Acknowledge

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Strategy

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Adapt

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Evolve

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Medical Billing Consultants serving Texas, San Antonio Metro Area

Evolution Consultants, LLC practice innovative processes and programs to streamline the flow of information to and from your practice thus reducing the paperwork and filing clutter. This includes the "HANDS OFF" money approach. All co-pay, deductible, and co-insurance monies collected in house on the date of service are exclusively the practice's to retain. This strategy encourages proper collection by internal staff and rewards the practice for performance.

"Medical billers today need to understand the life of a claim. Billers need to be more educated in revenue cycle management and have critical thinking skills. It's not just data entry [anymore]," explains Pattie Rosbrook, president, PhySource Solutions, a medical billing firm in San Diego[1].

If you're in the market for an outside billing company, or want to see how your current company stacks up, look for these nine things that Medicare suggests looking into. All processes are customized around the needs and wishes of the client:

MD Evolution Answers:

  1. Technology: "Technology. Billing companies that use technology can work faster and more accurately" (Hirsch 1)[1].

    Evolution's Answer: Evolution Consultants uses innovative processes and programs to streamline the flow of information to and from your office, thus reducing the paperwork and filing clutter. Our office has the capabilities to be paperless. We utilize and/or have experience with over seven different software solutions, many of which are fully utilized EHR software. We have the capabilities to learn new software with an accelerated learning curve and can fully implement EHR software and map your billing accurately.


  2. First Pass Claim Denial Rates: The better billing companies have fewer claims denied when first submitted. The increased volume of clean claims comes from the use of more front-end techniques"
    (Hirsch 1)[1].

    Evolution's Answer: Our Medical clients enjoy decreased days in aging within the tolerance of MGMA standards for their specialty. This means that from the time you bill the claims, you are seeing payment within 20-45 days depending on your payer mix. Please note that for a high volume of workers compensation claims this may be slightly higher.


  3. Transparency. A better billing company will be able to provide the physician with access to the company's practice management system or other method to enable the physician to see the claims process
    (Hirsch 2)[1].

    Evolution's Answer: Evolution Consultants offers "CPA Style" reporting at the close of every month. These reports display total month production, monthly collections, monthly adjustments, Net and Gross collections percentage, days in aging, average day gross revenue (ADGR), and monthly over the counter collections. We also offer specialized reporting for practice specific interest such as DME/Orthotics, X-Rays, and Vaccines. We have overview monthly meetings with our clients.


  4. Handling of Collections: Handling of Collections. Ask how the billing company tracks claims and how quickly it takes action when a bill isn't paid (Hirsch 2)[1].

    Evolution's Answer: Evolution considers the best way to handle collections is to get insurance resolution sooner, and get the patient a statement as soon as possible. We use a set collections cycle once the practice determines the parameters. Our standard timeline is to send three patient statements then to send a 10-day letter if the patient has not communicated with our office or set up a payment plan. Once the ten days have elapsed and the account has been approved by the client, the account is submitted to third-party collections. It is important to note that some providers do not want to pursue collections. Our clients lead the way in determining our collections attitude


  5. Training and Expertise: Make sure the coders are certified and knowledgeable about your practice's specialty, says Rosbrook. Example: You want the company to be knowledgeable enough about coding to question a code it may believe is incorrect, and to be training its staff in new developments, such as ICD-10 and electronic medical record issues" (Hirsch 2)[1].

    Evolution's Answer: Evolution Consultants works with a wide range of specialties from Orthopedics to Primary Care and have shown the ability to adapt to a specialty very quickly. However, we choose not to work with physical therapy or chiropractic care. We do retain at any time at least two certified coders on staff who are directly involved and oversee quality control on billing/coding and documentation requirements. We provide outstanding communication to our client regarding code combinations and chart documentation. We are never authorized to code or alter codes, but we do scrub charges to provide feedback to the clients.


  6. Performance Standards: Does the billing company use benchmarks so its performance can be measured? (Hirsch 2) [1].

    Evolution's Answer: Evolution benchmarks our practices on a monthly basis when we compare our client's performance to accepted standards such as MGMA as well as offering comparisons to other date ranges. For those clients who have been with us for years, we have a really compelling history of growth and development with the practice. The better quantity of data, the more interesting comparison we can make.


  7. Partnering with the Practice: The billing company should be a practice's business partner, not just a vendor filing claims, says Miller. 'If a payer is no longer paying well, maybe the billing company should point that out' [because maybe] being [that] network is no longer a good idea (Hirsch 2)[1].

