Hospital & Practice Review Services

Reviews and Education:
Business Dynamics Limited (BDL) specializes in Facility Claims Review and Education, which may be performed either on-site or off-site to accommodate Hospital or Ambulatory Surgery Center facilities. These reviews are targeted for spine surgery service claims, and/or spinal injection procedure to assess the efficiency and financial viability of the spine care programs performed within the facility on an inpatient or outpatient basis.

Facility review analysis is designed to evaluate and aid in realizing the maximum reimbursement for facility fees generated. The review includes the following key reporting components:

CLAIMS REVIEW:

• Coding and medical record documentation issues (accuracy & compliance)
• Timeliness of claims submission
• Appropriate receipt of reimbursement
• Review collection method
• Denial and appeal process
• Revenue code accuracy
• Fee schedule application/markup for implants charges

Claims Review services are provided only on an off-site basis. Business Dynamics Limited staff will review a random selection of twenty (20) claims. Copies of all claim forms, operative reports/chart documentation, EOBs, and collection notes are sent to the BDL home office in Mineola, NY. This allows for the review to be done outside of the facility so as not to interrupt the daily workflow. The Claims Review provides valuable insight into the coding, billing, and collections processes specific to spine surgeries or spinal interventional procedures. A detailed written report is generated, containing comments, recommendations, and analyses of Business Dynamics Limited's findings during the review.

COMPREHENSIVE BILLING OFFICE ASSESSMENT:
(Includes the following components, in addition to those in the CLAIMS REVIEW)

• DRG and Length of Stay analysis
• Activity analysis (charges, payments, adjustments)
• Insurance dependency
• Contracted reimbursement rates review
• Tracking of supplier cost for spinal implants
• Collections protocols
• Denial management
• Appeal strategies
• Accounts Receivable management

On-Site:
Our team (comprised of Certified Coders, MBAs, Spine Billing Specialists, Practice Managers and support staff) perform the review on-site at the facility's central billing office. A minimum three-day visit to the facility is required in order to perform this review. The client will be charged for all expenses incurred by BDL staff for travel and any other expenses incurred during the onsite stay. All on-site facility reviews require a minimum of two (2) BDL representatives to complete the on-site data collection and analysis. The review includes the following components:

• Original claims, medical records, reports, EOBs, and other documentation are examined. Education is provided for the staff in the form of immediate feedback and training during the review process. At the completion of the review an exit summary recap is conducted.
• Following the site visit, a detailed report is generated, containing comments, recommendations, and analyses of Business Dynamics Limited's findings.

Off-Site:
Off-site Reviews offer a more flexible and cost effective option for the facility. Copies of all documentation, billing information, and reports are sent to the Business Dynamics Limited home office in Mineola, NY. This allows the review to be done outside of the facility so as not to interrupt the workflow of staff and administration. Our same highly qualified team completes the analysis from information submitted to our corporate headquarters. The facility may elect off-site Comprehensive Reviews without the added travel costs associated with on-site reviews. The review includes the following components:

• Copies of claims, medical records, reports, EOBs, and other documentation are examined & analyzed. Comprehensive analysis and financial review of spine related DRG groupings and Length of Stay reporting by the physician provider are included. Education is provided to the central billing office and/or administration in the form of written feedback and training outlined in the written report findings. We will communicate with staff via telephone and e-mail when necessary. At the completion of the review a telephone exit summary may be scheduled to discuss key findings in addition to the written report that is provided.
• A detailed report is generated containing comments, recommendations, and analyses of Business Dynamics Limited's findings during the review.