4D Global

BACKGROUND

Please describe your company and position.

I am the Managing Director of LogicRCM

Describe what your company does in a single sentence.

We provide medical billing services. 

OPPORTUNITY / CHALLENGE

What specific goals or objectives did you hire 4D Global to accomplish?

• Charge entry
• Payment Posting
• AR follow up

SOLUTION

How did you find 4D Global?

Online Search

Why did you select 4D Global over others?

Pricing fit our budget

How many teammates from 4D Global were assigned to this project?

2-5 Employees

Describe the scope of work in detail. Please include a summary of key deliverables.

The scope of work for medical billing involves a series of tasks and processes designed to ensure that healthcare providers are reimbursed for services rendered. It covers everything from submitting claims to insurance companies to following up on unpaid or denied claims. Here's a breakdown of the key responsibilities involved:

1. Patient Information Collection
Demographic Information: Collect patient data such as name, date of birth, insurance details, address, and contact info.
Insurance Verification: Verify the patient's insurance eligibility and coverage, checking for active coverage, co-pays, deductibles, and any restrictions.
2. Coding and Documentation
Medical Coding: Assign the correct ICD-10 (International Classification of Diseases) codes, CPT (Current Procedural Terminology) codes, and HCPCS (Healthcare Common Procedure Coding System) codes based on the diagnosis and procedures performed.
Ensuring Accuracy: Ensure all codes align with the clinical documentation provided by the healthcare provider to avoid errors or claim denials.
Up-to-Date Knowledge: Stay current on coding updates, payer-specific rules, and regulatory changes.
3. Claim Submission
Insurance Claims: Submit clean, accurate claims to insurance companies or government payers (like Medicare or Medicaid).
Electronic vs. Paper: Most claims are submitted electronically, but paper submissions may still be required in some cases.
Timely Submission: Adhere to payer-specific deadlines and guidelines to ensure claims are filed within the required timeframe.
4. Claim Follow-up
Claims Monitoring: Track claims through the submission process and ensure they are processed in a timely manner.
Denial Management: If claims are denied, investigate the reason for denial, correct any errors, and resubmit the claim or appeal the decision.
Communication with Payers: Communicate with insurance companies to resolve issues such as underpayment, overpayment, or denial.
5. Patient Billing
Patient Statements: After insurance payments are processed, generate bills for patients, outlining their responsibility (e.g., co-pays, deductibles, or coinsurance).
Payment Plans: Offer patients payment plans if necessary, and manage the payment collection process.
Collections: If payments are overdue, follow up with patients to collect outstanding balances.
6. Compliance and Regulatory Adherence
HIPAA Compliance: Ensure that all billing processes are compliant with HIPAA regulations, particularly regarding the privacy and security of patient information.
Payer Requirements: Stay up to date with the specific billing requirements of each insurance provider, including required documentation, forms, and deadlines.
Fraud Prevention: Detect and prevent fraudulent activities, such as upcoding, unbundling, or falsifying claims.
7. Reporting and Analysis
Revenue Cycle Management: Monitor and report on the practice’s overall financial health, focusing on metrics such as collections, denial rates, and accounts receivable.
Financial Reports: Generate regular reports to assess the status of unpaid claims, track reimbursement, and provide insight into operational improvements.
Adjustments and Write-offs: Adjust or write off balances as needed based on payer policies or patient financial circumstances.
8. Patient Support and Communication
Answering Billing Inquiries: Handle patient queries related to their bills, insurance coverage, or payment plans.
Dispute Resolution: Assist patients in resolving any billing disputes or issues with their insurance companies.
9. Appeals and Reconsideration
Appeals Process: If a claim is denied, investigate the reason and initiate the appeal process, which may involve submitting additional documentation or revising codes.
Resubmission: Correct and resubmit claims where necessary, ensuring that all documentation and coding are accurate and in compliance with the payer's guidelines.
10. Credentialing and Contracting
Payer Contracts: Ensure that the healthcare provider has the proper contracts with insurers to be reimbursed at the correct rates for services rendered.
Credentialing: Verify and maintain up-to-date credentials for the provider with various insurance companies and government programs.
11. Training and Education
Staff Training: Provide ongoing training to staff on coding, billing software, payer rules, and changes in regulations.
Keeping Up with Changes: Educate the team on any changes in medical billing laws, coding updates, or payer-specific guidelines.
Tools and Software Utilized
Billing Software: Medical billing software such as Epic, Cerner, or smaller solutions like Kareo, AdvancedMD, or NextGen.
Electronic Health Records (EHR): Integration between EHRs and billing systems is crucial for accurate claims submission and coding.
Clearinghouses: Use of third-party clearinghouses to submit electronic claims and receive responses from payers.

