BUSINESS ADVISORY SERVICES
About Business Advisory Services
ADVOCATE’s business advisory professionals provide clients with the confidence to succeed by helping them anticipate, create and manage change. Whether clients are proactively implementing change or reacting to an unplanned event, we leverage our resources, extensive industry experience, and functional acumen across the areas of operations, finance, practice strategy and structure, process improvement, human resources effectiveness, technology integration and implementation, risk mitigation and crisis management to help practices achieve sustainable change.
BUDGET AND FINANCE
About Budget and Finance
The journey to success is governed by increasingly complex and broadening regulatory requirements and stakeholder demands.
Strong independent assessment helps meet the demands of your practice by providing timely, constructive financial information to management, a robust and clear perspective to partners, and easily understandable critical information for stakeholders.
The quality of our financial services starts with our professionals, who have the breadth of experience that comes from being specialized in radiology. We provide a consistent fundamental approach to financial issues by assembling the right multi-disciplinary team to address the most complex issues. This team uses a proven methodology and deploys the latest, high quality financial analyses and perspectives to give you optimal results.
And because we understand that to achieve your potential you need a tailored service as much as a consistent methodology, we work to give you the benefit of our focused radiology industry knowledge and the latest insights from our work nationally.
Preparing for the next year can be time consuming and often frustrating. Our years of experience make budgeting easier and more accurate. We also provide forecasting and feasibility services for business planning.
ADVOCATE has a proven proprietary financial modeling process to monitor and improve cash flow control, called a Diagnostic Revenue Analysis. The package includes accurate revenue projections, a Diagnostic Revenue Analysis and a complex key indicator monitoring matrix.
About Accounting Services
Today’s uncertain world requires a comprehensive and transparent approach to building a successful practice infrastructure. A comprehensive and transparent approach builds a strong reporting foundation and facilitates planning and growth. It helps you develop financial strategies aligned with your business. It lets you meet today’s business goals, while laying the groundwork for tomorrow’s success.
To support this approach, you’ll need trusted advice on planning, compliance and reporting. ADVOCATE’s professionals bring technical knowledge, practical experience and consistent methodologies to your practice:
– Preparation of monthly financial statements by location of service
– Complete payroll preparation
– Federal, state and local tax filings
– Variance analysis
– Bank reconciliations
– Coordination with other accounting and legal professionals
– Processing of accounts payable
– Development & administration of pre-tax expense reimbursement programs
– Physician benefit package design and administration
STRATEGIC PLANNING & BUSINESS DEVELOPMENT SERVICES
About Strategic Planning & Business Development Services
ADVOCATE provides industry-focused experience on your business. You want to compete, now and in the longer term. Our strategic planning approach enables your business to do that. Strategy is defined in many ways. Look at it as the road map of an organization, giving direction on how to operate and providing orientation for setting goals and making decisions. Strategy should always be achievable and measurable, which means linking it to business plans and budgets.
ADVOCATE can help you to analyze and address business issues and make the right choices. Radiology practices today are looking to solve three key challenges: improving business performance, improving efficiency, and reducing costs. These objectives can deliver significant benefits and position your practice with a stronger and more competitive profile.
To help you meet these interconnected challenges and achieve your potential, we have assembled a seasoned multi-disciplinary team to work with you to deliver a superior experience built on a consistent methodology, a robust knowledge culture, and insights from our work around the country.
We also understand that to achieve your potential as a practice you require services that respond to your specific issues, so we bring our specialized experience and deep subject matter knowledge to bear in a proactive and objective way.
Taking a 360 degree view of your practice is a necessary first step to securing the present and building for the future. Many practices are focused on short term issues, but it is equally important to consider performance improvement opportunities that will drive growth and operating efficiencies for the longer term and create a stronger competitive position. We take a structured approach to helping you grow your business. The following pages highlight some of the types of strategic analysis performed.
MANAGED CARE CONTRACTING
About ADVOCATE’s Managed Care Contracting Service
Doing the right deal right can make your business more competitive and profitable
ADVOCATE will work with you to evaluate opportunities, make your transactions more profitable and achieve your strategic & financial goals. Whatever the size, nature or location of your practice, we can play a critical role in achieving contracting success.
We combine proven practices and consistent methodologies with fresh thinking, giving you the advice you need to make informed decisions, mitigate downside risk and achieve a successful outcome.
Our team has many years of experience assisting radiology practices increase the annual revenues collected from managed care companies. We have significant experience with many of the country’s leading managed care companies including United Health Care, Aetna, Cigna, Humana and Blue Cross/Blue Shield Plans.
To ensure that all available revenues are captured, we negotiate language necessary to achieve your goals. Our national exposure gives us one of the largest radiology managed care data bases in the country.
CONTRACTING TOP 10
It does little good to obtain a healthy increase in fees if denials increase at the same or a higher rate. Both language and rates need to be effectively addressed in any new contract. The group needs to eliminate one-sided clauses and unreasonable restraints placed on the practice. Other sections may require language to be added. The following list describes the top 10 situations to consider when evaluating contracts and some best-case scenarios. Of course, the list isn’t all-inclusive. Each contract should be evaluated on its own merits.
1. Make sure the contract addresses inappropriate denials. In general, consider all denials inappropriate, except in cases where the patient lacks coverage. An example of an inappropriate denial is rejection of CPT code-bundling combinations outside of the national correct coding initiative.
2. Lack of pre-certification should not be the basis for denials, and the contract language should reflect this. This safeguard is important because hospital-based radiology practices have no way to verify precertification of exams.
3. Rapid termination language is typically in the best interest of the practice. Ideally, you should be able to terminate with 60 days notice, although 90 to 180 days is more common. In addition to the termination rule, it should be made clear that the group will not be forced into arbitration or mediation in the event of a dispute.
4. The contract should address medical necessity issues. All exams with medical necessity criteria should be documented in the contract. Any exams not included should be contractually exempt.
5. Do not agree to language that is simply beyond the scope of the agreement. For example, the payer should not be allowed to approve new locations or approve mergers with other groups. Do not allow the payer to ask for limitations on class action lawsuits in the event of termination.
6. Verify that the managed care company has the ability to assign only the payment mechanism and not payment responsibility.
7. Delete product provisions in which the managed care company can sell the network, but the practice cannot determine who is to pay or how much is to be paid.
8. Verify that the contract clearly provides the radiology practice with remedies to recover monies for denied claims.
9. Demand a full fee schedule for payment compliance. Proper payment compliance cannot be achieved with an abbreviated fee schedule. Also, get a complete list of all denial codes. You need a full fee schedule for contract compliance and denial evaluation.
10. Eliminate unilateral change provisions and decision-making for the managed care company.