Patient Flow

How does a patient enter the lobby, receive services from the provider, exit the office and still maintain a high level of service satisfaction concerning the experience. This flow process examines the following:

• Patient scheduling
• Lobby image
• How the receptionist greets the patient and presents organizational skills upon patient entry
• How the nurse greets the patient and prepares the patient for the physician
• How the physician enters and exits each encounter
• How patient care instructions are carried out by the staff
• How referrals for testing or specialists are generated
• How well does the staff perform patient checkout, (Requesting payment for services rendered)




Paper Flow

This process examines the utilization of all forms in the practice. It determines if all forms are being utilized and with what consistency. It also makes recommendations on forms to be created, eliminated or updated to meet legal standards.

Telephone Flow

This process examines how calls are answered and how the call is transferred to the party who needs to respond to the inquiry. This area is generally where most practices fail patient expectations due to the inability to answer calls professionally.

• A telephone matrix is often developed to obtain agreement on the type of calls that will be transferred to office personnel or the physician. There is also an agreement on calls in which messages are taken as well as a system for returning those calls.
• Medical practices often respond to telephone flow problems by purchasing a larger telephone system or obtaining a voice mail system. If you cannot answer a telephone matrix questionnaire, you have just wasted a great deal on money.




EMR/EPM System Utilization

This process examines how your organizations software system is functioning. We will review how well the system meets your needs, the needs of your staff members, and how the system will meet your growth over the next 3 years.

Business Office Operations

Coding: This review examines the coding patterns of the practice and looks at improving revenue through appropriate coding enhancements. This review notes codes that are not being utilized, as well as the method of how codes are documented via the EMR/EPM, office superbill and/or encounter form.

Billing Procedures: Procedures are reviewed to determine the timelessness of the billing process. The entire billing process comes down to filing claims with accurate information that meets payor guidelines as well as filing claims in a standard time period. This review examines this process.

Account Receivable Analysis: Following the physician, accounts receivable is generally the next greatest asset in the practice. However, it is often treated as an after thought by the practice. If you have concerns with an ever increasing balance or a decreasing collection percentage, this area needs to be examined.

Payor Mix: This analysis examines where revenues come from within the practice. It is important to understand the importance of various payors to the practice and the effect of a lost contract or reduction in payment rates on the practice.

Managed Care Contract Review: Evaluation of current Managed Care contracts and payor reimbursement issues. A sample review of a current contract will include, but not be limited to, offering contract language suggestions, appeal letters, and payment tracking.

Performance Driven

Management Reports: Practice management is all about the collection of information and placing it into formats that allows for the review of trends and indications of downward areas. The trick is to become aware of a downward trend early and make the appropriate adjustments. The creation of these reports allows for understanding a practice’s financial situation.

• Statistical Performance: This benchmarking process evaluates the practice’s statistical performance to best practice standards. Statistical comparisons include some of the following: charges, adjustments, revenues, expenses, gross/net collection percentages, and account receivable days.

Denied Claim Review: evaluates the source of the denial whether due to inappropriate medical documentation, non-covered services, patient coverage limitations, and/or facility errors.

Once the evaluation is completed, a written report is provided to the facility in an easy to review format that will include suggestions for improvement, a list immediate needs and/or concerns, future project needs, staffing ratio and performance evaluations, etc. Facilities will be able to use this information as an implementation guide for an Action Plan to improve the A/R process, which will assist in increasing the Cash Flow.