Common data sources for Brault’s clinical metrics benchmarking include hospital EDIS and Press Ganey (and other) satisfaction surveys, as well as the physician-scheduling system. Using Brault’s coding data, you may establish key performance indicators (KPIs) for more than 120 clinical, operational, billing and patient-satisfaction measurements. All metrics can be interactively displayed, along with indicators pulled from more than 900 emergency departments. It is also possible to monitor and report on trends in clinical protocol compliance, such as 72-hour bounce backs and over-utilized prescription medications. Performing a root cause analysis on poor incremental turnaround times, for example, can reveal an ED-patient walkout problem, while identifying possible links to staffing patterns, census by hour, acuity and more.
By closely monitoring strategically selected data sets, Brault can develop models that provide insight into specific business and operational processes. The possibilities are many but one practical example is compensation modeling, which allows practice leaders to easily analyze cost trends, total group compensation, individual salaries and related information. Analytics-based modeling can also help identify patterns in patient arrival, treatment and discharge times, which could reveal under-staffing issues that affect patient satisfaction, and by extension, Net Promoter Score (NPS) or NP ratios. Brault’s custom analytics can also help nurture the relationship between acute care physician groups and their hospital clients, by better illuminating the patient experience in the ER, observation and daily-care settings.
Practice Management and Accounting Reports
Brault’s standard and custom reports provide all the accounting and management information needed to lead and direct an emergency medicine practice, and to review our billing and accounts receivable collection operations. There are more than 50 standard month-end reports, and report packages are always tailored to your specific needs.
Chart Detail Requirements
Brault’s chart-tracking module flags charts that are missing components. Notices are sent directly from the coder to each provider, along with a message detailing which areas need to be completed. This chart return process not only helps safeguard your practice by reducing risk, it also serves as an invaluable tool for educating individual physicians about your group’s information requirements. For added value, practice administrators can use our Patient Account Tracker system to monitor the responsiveness and timeliness of individual providers.
MIPS and Documentation Deficiencies
For quality assurance, Brault provides monthly reports detailing, by physician, the volume and types of documentation deficiencies that are causing lost income. There are more than 25 discrete causes, each of which can be tracked by provider, with related RVU and charge losses. MIPS tracking reports show monthly and year-to-date performance scores related to the quality measures that apply to your practice. Using these reports, Brault creates an action plan that allows leaders to see where specific training interventions could help increase MIPS scoring and produce additional income.
Each month, or other interval of your choosing, Brault provides deficient chart examples for physicians who fail to meet your stated documentation standards three or more times during the period. The examples also contain suggestions for improvement, specific to the chart and type of deficiency. Examples and suggestions are emailed securely and directly to each provider, who may then receive improvement training from one of our Practice Improvement Specialists.
New-client orientation typically involves an onsite documentation presentation, coupled with an electronic medical record (EMR) review to determine how your practice uses its EMR. This process not only helps orient our collaborative teams but also uncovers areas for improvement and training. Brault’s experience with more than 20 different EMR systems allows us to anticipate potential issues and common pitfalls before they become problematic.
1-to-1 Online Training
Providers who want to improve their charting skills may request one-to-one, online training with a Brault Practice Improvement Specialist. We use a chart-discussion format, and tailor all sessions to each provider’s specific practice style. Scheduling sessions is as easy as clicking on a web link in our Brault Practice Solutions portal. Providers simply select a topic of interest and the Specialist collects and jointly reviews relevant examples from their work and jointly reviews with the doctor over a shared computer screen.
Practice Improvement Specialists can also conduct acuity reviews to identify declining levels of care, or reporting ratios that fail to meet internal benchmarks. If indicated, Brault will proactively suggest training interventions and onsite meetings to help correct the issue(s).
Documentation Tip Emails
To help providers optimally document their activities for common EM health challenges, Brault makes available for emailing, dozens of one-page monthly tip sheets. Physicians may access these resources through our secure Provider Portal to learn best documentation practices for:
- Wound care
- Fracture care
- Critical care
- Observation care
- Differential diagnoses
- Diagnosis reporting
- MIPS measures
- History and physicals
- And many more
To gain online, anytime access to documentation training videos, slides and topical one-page tip sheets, providers may use Brault’s secure Practice Solutions Portal. Training modules are optimized for smartphones (to facilitate access at the doctor’s leisure) and are available to all providers in your group, 24/7.
