FAQs For Risk Adjustment
1. What can we do to improve the MRA and Revenue for our risk contracts?
Independent and unbiased audits are the best solution for a practice.
2. What can we do if the revenue and risk scores assigned to our patients seem inconsistent with the conditions that have been reported?
This is a common issue for providers working with risk contracts. A healthcare professional with expertise in finance and revenue cycle management is needed to identify the root cause(s)
3. How can we be sure that our coding is accurate and current?
Using a certified coder is a necessity, using independent auditors to work with your coders is the best policy
4. How long will an audit of our practice take? What is the cost associated with an audit?
The time and cost are directly related to the number of charts.
5. How often should we conduct chart audits?
Audits should be done twice a year.
FAQs For Billing
1. How often should claims/encounters be submitted?
At a minimum weekly
2. What is the normal turnaround time on a fee for service claim?
Our experience is that some commercial payors will pay within five business days.
3. How do we know if our claims have been accepted by the health plans?
Most Insurance Companies allow you check their on-line system and verify the status of the claim.
4. Should we keep using the billing system that we have?
If you are having trouble with the encounters/claims getting through to the Health Plan or CMS, we recommend a process that verifies it was submitted correctly and can check it was accepted plus produce a summary of the value of all claims.
5. What can I do if my practice has been singled out for an audit or if our payments are being garnished?
These situations require an expert to review your charts and verify that your documentation justifies the level of care that is being reported to the insurance companies. These types of discrepancies typically are what triggers a full fledge audit of your practice.
FAQs For Medicare Advantage, Population Health Management and Financial Review/Contract Review
1. I already have an AWV process, what is the difference between what I do and what you have?
We understand every provider has his methods, so we offer it for guidance as it is very comprehensive.
2. What does Risk Stratification provide me?
The ability to stack-rank your patients allow you to identify the 5% to 15% that represent 75% to 85% of your costs.
3. Why would I need Social Determinants of Health?
Because it provides an opportunity to address issues related to indicators based on social, ethnic, behavioral tendencies.
4. Why would I get involved in TOC when it’s taken care of upon discharge?
To avoid re-admissions.
5. I have a CCM program, what are you doing differently?
Our is very comprehensive and facilitates reporting on chronic conditions.
6. How do you address redirecting a chronic patient?
Patient engagement techniques.
7. Do you have access to a robust population health management platform?
Yes, a very comprehensive one.
FAQs For CMS Applications & Compliance
1. How long is the process from COA to contract for an MA plan?
Depends on whether your State is a one track or two track application (State and Federal) but it generally takes about 12-18 months to complete.
2. Is the application for an MA plan with CMS only?
Depends on what State you are filling in.
3. What is application cycle for MSSP or other ACO applications?
Generally, 6 to eight months prior to payment year.
4. Do you tailor the policies and procedures to an organization needs?
Yes, we do.
FAQs For Physician Training Modules
1. Are the trainings live or self-study?
Live mostly via web-based software.
2. My providers are busy, how do deal with that?
We fully understand the time constraints, so we tailor it to the clients’ need with a series of short on-line events.
3. Is there support during and after the training sessions?
Yes, we provide it.
FAQs For Marketing for Primary Care Providers,
Medicare Provider Groups
1. Do you provide sales support in person or remotely?
Either, based on your needs.
2. What kind of content do you create?
Digital campaigns; video, email, text. Depending on the clients’ preferences and goals.
3. Do you also combine traditional marketing as well?
Yes, if the client wants to.
4. What do you usually promote and how?
We promote doctors not Health Plans.