Whether we consult with your practice or manage your revenue cycle for you, we systematically cover every aspect of the revenue cycle finding answers to the questions indicated. 

Patient eligibility: Are patient insurances being verified? How often and how many days prior to the date of service?

Prior authorizations: Are there any denials owing to prior authorizations? If so, from which insurance companies? What is the process of obtaining authorizations?

Scheduling: How easy or difficult is it for patients to schedule an appointment? What options do they have? Are Advanced Access principles being applied? What information is collected during scheduling a patient? Does staff remind patient of a previous balance?

Patient check-in: How long do patients wait before someone talks to them? Is their privacy and health information protected? What information is taken and how?

Clearinghouse process: How quickly are EDI rejects from the clearinghouse are worked on? What's the lag for resubmission? Why do errors from EDI reports occur? 

Under this model, we start with consulting (complementary) and transition the practice from either in-house or outsourced billing to the NextServices revenue cycle model. We cover every aspect from checking on the benefits and eligibility of your patients' insurances prior to the date of service to getting the provider fully and correctly paid in record time. Physicians are provided customized analytics that reflect billing success on a daily basis.

Operations Review

Demographic entry: Who enters patient demographics? What is entered? What is the lag from the patient entry to actual entry into the system?

Charge capture: How do physicians (or clinical staff) capture what was performed? How much time does it take them to do so? When was the encounter form last updated?

Charge entry: What is the lag from the time charges are captured to charges are entered into the practice management system?

Coding: Who reviews the codes submitted the physicians or the practice? When were the coding guidelines updated? Are Local Coverage Guidelines applied?

Charge submissions: What is the lag from the time charges are captured to the time charges are submitted to the clearinghouse? If an EMR is used, are charges checked for quality and coding compliance from someone other than the system?
 

Posting payments: Are electronic fund transfers (EFTs) for all possible insurances setup? How quickly are payments posted into the system from the time of receipt?
 

Accounts Receivable: What are the AR days for the practice? How does it compare nationally and to other physicians in the same specialty?
 

Insurance negotiations: When was the fee schedule last adjusted? Does the practice possess all contracts for all major carriers? Is the practice getting paid the usual and customary charge? How were the fees determined?

Patient statements: How often are patient statements sent? Is the process effective in yielding results? How does the practice decide on moving patients to collections?
 

Patient customer service: What types of questions do patients have that are related to billing? Why do they occur?
 

Revenue cycle services: Pricing model: percentage of collections. Under an operational review, NextClarity assumes the review of flow of operations within a practice. The following areas are covered:

Lean operational management: How do operations flow within the practice? What kinds of bottlenecks lead to delays? Are processes, flow and systems standardized? Is there predictability from one day to the next? Is there sufficient automation? Are people cross-trained for smooth handoff from one step of the process to the next?

Human resource management: Is staff capacity appropriate? Is everyone trained on the job? Is the team sufficiently motivated and focusing on patient care? How often are training programs conducted? How is performance measured? Is there an appropriate review process?

Financial management: How are practice finances handled? Are there cash control measures? Is the process fairly automated to avoid theft? What are the financial ratios that the practice tracks on a monthly and quarterly basis? Do physicians or the board meet regularly to review finances of the group?

Technology management: How are technology decisions made? How much is technology or software used to automate operational flow of the practice? What types of analysis is used to measure practice performance? Is there a clear understanding of how a particular technology benefits business performance of the practice? What is the process for deciding on implementing an EMR?

Legal compliance: How compliant is the practice? What types of legal risks does it carry? How often are contracts with vendors reviewed? What types of insurance audit risk does the practice carry and for which insurances? What steps has the practice taken to comply and reduce legal risk?