Consulting support for PHI Health's patient financial services team, beginning with coding and billing guidance for higher-acuity air medical transports.
PHI has asked for coding and billing guidance on the additional services and resources used during higher-acuity air transports. The engagement addresses that question first, with the broader revenue cycle consulting scope below available throughout the agreement.
Review of HCPCS and CPT codes, modifiers, and other appropriate billing mechanisms that may capture the additional services and resources associated with higher-acuity transports, including ECMO, Impella, VAD, neonatal specialty care, ventilator support, additional clinical personnel, specialized equipment, blood products, and supplies.
Where services and resources are not separately billable, guidance on whether and how PHI can establish higher charges for higher-acuity transports based on the additional equipment, personnel, supplies, resources, and level of care required.
Every recommendation is grounded in applicable federal and state coding and billing requirements so PHI can capture additional costs and resources appropriately while remaining compliant.
Each monthly scope and the hourly option includes assistance with the scope of work outlined above. Select the structure that best matches the cadence and depth of support PHI wants.
Consultation hours via phone, interactive media solutions, email, and document review and creation. Scope of services may include assistance with questions on revenue cycle best practices; billing compliance questions; and guidance regarding revenue cycle practice implementation.
Estimated monthly time allotment: less than 3 hours per month.
Consultation hours via phone, interactive media solutions, email, and document review and creation. Scope of services may include assistance with questions on revenue cycle best practices; billing compliance questions; and guidance regarding revenue cycle practice implementation.
Estimated monthly time allotment: 3 to 5 hours per month.
Consultation hours via phone, interactive media solutions, email, and document review and creation. Scope of services may include assistance with questions on revenue cycle best practices; billing compliance questions; guidance regarding revenue cycle practice implementation; as well as other objectives as defined in the Statement of Work.
Estimated monthly time allotment: 5 to 7 hours per month.
Consultation hours via phone, interactive media solutions, email, and document review and creation. Scope of services may include assistance with questions on revenue cycle best practices; billing compliance questions; guidance regarding revenue cycle practice implementation; as well as other objectives as defined in the Statement of Work.
Estimated monthly time allotment: 8 to 10 hours per month.
Consultation hours via phone, interactive media solutions, email, and document review and creation. Consultation hours billed in 30-minute increments. All email communication related to your organization billed in 15-minute increments. All document review and creation services billed in 30-minute increments.
*Minimum of 1 year agreement.
**If onsite visits are requested, they will be billed at $5,000 per day; travel and related expenses will be charged as incurred.
Available on their own or alongside any monthly or hourly option.
Solutions Group Services will provide an introductory assessment of the current state of the Revenue Cycle Management portfolio for air medical transports for PHI Health. This solution includes, but is not limited to: review of the current state of revenue cycle policies and procedures; review of all relevant medical and billing documentation to ensure compliance with federal and state laws regarding reimbursement; review and analysis of the current air ambulance chargemaster to ensure maximization of revenue opportunities with recommendations where applicable; and recommendations for suggested improvements to revenue cycle management processes.
It is anticipated that this initial assessment with recommendations will take approximately 25 to 30 hours and will require (1) 6 to 8 hours of virtual meetings, (2) access to RCM reports, (3) the air ambulance chargemaster, (4) access to medical documentation, and (5) other data as requested to achieve expected outcomes. If requested information is provided to SGS in a timely manner, the assessment will be completed within 75 days from the date of the kick-off meeting. If PHI would prefer the interview process to take place via an onsite visit instead of virtually, an additional fee of $5,000 per day plus travel expenses would be incurred.
Comprehensive data analysis of the current ChargeMaster for PHI within an operating state. This analysis compares the current ChargeMaster against the 2023 Medicare Public Use Part B data file for all ambulance agencies with a National Provider Identification (NPI) number associated with the state in which the provider is based. It also ranks the provider's ChargeMaster against other ambulance providers in the operating state and provides the median rate for 2023, then adjusts it for the Ambulance Inflation Factor (AIF) to provide a starting point for assessing any revisions needed. FAIR Health data is also used for each locality to assess the average in-network and out-of-network agreements for the relevant ambulance HCPCS codes.
The ChargeMaster Analysis is completed within 30 days of signed contract.
This solution includes the development of an OON appeals strategy, including state-specific draft patient and payer engagement letters for each state where a ChargeMaster Analysis was completed. The strategy will be delivered through a Best Practices Policy and Procedure guide, providing ready-to-use correspondence to support effective appeal initiation and active engagement.
Implementation consulting is separate and billable according to a monthly or hourly consulting option.
Confirm the engagement option, meeting cadence, and the order in which questions are addressed, starting with higher-acuity transport coding and charges.
PHI shares transport examples, current billing information, documentation, and chargemaster detail so SGS can advise accurately.
SGS works the scope of work with PHI's patient financial services leadership through scheduled meetings, document review, and written guidance.
Guidance is reviewed with PHI leadership, refined, and carried into any project-based work PHI selects.
Supporting detail behind the scope and fee options above. Expand any section for the full context.
PHI reviews the scope of work, the monthly and hourly options, and the project-based options.
Confirm which option best fits the cadence and depth of support PHI wants.
Accept this proposal and execute the consulting agreement.
SGS schedules the kick-off with PHI's patient financial services leadership and work begins against the scope of work.
Acceptance confirms the scope of work and the engagement option selected. Start date and meeting cadence are documented at kick-off.