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Management Consulting - Health Care Services
- Economic analysis; premium dollars, capitation, discounted fee, relative Value systems
- Practice Development Services through fee schedule analysis, contract review, managed care plan review, general problem identification, plan performance review, contract negotiations, practice management assistance, joint venture opportunities, continuing medical education, practice enhancements
- Medical educational series for physicians; devise practice protocol guidelines, audit review tool, medical record standards and physician satisfaction survey in accordance with NCQA and OSHA guidelines
- Electronic connectivity with physicians
- Physician profiling capabilities utilizing epidemiological methods, comparative data on physician practice patterns assessing dimensions of cost, utilization of services and quality of care; to increase physician profile and patient care management scores
- Maximize efficiency and Physician Practice Management for physician offices
- Spearhead physician credentialing utilizing NPDB, streamline provider networks
- Institute medical policy and procedure committee with disease management and operational initiatives
- Purchasing alliances; group purchasing and shared services
- Disease specific management compliance
- Quantitative and Qualitative analysis by specialty
- Start-up operation, direct and administer all day to day non-medical business aspect of physician’s practice including administrative management, provider network maintenance, member services, maintenance of payer contracts, utilization review, quality assurance, claims administration and financial management
- Agreements negotiation with hospital, non-hospital ancillary service providers and all managed care plans, Medicare, Medicaid and all governmental payers
- Member eligibility verification, compensation, distribution and utilization review management
- Research, Follow up and Analysis on Managed Care contracts
- All operational departments including nursing, laboratory, pharmacy, physical therapy, medical records, utilization, patient relations, data processing, medical/legal matters, insurance processing and all other support and professional services
- Systems for receivable management, policies and procedures, staff recruitment and training
- Historical collection rates, the procedures used for billing and collection.
- Medical record review and analysis of codes utilized to ensure proper coding (CPT and ICD)
- Current charging and coding methodology (CPT and ICD) to ascertain potential “audit liability”, training for staff and physicians to correct and avoid further problems
- Reimbursement issues and detail billing procedures to assist with operational changes, new programs or service development for third party investigations
- Separate physician billing from facility billing.
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