Billing Company Operations:
As the leader in medical billing, Medorizon understands the importance of the front end working with the back end. In other words, the practice and billing staffs must be working together. On a quarterly basis, we schedule meetings with your staff to discuss issues, as well as current industry trends.
Our compliance program is based on the Office of Inspector General Guidelines for Third Party Billing Companies. A copy of the compliance plan will be provided to the client. Medorizon developed forms that assist with compliance guidelines such as coding change requests, chart audits, physician and staff training.
Medorizon has a billing Policy & Procedure Manual, which addresses regulatory compliance implications such as credit balances, coding, problem resolution, system integrity, and appeals. Additionally, this manual documents the entire revenue cycle, which is reviewed on an annual basis. The financial policy addresses the process for following up on claims, correspondence, appeals, write offs, bad debt, and self-pay collections.
We base our staffing levels on claims generated as opposed to physician FTE. Our staff is assigned specific accounts and they are held accountable for specific standards. Each account is assigned to an Account Representative.
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Regulatory Compliance:
As previously mentioned, Medorizon has a written compliance plan. Our Compliance Officer is responsible for the plan and handles all issues, including ongoing training and audits. Should an issue arise with a client, they document the issues and follow it through resolution. Our compliance guidelines are shared with all new employees during orientation, as well as clients, during the implementation phase. Ongoing training and updates are provided during the quarterly meetings that we hold with clients. Annually, we perform internal audits on the charge entry, coding and payment posting processes. Additionally, we recommend regular audits be performed by the client and a training schedule developed for the physicians. Our software database resides at an Application Service Provider (ASP). Hence, it is secure and backed up three times per day. The backs up tapes are stored off site. We have a Service Level Agreement with our ASP, which addresses control policies including security, access, performance, disaster recovery, etc. |
Staffing & Communications:
Our organizational structure is based on a team-based approach, where a certain group of staff is responsible for specific clients/specialties. For example, we have a surgery team that handles all of our surgical clients including ambulatory surgery centers, primary care clients and ancillary service groups. A Team Leader is assigned to manage the day-to-day operations of the group. A client-assigned Account Representative would report to the Team Leader. This Account Representative would be responsible to handle your specific account and would communicate with you on an as needed basis (in most cases, daily). Medorizon would meet with you on a quarterly basis to review performance, goals and objectives. Our goal is to provide exceptional customer service, not only to the patients, but to our clients as well. We understand how critical communication is to the success of a healthy revenue cycle.
We work together with your staff as a team to produce tangible goals that are identified and shared with all parties. Should you require more frequent meetings, we will be available to meet with your management team on a monthly basis or as needed (initially, we would be meeting frequently during the implementation stage). We have found that the most effective relationship between a client and our company is one where both parties function as a team. We encourage our staff to develop positive relationships with your staff and be in contact on a regular basis. Often, our Account Representatives spend time at your office reviewing issues with your staff. This gives both parties
an opportunity to develop a positive relationship with common goals in mind.
Performance Standards:
- Charges are entered within 3 days of service
- 90% of copays are collected at time of service
- Payments are entered within 2 days of receipt
- Credit Balances are resolved within 30 days
- Registration accuracy rate greater than 97%
- Response time within 2 days
- Claims and statements are generated daily
- AR follow up starts at 30 days
- Customer inquiries/issues are resolved within 3 working days (written and phone)
- Monthly reports are distributed by the 5th business day of the month
- Denial percentage less than 3%
- Days in receivable less than 45 days
- AR percentage over 120 days less than 15%
- HIPAA/OIG Compliance
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