Medical Billing Resources, Inc.

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BILLING AND RECEIVABLE MANAGEMENT FOR FACULTY PRACTICE (REAP)

Q. What criteria should be considered when evaluating if this service is beneficial to my operation?

A. MBR will be happy to assist you in determining how it's services could be of greatest benefit to your organization. Completion of the “Contact Us” section with-in this web-site will begin the process. Generally, our services will benefit any organization that needs to automate processes, ensure regulatory compliance, optimize cash flow, enhance receivable management efforts, or need to support growth without making a significant investment in equipment, space and staff.

Q. What is needed in order to implement one of the MBR programs?

A. In order to implement one of our programs MBR requires only the assistance of a key contact person with-in your organization. This individual will provide any data or insight required for MBR to establish the system profiles and back-office structure needed to maximize it's efforts. If hardware is required on-site for appointment scheduling, patient registration, or system inquiry/ report generation, MBR will assist in evaluating the equipment you presently have and determine what if anything additional is required.

Q. How are the fees for these programs structured? What is required in order for MBR to propose the fees related to the service chosen?

A. Other than certain exclusions that are specific to the particular program, MBR services are provided in a manner that provides incentive for it to perform, thereby limiting it's client's risk and creating a true incentive based and mutually rewarding partnership. Upon making contact with us, we will discuss what information is needed in order for us to propose fees. The information will depend upon the type of assistance requested.

Q. How is data exchanged?

A. In order to maximize productivity and efficiency, data is exchanged in electronic fashion. This is done through state-of-the-art systems with the security of patient information, and regulatory compliance as primary issues.

Q. What is the estimated timeline for the implementation of a program?

A. The estimated timeframe for install of any of our programs is approximately four to six weeks. This is based upon a number of factors including, readily available information for system set-up, the complexity of interfaces that may be required, and special requirements of the client. MBR attempts to begin production in as timely a manner as possible without jeopardizing the long term benefits to be derived from a project that is well structured and thought out.

Q. What effort is routinely required from the client?

A. On a routine basis the MBR client is asked to be available for status meetings, review of executive management reporting, and assist with any issues that MBR feels requires the input of the healthcare provider.

Q. How often if billing generated?

A. Billing is generated on a daily basis, or as often as third party carrier requirements permit.

Q. How is account follow-up performed?

A. Follow-up is an intense and highly focused function of our overall back-office processes. Specific follow-up criteria has been developed, tailored to the medical specialty, hospital service, patient type, and the insurance status and age of the account. This is all based upon the significant experience that MBR possesses. An automated “Worklist” environment is employed using telephone and letter series routines. All follow-up efforts are noted on the system. Classifications of problem accounts are reported to the client in order to assist in addressing front-end issues affecting revenue generation and cash collection.

Q. How is the self-pay population handled?

A. Self-pay, including the uninsured and the partially insured individuals, is handled by MBR in accordance with policy and procedure established by the client. MBR will provide recommendations based upon our experience. A dunning cycle, with tailored letters and patient statements, is utilized. Both the letters and the statements provide toll free telephone access to the patient, directly into the MBR customer service area. As new information is obtained from the patient/guarantor, the system is updated generating an immediate re-bill as may be appropriate. At the conclusion of the dunning cycle, delinquent accounts are listed as pre-collection to be handled in accordance with the client's instructions governing write-off, return, or collection agency referral.

Q. How is correspondence with the patients handled?

A. All correspondence is handled in a supportive manner. MBR presents itself to the patient as an advocate offering it's assistance in getting their claim appropriately recognized by their carrier.

Q. What receivable management services are included with-in the program?

A. When a comprehensive outsourcing program is chosen, MBR provides all aspects of receivable management. These services include cash and adjustment posting, classification transfers, analysis and feedback to the client, audit letters, dunning, intense follow-up processes, management report maintenance and review, and the preparation of delinquent accounts for final disposition.

