physician-practiceGeneral physician services Today’s physicians must not only provide excellent clinical care, but they must also keep up with ever-changing regulatory requirements. Physician practices must implement electronic health records, comply with the Physician Quality Reporting System (PQRS), prepare for ICD-10, and more. Documentation and coding has never been more important. In times of auditor scrutiny and data-driven healthcare, physicians practicing in any healthcare setting must ensure that they assign accurate codes for evaluation and management (E/M) services and diagnoses. The ultimate goal is to ensure appropriate reimbursement and to paint a complete picture of patient severity. Physicians must also understand how their fee-for-service payments may change under Accountable Care Organizations. 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. NEMB understands the challenges that today’s physicians face. Our staff of Certified Professional Coders works side-by-side with our physician clients to provide timely billing, manage denials, communicate with patients, and more. We strive to build personal relationships with each of our clients which is why we also appoint an NEMB coding manager specifically for each client account. NEMB takes the stress out of the billing and accounts receivable process so our clients can focus on providing care to patients.

Following is a list of the services we provide:

  • 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.