Medical Billing & Collections
Evolution Consultants, LLC
Medical Billing Consultants serving Texas, and Nationwide 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.
"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.
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:
- "Billing companies that use technology can work faster and more accurately" (Hirsch
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.
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"
Evolution's Answer: Evolution Consultants 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 payor mix. Please note that for a high volume of workers compensation claims this may be slightly higher.
- 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
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.
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).
Evolution's Answer: Evolution Consultants 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.
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).
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.
- Does the billing company use benchmarks so its performance can be measured? (Hirsch 2) .
Evolution's Answer: Evolution Consultants 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.
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).
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.
- 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
Evolution's Answer: Evolution Consultants 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.
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).
Evolution's Answer: Evolution Consultants performs 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
serving all of Texas and nationwide for medical billing services.
serving all of Texas and nationwide for medical billing services.
 How to choose an outside billing company that works for you, Decision Health (website). Marla Durben-Hirsch, Published Mar 21, 2011.