Billing implications while merging groups to create a super group

ABOUT

Two large groups on the east coast of US decided to merge over the period of a year. This had significant implications for billing. Here’s how we helped.

CHALLENGES

These were the following steps we took:
1) Risk analysis. We conducted a detailed risk analysis covering areas impacting billing such as common Tax ID generation, working with top insurances that the group would participate with and identifying all possible areas for payment disruption.
2) Credentialing. We initiated and completed credentialing for all top insurances successfully.
3) Merging of software systems. Our technical team worked with the practice management software vendor to combine office keys of both groups to create a unified group without disrupting past billing records.
4) New interface with the EHR vendor. We worked with the EHR vendor to establish an interface for the new unified practice management system and the merged EHR.
5) Contract negotiation. We gathered all essential documentation required for negotiating higher contracts for the super group.
6) Operational policies. We helped them prepare operational policies to streamline billing updates and avoid any overlaps in administrative processes.

WHAT WE DID

We first understood and documented the various requirements that each end client had. This helped us establish a repeatable process around global billing, technical component billing with specific modifiers, insurance specific billing, end client reporting and invoicing methods.

LIFE WITH NEXTSERVICES

A merger of any kind involves a great degree of complexity and is wrought with challenges. One of the biggest reasons why mergers fail is because back-end systems that ensure cash flow are disturbed. Our team worked hand-in-hand with both groups operationally and technologically that resulted in a smooth and outstanding merger. Today, the super group enjoys the benefits of the merger in terms of saved costs and a streamlined process while we continue to guarantee their financial success everyday.