As healthcare continues to move to outpatient/urgent care, emergency department (ED) physicians must ensure that they capture all revenue for the services they provide. At the same time, revenue models are quickly evolving. With the growth of Accountable Care Organizations (ACO), physicians must understand how their fee-for-service payments may change. An ACO that includes various entities typically negotiates only one contract with an insurance carrier. Under the ACO model, there is one payment distributed among each of the different entities that belong to the ACO. Although ACO participation is voluntary, it remains unclear whether this patient care model will eventually become a requirement for all providers.
In addition to navigating the uncertainty of ACOs, ED physicians must also comply with a whole host of other complicated regulatory requirements, including the Physician Quality Reporting System (PQRS). New PQRS measures are added frequently, and physicians must ensure that they document necessary requirements for appropriate coding. ICD-10 is also on the horizon, and physicians must know how codes and documentation requirements are changing.
NEMB knows that today’s ED physicians operate in a very complex regulatory environment. Physicians must strike a delicate balance between meeting regulatory requirements while also providing top-notch patient care. We strive to make the billing process as seamless as possible so that our clients can focus on patient care.
NEMB specialists have more than 100 years of combined ED billing and coding experience. We bill for more than 100 physicians and practitioners who provide emergency medicine, emergency medical services, internal medicine, and mental health. We are actively involved with the American College of Emergency Physicians (ACEP) at both the national and local levels, and we strive to build personal relationships with each of our clients. That’s why we also appoint an NEMB coding manager specifically for each client account.
Following is a list of the services we provide:
- Comprehensive and personalized coding and billing services. NEMB coding specialists, each of whom is certified through the American Academy of Professional Coders (AAPC), perform rigorous documentation reviews to ensure accurate E/M coding. Staff members understand the nuances of various coding specialties. NEMB ensures correct coding for laceration repairs, control of nasal hemorrhage, incision and drainage, burn care, fracture care, splinting/strapping, endotracheal intubation, critical care, EKGs, and more.
NEMB clients have the reassurance of knowing that credentialed specialists review each claim manually before submission. We perform extensive front-end research for insurance information and strive to meet a 48-hour turnaround time from receipt of the medical record. Our specialists catch errors and omissions before those claims are sent, saving clients significant resources and time spent chasing denials.
All billing specialists assigned to your claims report to a senior NEMB billing manager who is solely dedicated to your account. Your personal billing manager will review day-to-day issues and establish productive solutions in concert with your staff. This person is available at all times to provide support.
- Accounts receivable (A/R) management. NEMB’s coding and billing specialists perform the following functions to ensure a clean and efficient A/R process:
- Data entry
- Reconciliation and audit of daily transactions
- Electronic billing and patient statements
- Payment posting
- A/R reconciliation
- Daily electronic check scanning/bank deposits
- Client and patient communications
- Detailed reports and analyses. NEMB clients have access to a whole host of reports on demand. These include physician productivity reports, E/M level distribution by physician, average charge and payment per patient, executive financial summary reports, A/R analyses, procedure analyses, detailed payment reports, and more. NEMB has a robust database that our specialists can access to extrapolate essentially any data that physicians need to assess or improve business practices.
- Provider enrollment. NEMB specialists work with physicians to ensure proper enrollment with each insurance carrier. We complete the initial enrollment, prepare W-9 forms, and establish mechanisms to receive EFT payments. As Medicare Administrative Contractors (MAC) change, we go the extra mile to ensure that our provider clients are enrolled properly. We take the time to understand each MAC’s specific protocols. We also track all payers and notify physicians after final approval. We take the headache out of this complex and payer-specific process for you.
We also recognize and respect the gravity and risks associated with ending a long-term, third-party billing relationship and transitioning to a new carrier. This is something we have handled successfully many times before. It has never been more intense or challenging to manage the growing complexities and financial pressures of the billing process while also concurrently controlling practice operating costs. NEMB can help clients achieve success.
- Documentation audits. NEMB clients receive ongoing feedback regarding documentation insufficiency and areas for improvement. Our staff are PCA-certified physician chart auditors. We notify providers when documentation is lacking, and we strive to provide education and helpful tips.
- Denial and appeal management. In this age of auditor scrutiny, denials are inevitable. However, NEMB works hard to mitigate denials and appeal them, when necessary. All NEMB staff members are aware that carriers make errors. NEMB carefully reviews EOBs for reimbursement levels and reasons for rejections. Denials are reported and promptly resolved to ensure payment in an expeditious manner.
- PQRS claim submission and data analysis. NEMB clients can rest assured that PQRS measures are submitted along with accurately coded claims data. We notify clients as measures change and new measures are added so that documentation will support the coded data.
- Ongoing support and advice. NEMB clients regularly receive new information about ever-changing regulatory requirements. We encourage clients to contact us with questions about how these regulations may affect their businesses. Whether it’s ICD-10, Meaningful Use, Accountable Care Organizations, or other initiatives, we’ll work by your side to ensure that you’re prepared.
To further our commitment to your success, NEMB offers monthly/quarterly progress meetings with in-house staff to review coding and general billing issues, accounts receivable statuses, compliance programs, developing trends that affect emergency medicine, regulatory changes, and more.