Common Questions from Our Prospects

1.  Who have we worked with before?

We have worked with over 350 independent laboratories, hospital outreach laboratories, health systems and pathology clients.  Some of our clients include, Aroura Diagnostics, Sonic Healthcare, Ameripath/Quest, and South Bend Medical Laboratory.  We have worked with clients in 49 states and currently have over 100 clients on our roster.

2.  What do our services include?

We have two version of our contracts.  The first is a one-time audit that includes the following processes:

a.   Revenue Insurance Audit:

  i.  Provide initial audit (100-300 cases) and quarterly billing audit (50 cases). Review the charge document, the HCFA, the EOB, all managed care contracts and all billing reports.

  ii.  Set and track billing performance indicators for charges, payments, and procedures.

  iii.  Monitor payments and denial activity by carrier. Provide quarterly assessment.

  iv.  Review accounts receivables. Monitor aging buckets by payor and offer trends feedback.

  v.   Review Part A contracts, if relevant.

  vi.  Review client bill contracts, if relevant.

  vii.  Monitor and track monthly bad debt and refund activity.

  viii.  Monitor monthly case reconciliation (accession tracking).

  ix.  Monitor and track charges/CPT by date of service.

  x.  Monitor CPT volumes and provide annual review of year-over-year variance.

  xi.  Provide RVU analysis and tracking by physician, location or referring physician.

  xii.  Monitor referral trends and provide annual analysis of year-over-year variance.


We also offer a yearly contract which includes the audit listed above, plus the following services:

a.   Revenue Management:

  i.  Oversee the current revenue processes and compare to the norm, built on our 686-step process.

  ii.  Provide a fee schedule review.

  iii.  Billing contract review for any new billing software or service agreement.

  iv.  Billing RFP/transition, if requested.

  v.  Collection agency contract review and/or negotiation, if needed.

  vi.  Client bill analysis, if requested.

  vii.  Implementation of new billing procedures.

  viii.  Compliance plan review and implementation.

  ix.  Review all current managed care contracts and renegotiate as needed.

  x.  Provide analysis of managed care contracts.

  xi.  Provide analysis of reimbursement by CPT in comparison to Medicare and other payers.

  xii.  Work with billing to ensure enrollment is complete and accurate with payers.

  xiii.  Oversee enrollment and monitoring of managed care value/quality programs.

  xiv.  Weekly communication to client regarding open items/progress/issues.

  xv.  Weekly report on charges and payments.

  xvi.  Monthly call to review monthly/quarterly/yearly performance tracking and open items.

  xvii.  Monthly trend and auditing newsletter.

  xviii.  Quarterly /yearly presentation, on site.

3.  What is our price?

We typically charge between $10,000-$50,000 for a one-time audit.

Our monthly clients pay between $2,500-$10,000 per month, plus expenses, depending on their size and a number of other variables.

4.  Do you work on a percentage?

We do not have a percentage-based compensation package.  We are open to this model, if requested.

5.  Do you work with my biller?

We have worked with over 92 different billing companies in the past 17 years.  We have worked with all the major billers in the nation, plus many smaller billing companies.  We also work with numerous companies who do their own internal billing.  We track all our audits and can provide a direct comparison of your billing company versus the competition.  Yes, this means we can tell you the trends in billing errors by biller.

6.  What do our audits entail?

We start working with our clients by performing a large audit.  This is a process which covers coding, reviewing charge documents, reviewing the front-end denial process, and comparison of the actual charges versus the HFCA that is billed out to payors. We then review the current set of billing reports from the current billing entity (we have a set list of reports we request from all our billers).  We compare the payment EOB versus the actual allowed amount to ensure you are being paid correctly.  Finally, we review all the denial reports to see the root cause of the billing errors and denials.  We can then use these results to help improve your billing process.

7.  Do you have to visit our site?

Typically, we provide one site visit to the client to get an understanding of their billing process and ask the needed questions.  To keep costs down, we do the rest of the work via internet, Skype and phone calls.

8.  How long does an audit take?

Our initial audit takes 60-90 days depending on the audit type, the response of the billing entity and the size of the audit. 

9.  Do you have a certified coder on staff?

We have both certified coders and certified auditors on staff.

10.  Do you have insurance?

Yes, we carry E&O insurance and we also have web security insurance.

11.  How long does a typical engagement last?

Many of our clients work with us for years.  We understand their revenue cycle and their billing processes and provide necessary insurance which covers the variables in the revenue cycle process.  Our processes audit billing and this keeps our groups getting paid. 

12.  What is the typical ROI?

Over the past 18 years we have tracked many of our clients and the recommendations we have suggested.  On average, we see a 3:1 return on the client’s bottom line.  This means for every dollar you spend with us you should receive three dollars in your pocket.

13.  Why we might not be the best option for you.

There are several situations where we are not the best fit.  Usually, this is a prospect who is not ready to actually make the change because they have not reached their pain point.  Also, we have found some clients are simply not ready to implement the changes we recommend and they continue to lose revenue after our intervention.  If you are not ready to make the changes we request, then perhaps your money would be better spent elsewhere.

14.  How do I get the cases to you?

Most of the time our clients can put these cases and items for the review in an online DropBox. We can also take documents via secure email or FedEx.

15.  How big is your company?

We currently have 15 employees, the majority of whom have either a bachelor’s or master’s degrees.

16.  Who else does this in the industry?

You can find medical auditing at a CPA firm or one of the large consulting firms like KPMG.  Often, these firms use us as a subcontractor because of our specialized knowledge in the laboratory and pathology industry. We recommend you contact one of these firms to compare our knowledge and processes against theirs.

17.  What about customer reviews?

We are more than happy to provide references as we have many satisfied customers.

18.  Who do we work with on a day-to-day basis?

We have a three-tiered system.  Every client has a Client Manager who handles day-to-day calls and issues.  All our clients also have access to our President and Senior VP for larger issues.  Additionally, all our clients have access to our CEO for strategic questions and issues.

19.  What can I expect?

You can expect great communication on the issues in your practice and expert advice on how to fix these problems. Our Client Managers have a detailed list of activities they perform on your behalf every day, week, month and year.  You get daily access to them for simple questions, weekly updates on how your issues are being resolved, monthly reports and action plans, and yearly updates and projections on revenue changes as CMS changes its fee schedule. 

20.  Are you the best in class for this service?

There are no awards for best medical billing auditing firms.  What we can tell you is we are going on our 18th year in business and we have presented at numerous healthcare tradeshows and conventions.  We are the only firm who has an actual scoring system for the revenue cycle process.

Who's reviewing revenue strategy with you at this time?

Are you billing all the correct CPT codes? You’d be surprised at what you might be missing. We will review your Fee Schedule/Charge Master at no cost.

That’s right. For free.

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