StraightLine can provide services to assist you in meeting Meaningful Use and Patient Centered Medical Home standards.

Consulting

Compliance audits

Chart audits

Best Practices/Work flow Review

Contracting

Credentialing

StraightLine works with practices that have never conducted an internal audit. They need a baseline audit to determine the current status of their revenue cycle in order to establish benchmarks and goals.

No one wants to get a notice from a RAC or have the OIG or DOJ show up at their practice. Yet statistically, someone is going to get audited. As an industry we tend to focus our concern on the financial impact of an audit, with good reason, but the true goal of a compliance audit is to fix problems. Remember that fraud isn’t defined as an intentional act – it is merely the act of billing something wrong.

Large practices generally have the resources to conduct self-audits however smaller practices and those with limited resources often don’t make the time for self-audits. The cost of an external audit to identify and resolve potential billing problems will likely be smaller than the cost of a recovery.

StraightLine works with practices that need external chart audits by impartial certified professional coders.

Medical providers have always relied upon chart audits to ensure their medical documentation supports the services billed and that all their services are being captured. This continues to be a key measure of provider productivity.

Medical providers have a new reason to conduct chart audits – ICD-10. The biggest impact to the clinical staff will be the increased need for documentation and specificity. While ICD-9’s coding to the 5th digit required more from our medical notes, ICD-10 requires even more specificity like lateral, medial, subsequent, late effect, etc. Failure to document appropriately will either delay coding for additional documentation or reduce reimbursement when the medical record does not support the services provided.

StraightLine works with practices that want to establish or evaluate their benchmarks and review process and work flow to increase efficiency.

If a practice doesn’t know why they’re not getting the reimbursements they believe they’re entitled to and they don’t know how to get the data they need from their practice management system, an outside Best Practices Review is a great place to start. Best practices benchmarks are the vital signs that indicate your practice is doing the best it can. Some practices have great reporting systems and they receive regular feedback from their billing and accounting departments on their revenue cycle performance. Other practice management systems don’t provide the kind of information that truly measures performance.

Practices are investing capital in electronic medical/health record systems yet statistics indicate that 73% of practices are not using their EMR as intended after one year. Sometimes it’s because the use of the EMR has been restricted to meet the process and work flow rather than the other way around. Work flow analysis can identify opportunities to streamline process, eliminate duplicate efforts and utilize the EMR to its fullest extent.

Sometimes it’s new revenue streams, products or services that trigger a process review to ensure staff has all the tools they need. It’s often more cost effective to provide training and oversight in the initial stages of a new venture than to wait for the staff to learn in the school of hard knocks.

StraightLine works with practices that need a contracting specialist to navigate through the complicated process of negotiating and obtaining federal, state and commercial contracts.

Smaller practices are often not staffed in the 3-6 months prior to opening at a level to accommodate contracting. Contacts and knowledge of how each carrier works and what the critical path is in meeting opening dates is a skill that is not easily acquired. StraightLine has the knowledge, skills and ability to coordinate your practice’s contracting efforts.

Expansion often requires updates to your contracts and privileging with commercial carriers. The notification process appears to be simple however the follow up required to ensure that the contracting, data management and claims processing arms of even one commercial carrier get the information correct can be time consuming. StraightLine is able to provide the contacts and resources to ensure that not only will your contract be updated but also that you can obtain authorizations and get payment for the services you render.

StraightLine works with practices that need individual provider credentialing and linking to existing contracts.

Medicare, Medicaid and Tricare are conducting detailed primary source verifications and requiring a higher level of documentation than ever before. Commercial carriers and regional networks have reams of applications they want and processes that don’t connect provider credentialing to practice contracts. Provider credentialing is similar to contracting in that knowing what to do, who can assist and where things can and will go wrong is key to meeting your practice’s objectives. StraightLine can help your practice utilize the most effective means of credentialing and push the process through as expediently as possible.

Providers have to be re-credentialed a minimum of every three years. For some practices all contracting and credentialing was done at once and that three-year cycle is predictable. For others contracts have been added over the life of the practice and it seems like you’re always in a state of re-credentialing. When a practice’s resources are better assigned to the patient’s care, StraightLine is able to handle the carrier communication required to keep your providers in network.

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