The Preliminary Systems Team, under the direction of Connie Ziccarelli, Chief Operations Officer, and Sarah Pollitt, Director of Managed Care & Credentialing, is utilizing technology to make it easy for providers to get credentialed. Instead of paper, the Internet-based PECOS and CAQH systems electronically enroll providers with Medicare and other third party payers, respectively.

The process saves time by collecting providers' information up front and enrolling them behind the scenes. This means the provider can be in-network at an earlier date and begin receiving payment from insurances sooner. Additionally, the team proactively monitors the credentials of all providers and re-certifies them when needed.

PECOS - which is Medicare's online tool for provider enrollment - is just one example of technology enhancing the process. Though PECOS is not yet an industry standard, the Prelim Team is going on its third year of PECOS utilization. The team also uses CAQH, which allows for all-electronic submission of the provider's information to many different payers at the same time.

"Sarah has done an awesome job at transitioning us from paperwork to PECOS," Connie said.

Outpatient private practices not affected by MPPR error

Sarah and the Preliminary Systems Team

Sarah Pollitt, Director of Managed Care & Credentialing

 

» Commitment to RMS: 9 years

» Family: Son, Kyler and husband, Tim 

» Role: Sarah leads all aspects of the Central Office credentialing process. She is a specialist at fee schedule maintenance, contract maintenance and payer relations activities. 

 

She facilitates training and education of Central Office castmates and clinic team members. Sarah also is an expert at claims resolution due to incorrect processing by the payer.

 

Sarah also oversees the daily operations in the Preliminary Systems Department, including patient registration, authorization and verification. She works to seamlessly integrate communications from payers between the family of clinics and Central Office team.

Karolina Lesniewska, PT, DPT

While it's important to diversify referral sources, it's also important to consider the diversity of your customer base. One advantage of being a locally based provider is that a therapist can immerse themselves in their community and establish a strong bond with potential patients, always staying in touch with the pulse of the neighborhood.

 

Our community in Addison, Ill. is a prime example of this. Recognizing a previously untapped market, Karolina Lesniewska, PT, DPT of Optimal Physical Therapy has introduced therapy services targeting foreign language-speaking patients. While remaining fluent in English as her first language, Karolina also is fluent in Polish.

 

With consultation and encouragement from the Clinical Growth and Marketing teams, Karolina identified the need for multilingual services in her community, collaborated to make language-specific marketing materials and has since hit the ground running. Karolina has even worked with the Marketing Team to do media outreach to a Polish language newspaper in her community.

Much like we talked about teamwork in the previous newsletter, we're taking that a step farther this time. Using teamwork to assist you, it's possible to achieve seamless integration.

  

The dictionary definition is, "integration that occurs without causing any errors or complications." Seamless integration is the pinnacle of efficiency - all systems working together toward the same goal.

 

Though this level of complex integration may require planning and testing in advance, an optimum level of integration can have benefits at work, in the clinic and in your personal life. 

» Book: If You Want It Done Right, You Don't Have to Do It Yourself!
by Donna Genett, PhD

 

» Webinar: "Expanding Occupational Medicine & Work Injury Specialties: An Expert Panel Describes OPT Opportunities" presented by Sue Isernhagen, PT; Scott Ege, PT, MPT; and Gina Sandoval, PT, DPT, CEAS

RMS will be well represented this April at the 2011 "Coding, Payment, and Practice Applications for Outpatient Rehabilitation Services" seminar in Indianapolis, Ind. The Medicare Committee - Larry Briand, MS, PT, ATC; Connie Ziccarelli, COO; Kevin Svoboda, PT and Emily Monson, PT will attend. Jodi Woodward, Director of Medical Billing, and Catherine Saaski, Director of Patient Accounts, also will attend.

 

The seminar will take place April 8 and 9, and will feature presentations by Helene Fearon, PT; Stephen M Levine, PT, DPT, MSHA; Roshunda Drummond-Dye, JD and Gayle Lee, JD.

 

RMS leaders have attended this same conference consecutively for more than 15 years in order to remain current on the changing landscape of billing and reimbursement. 

Amanda, Brooke and Galen

This year, RMS has again been asked to partner with William Horlick High School in Racine to accept placement of three outstanding seniors who are involved in the Business Co-Op Program. We believe this is a great way to invest in the future of corporate culture. By reaching beyond the confines of our business, we're providing learning opportunities for the youth of the community in which we live and work.  

 

RMS has successfully provided this type of outreach for several years now and this year the program has grown. The students - Galen Horton, Amanda Kitelinger and Brooke Larson - have been accepted into their school's Co-Op Program and are required to leave school early each day in order to gain valuable real-world work experience.   

 

The students work right alongside the Central Office team and are a valuable asset to the day-to-day systems that make RMS run smoothly. The students are gaining experience in office settings and the responsibilities that go along with work life. They also have the unique opportunity to receive mentorship in the career fields in which they might one day pursue after college.

Before the transition to ICD-10 can take place, claims must be compliant in the ANSI 5010 format. The Medical Billing Specialist Team, led by Jodi Woodward, has begun the first of a series of testing phases for compliance with ANSI 5010. The testing will take place for the remainder of 2011, meeting the industry standard of submitting all claims in the ANSI 5010 format by Jan. 1, 2012.

 

ANSI 5010 is a standard that ensures compliance for all electronically submitted transactions (electronic claims, remittance {E.O.B's}, etc.). During the testing phase, Jodi will receive feedback on each transaction submitted with the new standard. This timeline is more than adequate to make any modifications to ensure 100 percent compliance well before the implementation date.

 

"The Medical Billing Specialist Team has attended multiple training sessions over the last few months to keep abreast of the changes with ANSI 5010 and ICD-10," Jodi said.