A: "Billing" usually refers to the technical function of entering medical charges into a computer software program, whereby the medical services are converted into specific designated codes, and then generating some type of standard claim/or bill, which is forwarded to the patient or to a third party for reimbursement.

"Full Service Billing" is a comprehensive service which is offered by a Medical Management Organization or Billing Service, acting as an Outsource Agent. A Healthcare Provider will contract with an Outsource Agent to contract out a variety of administrative functions which can include; Accounts Receivable Management, Reimbursement Management, Cash Receipt Analysis, CPT and ICD-9 coding, 3rd Party Billing, Capitation Management, Encounter Data Submission, Claims Management, Intensive Account Follow-up and Collections, Patient Billing [Patient Statements and Payment Plans], Consulting and Training Services Compliance Solutions [Refocuses outside audits to third-party] , Contract Management [Managed Care and PPO], Data Management through EDI Solutions, Integration of Clinical and Financial Data, Comprehensive Financial Management Reporting. In addition to services offered, the Outsource Agent will also absorb daily operating expenses. [For example, postage, billing forms, supplies, telephone and long distance charges, software & hardware licensing and maintenance, etc.] In other words, the Outsource Agent will simply act as an extension of your administrative office.

A: "Claims Auditing/Processing" are services usually provided by a Medical Management Organization or Billing Service, acting as an Outsource Agent. The Outsource Agent will receive medical claims via an electronic file (in various formats) from the Healthcare Provider. The Outsource Agent will then offer various levels of edits and auditing of the submitted data. Such services could include; General Audit For Accuracy Of Data, Complete Coding Audits [ICD-9, CPT, HCPCS, CPT Modifiers, Coding Links To Related Data], Identify Incomplete Codes, Identify Invalid and/or Obsolete Codes, Identify Use Of Unspecified and Non-Specific Codes, Validate Codes to Service Descriptions, Audits For Proper Facility and Service Type Codes, Audits For Subsequent Attachments, Audits For Necessary Authorizations, Audits For Accuracy Of Payer I.D. and Carrier Locations, etc. The "Clean" claims are then forwarded on to the appropriate payer for processing. The Provider will then receive an exception/rejection report from each payer.

"Clearinghouse" services are usually limited to providing technical support only. The Healthcare Provider will send an electronic claim file (in a pre-determined format) to the Clearinghouse for processing. The Clearinghouse will then forward the electronic file (un-edited) on to the appropriate payer for processing. The Provider will then receive an exception/rejection report from each payer.

** Advanced Healthcare Solutions, Inc. offers both Claims Auditing/Processing and Clearinghouse Services **

A: Most Medical Management Organizations will offer Healthcare Consulting services to Healthcare Providers who are interested and understand the necessity of being compliant. For example, Advanced Healthcare Solutions, Inc. insists on consistent compliance programs for all Clients, including, written compliance plans, and on-going compliance education. Medicare has taken an active role in regulating and enforcing overall compliance within the industry, thereby paving the way for other governmental and commercial payers. Medicare fines are in excess of $10,000.00 per offence. A Medical Management Organization, such as Advanced Healthcare Solutions, Inc., can offer a comprehensive compliance audit, and can structure and tailor specific services to meet your individual needs. This service can be charged per hour, or on a "project-based" flat fee. See Consulting Services for more information.

A: Whether your job function is clinical or administrative, initial training as well as, regular subsequent training is necessary in today's ever changing, and further advanced technological Healthcare industry. It is imperative that your computer systems and your available technology is utilized to it's maximum potential. Each staff member should be trained by a professional who is familiar with the job functions and the technology. An Outsource Agent can be contracted to act as your designated staff "Trainer" and evaluator. The Outsource Agent can offer a "one-time" evaluation and training session, or an "on-going" monthly, quarterly, or annual subsequent training sessions. A Medical Management Organization, such as Advanced Healthcare Solutions, Inc., can offer comprehensive training and education services, and can structure and tailor specific sessions to meet your individual needs. This service can be charged per hour, or on a "project-based" flat fee, or on monthly, quarterly, or yearly flat fee. See Consulting Services for more information.

A: Good question! And hats-off to you for having the foresight to realize this goal! In the new world of Internet, Intranet, E-commerce, and even Wireless Internet, why is the Healthcare Industry still generating staggering amounts of paper? Only because the majority of Healthcare providers have not yet realized the potential, or have tapped into the realm of technology. It's also quite possible that Providers have not yet realized the value, nor have they been interested in investing in technology. The technology available to Private Practice Providers is incessant. For example, a Private Practice could book patient appointments online via their own web site, as well as, accept patient payments, and communicate with patients via email. The front office could electronically and immediately verify patient insurance benefits, and immediately connect online, real-time to an Outsource Agent or Billing Service. The Care Provider can electronically access patient records and chart information with the touch of a fingertip. He/she can electronically chart the medical service by keypad entry or by voice dictation. He/she can send orders directly from the exam room to the local x-ray department, Laboratory or even RX's to the Pharmacy. All, without the need to generate one single sheet of paper. The charted information can then be automatically programmed to transmit billing information to the in-house billing department or directly to an Outsource Agent, for further electronic billing and handling. Electronic charting eliminates, scrawl, printing and expensive storage and cabinetry. Even the local IPA's have electronic verification and referral capabilities. There are also local community Intranet Services to connect your Practice to your local Hospitals, facilities and affiliates. To get started on automating your Practice, you can hit the computer and go web surfing to accumulate and compare product and service information. However, before you join the technological revolution, it's a good idea to consult with a Healthcare Consultant or an Outsource Agent. An experienced professional can listen to your wants and desires, formulate recommendations, and can offer non-biased solutions. A Consultant can also assist your Practice from inception through implementation, and into successful operation. It's an exciting challenge, but a word of caution; "be prepared to get hooked"!

