The 14 Questions You Must Include In An Emergency Medicine Billing RFP

The 14 Questions You Must Include In An Emergency Medicine Billing RFP

THE 14 QUESTIONS YOU MUST INCLUDE IN AN EMERGENCY MEDICINE BILLING RFP The standard process for evaluating organizations you re considering for a service should involve an obligatory request for proposal (RFP). This document, often submitted as part of a bidding process, requests proposals from potential suppliers. In the Emergency Medicine space, it becomes increasingly difficult to ensure that one is receiving a thorough and effective RFP from prospective partners to ensure that all of your business s needs are being met. The fact remains that when it comes to Emergency Medicine Practices, like most organizations soliciting requests for bidding, if you re not asking the right questions, the answers you receive may have little to no consequence and can lead to an unfavorable and potentially hostile business partnership. At DuvaSawko (DS), we know that you must ask the right questions of your billing partner to get the answers that can truly have a positive impact on your business. Our newest Blog Posting highlights SOME of the necessary questions that you should be asking of your billing partner and the reasons why these questions should be at the top of the list. DS offers a comprehensive RFP Q&A system-one of the perks of being Founded and Operated by ED Physicians. Without showing all our cards, here are the top 14 questions on an RFP that should be answered when considering a partner. These are a sampling of the 45 Questions available on our complete RFP list.

RFP QUESTIONNAIRE 1 Provide a company history including past and current ownership and scope of services you provide. Asking your RFP provider for a company history lets you get a good idea of how long they have been in the field and allows you to vet them based on their experience. Finding out what their full scope of services are will help you determine if there are gaps for the services that your ED needs and allows you to compare them to other providers you may be looking at. 2 Provide a vision of future emergency medicine reimbursement and your strategies for providing necessary tools for independent EM groups to be successful. When choosing a RFP provider, you want to make sure that you are partnering with someone who will contribute to your long-term strategic goals. Asking this question gives you a clear sense of their development roadmap and whether or not their technologies provide the necessary tools to meet your needs.

3 Describe your company s approach for measuring and reporting to the group metrics such as MIPS. Merit-based Incentive Payment System You want to partner with an organization that will enable you to optimize your MIPS score through the use of well-established quality measure benchmarks and reporting mechanisms. You want to ascertain whether or not this partnership will yield bonuses, or penalties, on medicare filings in ensuing years. 4 Describe your company s Compliance Plan and identify any CMS or health plan coding audits that have had negative outcomes for your clients. Furthermore, If you are the Revenue Cycle Management provider selected, are you willing to provide a copy of your Compliance Plan? Over the years, compliance plans have played an integral role in the way health care providers conduct business as they ensure that providers practice within the four corners of the law. When choosing an business partner, you want to be certain that they have an established compliance plan aimed at reducing, preventing, and discouraging deceitful and improper conduct. Knowing this information will help you avoid costly lawsuits.

5 In the past 10 years, has your company, its parent, or a subsidiary ever been investigated for suspected fraud and abuse by any department or agency of any federal or state government agency including but not limited to OIG, CMS, Recovery Audit Contractor, etc.? You want to determine that there are no outstanding issues or problems with the organization you are trying to do business with. 6 In the past 10 years has your company, its parent, or a subsidiary ever been required by a department or agency of the federal or any state government to follow a Corporate Integrity Agreement? Knowing this history will enable you to remove any providers with a problematic history from consideration. Any company with a history of civil false claims statutes would jeopardize your participation in Medicare, Medicaid, or other Federal healthcare programs, and ultimately be harmful for your business.

7 In the past 10 years has there been an investigation where the final decision resulted in a client paying a fine or penalty related to coding and billing which was related in any degree to your provision of services? Any affirmative answer to this query may signal a red flag against doing business with this provider. 8 Does your company use an independent, bona fide auditor to assess appropriate coding guidelines? Ultimately, compliance is key. Working with a provider who prioritizes this at each step, including the use of an independent auditor, provides additional protection against fraud while also uncovering any potential non-reimbursement related issues that could develop

9 Describe your coding process and methodology (e.g. software vs human, etc.) Knowing this information beforehand will help you identify partners whose coding methodologies are in line with your goals. From a financial standpoint, you may prefer a provider who has a mature development roadmap and QA for their software program and have reference site as these accelerate the coding process and ensure greater accuracy. Furthermore, it s important to partner with organizations who conduct this very important process in an environment fully compliant to US coding standards. Far too often, billing and coding companies farm this job out to inexperienced coding companies overseas, opening practices up to significant compliance risk that can result in steep fines and even jail-time for the physician. 10 Are all coders certified? Which accrediting bodies are acceptable? In today s medical environment, coders must be well-versed in government and private payer regulations, changes in code and coverage changes and a slew of other technical facts. You can t jeopardize your practice by hiring an uncertified medical coder. You must therefore look for coders who have met the challenge of acquiring medical coding credentials such as those provided by the American Health Information Management Association (AHIMA), Board of Medical Specialty Coding and Compliance (BMSC) etc.

11 What is the acceptable coding accuracy rate (percentage) of audited charts for each coder? If a coder fails the rate, will he/she be removed from coding our charts? Accuracy, or lack thereof, could spell disastrous effects for the bottom line. You want to have a clear idea of how the provider s coding accuracy rate compares to the standards set by Medicaid and Medicare as this gives you a better picture of what you can expect in terms of clarity in audit. Imprecision in coding will produce discrepant audit records which may severely impact reimbursement. In short, you only want to work with top-performing organizations. 12 Are all charts coded to one CPT or CMS standard or are payer specific guidelines used? Uniform coding is necessary for Medicare and other health insurance programs to file claims for payment in a consistent manner. Any deviations from the national coding standards set by the governing bodies can lead to inappropriate payment and could negatively impact your business.

13 When the coder determines there is not sufficient information to code what is the reconciliation process? Insufficient documentation can halt the payment of the services billed. Is your RFP provider equipped to remedy any errors and facilitate these transactions? It will be in your organization s best interest to partner with a provider who assists in managing any errors that may negatively impact collection. 14 Please describe your approaches to provide continuing education to providers for documentation. What is your process for identifying provider specific education opportunities? The top-performing organizations are those that continuously strive to expand their knowledge base and stay-up-to-date with the latest developments within their industry. You will want to partner with a provider that is committed to your goal of having a workforce of well-trained, subject matter experts. Do they have a mature method of providing training and continued education to the organization? Can they provide customized training if necessary?

Without an RFP, it would be extremely difficult to discern the differences between a highly qualified candidate and one who is mediocre, at best. With Emergency Medicine billing, the devil is truly in the details, and the more you know, the better the long-term decision you will be making for your practice. To receive our entire list of must ask questions when considering a billing partner or to have the team at DuvaSawko submit an RFP to your organization, contact us today! CONTACT DUVASAWKO TODAY TO RECEIVE YOUR COMPLIMENTARY PRACTICE ANALYSIS AND SEE HOW WE CAN HELP YOU! (888) 311-8760 DuvaSawko.com