Frequently Asked Questions—Practicare Medical Management:

Computer Billing System:

Practicare has two systems available for billing depending on the needs of the practice: 1) MED FM by CPU Medical Management Systems version 5.1 billing software, and 2) Allscripts Professional PM.   As an additional option for clients interested in EHR, Practicare offers Allscripts Professional EHR which is CCHIT Certified.

Practicare uses all HIPAA compliant methods of data exchange.  Our preferred method is secure site FTP electronic data exchange, however manual demographic submission is also acceptable.

Practicare submits over 95% of its claims electronically and utilizes direct electronic claim submission for National Government Services (Medicare), Blue Cross Blue Shield, and Medicaid claims.  Additionally, Practicare is a preferred vendor with the clearinghouse EMDEON as well as utilizes Navicure and Post-n-Track for claim submission and claim tracking.

Yes.  Practicare currently has electronic remittance capabilities with National Government Services (Medicare), Blue Cross Blue Shield, Medicaid, and many commercial carriers ( Aetna, Cigna, MVP, United Healthcare, etc).

Does Practicare utilize a clearinghouse for claims adjudication?

Yes. Practicare uses EMDEON, NAVICURE, and Post-n-Track clearinghouses for those payers that do not accept direct electronic claims submission.

How many dunning letters do patients receive and in what time frame?

Patients receive three statements at 30-day intervals, followed up by a pre-collection notice, and a final collection notice.  Examples of these materials are available to prospective clients upon request.

Yes.  Statement messages are customizable by client, by financial class, and by dunning level.

Standard monthly output from both CPU v.5.1 and Allscripts Professional PM billing systems include the practice transaction analysis, financial class / insurance carrier type activity summary, procedure type analysis, daily posting summary, and aged trial balance. Examples of these reports are available to prospective clients upon request.

In addition to the regular month end reporting, Practicare provides the following additional reports that have proven to be of significant value to our clients: RVU tracking analysis report; Monthly and Yearly Comparative Reports; Denial Tracking; A/R monitor report; Comprehensive Medical Practice Analysis (CMPA) reporting which includes a fee schedule anaysis.

Is your billing system accessible to clients for viewing of patient accounts?

Yes, through a secure VPN connection, clients may have access to all of their data and have functional access depending on their needs, e.g. patient registration, scheduling, management reports and if interested in using our system in an ASP environment, may perform all charge entry, payment posting and following functions.     

Most ad hoc reports can be produced the same day as requested.   For recurring ad hoc analyses, our software development professionals can develop custom software applications.

Charge Entry:

Practicare prefers to have all charge documents submitted electronically via our secure FTP site to speed the payment process.  In the event the client lacks the necessary infrastructure to submit electronically, Practicare will utilize the US mail, couriers, and/or overnight delivery services.

Yes.  Both billing systems utilize front-end screening of claims to verify compliance with the National Correct Coding initiative (NCCI) coding guidelines as well as the National and Local Coverage Determinations (NCD, LCD).

If clean claims are submitted electronically, the charge is submitted within 24 hours of receipt.  In the event that Practicare must perform coding of procedures and/or obtain missing information for the claim, the charges are typically submitted within 2-4 business days.

Yes.  Practicare employs several Certified Professional Coders (CPC’s) with an average over 5 years coding experience.  We have procedural coding expertise in the areas of Radiology (including Interventional), Pathology, Evaluation & Management (E&M), Physical Therapy, Anesthesia, Surgery, Psychiatry, and Pain Management.  We have extensive diagnosis coding expertise in almost all specialties.  Most of our coders are active in the local AAPC chapter which Practicare supports, and all complete the required continuing education unit (CEU) credits to maintain certification by the American Academy of Professional Coders (AAPC).

Upon receipt of the edits, the Billing Specialist will, as required, contact the client directly using several specific forms that are executed by the client and subsequently returned to Practicare staff prior to the submission of the claim.       

Describe controls in place that all charges received are entered and processed.