A: The decision to recover potential lost or delinquent accounts is an apparent one. In today's complicated Healthcare reimbursement world, timing is everything! Most Healthcare Providers are subject to contractual obligations with governmental and commercial carriers, whereby; any appeal process must be submitted within a designated time frame, (Usually 30-90 days from the date of the original claim processing date). If a Provider's claim has never been processed, the time filing limit usually doesn't extend past 13 months from the date of service. In some cases, time filing limits are 90 days, period! If your patient is responsible for an outstanding debt, each State has time statues which range from 4-7 years, from the date medical services are rendered. Most Providers who wish to outsource their inappropriately processed or un-paid claims to an Outsource Agent, usually, make an agreement, to automatically assign accounts at 90 days - 150 days. Some Providers will opt to contract with an Outsource Agent to audit and review reimbursement on current paid claims, on a monthly basis, to prevent thousands of lost dollars on overposted write-offs. Advanced Healthcare Solutions, Inc. offers comprehensive Recovery Services.

A: On the contrary. Although a true administrative conversion takes a minimum of 90 days, most of the preparation work is completed before the Outsource Agent commences services. Therefore, from the first week of operation, your billing is on the track of a regular cyclic flow, and you will not see a delay in cash flow. However, if you are hiring an Outsource Agent due to botched or irregular billing procedures and stagnant cash flow, it is likely that it will take approximately 4-12 weeks to establish a regular cash flow. If you're having a cash flow crisis, click here, to find out how to get immediate assistance.

A: With today's advanced technology and the introduction of electronic billing, Providers can now realize faster reimbursement then ever before. In an effort to encourage Providers to submit electronic claims, Government agencies, such as Medicare and Medicaid are rewarding Providers by processing claims within 3-20 days of claim submission. Providers are usually receiving reimbursement within 3 weeks from time of claim submission. In the past, Providers could wait up to 2-3 months for reimbursement. Several of the major commercial carriers have also followed suit, by processing claims within 1-3 weeks following submission. Unfortunately, not every payer accepts electronic claims, and reimbursement time can still run between 1 to 3 months depending on the payer's capabilities. In order to determine an overall average reimbursement time frame, the Provider will have to evaluate his payer mix. If you do not have the capability to submit electronic claims, click here, to find out how you can.

A: Technology has made it easier and more cost effective for Providers to hire Outsource Agents. There are a variety of ways in which a Provider can submit information to an Outsource Agent. Listed below are some of the most common means which Advanced Healthcare Solutions, Inc. currently offers:

• EDI - Electronic data transfer (modem to source, or via the Internet)
• Internet - Online, real-time data capture. (eliminates need to transfer data)
• Scanning - Scanning of paper forms (eliminates need for data entry)
• FAX - Faxing of paper forms directly to Outsource Agent
• Courier - Same day pick up of paper documents by local courier

A: Using an Outsource Agent should be a profitable and educational experience. Your chances of finding the right Organization are greatly enhanced if you follow a few common sense guidelines:

• Have a clear idea of the tasks you would like accomplished, or what services you are interested in.
• Be objective and realistic in your expectations related to the amount of time, cost and staff that will be required. An Outsource Agent may require some general office backup, or physicians' assistance particularly in the accurate diagnosing process.
• Find someone who has excellent references. Don't let the Outsource Agent learn on your Practice.
• Use an appropriate Organization. Do not assume that an ex-office manager, or former billing assistant, for example, has the knowledge to manage your receivables, generate accurate coding and billing and keep your office in compliance.

Finding an appropriate Outsource Agent:

You have already taken the first step by viewing this web site. Take a moment to review Services offered and available pricing. There are many Medical Management Organizations that offer a variety of Healthcare administrative services. You can search the web by certain keywords which pertain to your needs. You can also reference the yellow pages, or local directories. Another valuable source is also "word of mouth". Ask a friend or colleague what Outsource Agent they are using,

Call or email potential Outsource Agents to schedule an initial interview. By providing some detailed information regarding your Practice, the Agents can prepare a customized quotation.

Once you have identified the Outsource Agent or individuals that seem appropriate for your task(s), consider these additional factors:

• Is his/her/their personality, temperament and work style such that the group can establish a rapport with them?
• Does he/she listen to the Provider and staff, and their desires and concerns or does the Agent merely tell you how things need to be done?
• Is the proposed reimbursement appropriate? Expensive is not necessarily better; neither is inexpensive necessarily cost effective.
• Payment issues should be identified and clearly spelled out up front. When will the Outsource Agent bill? How quickly will payment be expected? What other expenses will the Provider be responsible for.

And finally, it is critical for the Outsource Agent to work directly with the Physician, Administrator or Office Manager. Do not delegate the clerical staff or interim supervisor to coordinate the process or act as the "go between". This can create a political situation that may not be in the Providers' best interest.

Advanced Healthcare Solutions, Inc. provides a wide range of Healthcare administrative services. Our pricing is competitive, our knowledge is commendable, our work ethic is admirable, and our references are impressive. To schedule an initial consultation, please Contact Us.

Advanced Healthcare Solutions, Inc.
23010 Lake Forest Drive, #D
PMB410
Laguna Hills, CA 92653
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