Thanks to managed care and government regulation, your practice can't grow and thrive by simply responding to each change. Costs are up, and the revenue stream isn't what it should be from reimbursement rates going down.
How do you address these issues in the most cost effective way? Cut staff? Bring in more patients? Work harder than you already do?
Maybe, your practice just needs to diagnose what can be done differently to improve work flow, patient intake, and billing.
Maybe, you're a physician that is breaking away from a large practice, or striking out with your first practice and need help setting up the systems to succeed.
Let's Be Honest...
Today, modern medicine is a complicated business. Simply because you're a terrific doctor, doesn't mean that you have the time to catch every single regulatory change, maintain your CAQH profile, update your NPI, and continually re-negotiate and update each and every insurance contract as it comes along.
Do you know what we find to be the biggest problem in 95% of the practices that become one of our clients? A failure to take care of all of the details. We've seen practices relocate, hire new physicians and nurses, incorporate, and not notify a single insurer of any change. They don't even log into the NPI Registry or CAQH to update their profile.
Suddenly, it happens! Medicare or some other insurer discovers that the required changes to your public records haven't been done. Payments stop. Auditors show up at your door. The IRS sends a handful of back-up withholding letters to you and the insurers you do business with.
We've taken over the billing and management of practices that have experienced 50% and 70% reductions in monthly income, simply because the were so busy practicing medicine that they forgot that they had a business to run as well.
Think you've got it all under control? Guess again! Every one of our clients used to think so too, until they hit the regulatory iceberg. Remember: The builders of the HMS Titanic thought that they had built an unsinkable ship too.
We're here to help you. Whether it's outsourcing your billing, a review of staff procedures, or setting up the complete nuts and bolts of a practice, our staff can help with the road map that will take you and your practice to where you want to be: a practice where patient care can come first because the revenue stream is consistent, and not something you have to worry about.
Accountants, lawyers, insurance companies, cutting expenses, laying off employees.
These are not the answers. Doesn't it make sense to work with a company that fully understands the regulatory environment, who can negotiate with insurance companies, who knows office systems, who will make sure you're getting the most out of your investment in not only your practice, but in your patients?
Our solutions are affordable, and our services are the lowest cost investment that you can make in your practice. With us, until you decide to proceed with any us, all of our initial consultation work is at no cost to you. We'll help cut through the hype, the jargon, and regulation to make your practice more efficient and more profitable.
In fact, we'll do most of the work BEFORE we've even sent a single claim on your behalf. It's up to us to prove ourselves to you from the start.
Thinking About Relocating to Another State?
Before you do, you have to do some legwork. A pro golfer doesn't even play a qualifying round without first playing the course.
A race car driver does practice laps to get a feel for the track before doing a qualifying round. Shouldn't you do the same?
In this economy, many insurers have closed their panels to new doctors. Unless you're moving to join a large, established practice, you can expect problems. The days of just saying, "I'm here!" are over.
Let's Talk About Credentialing
You saw 12 patients today. Your checkbook is on "E". You can't bill an insurer because your contracting isn't done. You can swear you hear crickets in the silence.
The economy is bad and unemployment is at 9%. Insurers are slow to pay claims because their claim paying pool is often running low. This is due to the fact that investment returns are down, premium payments are down, reserves are down. There is zero incentive to an insurer to contract a new doctor and adding to the drawdown of the reserve pool.
Sadly, it is true. Insurers ARE declining doctors. Those that are not declining a new provider are taking their sweet time in issuing their contracts. If you are going to open a new practice, you need to plan accordingly, and give yourself time to credential.
Factually, Medicare promises that 95% of provider applications will be completed in 90 days or less. Dependent upon the state, Medicaid will take a minimum of 6 weeks. Commercial insurers can take less than a month if you're moving within state and are already credentialed, or as long as 6 months if you're new, meet their selection criteria, are approved by their credentialing board, and in some cases, pass a site review.
After you are issued a contract, you must go through an EDI enrollment to send claims electronically, and that can take as little as 24 hours with some commercials, and up to 2 to 3 weeks with public plans.
For clients who involve us in credentialing, we work directly with insurers, and prepare documents (including all Medicare forms) so that they are signature ready.
The key to your sanity is to take a realistic approach. Realize that you may NOT get the contract you're looking for, and build a business plan accordingly.
However, we are here to help.
Practice Management Services
State Licensing & Credentialing
Medicare and Medicaid Credentialing
Insurance Carrier Credentialing
Insurance Carrier Contracting
Fee Schedule Negotiation
Fee Schedule Analysis & Calculation
Front End Staff Training
Complete Practice Set-Up Services
The above services are available at a negotiated rate.
All of the above services are at no charge to all new and practices who use our billing services, and are available at a negotiated rate to our non-billing clients.
Berkshire Group Services Inc.
Massachusetts Museum of Contemporary Art 1325 MASS MoCA Way