Products

Setting fees is not an art but a science. The way to succeed is to build a systematic approach to fee-setting with the Resource Based Relative Value Scale (RBRVS) data in the 2011 RBRVS Calculator. The straight-forward instructions, examples and formulas in this well-organized resource will help clarify the fee-setting process. read more ...

Proper E/M utilization is an absolute must for those practices that want to both assess and mitigate their risk for an outside audit or review. Identify patterns of over or under utilization for your E/M codes before someone else finds it for you. Just enter your charge and frequency for each E/M code you report and the worksheet will do the rest. It even builds graphs and charts to assist with presentation to physicians and coding staff. read more ...

The fee schedule is, without question, the single most important financial tool in any business and a medical practice is no exception. Our fee schedule workbooks are designed to not only provide you with accurate benchmark information but are also the only data sets of their kind to also show variability and sample error, two metrics that are absolutely critical to understanding the value of the data. read more ...

Compliance risk assessment has moved to the forefront of concerns for practice administrators, managers and coding professionals. The reason is simple: it’s easier to address the risk in advance of an audit than after the audit is engaged. It’s no secret that many audits are driven by what appear to be aberrant use of procedure codes and modifiers, particularly those that are considered to be high-risk. In essence, the auditing agency compares your utilization of procedure codes and modifiers against your peer group using data collected from the national repositories.

So knowing, in advance, how you look to the potential auditor is paramount for mitigating your risk. Our procedure code and modifier worksheets draw upon the same repository that the auditors use to allow you to benchmark your practice and see just what the auditor sees. Not only will this give you the information to address potential risk areas, but can prepare you in advance should an audit occur. The worksheets? $99. Peace of mind? Priceless. read more ...

Lean Six Sigma for the Medical Practice: Improving Profitability by Improving Processes
This is my new book (co-authored with Owen Dahl) on applying the concepts of Lean Six Sigma to the medical practice. This book will allow you to:

• Learn how to use analytics to identify inconsistent behavior by payers - so practices can hold payers' feet to the fire.
• See how process improvement can help practices reduce denials by upwards of 50%. Use these techniques to improve both patient satisfaction and staff morale.
• Learn how to eliminate bottlenecks in your practice and use metrics to make smart practice improvement decisions.

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Nearly 20 years old, the National Correct Coding Initiative (NCCI) database has grown from around 20,000 edit pairs to almost one million and is used by the majority of payers as a source of their edit policies. Ignoring the importance of the data contained within the NCCI can result not only in a loss of revenue through denials, down coding and increased appeals cost, but may also increase your risk of audit and review. The problem for many practices is that the database is so huge, it is nearly impossible to use in standard spreadsheet form. Our NCCI+Plus search engine provides the perfect solution; rapid search capability combined with ease of use and multiple reporting methods. read more ...

With the improvement in both computer and information technologies, analytics are becoming a household model for the more successful medical practices. Information is truly power, but only if it can be managed properly. When faced with an overwhelming amount of information, managing it becomes more than just an isolated job; it involves the entire organization. Clinicians, administrators, managers, coders, billers and even the folks at the check-in desk need to have access to immediate and accurate feedback if we expect a practice to operate at maximum efficiency and profitability. The TPA system is designed to manage three critical analytical components:

1. Build and maintain a defensible and profitable fee schedule; perhaps the most important financial tool within the medical practice.
2. Analyze and benchmark procedure code utilization to improve quality of care, reduce compliance risk and increase profitability.
3. Analyze and benchmark modifiers to reduce denials, improve cash flow and reduce the risk of audit or review due to overutilization of high-risk modifiers.

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