MACRA/MIPS/APM
A practice’s effective preparation and efficient data collection for MIPS can result in up to a 119-127% of Medicare reimbursement by 2022.
MIPS assigns scores for reporting Quality Measures, Advancing Care, Clinical Practice Improvement and Cost/Resource.
Healthcare Management Consulting (HMC) can help set up your practice for successfully reporting MIPS by analyzing the measures best suited for reporting by your practice and configuring your EMR to efficiently capture your data, suggesting high-level Advancing Care and Clinical Practice Improvement options, and reviewing your Resource & Cost Management practices.
Revenue Cycle Management (RCM) requires proper set up; maintenance and monitoring to ensure success.
Healthcare Management Consulting (HMC) are certified billers and coders that guide you through the best set-up for proficient set-up and give your practice to experience the best possible outcome.
We analyze your aged A/R, review billing practices & policies, check electronic submissions to payors, assess billing denials and review payor contract rates and provisions and negotiation higher rates (if necessary) to maximize collections, potential, reduce payment turnaround time, and decrease overall days in A/R.
Healthcare remains one of the most heavily regulated industries in the United States with a variety of statutes, regulations and program requirements.
Physicians are under increased scrutiny by government enforcement agencies and frequently audited by such. Proper documentation is your best audit defense.
If, however, your practice is audited, contact us to assist.
Our consultants have successfully navigated many audits and then installed compliance programs to help your practice consistently meet all regulatory guidelines.
Healthcare Management Consulting (HMC) can help with a new business endeavor or expansion of your organization’s current business model by assisting management in research and development of a model that is in line with compliance regulations and corporate vision.
Our consultants will assist management in analyzing and organizing the clinical workflow and financial reports in order to capitalize on the revenue production from the entire operation.
You will receive a recommended model and a 12-month schedule of the anticipated revenues under your chosen business model.
Regularly scheduled chart audits benefit your practice by assuring proper documentation, coding, and billing to help you receive optimal reimbursement while maintaining compliance with policies and regulations. Our chart audit includes instruction/education to improve procedures that can keep your practice profitable and in compliance. Our auditors provide a comprehensive review of provider documentation to demonstrate any possible exposure to payer or government agency audit and identify services that have possibly failed to be billed. Whether preventing “pay-backs” or finding new revenue, our chart audit adds to your bottom line.
Ensure that your practice is getting the maximum payor benefit by negotiating the best payor rates available.
Let our consultants analyze your current top payor contract rates and provisions.
With input from your Management team, we will contact each payor to begin contract negotiations.
Renegotiation involve moving toward analyzing contract performance for continuation or termination, and adding new services to the best benefit of the Organization.
The Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG) continue their scrutiny of practitioners’ documentation and coding practices.
Medical practices need to limit their risk of an audit by developing, documenting, and implementing a compliance plan.
Healthcare Management Consulting (HMC) offers a complete risk assessment to include: documentation review (chart audit), coding & billing analysis, individual benchmark E/M Bell Curve Coding Profile Report per physician, creation or remake of Compliance Program Manual (as needed), and compliance training/education.
Whether a solo practitioner, multi-specialty group, or community hospital, let Healthcare Management Consulting (HMC) help you expand your business or start it right.
We will complete all necessary Medicare forms and applications, PECOs, CAQH, NPI enrollment, Medicaid and third-party payor applications.
Additional credentialing services include: MAC Setup (if your Medicare contractor is changing), revalidation, physician practice start-ups, physician and medical provider credentialing & insurance enrollment services, annual credentialing maintenance, Medicare enrollment services, ASC Credentialing, and PCMH designation.
We are certified ICD-10 Coding experts.
Don’t let EMR software companies promise you “rainbows and unicorns”, then fail to deliver.
Selection of an EMR software that has proper clinical quality measures for your practice specialty is critical to capturing the data needed for MIPS.
Our team of experts can guide you through EMR selection, project planning, design, clinic workflow redesign, staff training, activation with “Go Live” support, attestation support, business intelligence and long-term adoption.
Also essential to EMR success is the initial template building for your patient demographics, assessment of system capabilities, and incorporation of workflows to streamline processes.
Our template building specialists will help you develop the best use templates for your practice’s unique needs and successfully implement your EMR!
Healthcare Management Consulting (HMC) works with medical providers subject to investigation or other attorneys who may not have a health law specialist in-house.
Audit Defense most often entails chart audits and litigation support.
We will perform an analytical review and sample testing of a representative (or actual sample) of the claims in question.
Our review will ensure that the medical records are clear, concise and support the claim (coding) you submitted to the payer.
A written summary will be provided for each chart detailing the coding assigned versus coding supported by documentation.
As an independent professional I can also provide litigation support that includes research, analysis and advisory services.
During the next few years, healthcare is transitioning from fee-for-service to pay-for-performance.
Medical practices need to prepare for these imminent changes that will affect the entire practice revenue cycle.
So how does your practice maximize profitability under the current Healthcare Reform?
The Roadmap to Success is the 3 P’s: Position (your practice for the future of healthcare) + Protect (compliance) ; and Produce (results) = PROFITS.
Healthcare Management Consulting (HMC) uses analytics and detailed reports to show your practice how to build a personalized Roadmap to Success.
Let our consultants answer your health care questions or clarify your situation in terms of meeting state and federal regulations.
In addition, we can investigate opportunities for your practice to cut costs, expand services, and/or increase income.
With the many new “Affordable Care Act” requirements, it is imperative that you understand the projection of your practice.
The future of health care is quickly evolving and you need to insure your practice remains productive and profitable.
Healthcare Management Consulting (HMC) can examine your practice demographics and financials to forecast future productivity.