    Evolution's Answer: Evolution Consultants is an audit style billing office. It does take time to perfect the processing and uncover all the information we may need to perfect your practice, but our overall goal is to perfect your practice and have the highest recoveries possible. Partnerships are however a two way street and we expect a professional ethical partner from the client as well. Our clients have to be able to make changes and monitor their own quality control for responsibilities assigned to the practice.


  8. Compliance Programs: The better billing companies have voluntarily implemented a compliance program along the lines of what HHS' Office of Inspector General has suggested to reduce the risk of improper billing" (Hirsch 2)[1].

    Evolution's Answer: Evolution and all of our staff must go through yearly training on CMS Fraud, Waste, and Abuse guidelines. We are a downstream compliant organization. We also train yearly on Red Flag guidelines, HIPAA Compliance, Federal Fair Debt Practices Act, and the Texas Collection Practice Act. We retain certified coders and meet all annual requirements for continuing education and each of them have a keen eye for detail and coding integrity. We are compliant to the Workers Compensation Guidelines as well as investing in continuing education literature from Medicare. We always utilize current year CPT and ICD10 guidelines.


  9. Other Business Operations: The better billing companies will engage in employee applicant background checks and tests applicants regarding their billing and coding knowledge. They'll also have better references (Hirsch 2)[1].

    Evolution's Answer: We do perform billing quizzes to test the skills of potential billers. All hiring candidates participate in working interviews, and we check all references. We have excellent staff retention after the first year of employment. Our standards are set high and not all can endure this type of environment. We always promote from within, and are looking for the coachable and pleasant few who shine.

    Contact Evolution Consultants, LLC

[1] How to choose an outside billing company that works for you, Decision Health (website). Marla Durben-Hirsch, Published Mar 21, 2011.
Evolution Consultants, LLC uses innovative processes and programs to streamline the flow of information to and from your practice thus reducing the paperwork and filing clutter.
We practice the "HANDS OFF" money approach. All co-pay, deductible, and co-insurance monies collected in house on the date of service are exclusively the practices to retain. This strategy encourages proper collection by internal staff and rewards the practice for performance.
If you were an early implementer of EHR software, then you probably find yourself needing to qualify for meaningful use of that EHR. In order to qualify for meaningful use, including incentives, and to avoid potential penalties, a practice will need to execute e-prescribing compliance.
Evolution Consultants has the ability to collect effectively from Workers Compensations plans. We are well aware of Workers compensation billing guidelines and are constantly in communication with the carriers in regards to outstanding bills.
Many people confuse the difference between practice management and administration. Evolution Consultants define Administrations as overseeing of profit and foundations such as billing performance, reporting, and insurance contract management. Practice Management is the overseeing of the daily office requirements such as human resources issues, office processes, and patient complaints and problems. Evolution Consultants is capable of offering both.
The foundation of any practice's financial success is built from the contracts it holds with insurance carriers. Insurance companies are sneaky in regards to how they slowly adjust your fees. Were you aware that your main commercial carriers adjust your rates yearly depending on your contract language? Many of them send correspondence that you would like to call on but never get time. Sometimes you just dont know what to ask of how detailed to get. Evolution Consultants wants to make those calls and monitor your fees to make sure you are not practicing medicine, doing procedures, or administering vaccines at a loss.
A billing audit is similar to a practice audit with the exception that Evolution Consultants would place our sole focus on the billing performance including clearing house reports, accounts receivable analysis, collections process and volume. An audit report is provided at the end of the audit.
A practice audit would provide a detailed overview of the entire practice including but not limited to customer service, work flow, benefits and front office performance, billing performance insurance contract review, charting documentation, and coding. An audit report is provided at the end of the audit.
Many physicians do not have much credentialing, while some credential with multiple facilities and insurance companies. The maintenance can sometimes be overwhelming and time consuming. Many times it becomes that piece of paper at the bottom of the stack. Evolution Consultants' goal is to provide maintenance and ongoing support to this entire process in an organized way.
EHR are also referred to as Electronic Medical Records allows you to schedule, chart, and charge capture, bill, and store medical records all in one software. Many of them work with lab results interfaces, X-ray storage, and E-Prescribing systems to allow a streamlined flow of information. Evolution Consultants can help select and implement an EHR. We have done at least five EHR conversions in the past frew years with different software, different specialty, and different office requirements and all have led to full implementation.
A new practice set up begins at least six months prior to billing your first client. This allows for the appropriate time for contracting should contracting be needed. Evolution Consultants can help with qualifiying a location, software selection, staffing and interviewing, processes and flow, and eventually to medical billing and ongoing oversight of the practice as a whole.