LBA Media Room:
LBA Healthcare Consulting Media Fact Sheet

LBA Healthcare Consulting Services is managed by healthcare professionals who are reinforced with a highly accomplished financial and management team. Providing the personalized service that focuses on the most innovative financial and practice management, LBA Healthcare Consulting professionals help boost the efficiency and bottom line of healthcare practices of all sizes and specialties. This highly regulated and constantly changing business environment presents numerous challenges and opportunities, and LBA Healthcare Consulting professionals work with practices to identify needs and focus the correct expertise to improve productivity, efficiency and profitability.

Contracting & Credentialing

The numerous contract and insurance plan negotiations involved in maintaining a successful practice can be overwhelming. LBA Healthcare Consulting professionals know what services matter and what to negotiate for, including fees and contract language, to enhance practices’ success. LBA’s contracting and credentialing negotiation services include:

• Initial credentialing and contracting with insurance companies
• Re-credentialing reviews
• Addition of providers to current plans
• Hospital privilege applications
• CLIA waivers and certificate applications
• Healthcare clinic applications

Revenue Enhancement & Office Optimization

Efficient operations and maximizing revenue are critical to success. LBA Healthcare Consulting professionals conduct comprehensive evaluations and analyses to assess practices’ operational and financial health to enhance revenue and optimize operations through services such as:

• Budget and cash flow analysis
• Fee schedule analysis
• Payer mix analysis
• Overhead production analysis
• Revenue enhancement analysis
• Office staff evaluation and optimization (recruiting, performance appraisals, employee compensation review/recommendations, staffing analysis, team-building workshops and leadership training)

Strategic Management Consulting

Short- and long-term planning is necessary for any business or individual to grow and succeed. Healthcare practices are no different, so LBA Healthcare Consulting professionals work with practices and individuals to determine and evaluate goals for the future, which may include opening your own practice or merging with another. LBA’s strategic management consulting services include:

• Group mergers and formations
• Banking negotiations for financing
• Consultations with architects to design office space that is HIPAA compliant and enables efficient work flow
• Development of time tables and action plans
• Insurance contract enrollment and negotiation
• Staff planning, hiring and training
• Guidance on major equipment purchases, etc.

Regulatory Issues

The government is always watching: the creation of special investigative task forces and the imposition of heavy financial and criminal penalties for violations illustrate the strong commitment to a determined and sharply focused compliance enforcement effort. Interpretation of law is essential, and LBA Healthcare Consulting professionals provide a knowledgeable, proactive approach to compliance with applicable laws and regulations. The implementation of an effective compliance program provides practices with the “insurance” needed to protect against future liabilities on two levels:

• Implementing a solid self-compliance program with appropriate controls can reduce the chances of an investigation.
• If a problem should arise, being able to document that you have processes in place that are attentive to compliance issues can minimize the impact of an investigation, including such aftereffects as punitive damages and interest.

LBA Healthcare Consulting professionals monitor government agencies, Wall Street, and local managed care markets to proactively identify developments that have the potential to produce significant opportunities or repercussions. LBA’s regulatory compliance services include:

• Medicare compliance
• HIPAA compliance
• OSHA compliance
• CLIA compliance
• NPI compliance
• Chart audits

Chart Audits — How They Help

Using national averages as benchmarks, LBA Healthcare Consulting professionals conduct an audit of a random sampling of charts and the documented billing codes associated for each type of patient visit. If a healthcare practice is using a certain billing code more than the national average, LBA professionals alert the healthcare practice that this higher-than-average use of a particular billing code may flag an audit by Medicare. Careful review of each record and comparing it against Medicare Evaluation and Management (E/M) guidelines provides an accurate view of how a healthcare practice is billing and being reimbursed for patient visits. This can help avoid the litigation fees, miscoded billing fees and other fees — which have increased exponentially over the past few years — that may be incurred. While medical necessity factors into the billing equation as well, and most healthcare professionals are aware of Medicare guidelines, the time associated with reviewing and ensuring all medical records are 100 percent accurate is demanding. LBA Healthcare Consulting professionals provide the expert analysis and industry knowledge to help ensure healthcare practices are operating as efficiently as possible.

Healthcare Fraud Services

Healthcare fraud costs Americans an estimated $100 billion per year; therefore, new Office of Inspector (OIG) guidelines and recent changes to the U.S. sentencing guidelines raise the bar for compliance programs. LBA Healthcare Consulting Service’s Special Investigations Unit (SIU) examines possible incidents of fraud. The SIU receives complaints (or leads) from a number of sources including providers, attorneys, employers, beneficiaries, law enforcement and government officials and other healthcare companies. After receiving a report of possible fraud, the SIU investigates the allegation and works with the appropriate agencies or groups to resolve the issue.

LBA’s Healthcare Compliance Services Include:

• Physician educational audits, including E/M guidelines, medical necessity rules, incident to, and consulting
• Benchmarking against national guidelines
• Medicare compliance plan program, including development and implementation
• Federal inspection preparedness

LBA’s Healthcare Audit Services Include:

• Survival of a Medicare audit
• Expertise on coding issues
• Federal program negotiations with regards to audit issues
• Internal control procedures, including assessment, development and implementation

Educational & Training Services

LBA Healthcare Consulting professionals are experienced in conducting training sessions and leading educational seminars on a variety of topics. Seminar titles have included:

• A HIPAA Roadmap — Past, Present and Future
• Clinical Efficiency
• Everything but Medicine: The Practical Approach to Managing Your Business
• Financial Assessment of Your Practice
• Fundamentals in Supervision — Are you Managing or Leading?
• HIPAA Awareness
• Implementing HIPAA
• Medicare Compliance
• Medicare in Your Practice
• Moving your Practice from Good to Great
• OSHA Rules and Regulations
• Personnel Policies
• Preparing for the OIG
• Salary and Benefits Trends for Physician Practice Groups
• Surgical Coding: Not an Open and Shut Case
• What’s New in Coding?

Several local and state organizations have engaged LBA Healthcare Consulting professionals to speak at their educational seminars and conferences. These organizations include:

• First Coast Management Association
• Florida Society of Ophthalmology
• Florida Surgical Society
• In Health Record Systems (Jacksonville, Fla.; Atlanta, Ga.; Austin, Texas; Indianapolis, Ind.; Birmingham, Ala.)
• Medical Society of Memphis, Tennessee
• MGMA (Jacksonville and Gainesville, Fla.; Memphis, Tenn.)
• PAHCOM
• The Florida Obstetric and Gynecologic Society

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