Through the adoption and enforcement of our corporate compliance and patient privacy plans, IDS insures patient confidentiality. These plans address the confidentiality of patients PHI information in the following areas; network security, system access, login and password policies, as well as contracted off site work policies (mailings and audits). We also have an industrial shredder so no patient information gets thrown away without first being shredded.

Have you or your clients ever been the subject of a HCFA/Inspector General investigation?

No, not while being billed by IDS, Inc.

What are the average days in receivable for your Michigan clients? How does transfer to collections affect this? Describe the collections process?

On average, clients range from 25 to 50 days. Accounts transferred to collection are taken out of the totals for our current receivables. At an agreed upon time frame, usually between 60 and 90 days, all self pay accounts with no resolution are called and given options (IE. Payment plans, discounts, etc) prior to being transferred to collections. If no solution is found, their information is transferred via encrypted email to the collection agency so they can begin their collection process.

Please describe your coding process. Include any QA compliance and physician feedback processes you may have.

All of our coders are certified, some having dual certification. Our coding staff is active, some in leadership positions, in the local AAPC chapter. Each medical record is assigned the appropriate CPT and ICD-9 based on the physician’s documentation. IDS follows HCFA and CPT regulations when coding our clients’ medical records.

IDS has a full-time Quality Assurance person who audits charts for each of our coders on a monthly basis. These audits are used for training as well as quality assurance.

On a monthly basis we include a report, which illustrates the areas of deficiency by physician. (We refer to this report as our MED508 report.) The areas of deficiency are broken down by chief complaint/HPI, PFSH, ROS, physical exam, procedure not documented, time element missing for CC, X-Ray interpretation lacks documentation, EKG not documented and nursing note not reviewed. Our coding staff gives the clients feed back on their documentation deficiency.

On a yearly basis our Compliance Officer arranges for an outside audit to be performed.

Describe your billing process and cycles. What is the average time it takes to get an initial bill out?

The average time it takes IDS to get an initial bill out the door is 3 days from the date the chart is received in the office. We perform daily billing runs with form and electronic generation.

The medical records are first received in our Logging Department. The charts are first batched by date of service and then reconciled against the ED Log. Our Logging Department reports back to the client representative all charts which were not received or which were not complete. This reporting is typically done on a weekly basis. Once Logging has completed their process, the charts are sent to our Coding Department.

Our Coding Department assigns the appropriate CPT’s, ICD-9’s and statistics for reporting to the charts. Once completed, the charts are sent to our Billing Department.

Our Billing Department reviews the patient demographic information. They verify insurance information, which includes obtaining authorization numbers and referring physician information that are missing from the demographic files provided by the hospital. Once completed the charts are sent to our Data Entry Department.

Our Data Entry Department inputs the medical record information into our system.

Daily our IT Department prints HCFA 1500 forms, submits statements and letters to Presort, and electronic claims to the appropriate carriers.

Our billing system has a variable schedule matrix. This schedule matrix allows us to send statements, letters and 1500 forms based on a 7-day cycle. We typically bill on a 21-day cycle for our self-pays and a 49-day cycle for our Medicare, Medicaid and Blue Shield. This schedule matrix allows us to bill each carrier mix uniquely.

Can you file claims electronically?

Yes, we send electronically to Medicare, Medicaid, Blue Shield, BCN and Priority Health. We also send Tri-care and a number of commercial claims through various clearinghouses. When IDS identifies a carrier that processes many claims for a specific hospital, we will contact that carrier directly to try to submit claims electronically, either directly to them or through a clearinghouse they currently use. We send approximately 96% of our claims electronically.

How do you handle claim rejections or claims with incorrect addresses?

We have a Return Mail Department that handles all non-deliverable mail. They contact the insurance carriers for corrected claims addresses. They also attempt to contact the patients for correct mailing addresses. They take advantage of hospital information systems if we are linked internally and they take advantage of the Internet to locate individuals and companies. We also use Cass certification software to verify all postal addresses. This allows us to identify invalid addresses before mailing. Prior to sending an account to an outside collection agency, we electronically verify all accounts against the Michigan Medicaid system verifying eligibility.

We have a Billing Department that follows up on all rejected claims. They take the necessary actions to correct our billing system and submit a corrected claim to the carrier. Their Supervisor assigns the claims to them to insure that the follow-up is being completed. Once their assignment is completed the Supervisor follows up on the claims to insure that their action resulted in payment.

How do you reconcile that all patients are billed?