RESULTS & FEEDBACK

What were the measurable outcomes from the project that demonstrate progress or success?

Measuring progress in medical billing can be done through various key performance indicators (KPIs) and outcomes. These indicators can reflect the efficiency, accuracy, and overall performance of the billing process. Here are some measurable outcomes that can show progress in medical billing:

1. Claim Denial Rate
Description: The percentage of claims that are denied by insurance companies.
Goal: A decreasing denial rate over time shows improvements in accuracy and completeness of claims submitted.
Target: Ideally, aim for a denial rate under 5%.
2. First-Pass Resolution Rate
Description: The percentage of claims that are accepted by insurers on the first submission without requiring corrections.
Goal: Increasing this rate indicates better claim preparation and submission quality.
Target: A good target is over 90%.
3. Average Days in Accounts Receivable (AR)
Description: The average number of days it takes for the practice to collect payment after a claim is submitted.
Goal: Lowering this number shows that payments are being processed more quickly and efficiently.
Target: Typically, aim for 30 to 45 days or lower.
4. Collection Rate
Description: The percentage of outstanding balances that have been successfully collected.
Goal: An increase in the collection rate indicates better follow-up on unpaid claims.
Target: Aim for over 95% of collectable balances to be collected.
5. Charge Capture Accuracy
Description: The accuracy of charges entered into the billing system, compared to services provided.
Goal: Improving charge capture accuracy means fewer under-billed or missed charges.
Target: This should be as close to 100% as possible.
6. Claim Rejection Rate
Description: The percentage of claims rejected due to incorrect or incomplete information.
Goal: A declining rejection rate signals improvements in the completeness and accuracy of the claims process.
Target: Ideally, a rejection rate of less than 3%.
7. Payment Posting Accuracy
Description: The accuracy with which payments are posted to patient accounts.
Goal: Increased payment posting accuracy reduces errors and rework, improving overall efficiency.
Target: Aim for over 98% accuracy.
8. Patient Payment Responsibility
Description: The portion of a patient’s bill that is collected at the point of service or shortly after.
Goal: Higher rates of patient collections at the point of service can help improve cash flow and reduce AR days.
Target: Aim for 30–50% of patient payments collected at the time of service.
9. Coding Accuracy
Description: The rate at which claims are coded correctly according to current coding standards (ICD, CPT, HCPCS).
Goal: A high coding accuracy rate indicates that claims are being submitted with the correct codes, which reduces the chances of denials or rejections.
Target: Aim for 98% or higher coding accuracy.
10. Refund Rate
Description: The percentage of payments that need to be refunded to patients or insurance companies due to billing errors.
Goal: Reducing the refund rate indicates that billing practices are more accurate and fewer overpayments are being made.
Target: Ideally, this should be as low as possible (close to 0%).
11. Time to Payment
Description: The average time it takes from the submission of a claim to receiving payment.
Goal: Shortening the time to payment means quicker reimbursement and healthier cash flow.
Target: Aim for 30–45 days for clean claims.
12. Patient Satisfaction with Billing Process
Description: Patient feedback on the billing process, often measured through surveys.
Goal: Improving satisfaction indicates that the billing process is transparent and easy for patients to navigate.
Target: A high satisfaction rate (typically 90% or higher) shows progress.
13. Billing Staff Productivity
Description: The number of claims processed or tasks completed by each billing staff member in a given period.
Goal: Higher productivity, with maintained or improved accuracy, shows better efficiency and workflow.
Target: Set specific targets based on team size and workload, but aim for increasing output without sacrificing quality.
14. Bad Debt Write-Offs
Description: The percentage of accounts receivable that is deemed uncollectible and written off.
Goal: A declining bad debt write-off percentage shows that the billing team is improving in collecting payments and reducing uncollectible balances.
Target: Bad debt should be kept as low as possible, typically under 5% of total revenue.
15. Revenue Cycle Cycle Time
Description: The total time it takes for a practice or facility to go from patient intake to final payment.
Goal: Reducing the overall cycle time indicates more efficient handling of claims and faster reimbursement.
Target: Ideally, aim to reduce cycle time to 60–90 days.
16. Compliance with Payer Requirements
Description: The degree to which billing complies with payer guidelines, including documentation, coding, and submission processes.
Goal: Ensuring compliance helps reduce denials and rework, leading to faster claim approvals and payments.
Target: Full compliance with payer requirements for all submitted claims.

