Frequently Asked Questions

There is no one-size-fits-all approach to medical practice management. Each practice has its own environment, leadership style, workflow challenges, etc. Our practice management program is designed to let providers decide what areas they want to participate in, what areas they would like or need assistance with, and how much assistance.  Evolution’s Consulting team can collaborate with practices on start-up or project management, compliance, training, software selection and implementation, credentialing/contracting, practice finances, and essentially any aspect that doesn't involve direct clinical care of the patient.  As much or as little assistance as the practice needs. We bill hourly and can work into just about any budget. We have no long-term agreements and there is no usage requirement. Practice management consulting in the hand of the practice. 

Yes. Evolution is located in the beautiful Texas Hill Country in New Braunfels, Texas. We have been in New Braunfels since 2006 and service clients all over the United States, depending on needs. Evolution is a boutique-style consulting firm that believes when you work with the right clients, for the right goals, in the right way, we can achieve great things together. We pride ourselves on our performance, attention to detail, and going above and beyond for our clients. It is this performance that has yielded client relationships of 15+ years and counting. We have a proven infrastructure and knowledge base that can grow with any size practice.

Clients have options.  We offer 100% onshore and hybrid structures designed to control cost.  Our entire leadership team is onshore and resides in the United States. Our internal team consists of RCM leadership, experienced medical billers, certified coders, and billing support staff.  In hybrid models, any offshore staff is supervised, trained, and overseen daily by our inhouse team.  Your office team and your patients will only interact with our internal team.  Each Client regardless of the model is assigned an internal billing team and consistent points of contact.  Our main focus is on communication, performance, and attention to detail which pays off in the form of higher recovery rates.  There is a cost to the extremely low rates offered by full offshore RCM companies.  The real cost is how much you don't collect when there is limited or no personal contact with your billing team.

Yes. Coding is the selection of CPT codes that are billed out to the insurance payer and the documentation required to support the code selection.  Billing is the art of navigating the revenue cycle in the form of getting the charges to the payer timely, posting, working accounts receivable, and appeals to bring in the revenue.  It does not matter how great your coding and documentation is if you cannot bring in the money from the payers.  In the other instance, your revenue cycle may be great, but you're not getting paid due to coding and documentation deficits.  The two must thrive together for the best cash flow performance.

Your gross (cash) collection percentage is as unique as a fingerprint.  It is based on your set billed charge as a percent of your payer contracts, your payer mix, CPT utilization, payor allowables, and specialty.  Benchmarks are helpful only to provide a ballpark estimate, but cannot be used for accurate predictions, as with most benchmarks, they do not tell you all the needed information to make a direct comparison from one practice to another.

Evolution always estimates 120 Business days as the payers don’t work on the weekends. The timeline with commercial payers has grown over the years. Some payers credential first and then contract, while others contract first and then credential. The longest delay we currently see is getting the payers to load the providers into their systems and assign effective dates. We have also seen that retro effective dates are not as common as they once were. The payers now state that it can take 90-120 days to credential and up to 90 days to load the provider. With years of experience and building on established relationships with payers, we have been successful in navigating those timelines. 

Every mistake and open window of revenue loss can be identified in the revenue cycle or the accounts receivable of a practice. A revenue team is so much more than the billing of the past. A great revenue team searches payer policies and educates the provider and the practice on new or changing guidelines. They work with the practice management team to see what problems are observed in demographic data entry or securing of money. Custom appeal letters, payor grievances and escalations are more common today than ever.  This is what makes the Evolution Revenue Cycle team so unique from the competition. For others, it is the quantity of billing, and for Evolution, it is about the quality of our work. We pay attention to the information that the revenue cycle shares and then work with the practice to close every window of revenue loss. 

Medical billing is the act of submitting charges, posting payment, calling AR, and appeals.  Revenue cycle management takes this many steps further with reporting and by looking ahead and behind with data. RCM looks for current trends in the data to strategically move resources and address the trends.  RCM looks at previous trends to monitor performance and improvement.  RCM provides useful and custom feedback to the practice.  

Many years ago, the term RCM did not exist, it was just medical billing.  Medical billing companies had earned a bad reputation for being quantity over quality.  The term RCM was just a way to rebrand the same service.  Many companies still call themselves RCM companies when all they do is medical billing.  Ask the competition, what they do above medical billing that satisfies the RCM component.  In all the years of working on medical billing clean-ups, it has become very clear that big corporations such as software companies who offer RCM, are really providing medical billing on a large scale...quantity over quality.  At Evolution, our focus is on improving and perfecting cash flow cycles.