There is a financial upside to receiving subsidies. But becoming dependent on them can make groups vulnerable to changes in institutional leadership or payment policies. Over-reliance may also chip away at your group’s financial independence. Brault can help you develop strategies that result in more equitable contract and payment terms, and reduce reliance on subsidies, all without compromising your patients’ experience.
Hospital Contract Management
Like any business, you are challenged by competition which means contract negotiations and management should be core business strategy for every acute care group. Drawing on decades of firsthand emergency medicine experience, Brault provides the guidance and expertise necessary to strengthen your negotiating position, identify more favorable terms, and improve your long-term contract retention strategy.
Accurate, timely enrollment is key to ensuring optimal revenue and cash flow. Once payer contracts are identified, our Provider Enrollment Department enrolls the group practice and all providers where required, including government programs. You can finally stop chasing providers for documents and signatures because Brault does all that for you for each provider.
Fee Schedule Management
Once you partner with us, Brault will provide a revised fee schedule for your review, and annually thereafter. For each CPT code, we will identify the practice's current fee, if one exists, compare fees charged by other physicians in your area, and check other relevant industry reference points. We will review the schedule with you and incorporate any changes requested, prior to your approval. We will also suggest periodic revisions, including each year, when the AMA revises and issues its new CPT manual. We will delete outdated codes and add new ones, and suggest fees that are appropriate for your market area.
Brault’s recruiter has more than 25 years of experience recruiting for physician practices, most of it working with the specialty of emergency medicine. We work with the practice to develop a position description and identify compensation and benefits structures and preferred candidate credentials. The recruiter then uses proprietary and commercial databases to look for probable candidates, initiate contact, receive CVs and application documents and advocate for a successful placement with the group.
A vital part of practice management is assuring that the provider schedule is created and distributed timely, fairly and accurately. Brault uses industry leading scheduling software that builds and tracks provider preference records and manages time-off requests. The scheduler then personally builds preliminary and final schedules and distributes them electronically when approved by the group. Providers can see, select and swap shifts and respond to urgent needs on-line or by text and can speak with a live scheduler who is skilled at quickly resolving coverage gaps. Monthly and periodic reports by provider, by location are easily distributed and hours worked are directly integrated into the payroll and provider productivity reporting.
To provide a clear picture of where you are financially, Brault can produce a monthly financial-statements package that includes a P&L statement, a balance sheet, and cash flow reporting. We can also prepare a monthly variance and trend analysis, an amortization and pre-payment schedule, and related journal. Other available support include preparing and posting payroll journal entries, reconciling your payroll bank account and all balance sheet accounts.
Working Capital Management
To help you better monitor and manage available capital, Brault can generate detailed metrics reporting, as well as a monthly cash-flow forecast. We can also reconcile bank accounts and assist with recording, monitoring and reconciling credit card expenses. If necessary, we can work with your Bank on covenant monitoring and reporting.
Accurate time tracking is the first step in accurate compensation. To make this essential function easier, Brault translates provider time cards into a record of time each person works. We can accommodate a myriad of productivity compensation models ensuring accurate and timely incentive payments. Addtionally, we provide summary time monitoring and reporting..
Payroll – Contractor Model
To help ensure that your contractors are paid properly and on time, Brault offers monthly contractor payment and reconciliation services. In addition, we can set up, monitor and administer direct deposit and check delivery, and handle the documentation and reporting of 1099 income.
Payroll – Employee Model
Meet expectations of timely, accurate compensation with Brault’s employee payroll services, including the translation of payroll cycle timekeeping into employee payroll input and funding. We also oversee direct deposit and check deliveries, as well as coordination with banks and payroll processor reporting.
Benefits brokers are plentiful, and identifying one that’s compatible with your practice isn’t always easy. Because of Brault’s extensive industry network, we often aid clients in the broker-selection process. We also: coordinate employee-benefit selection with your practice’s HR contact; make and track retirement account deposits; and track employee benefit deductions in your payroll system.
