Our Services Include:

Comprehensive Medical Billing Services • Coding
Electronic Claims Submission • Comprehensive Insurance Follow-up
 Consulting Services • Medical Practice Report Cards

Coding:

STAT Medical Consulting, Inc., specializes in the education of providers to select the appropriate code in order to maximize physician reimbursement.
All physician reimbursement is based on the use of the CPT (Common Procedure Terminology) book developed by the American Medical Association. Each year, these codes are updated.

In addition, for all procedures that are performed on a patient, a medical justification is needed by assignment of the appropriate diagnosis code, as selected from the International Classification of Diseases, 9th Edition (ICD-9) code.

Our services include, but are not limited to:

• Reimbursement Analysis
• Modifiers
• Coding Audits
• CPT & ICD–9 Review
• In–House Seminars on Coding
• Past Topics Include:
• Practice Enhancement
• Fraud & Abuse
• Medicare & Medicaid Changes
• Billing Tips & Tricks
• In–House Compliance Audit

Electronic Claims Submission

STAT Medical Consulting, Inc., transmits all claims for all carriers that are able to accept electronic claims submission. These include:

• All Commercial Insurance Carriers Through a National Clearing House Web/MD/ENVOY such as Aetna, Cigna, Prudential, and BlueCross
  BlueShield. Please contact us for a list of all companies that accept claims electronically.
• Medicare direct to the Fiscal Intermediary (for your region with the new HIPAA National Standard format, as required by law effective 10/03).
• Medi-Cal Direct to EDS for California and all other state Medicaid.
• Any HMO or IPA that is accepting claims electronically
• Government Claims
• We are fully equipped to transmit electronically to all states’ Medicare fiscal intermediaries and out-of-state Medicaid claims.

Our experience in electronic claims have resulted in the following:

• Reduced Errors - Up-front edits make for cleaner submissions
• Increased Turnaround on Reimbursement - Reduces payment delays significantly, which translates into increased cash flow
• Increased Efficiency
• Increased Reimbursement
• Decreased Denial Claims

Examples:
BlueCross of California: 4 days
Aetna: 10 days
Medicare: 14 days
Compared to 45-60 days for paper claims.

MYTH: Many physicians and surgeons think it is necessary to submit paper on claims because of the need to send operative report attachments. THIS IS FALSE. Insurance carriers incent physicians to transmit claims electronically and encourage providers to do so. In less than 10 percent of cases, an operative report will be requested. However, the claim is in the system at the insurance company, therefore reducing additional payment delays.

Comprehensive Insurance Follow Up

Our Follow-Up Division is segregated into the following components:
1. Correspondence
2. Accurate posting of EOBs
3. Generation of Secondary Claims
4. Actual calling of insurance companies to determine status and expedite payment

1. Correspondence:
We handle all the excess paperwork that is returned from the insurance carriers. Be aware that many of these responses are simply delay tactics on the part of the insurance companies to process claims and payments.
Most correspondence falls into the following categories:
- Request for additional information (i.e. ID cards, Operative Reports, Authorizations, etc.)
- Claim denial (i.e. deductibles, patients coverage expired, etc.)
- Request for medical records
Our team works closely with the offices to ensure the timely return of the requested information to reduce any additional delays.

2. Accurate Posting of EOBs (Explanation of Benefits)
Our system is an open-item payment system that operates on real time. Therefore, if an insurance company pays for 4 out of 5 line items on a claim, we are able to identify and re-bill the missing items. As a result of this ability, we are able to recoup thousands of additional dollars each year that provider offices have often been remised in collecting themselves.
In addition, we provide DENIAL REJECTION ANALYSIS to our clients as an education tool to assist them in the identification and elimination of errors.

3. Comprehensive Insurance Follow Up
Using an aged accounts receivable report, our trained professionals contact insurance companies directly to determine the claims status on outstanding claims. Proactive in our follow up, we contact insurance carriers within 21-30 days if no response has been received. We are able to isolate claims including, but not limited to, the following sorts:

• Highest balance owed
• Oldest account (aged by date of service)
• Provider
• Place of service (hospital vs. office)
• CPT codes (i.e. surgeries vs. office procedures) or specific surgery
• Insurance carriers - by category (i.e. Medicare or Medi-Cal) or for each P.O. box for BlueCross

Consulting Services

STAT Medical Consulting, Inc., has been involved in consulting all over the United States for over 15 years, primarily in the area of Physician Practice Management. For the last 5 years, we have been assisting large hospital networks in the area of Operational Analysis for integrated physician services, such as CBO formation for large MSO organizations.
Our expertise is in the identification and implementation of problem areas in operations.

We offer the following:

• Practice Assessments
• Benchmark Practice Comparisons
• Physician Practice Compliance Audits
• Integration of Hospital Physician Services
• Fee Schedule Analysis
• Information System Selection
• Large Medical Group Analysis
• Central Billing Operational Assessment for Management Service Organizations
• Practice Evaluations
• IPO/HMO Contracting
• Set up New Physician Practices

Medical Practice Report Card

The Medical Practice Report Card is a tool designed to assist physicians and managers to evaluate their performance in areas that have the greatest impact on the practice’s financial health. The Report Card is designed as a mechanism to evaluate the performance and efficiency of the practice’s operations.
In each area, the practice will get a "grade", and that will be compared to those of similar practices in related specialties. Areas needing improvement will be identified and recommendations will be made on how to achieve these improvements.

• Billing
• Accounts Receivable Management
• Appointment Scheduling
• Practice Overhead
• Staffing
• Marketing
• Practice Performance