Practicare insures that all charges received are entered and processed by the use of the Charge/Edit Log; which verifies that the Charge Files sent by the client reflect continuous dates of service, with no gaps in service delivery dates.  This form is executed with every charge file sent to Practicare.  Through the use of a sequential numbering convention, the Practicare staff is able to instantly identify missing charges.  When missing charges are identified, the client is contacted and given specific patient account numbers that are used by the client to obtain any missing information prior to claim submission.          

Accounts Receivable Follow-up:

Practicare employs a dedicated Accounts Receivable follow up group whose sole purpose is to investigate past due A/R balances and pursue collection of outstanding funds.  The AR group uses a four part process consisting of: 1) Production of Aged Trial Balance reports to clarify those payers contributing to past due A/R balances, 2) Prioritization of accounts to be worked from the oldest to current with a balance greater than 60 days in conjunction with, 3) the production of the Selective Accounts Receivable report which identifies aged balances on the patient level.  4) A/R department staff also receive from the front end payment posters denials for accounts over 60 days old that will require an appeal or re-submission with appropriate amendments.

Yes.  A/R group representatives are dedicated to servicing specific client accounts.  Similar to Practicare Client Managers, this structure allows our staff to gain an in depth understanding of the accounts they manage.  The primary responsibilities of the A/R group staff are to research aged A/R balances, and collect outstanding payments in the most efficient manner possible.  The A/R staff is in regular communication with the Client Managers who contact client practices as necessary to obtain key billing information that will result in payment.

Yes.  A toll free number can be established for Practicare clients if requested.

Will Practicare perform credentialing for Medicare, Medicaid, Blue Cross and other Insurers.

Practicare currently employs two (2) FTE’s in our dedicated credentialing department. We utilize an automated credentialing software system to streamline the process and assure that Providers are credentialed appropriately.

Yes. Practicare processes refunds for our clients based on refund policies specific to each client and within the OIG guidelines for third party billing companies.

Yes.  An example of the Practicare Compliance Plan is available for review by prospective clients upon request.

Yes.  Practicare employs a Compliance Officer who is responsible for maintaining and updating the Compliance Plan, and convening regular meetings of the Compliance Committee on a monthly basis.

Setup time for new clients can vary based on the practice specialty; the number of physicians in the group, participation status with Medicare; and on site Information System infrastructure required.  Assuming the physicians participate with Medicare, and there are no unusual IT requirements, a new client can usually be set up within one to two weeks.

Practicare currently performs Billing and A/R Management for over 85 practices.  As of January 2009, the total number of providers associated with this client base is approximately 360.

Our client practices range in size from 1 to 23 providers across several medical specialties.

Yes, we measure procedures per FTE, revenue per FTE, number of accounts touched per day per employee which includes patient phone calls, number of days to post charges, % AR greater than 120 days and number of days in AR per client.  This helps us ensure the quantity and quality of productivity.

Yes, we perform random internal claim audits on a regular basis that are presented to our Compliance Committee.  We also have an annual Type 1 SAS 70 audit, which is an operational audit performed by independent accounting firm.

Do you have performance benchmarks?  If so, what are they?

We regularly compare our billing performance against nationally and regionally recognized benchmarks from a number of sources including the Medical Group Management Association (MGMA) and The Radiology Billing Management Association (RBMA).  Additionally, we compare performance against our own internal benchmarks by specialty.

Do you have record retention and storage policies?

Yes. Practicare’s record retention and storage policies are in accordance with all applicable Federal and State laws.

Do you provide electronic imaging?  Which documents?

Yes.  In addition to our Practice Management and Electronic Health Record (EHR) applications, we have industry-leading data capture technology from AnyDoc Software.  We image EOB's, insurance cards, drivers’ licenses, and correspondence.

Do you process credit balances and refunds?

Yes.  We are in compliance with third party guidelines from the Office of the Inspector General (OIG) for third party medical billing companies.

Yes.  We have the ability to provide a variety of information to assist your practice.  We can track and report referring doctor activity, top diagnosis codes, and other data relevant to Pay for Performance.  For clients that require our coding resources, we are providing coding and billing of category II codes that are part of Medicare’s PQRI program.  We have offered this service since the inception of this program in July 2007.