We’ve been specializing in healthcare reimbursement consulting for over 20 years. 

Most recently we have been working with small to medium sized physician practices and the entities that support them, such as attorneys, billing and/or coding companies, accountants, etc.

Our considerable experience with governmental payors and large institutional providers and the entities that service them brings a high level of insight in supporting work in these areas (such as Medicare audits).

Our work is project based.  We consult in billing, coding, or management of medical practices. Although we do no provide these areas of service on a full time basis we can make recommendations to providers of these services.  Clients typically call upon us when they have a short term problem or would like an outside assessment.  We allow our clients to select and combine our service options to best suit their specific needs.

Services we provide:

  • Billing and Audit Support.  These services are primarily reimbursement oriented. There are a variety of options, including:
    • High level end-to-end revenue cycle audit.  This review takes a small sample of services provided.  Each service is followed from appointment to final disposition to identify any potential revenue cycle concerns.
    • Medicare and other payors are auditing provider services with increasing frequency.  Responses to these audit activities should always be carefully reviewed to ensure enough, but not too much, documentation is submitted.  We support physicians in minimizing the negative impact of such audits at every step of the process.  Note there may be times when referral to legal representation is recommended.
    • Targeted internal audits.  There are many reasons to perform a targeted (preventative) audit, including but not limited to concerns over individual internal or billing company staff; specific procedure code audits; reimbursement practices for a specific payor; any other area of specific concern.
    • Establish and implement Corrective Action Plans (CAP)
  • Coding Audits/Chart Reviews.  Coding reviews ensure a provider is maximizing both reimbursement and compliance by properly documenting and coding for services rendered.  A coding audit/chart review typically includes:
    • Identification of the top procedures preformed
    • Selection of 5-10 procedures to review in detail
    • Collection and review of all documentation supporting those procedures, including office visit/procedure notes
    • Written report of findings, with specific attention to accuracy of documentation and coding to support the services performed
    • Meeting with provider(s) to review report and answer any questions
    • Implementation of internal audit program
    • Conduct regularly scheduled coding and reimbursement reviews
  • Coding Training and Provider Education.  We work closely with both on-shore and global organizations to train coding staff, perform operational analyses, and fine tune internal training protocols.
    • Chart review.  This service takes charts for a variety of services and reviews them from a wide perspective, including documentation improvement suggestions, compliance recommendations, identification of potential areas of concern, payor specific considerations, bundling, etc.  It includes a written report, and customized provider education sessions, where appropriate.
    • Customized training of staff and education of providers
    • Develop and organize library of coding reference materials
    • Coach staff on effective communication strategies (particularly important with on-shore/off-shore arrangements)
    • Value-based staff development can help your staff reach that next level to deliver enhanced value to clients (this service is provided to medical practice support partners such as billing companies)
    • Services can be provided directly or as train-the-trainer, and face-to-face or remotely
  • Operational and Staffing Assessment.  We work with the provider and staff to identify areas to enhance the efficient and effective operation of the Practice.
    • Current staff is evaluated and recommendations are developed and presented to the provider.  Recommendations typically include training current staff, or hiring and training new staff.  The latter incorporates all aspects, including development of job descriptions, interviewing, etc.
    • Full service operational maximization  is a retainer based relationship with on-site visits plus emails and phone calls as needed. Our focus is to review all business aspects of the practice and make recommendations to improve your income and efficiency. On-site services provided by a Certified Healthcare Business Consultant.
    • Detailed review and update of physician’s online presence and patient referral sourcing to enhance the patient screening process and help attract the right new patients
  • Reimbursement Consulting.  Ensuring maximum reimbursement available for each patient visit is more than just submitting clean claims.  Our periodic review of your revenue cycle will:
    • Increase your cash flow and identify hidden revenue opportunities
    • Reimbursement analysis of potential payors to participate with (based on preferred procedures performed by physician)
    • Reimbursement maximization services to ensure all available revenue has been received for services provided, including denied and underpaid claims
    • Evaluate in/out of network participation
    • Identify streamlined payor processes (many of them want to trim expenses too!)
  • Privacy & Compliance 101 Packages.  We can help provide you with the basics. Customized HIPAA Privacy Policy for YOUR practice to inform your front desk staff, who are on the front lines of patient communications.

 

  • Additional Service Offerings.  Some of the other services Habanero offers include:
    • High Level Reimbursement Review is for the provider who isn’t aware of any particular problems or areas of concern, but would like a high level external review of their reimbursement processes.

We welcome the opportunity to meet with you to discuss your specific needs and to see if we might be able to assist you in achieving your goals.

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Healthcare Reimbursement Consulting Services
We maximize provider reimbursement while maintaining the letter, spirit & intent of compliance rules.

WHAT WE DO

REIMBURSEMENT MAXIMIZATION:

Ensuring maximum reimbursement available for each patient visit is more than just submitting clean claims.  Our periodic review of your entire revenue cycle will:

  • Increase your cash flow and identify hidden revenue opportunities
  • Identify payers who have implemented streamlined processes (They want to trim expenses too!)
  • Evaluate in/out-of-network participation
  • Define expected payment cycles for each payer

STAFFING & BUSINESS OFFICE PRACTICES:

Documented Policies & Procedures promote consistency, mitigate risk and encourage professionalism.

  • When new staff join you, is their “training” a bunch of yellow sticky notes on the
    office computers?  Or do you provide comprehensive instructions customized for YOUR
    practice, outlining how YOU want your business run?
  • We provide a customized quick-reference guide that documents your instructions for patient
    interactions, remit processing, and insurance calls

MEDICARE COMPLIANCE / CODING AUDIT:

Internal audits increase confidence that practice operations comply with current guidelines and regulations.  Accurate, comprehensive coding maximizes revenue, and enhances compliance.

  • Do you get paid for all billable services you perform?
  • Does your documentation support the codes on your insurance bills?
  • Have you reviewed the most current fee schedules from all payers to bill all allowable and billable services?