Describe their project management. Did they deliver items on time? How did they respond to your needs?

The 4D Global team has been responsive to our needs. When given goals and guidance, the  team is focused on completing the taks given.  

What was your primary form of communication with 4D Global?

Virtual Meeting

What did you find most impressive or unique about this company?

I am inpressed with the auditing of the work to insure the team is delivering qualirty service.

Are there any areas for improvement or something 4D Global could have done differently?

Nothing additional to add currently.

BACKGROUND

Please describe your company and position.

I am the SVP of Client Services of Parsons Medical

Describe what your company does in a single sentence.

Provides full RCM services for 40+ clients across the country

OPPORTUNITY / CHALLENGE

What specific goals or objectives did you hire 4D Global to accomplish?

• Data entry/charge entry of encounters
• Review and working of old AR - outstanding claims needing resolution
• Reporting of client metrics/ internal workflow
• Posting of manual payments and uploaded ERAs
• Tracking of EDI rejected claims and corrections

SOLUTION

How did you find 4D Global?

• Online Search
• Referral

Why did you select 4D Global over others?

• Pricing fit our budget
• Great culture fit
• Company values aligned

How many teammates from 4D Global were assigned to this project?

6-10 Employees

Describe the scope of work in detail. Please include a summary of key deliverables.

Team is separated between two departments: Data entry/charge entry and AR follow-ups. Team reviews superbills/charges received by an array of areas. This includes: uploading documentation to practice management software, reviewing charges for front end edits, and manually key in charges from rosters/superbills. Daily charge capture reports sent with weekly updates. The same process is used for manual EOB payment posting and ERA batch postings. 

The AR follow-up team pulls monthly reports to identify outstanding claims where payments have not been received. Team works based on set rules for corrections to claim denials and rejections. Team will also utilize online web portals and call insurances to identify denial trends and claims that may not be on file. Weekly AR reports are provided to show productivity anad areas staff need advisement on. Monthly "KYI" reports are furnished to show trends and full AR analysis.ollow-up

RESULTS & FEEDBACK

What were the measurable outcomes from the project that demonstrate progress or success?

• Speed of claim submissions along with lower measurable front end rejections. 
• Speed of manual payment postings along with audit reports showed positive movement in time studies. 
• Lower accounts receivables due to AR work and higher revenue from older claims that were previously denied.

Describe their project management. Did they deliver items on time? How did they respond to your needs?

The entire team at 4Dglobal is very responsive, often time within 24 hours. Requests are handled timely and meetings are scheduled with agendas and action items. Meeting minutes are supplied along with weekly production reports. The response is always pleasant as the team is very eager to assist in any way possible.

What was your primary form of communication with 4D Global?

• Virtual Meeting
• Email or Messaging App

What did you find most impressive or unique about this company?

The weekly reporting and outlined follow ups. Monthly reports and QA reports provide clear metrics.

Are there any areas for improvement or something 4D Global could have done differently?

Not at all! The relationship has been a very positive one.

BACKGROUND

Please describe your company and position.

I am the Manager of a medical company

Describe what your company does in a single sentence.

We have perfected the art and science of medical billing and healthcare consulting

OPPORTUNITY / CHALLENGE

What specific goals or objectives did you hire 4D Global to accomplish?

• Data Entry
• AR

SOLUTION

How did you find 4D Global?

Referral

Why did you select 4D Global over others?

Company values aligned

How many teammates from 4D Global were assigned to this project?

2-5 Employees

Describe the scope of work in detail. Please include a summary of key deliverables.

