In-Depth Practice Analysis
At infinte Solution we have team of the best analysts who identifies the requirements and improvements for Evaluation & Management documentation analysis upon practice's request.
This will help the practice in understanding the level of care required to make necessary improvements for easy work flow between practice and us.
Utilization & Medical Necessity
Medical Necessity and/or Utilization defines whether a specific procedure will be covered by Insurance company's guidlines or not, it also includes Local Medical Review Policy(LMRP), National Coverage Determination(NCD) and Local Coverage Determination(LCD).
To eliminate any kind of coverage issuses by staff during data entry, Infinite Solution follows strict guidlines of updating information on any procedures performed by our clients and keeping them in loop in case there are any changes in coverage criteria for procedures which is performed by the practice.
MIPS/APM Participation and Compliance
Infinite Solution helps you in avoiding Negative Medicare B Payment Adjustments resulting from non-participation!
The Physician Quality Reporting System (PQRS) applies to Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). Objective behind this entire program is to motivate health care professionals (EPS) to incorporate as well as to make a comprehensive reporting on measures which are quality centric. Medicare uses incentive payments and negative payment adjustments (fee reductions starting in 2015) to promote participation in the program.
Below are the details of yearly reduction for providers who choose not to participatein this program:
- 1.5% Negative Payment Adjustment has been imposed in 2015 for non-participation in 2013.
- Non-participation in 2014 will result in a 2% reduction in Medicare reimbursement in 2016.
- The same 2% reduction will be imposed in 2017 for 2015 activity.
- Separate from the PQRS reductions, Value Based Modifier (VM) payment adjustments will impose additional reductions of 2% to 4% for non-participating groups in 2015 and 2016, and will add individual practitioners in the 2017 VM reductions.
- Being customer centric
Conversely, participating practitioners and groups may be awarded upward payment adjustments or neutral payment adjustments (no penalty) depending on the degree of participation in the program.
There are various methods of reporting PQRS participation to CMS/Medicare. For those billing client practices who choose to report PQRS via Medicare B claims, each year Infinite Solution offers assistance in the review, selection and implementation of PQRS measures.
For 2015, there were more than 250 measures under 6 domains from which to choose; each with extensive documentation as to qualifying criteria, rationale, implementation and documentation requirements.
As a value-added service to our billing clients, Infinite Solution performs an annual review of all active PQRS measures. Upon completion of the review Infinite Solution:
- Identifies those measures pertinent to the specialty, place(s) of service and patient demographic for each of our participating clients.
- Creates a custom list of measures for review and selection by each practice greatly reducing the number of possible measures to consider and the time and effort required by the practice to make selections. Measure descriptions are summarized to clearly identify criteria, place(s) of service and required provider action and documentation.
- Offers guidance regarding the number and type of measures required to meet minimum compliance standards to avoid payment adjustment penalties as well as incentive level compliance.
- Provides the practice with specific instructions on required criteria, implementation, and documentation for each measure selected by the practice and the procedure for reporting measures performed for billing purposes.
Additionally, Infinite Solution staff receives a review of the practice selections and instructions are set up in each client database that guide data entry staff in PQRS measure criteria and coding.
The selected PQRS measure codes are reported with billing throughout the year with associated procedures appropriate to defined measure criteria. All charges are reviewed prior to submission of claims to be sure patient demographics, diagnosis, location of service and /or procedure performed meet the specifications of the associated PQRS measure reported. Infinite Solution then tracks PQRS code usage to assure continuing compliance.
The cooperative effort of Infinite Solution together with each of our practices has resulted in $0.00 negative payment adjustments since the inception of the PQRS program.
Custom Reporting and Real-Time Access to your Information
At Infinite Solution, we understand the importance of being able to check on the status of your claims, payments and financials in real-time. For any business that chooses to outsource their billings and collections, kept in the dark is a big concern. That’s why our business and operating model is based on complete transparency. With Infinite Solution, you get:
- Real-time access to your information
- Easy to understand charts and graphs
- Custom reports designed based on your needs
- Ability to run ad-hoc report and queries on-demand
We provide real time access to all the information on the go. The information is presented in easy to comprehend visual modes.
As we say "YOU NAME IT, WE HAVE IT" keeping that in mind you can further drill down for details, reviewing information at the payer, provider and even patient levels. The information can be sliced and diced, and viewed in different output formats like graphs, Excel Spreadsheets, etc.
Our state of the art technology and in-house team of analyst makes us resourceful which allows us to customize reports and delivery based on the needs of each client. The completeness of the information we capture and make available for reporting provides valuable insights in to your operations.
Due to in-depth, custom tailored and timely reports provided to you, it can be helpful in identifying specific procedures or CPT codes that result in delayed payments for any given payer or coverage type. Our staff of elite experienced billers and coders can guide you through the best methods to maximize your collections in the shortest time.
As you know, real-time reporting is only valuable if the data you are accessing is up-to-date. We believe in FIRST PASS CLAIM process and so, we review and submit claims within 24 hours of our getting completed information from the practice. We make sure that payments are posted and denials reviewed within 24-48 hours of a response from the payer. We close, reconcile and distribute account statements on the first business day of each month. We don't miss out a single month-end statement delivery deadline. As a result, a stellar record by virtue of staying on top of your revenue and financials every day!
We have 'You Name It, We Have IT' attitude and for that you can rely on us efficiently.
Credentialing
At Infinite Solution we believe in maintaining the quality and focus in growing your collections which in return helps you to be successful. For you to be successful and to expand a new horizon for your practice, you need everything properly done.
We make sure you don’t get any issues and assist you with the following:
- Infinite Solution takes care of Initiating participation agreements.
- Infinite Solution makes sure to Renew participation agreements as required.
- You have new provider joining the group? Don’t worry Infinite Solution will take care of adding them in the group.
- Infinite Solution takes care of maintenance & re-validation of practice registrations on the various credentialing issues with insurances.
- Infinite Solution monitors and corrects errors in the carrier information which affects the timely payment or network recognition.
- Infinite Solution will respond to any carrier requests for credentials for the providers.
We tend to keep an eye out for a smallest thing which might be an issue for your practice to grow and we keep you posted real-time about any renewal and/or change in credentialing status.
Provider’s office Staff Training
Infinite Solution believes in “First Pass Claims” method, which helps our providers to get 80% - 85% collections in the first claim submissions. To achieve this, it is critical that documentation forwarded by the practice including but not limited to:
- Patient Demographics.
- Patient Demographics.
- Charges.
- Payments.
- Any special request.
All this information should be legible, accurate & complete.
We work with the provider’s office staff to ensure the quality of work and proper documentation.
