procedure code is priced at $125 (billed charges), but the contractual allowance (the money that you have agreed to write off as a function of your contract) is $50, then the billing office should be held accountable for collecting $75 rather than the full price of the code.

Calculation: This is (collections less refunds) divided by (gross charges less contractual adjustments). Note: Gross Billed charges minus contractual adjustments are also referred to as Net charges.

Expected outcome: ProMD recommends an overall:

Net Collection Rate of 90% or greater after 6 months and 95% or greater after 9 months.

When you examine a collection analysis report that links gross charges with collections by dates of services, you should see an increase in the net collection rate over time. The difference between the net collection rate and 100 percent includes bad debt, A/R in transition and administrative errors.

We are not recommending that you benchmark your gross collection rate to other practices. The gross collection rate is calculated as: collections divided by gross charges. This rate is highly subject to inter-practice fee variation as well as inter-practice payer/insurance mix fluctuations. The net collection rate represents a more advanced performance indicator and lets you benchmark billing outcomes against other medical practices, even those with dissimilar payer mix and fee schedules.

ProMD's comprehensive compliance program offers assurance that all efforts are being made to provide for accurate CPT and ICD-9-CM code selection, billing guidelines, and of course the Healthcare Insurance Portability and Accountability Act. There are several key components that encompass ProMD's compliance program for all of our services:

1. Employee education
2. Client documentation education and evaluation, and
3. On-going auditing