Q. How are payments handled when received directly by MBR?

A. When payments are received directly at MBR, if related to an aged receivable project, they are recorded and forwarded to the client. MBR will not deposit the cash. With aged receivable projects, MBR depends on the periodic reporting from the client for cash posting to its system. If related to a total outsourcing project, again cash is directed to the client, or the preferred approach is to establish a lockbox for directing the cash payments. In this way the cash is deposited immediately to the client's bank account, and the back-up is forwarded to MBR for posting. Either way, it is a better approach for both MBR and the client, that MBR does not take possession of the cash.

Q. How are accounts updated as payments are received at the client?

A. All cash is directed to the client (either through a lockbox or other preferred method). If related to an aged receivable project, the client posts the cash received to the patient's account through their routine processes. An electronic file is provided to MBR, on a regular basis, for use in updating the MBR system. The frequency and accuracy of these files is very important in order for MBR to maximize the effectiveness of follow-up efforts. If related to a total outsourcing arrangement, the backup to the cash received by the client is forwarded to MBR for posting.

Q. How flexible is MBR reporting?

A. MBR reporting is extremely flexible. The standard reporting is very comprehensive, and typically sufficient. However, for total outsourcing projects, there is a “report writing” module available. For aged receivable projects, special reporting requirements can be accommodated. Reports can be provided to the client electronically, or the client can be given the ability to generate reports at their sites. In addition to the reporting generated through the billing system, MBR provides Executive Summary Reporting. This reporting provides a management summary concerning areas of concern that MBR has identified through their efforts, as well as analyses of the status of cash and receivable levels.

Q. Is appointment scheduling available?

A. Appointment scheduling is available for all types of medical specialty practices. The scheduler allows the operator to view and schedule up to six providers, and six rooms simultaneously, creating centralized, coordinated scheduling for practices of all sizes. Some of the unique features that make the scheduler powerful enough for any practice are:

Full integration to the billing module
Insurance information fields for pre-authorization and verification
User defined: slot intervals/appointment types/schedule blocking/overbooking parameters
Reminder letters/recall letters
No show/cancellation tracking
Charge slip/label printing for chart preparation
Next available appointment type
Any combination of specific day, place, provider or appointment types
Morning, afternoon, or evening time slots or time ranges

Q. Is patient registration available?

A. If desired, a patient registration system is available for all types of medical practices. This is fully integrated with the appointment scheduling system. Information input here is passed to the MBR billing and receivable management system for processing. Editing features resident in this system prevent a variety of errors that can be caught at the time of registration.

Q. How user friendly are the MBR systems?

A. Systems from MBR are powerful, sophisticated and detailed, yet are easy to implement, use and maintain. Our systems are designed to be flexible, meet the needs of any practice, and expandable as needed. Features of our core system are:

Ability to locate the correct patient record quickly with up to 16 different search criteria;
Avoids duplicate records. The MBR system will issue an immediate warning the moment an existing social security number and/or name is entered;
The relational database allows for the culling of data from virtually any field, resulting in the customization of reporting for the practice;
Real-time processing allows access to information by all users;
Because there is no need to purge the system, retrieving historic information, re-billing, and reproducing statements to patients is easily accomplished;
Up to 100 insurance specific fee schedules;
User defined billing cycles, dunning messages, and links between procedure and diagnosis codes;
Up to six insurance carriers per patient;
Insurance forms, statements, and receipts on demand; and
Managed care tracking.

Q. What is the level of sophistication, and dedication to handling managed care activity?

A. Managed care today impacts upon every type of healthcare service provided. It is no longer enough to simply assume that any patient can be seen at any time, and for any reason. The healthcare provider must now keep detailed data on the numbers of visits allowed by a carrier, and warn patients when their limits are being approached. It is more complex than ever to know what co-payment amount is due from each patient at the time of service. It is also more complex than ever to obtain accurate information concerning what procedures a specific plan will cover or not, and to notify the patient as appropriate. It is imperative that the system utilized by the provider of service provide critical data to be used to review each managed care plan's profitability, especially those plans where capitation is employed. Our system is ideal for assisting in this regard.