• Data entry/payment posting. 
• Balancing of batches. 
• AR follow up to included notes and required follow up

RESULTS & FEEDBACK

What were the measurable outcomes from the project that demonstrate progress or success?

ongoing process and we are extremely happy with 4D and their timeliness to issues/concerns

Describe their project management. Did they deliver items on time? How did they respond to your needs?

Above and beyond outstanding service

What was your primary form of communication with 4D Global?

Virtual Meeting

What did you find most impressive or unique about this company?

I was impressed with their willingness to help us and maintain a great flow of data and continuous communication/s.

Are there any areas for improvement or something 4D Global could have done differently?

NO

OPPORTUNITY / CHALLENGE

Why does your company require back office services? Did you use to handle these needs in-house?

This service provides people who hold jobs in back office positions and can carry out functions such as settlements, clearances, record maintenance, regulatory compliance, accounting, and IT services. I think that it provides solutions to many problems.

SOLUTION

What do they provide for you on a normal basis?

They help with staffing projects, managing retirement plans, managing health insurance plans, and recruiting personnel.

Could you describe their pricing structure and how they bill you?

We have a long-term business package.

How did you find and select them?

We decided on them through reviews, searches, and social media.​​​​​​​

RESULTS & FEEDBACK

Please assess their quality of work.

Their quality of service is excellent. It´s getting better every day.

How much time and money do you estimate that they save you each month?

They save us $100,000.

Based on your experience, what takeaways can you share about working with them?

It's the best way to manage billing services. It is more efficient, unique, and easy.​​​​​​​

What do you think are their strengths?

Their strengths are their focus on the core components of your business, their immediate access to services and technology, their reduced cost, and flexible resource management.​​​​​​​

Where do you think they can improve?

Their service is great, in my opinion. There are no areas for improvement.​​​​​​​

OPPORTUNITY / CHALLENGE

Why does your firm need back office services? Did you use to handle these needs in-house?

We had not handled back office work in-house before, and needed help.

What types of work can your internal staff avoid by utilizing a back office service?

We can avoid about 25% of work that could slow our staff down.

What challenge were you trying to address with the service provider?

We needed to save time.

SOLUTION

What was the scope of the service provider's involvement?

We use their medical billing services.

Could you describe the service provider's pricing structure and how they billed you?

We use a short-term system.

How did you come to work with this service provider?

We conducted an online search.

How would you assess the service provider's ability to turn around quality work quickly, their client service, and communication.

They help our revenue.

How much time and money does this service provider save you each month?

They save us approximately $10,000 every month.

RESULTS & FEEDBACK

What takeaways and measures of success can you share about working with this service provider?

They helped improve our revenue.

What are the service provider's strengths?

Their assistance in ensuring accurate work is a strength. They also improved our revenue.

What areas can the service provider improve?

I have nothing to provide.

How long has your company been working with this service provider?

We began working with them in 2016.

How much money do you spend annually with this service provider?

It is in the $10,000 to $49,999 cost bracket.

OPPORTUNITY / CHALLENGE

Why does your firm need back office services? Did you use to handle these needs in-house?

I always want something more than what I originally ask them to do.

What types of work can your internal staff avoid by utilizing a back office service?

We can only avoid about 10%.

What challenge were you trying to address with the service provider?

Our goal is to avoid work that is not core.

SOLUTION

What was the scope of the service provider's involvement?

We always have a high amount of unpaid medical bills and the unpaid amount is constantly rising.

Could you describe the service provider's pricing structure and how they billed you?

It's a short-term need.

How did you come to work with this service provider?

I got a personal referral from someone that didn't want me to share this firm since it's a hidden secret.

How would you assess the service provider's ability to turn around quality work quickly, their client service, and communication?

I measure success by how hard they work and how they get along with our internal staff.

How much time and money does this service provider save you each month?

I think $40,000 per year.

RESULTS & FEEDBACK

What takeaways and measures of success can you share about working with this service provider?

I started my business in high school and it's going very well. They help us grow even more.

What are the service provider's strengths?

I think they're going to be a success.

What areas can the service provider improve?

Yes, we are working to improve.

How long has your company been working with this service provider?

I'm not sure.

How much money do you spend annually with this service provider?

It's $200,000 to $999,999.