Physician Consulting Services

Kforce Healthcare’s Physician Consulting Services address the specific needs of the provider community including coders (beginners to advanced), billers and other office staff, physicians, hospitalists and non-physician practitioners. We offer coding, billing, documentation and compliance in flexible consulting packages. All reviews are benchmarked against federal guidelines and criteria from the Centers for Medicare & Medicaid Services (CMS).   Comprehensive and Focused Medical Reviews of CPT and Clinical Documentation During a comprehensive review, our Physician Services Consulting team will review and assess medical record documentation against CPT, E/M, HCPCS-II, ICD-9-CM and ICD-10-CM codes, as well as modifiers. We review the clinical documentation for data quality/integrity, completeness, appropriateness and authentication. We can then make recommendations for documentation improvement, code changes and annotations where there are discrepancies, as well as advise on the potential fiscal impact of the suggested code changes.   Any particular element from our comprehensive physician review packages can be expanded upon and written as a focused medical review (FMR) per our clients’ needs. Variables include: Mix of services Mix of payers Specific billing activities Specific provider specialties

These FMR’s can also be offered as a follow-up to our more comprehensive reviews. In that case, FMRs can be performed as “probe” audits, assessing and analyzing specific audit criteria reflective of the Medicare Administrative Contractor’s approach to provider auditing.

Comprehensive Physician Revenue Cycle (Billing) Assessment 

Our Physician Revenue Cycle Assessments move beyond the services offered in our Comprehensive Review to include a review of the reimbursement cycle, including charge capture tools, processes and mechanisms as well as a detailed comparison of all services-billed data to the final EOBs/EOMBs. We will detail inaccurately paid services and offer reasons as to why they have not been paid properly.  Additionally, we can provide analytics based on services billed, services paid, services inaccurately paid (under/ over), services denied and the impact of these findings on the A/R.

Physician RAC-Reviews

Seeking to reduce incorrectly prepared claims as well as detect and collect overpayments, RACs (Recovery Audit Contractors) predominantly target medical necessity issues as well as medical record documentation and coding accuracy. We know RAC hot spots and can show your staff how to improve these areas by offering four types of RAC Reviews for physicians:

• Retrospective RAC Risk Identification Program – identifies RAC targets for cases already billed
  
• Concurrent RAC “Prevention” Program – identifies potential RAC targets reflective of service mix, reviewing and correcting these prior to reporting 
  
• Post-RAC Prevention Education & Training – constructs an education program on internal documentation, coding and billing to help prevent future RAC audit findings
  
• Client-Tailored RAC Review Package – identifies client concerns and constructs a RAC review program around Client history, facts, questions and concerns

Review-the-Reviewer

This ongoing flexible consulting option establishes a quality assurance (QA) oversight program, providing QA for the physician practice’s internal QA/monitoring program. Our Physician Consulting Services team can provide either a targeted or comprehensive review of CPT, HCPCS-II, ICD-9-CM, ICD-10-CM, modifiers, documentation and CMS policy adherence. We will review and report on a specified number of encounters on an ongoing basis for a predetermined period of time, providing an accuracy level of your own internal QA team’s efforts. Based on the review findings, we can tailor an education program for your internal QA/monitoring staff as well as your providers for the continued success of your internal QA program.

Physician Compliance Plan

We’ll begin by interviewing the head, lead or supervising physician(s) to ascertain the compliance plan already in place. Based on our findings from subsequent conversations with any applicable health system compliance officers, we’ll create a new customized compliance plan for the physician practice.  For practices without a current plan, we will follow the same course to structure and implement a viable compliance plan for your office. 

Physician Education & Training

Our educational services and products are customized to our clients’ needs in terms of scope, depth and breadth of any particular educational track, course or topic. Programs can range from baseline seminars up to highly detailed clinical specialty sessions. We can tailor educational programs for any group within a physician practice, including:

• Physicians
  
• Non-physician practitioners
  
• Clinical staff
  
• Coders
  
• Billers
  
• Office managers
  
• Practice administrators

Physician Practice Operations Assessment

Our workflow assessments can review responsibilities, determine problem issues and help streamline functions to ultimately help increase productivity in a physician practice. Our assessments may require on-site and off-site work and can review a number of functional medical practice areas, including:

• Clinical and/or administrative operations, workflow and efficiency
  
• Patient scheduling/registration and front-office duties including PATOS and patient check-out activities
  
• Charge capture and back-office third party billing operations
  
• Patient billing analytics and collections
  
• HIPAA Privacy & Security Compliance
  

We also offer other aspects including practice P&P manual, HIPAA and medical confidentiality training, A/R management review & analytics, and more.

To speak with a Kforce Healthcare Account Executive about Physician Consulting Services call 1-877-758-0742 or email HIMConsultingTeam@kforce.com today.  

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