First in Revenue Cycle Expertise

Audit/Compliance Programs

First Professional Services is here to offer you smart solutions in an ever-changing reimbursement world. Providing reliable coding and billing services for over 31 years, we are your business partner with the expertise and resources you need to be successful. We are here to offer you a comprehensive auditing service. We know you provide the utmost quality care to your patients, let us help you report and be reimbursed appropriately for it. We have a team of certified coders with expertise in a wide variety of specialties. We offer evaluation and management and surgical documentation/coding audits. What will we do?

• Work flow analysis of documentation and coding cycle: evaluation of who is involved in the documentation and coding process at your clinic.
• Review of current documentation and coding: identification of any deficiencies, and highlighting of well-functioning areas.
• Assessment of electronic health record usage: evaluation of whether your EHR is being used appropriately, effectively, and compliantly.
• Relay findings to appropriate staff: an onsite session to review findings and offer any necessary coding and documentation education. Work flow analysis, audit findings, and your input will help us determine who should be present during this education session.

Detailed audit findings and an in depth summary will be provided prior to onsite audit delivery. If additional training is desired beyond audit delivery, we are happy to provide such services. Evaluation and Management services are the most frequently reported codes across most specialties. E/M codes have gained scrutiny in recent years from the OIG and CMS. Additionally, procedural/surgical services continue to be closely watched, particularly with the coming of new modifier 59 definitions in 2015. A complete understanding of E/M guidelines and CMS documentation and reporting requirements is imperative for successful and appropriate reimbursement. Coding guidelines are ever changing, as is the way documentation functions in the electronic health record world. Do not become a target or an audit risk! Empower yourselves and your staff to know the ins and outs of coding compliance and stay one step ahead of the game. Annual audits, review of compliance policies, and review of clinic processes will ensure that your clinic never falls behind.

optimal care > optimal documentation > optimal $$$

MIPS

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate (SGR) formula, which would have made major cuts to Medicare payment rates for clinicians. The law requires CMS to implement the Quality Payment Program.  One way to participate in the Quality Payment Program is through the Merit-based Payment System (MIPS). MIPS consolidates three pre-existing quality reporting programs: the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VBPM) and Meaningful Use (MU). Under MIPS, four performance categories – Quality, Cost, Improvement Activities and Promoting Interoperability – affect your future Medicare payments. Each performance category is scored by itself and has a specific weight that’s part of the MIPS Final Score. The MIPS payment adjustment – either negative or positive – assessed each year for MIPS eligible clinicians is based on the Final Score. FPS can help you navigate this ever-changing and confusing requirement.

Reporting/Metrics

Reporting is essential for medical practices to be able to measure key metrics and utilize this information to make business decisions. First Professional Services utilizes several different reporting tools to provide our clients with the data they require, including numerous pre-defined reports, flex reports, and ad-hoc / custom style reports based on the needs of the client. FPS has also integrated a new technology which utilizes a Relational Search based business intelligence. This tool can provide data just by typing in a search bar, much like searching for a website. If the data is in the system, FPS can extract it and report on it.