Available support in the critical area of malpractice insurance includes helping you manage the broker selection process, and tracking malpractice insurance payments and coverage.
Brault offers unparalleled visibility of the billing and coding process. For example, chart handling is tracked for each patient by a proprietary Patient Account Tracker (PAT) software. All encounters are viewable and searchable through the Security Portal, providing full visibility into the status of every chart; historical data may be accessed for up to 13 months.
Transparent, Tenacious Chart Capture
Our PAT system lets you view which charts need addendums or corrections, and which contain documentation deficiencies that need correcting. This monitoring capability helps assure that every chart for every patient seen has been accurately and thoroughly accounted for. Brault’s reputation for being appropriately assertive on clients’ behalf has led to a minimum of 99% capture.
HIPAA-compliant Document Transfer
Brault’s secure online portal facilitates quick, convenient transfer of all documentation necessary to file a reimbursement claim. The electronic chart capture system allows for billing packages to be transferred without paper processing, even if providers are required to use a hospital’s paper charts.
One driver of Brault’s clinical edge is our extensive use of nurses – many with frontline acute and emergency care experience – to perform reimbursement coding. This clinical acumen and expertise, which other billing companies are unwilling to invest in, enables our nurse coding specialists to ‘think like physicians’ and apply a clinical logic to reimbursement documentation. Nurses know firsthand the vital but subtle nuances of charting patient data. Their advanced medical training enables them to instinctively understand the interplay between dozens of complex factors, such as: the patient’s age and history (relevant to their presenting complaint), number and purpose of medications, meaning of exam findings, lab values and diagnostic studies, as well as results of nursing interventions, and available management options. The ability to follow the acute care physician’s perspective, as well as the payers’, makes Brault’s nurse coders more effective at appropriate charge capture.
Clinical Training and Understanding
In medicine today, there is a constellation of complaints, co-morbidities, patient history traits, treatment options, studies and interventions that practitioners must know about and consider. Coders must also be fluent enough in this constellation to know which information is relevant, and which constitutes additional complexity. A clinical understanding of billable services rendered and documented helps us help you maximize revenue, help preempt payer denials, and even defend against payer audits and denials.
Payer Contract Management
Brault helps negotiate equitable agreements with health insurance plans. As each payer contract renewal period approaches, we use strategic-impact modeling to determine your strongest negotiating position (plus favorable alternate positions). We assess the payers’ past performance, including their record of honoring agreed-upon payment and other terms of the contract. Our Payer Compliance Officer, a licensed paralegal, oversees all payer communications related to contracting and fair-payment practices.
A patient’s visit to your acute care facility isn’t truly complete until billing issues have been resolved to their satisfaction. How people are treated during inquiry calls contributes directly to their feelings and attitude toward your practice. To help ensure a consistently good experience with all callers, Brault’s Patient Service representatives are equipped to answer patient questions quickly and accurately, with a high level of empathy and professionalism. With instant access to contract summary, charity care, and billing policy information, reps can work with patients’ insurance companies to maximize benefits and minimize out-of-pocket costs. Patients also receive informed insight into factors that may affect their bill, a service which helps to deepen their understanding and lessen frustration and anger. Throughout the day, managers routinely monitor incoming calls. This helps them evaluate staff’s knowledge and performance, and determine whether additional training or support may be required. To assure and maintain a high quality of service, every call is digitally recorded and reproducible for up to 60 days.
Convenient Phone or Online Payments
With Brault’s digital capabilities, patients can opt to get billing information and payment status 24 hours a day. Through patients’ manual keypad entries, the system confirms account number and identity to assure secure, timely access.
Online Statement Review
An additional patient convenience is Brault’s 24-hour, online statement review and payment processing system. Instructions printed on their billing statements remind patients that they may visit the secure site www.erstatement.com and, using a unique, personalized password, view account status and make credit card payments. Patient self-service can help speed and increase collections. It can also eliminate excessive calls to the billing office, thus increasing cash flow and reducing your service load.