MBR has always been committed to developing programs in anticipation of the changing needs of the healthcare industry. Our attention to the issues surrounding the managed care environment is an example of that commitment. Some of the capabilities the system will offer are:

Monitor the utilization of services based on the patient's specific treatment plan
Handle plan specific fee schedules
Manage co-payments and eligibility
Warn when service limits for a patient are being reached
Perform utilization outcome analysis by referring source
Analyze capitated service utilization and revenue
Compute plan specific fee schedules

MBR focuses heavily on the continuous fine-tuning of our follow-up processes. We value our productive working relationships with the major managed care carriers. Payments received are analyzed for compliance with contract terms.

Q. Can you describe in greater detail the reporting that would be helpful to a medical practice?

A. Reporting is flexible, detailed and reliable. Reports are available combining virtually any data sequence. Although the majority of reports are utilized by MBR staff in managing the client's receivable, many customized reports can be offered to the client to help them manage their practice. The system can generate:

Daily, weekly, monthly, or annual reporting sorted by place of service, provider , etc.
Reporting by department, insurance type, or any combination thereof
Trend reports allowing comparison of any four time periods
User defined aging categories
Revenue reports by procedure and/or insurance type
Referral trend and revenue by referring source reports
Capitated service analysis
Collection aging and collection agency productivity reports
Procedure/diagnosis utilization reports

Our reporting capabilities make it very easy to determine revenue produced by each physician with-in the Group, as well as the totals for the Group. In addition, the tracking of referring physicians, surgeons, assistant surgeons, and the simultaneous scheduling of multiple anesthesiologists is accommodated.

The system is fully functional regarding managed care, to include not only financial and utilization reporting, but also capitation, plan specific fee schedules, eligibility management and coordination of benefits.

Q. What are the main benefits of the “Total Outsourcing” approach provided through REAP?

A. As you examine the REAP Program for your operation, you will find that it is comprised of two separate components that greatly complement each other. These varied resources combine to provide a total solution for managing the practice and maximizing reimbursement. The first component of the program includes a full front-end management system, including automated appointment scheduling, patient registration, and fully integrated word processing. The second component comprehensively manages your initial billing, handles statistical processing, and the back-office operation manages the receivable. Receivable management is accomplished through:

Electronic bill generation to all carriers on a timely basis;
Analysis of system edits;
Analysis of, and handling of third party denials and correspondence;
Intense follow-up on delinquent third party claims with the respective carriers;p
Review of payments in accordance with contract terms;
Correspondence with patients to obtain missing, or replace incorrect information;
Communicate routinely with practice management concerning findings and issues to be addressed internally;
Handling of patient inquiries related to the bills received by them;
Generate collection letters and dunning notices as required regarding patient responsibilities; and
Generate executive management reports to help practice management easily monitor the current status of the receivable that is our charge.

As a total receivable management program, REAP combines ongoing management and operational support to provide continuous, focused collection and maintenance of the patient receivable. Through this program MBR provides staffing and systems to support segments of your operation with-in agreed upon timeframes and operational parameters.

REAP is designed to assist our clients with effectively maximizing cash flow and managing their accounts receivable. MBR's systems, and related billing and receivable management processes are unique in regards to how we view our responsibilities. MBR considers itself responsible for all aspects of managing the client's data, cash flow, reporting, and receivable level.

Our clients benefit through having the availability of our back-office staff to supplement their own, thereby increasing cash collections. Cash is enhanced as a result of our intense follow-up efforts, while the client's staff focuses on gathering meaningful data, and obtaining required referrals and authorizations for the services to be rendered. The client benefits further through MBR systems capabilities, which are employed in assisting them in managing their practice.

In summary, the results of our efforts, and the benefits to the client related to REAP are:

Preventing accounts from reaching undesirable aging levels;
Client staff is made available to focus on the quality of front-end data gathering;
Enhanced cash flow from aged receivables that typically do not get the required effort;
Maintenance of a more meaningful receivable;
Reduction in the degree of revenue tied up in the receivable;
Meaningful feedback provided to the client to assist them in improving internal processes that ultimately affect revenue generation, cash collection, and patient satisfaction; and
Providing flexibility concerning regulatory compliance, reporting and receivable management.

All of this expertise, experience and support is provided to MBR clients for a fee that is significantly lower than it would cost the Practice to do on it's own. MBR will enhance cash flow from the active receivable, and therefore reduce the magnitude of referrals to costly collection agencies, and minimize bad debt write-offs.