We require that we be furnished with a copy of the emergency department log. This log is matched against all incoming charts. On a weekly basis we report back to the client or hospital contact which outstanding charts were not received. On this listing we denote missing item(s) such as: dictation, T-System, Face Sheet, Nurse Notes, etc. This is a continual listing and a name does not drop off the list until the item is received.

At month-end time, we also have staff that balance back to the month-end report by date of service, by group, by facility, and to the number of charts invoiced compared to the number on the ED logs. All discrepancies are researched and it is determined why they did not make month-end.

How do you handle patient complaints?

Patient complaints are documented and forwarded to our clients for review. Some clients authorized an up front discount to deter some complaints from being sent to the client. Other clients want to review each of the cases.

How accessible and responsive are you to patient inquiries?

IDS staff are readily available by phone and/or by email. We try to adhere to a 24-hour turn around, depending on the depth of the inquiry.

Patients can check the balance of their account(s) or submit updated health insurance through our secure website. All outgoing correspondence contains directives to the patients on how to utilize our website.

Describe the collections process.

Based on our billing system schedule matrix, if an account goes unpaid by an insurance carrier, the account is placed on a report for the staff to call and check the financial class of the claim. For all HMO, PPO, Commercial and Workman’s Compensation claims, letters are sent out to the patient to request their help in getting the claim paid prior to the billing staff calling on them.

Based on our billing system schedule matrix, if a self-pay account goes unpaid, the account appears on a pre-collection report. Our pre-collection department attempts to arrange a payment plan with the patient. If the attempt is unsuccessful, the account is sent to collections automatically by the billing system. If the attempt is successful, payment coupons are generated and sent to the patient.

How and when are payments posted?

Payments are posted within 24 hours of receipt date. They are posted back to deposit date. Medicare, Medicaid, Blue Shield, and Priority Health are posted electronically in the states where available.

How are refunds handled?

All credit balances are researched to determine if a posting error has been made prior to issuing a refund. Once it is determined that refunds are due, we either forward the refund request to the client for issuing or we issue the refund on the client’s behalf utilizing an IDS account. When the latter method is utilized, we require that the client issue us a check for the amount of the refunds prior to IDS releasing the checks.

How do you assign patients to collections agencies? How are these agencies chosen?

If a patient account goes past end of cycle and we have not received payment or correspondence of any type, the account is transferred to a collection agency chosen by the client.

Prior to transferring to collections, our typical billing cycle is two statements, a ten-day notice and a call by our Pre-Collections Department.

Please discuss the storage and handling of charts.

Our charts are logged and batched by date of service, by group. Once the billing information is entered into our billing system, our Medical Records Department scans the completed medical record into an imaging system. The hard copy charts are then stored for six months. After which, they are destroyed by means of shredding.

Describe how you will get patient information from the hospital.

Most of our information is obtained electronically, however we still take paper. This answer varies depending on the client and the hospital system capabilities. Some facilities send us copies of the entire record, some facilities email us the demographics as well as the dictations, and in other cases we have access to the hospital system and we print out the dictated reports.

In all cases we like to have a person at the hospital level that is responsible for assisting us with obtaining the records.

Describe your billing software. Have you ever lost data? What are your back-up procedures?

The software was originally written for emergency medicine and clinic billing. We have continually enhanced and upgraded it over the years. Our billing staff uses our software and we lease our software to other billing companies to run their billing operations.

Due to our back-up methodologies, data has never been lost. All of our systems, (imaging, billing and network servers), are backed up daily and the back-ups are stored off site.

What standard reporting do you provide?

On a monthly basis we would provide a report, which would list how much was denoted for each of the facilities by deposit date. This report is utilized to balance the bank statement.

We also generate reports that detail payment by insurance carrier/financial class, we track aging by days in AR, we track the number of days it takes to collect payments, procedure by facility and by physician, average charge by physician, actual charges and payments by physician, diagnosis usage, expected payment reporting, down coding by physician, as well as custom reporting, color graphs and charts, etc.

On a weekly and monthly basis we would also include a deposit report for each of the facilities.

Can this reporting be done by division?

Yes. We will report each facility separately and then we will give you an all facilities report.

What other services does your company offer as part of the contract?

1. We will help you do contract projections for potential new facilities.

2. Physician documentation evaluation and training.

Do you assist in credentialing, insurance company contract evaluation and review, etc.?

Yes, we do assist in all of these areas.

Can you assume old AR and what fee would there be for that?

We can assume old AR, and our typical fee is 15% of collections.

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