Medical providers are under ever-increasing pressure to scrutinize how their patterns of diagnosis and procedural coding may be improved to most effectively recover appropriate reimbursement for services provided. Governing organizations threatening to discipline those with documentation and coding practices that fail to comply with existing guidelines.

Medical practices benefit substantially from efforts to refine issues related to Revenue managements, Charts review and quarterly tracking, Advanced Payments, and Coding. Fragmented attempts to address these issues can yield positive results, but an organized approach, with attention to priority, would be far more effective.

Payment errors cost US medical groups billions of dollars annually. A $25 million practice typically loses up to a million dollars a year on claims paid at less than the contract rate alone not to mention the cost of invalid denials and payment delays.

With our expertise and research we have introduced a system, PayD (patent applied for) to help you maximize your revenues and collections.

PayD is a revenue cycle management system and it was developed to streamline and manage revenues / collections in a systemic fashion so that operations go smoothly, timely and effectively. Our Patent pending PayD System will give the advantage of a bigger group without having to loose control and revenue. The system is designed to maximize revenues and at the same time comply with the current regulations. Managing the billing, coding and review of medical charts can be quite a task. The PayD system works seamlessly and reduces the burden. The process is simple and allows the physician to focus on what he/she likes doing the most.

Why PayD? A significant number of any practices's submitted charges are denied every day. Avanti's PayD system directs a review of denied claims in order to guide future coding practices, possibly resulting in fewer denials. Our process reduces denials by 10% or more.

Avanti examines the reimbursement patterns of various insurance carriers. We pay attention to whether the Practice is being appropriately compensated for services according to established fee schedules, and whether the practice abides by the regulations of Medicare and other carriers.

Avanti's contract analyst team works with clients to fully define the reimbursement logic contained in contracts. These analysts understand contracts from both payor and provider perspectives. By using their deep industry experience, contract-defining tools and unparalleled access to payor data, they unravel the complexities of these agreements - many of which require the definition of over 50 variables.

Avanti's Claims Accelerators verifies the accuracy of medical claims and allowables at the line-item level for each payor contract, combining well-defined contract data, continually updated formulas, fee schedules and payment rules. We automatically extract information from the client's practice management system (PMS) and transmit selected data over secure Internet connections to Avanti's data center.

We then extracts explanation of benefit (EOB) data from the client's PMS, comparing allowed amounts to expected allowed amounts per payor contracts or government payor rules. Claims and allowables are valued and verified using the clients contract data along with public and private sector payor rules. Allowables are reconciled against these valuations.

Where appeals are warranted, we have a highly efficient appeals process and track the progress of recoveries. Our system allows charts review on a quarterly basis and track the suggestions if they are being implemented.

Benefits :

• Proven Improvement in Collections of up to 50%
  
• Reduce rejections
  
• Claim denial rates reduced due to better follow up and coding correction
  
• Lower overheads and cost by up to 30%
  
• Better predictability of reimbursement patterns using payor business rule database
  
• Clean claims submission and resubmission
  
• Better cash flow
  
• Better compliance
  
  

CashNow Option:

There are many times that physicians wished the medical practice were a COD business?

HMO's, Medicare, Medicaid, Blue Cross/Blue Shield and other insurance carriers are using your cash for their own bottom line! Funding medical receivables instantly reduces inconsistent cash flow created by the insurance industry and third party payors.

If a medical practice could convert its business into COD simply by offering a discount across the board to its customers, how much of a discount would they offer? Dun & Bradstreet conducted a survey and learned that many businesses offered as much as 15% discounts for COD, while most offered at least a 10% discount. We're going to convert the physicians business into COD for half that discount.

Regardless of the efficiency in billing, collections and accounts receivable management, there is always a need for money immediately. We have partnered with Wachovia bank so that the physicians can be paid in 48 hours after submitting the claims. This can be used to improve cash flow for immediate needs, or capitalize on new business opportunities.

Benefits :

• You may have additional advantage of automatic increase in the Revenue due to the interest earned for a bill paid early.
  
• Better control of your practice.
  
• You have Predictability in your cash flow.
  
• You can focus more on what you enjoy (your patients).
  
• The additional funds could be used to improve cash flow for immediate needs, or capitalize on new business opportunities.