The focus on coding and reimbursement is a must if physicians are to receive appropriate reimbursement for the services they perform. Continuing education is the key to keeping staff informed, thereby, assisting them with developing efficient systems to effect positive workflow and production.
The PRS philosophy differs from mainstream thinking. PRS believes that consulting services, as such, are not the answer. PRS understands that the value of any consulting service is measured by the ability of the physicians and staff to use the information to improve systems, enhance revenues, and diminish their exposure to fraud and abuse. At PRS, the goal is to educate and involve practices in interactive learning activities that are reliable and cost effective.
Continuing education is the key to keeping staff informed. Proper application of the rules and regulations is imperative to working within the system and obtaining appropriate reimbursement for services rendered to patients.
In addition, PRS is called upon to conduct specialty-specific educational seminars throughout the country. The content of the seminars is based on Evaluation and Management Documentation Guidelines, Global billing with the correct use of modifiers, and an overview of developing a compliance plan. During the specialty presentations, all coding scenarios pertain to each specific specialty.
During PRS E/M seminars, wall charts and pocket cards are distributed to assist the participants with the coding exercises, giving them “hands on” coding experience during the seminar itself. The physicians also gain experience with easy-to-use coding tools that can be utilized on a daily basis. At the end of global seminars, problematic coding issues are reviewed and resolved. Medicare (CMS) rules and regulations are discussed as well as private payer mandates. With the threat of fraud and abuse charges for improper billing practices, it has become more critical to ensure that reimbursement processes are in check with the guidelines set forth by both CPT and CMS.
PRS also authors and publishes several monthly and quarterly publications. Through constant research of coding and reimbursement rules and regulations, PRS imparts pertinent information to physicians and their staff in a timely manner, helping to keep the physician’s office in compliance.
Physicians are asking for more and more help in the area of practice management. PRS consultants provide timely and accurate assistance to these physicians whether they are in need of instruction on general concepts or focused troubleshooting of billing and documentation procedures. The PRS audit team offers chart reviews and analysis of practice billing and documentation procedures.
PRS provides strategic research consulting through the Reimbursement Strategies division. PRS research experts help medical device, pharmaceutical and diagnostics companies by evaluating where their product falls in the reimbursement marketplace. PRS provides research, reports and websites to help these companies develop their marketing plan. Further, PRS can help these companies deal with issues that are revealed through the Reimbursement Strategy analysis by guiding the company in maximizing reimbursement for products, obtaining new CPT, ICD or HCPCS codes, developing a model payment policy, helping to develop arguments for national policy, creating practice ROI models to help physicians make informed decisioins, and sharing medicare and private payer successes and trends.