Healthcare Consulting

Services to Physician Practices | Services to Hospitals | Services to Hospital-Owned Physician Practices

The LBA Group is well known in Northeast Florida as a leading provider of consulting services to physician practices, hospitals and hospital-owned physician groups.   Our team of healthcare consulting professionals have decades of experience with strategic planning, regulatory and compliance issues, revenue enhancement and cost controls, office staff evaluation and optimization and operational assessments.

As healthcare professionals backed by a highly accomplished financial and management team, we are dedicated to providing the highest quality personalized services and the most innovative financial and practice management advice to our clients. We are always ready to help, whether your need is to ease the burden of finding the right physician or staff person for your practice, to sharpen the skills of your office staff, or to analyze current operations and receive recommendations that will help you boost your bottom line.

Although The LBA Group has all of the experienced and knowledgeable resources to help you with the most challenging issues that confront you in our highly regulated and constantly changing business environment, you can be assured that you will receive the individual and personal attention you deserve. Working with you and your staff, we will clearly identify your needs and focus the correct expertise and tools on providing effective and efficient solutions with the least disruption to your business.

Your patients expect quality care from you. Why should you expect any less from us?

Services to Physician Practices

Strategic Planning

  • Practice mergers and acquisitions
  • Contract review/negotiations
  • Practice valuations

Regulatory & Compliance

  • Medicare coding and compliance (training, audits and reviews)
  • HIPAA compliance
  • Compliance program development and implementation
  • Federal inspection preparedness

Revenue Enhancement and Cost Controls

  • Accounts receivable management
  • Cost accounting services (based on RVUs)
  • Fee schedule analysis
  • Payer mix analysis
  • Overhead and production analysis
  • Budgeting and cash flow analysis
  • Revenue enhancement
  • Benchmarking

Office Staff Evaluation and Optimization

 

  • Employment recruiting and interviewing
  • Job descriptions
  • Performance appraisals
  • Salary reviews and employee compensation evaluations
  • Staffing ratios
  • Effective team building
  • Management skills training

Office Operational Assessments

  • Office reviews
  • Internal control audits
  • Chart audits (by Certified Coders) including:
    • Physician educational audits
    • EM guidelines
    • Medical necessity rules
    • Incident to rules
    • Operational flow reviews
    • Billing department/billing company reviews

Services to Hospitals

CDM Review

  • Accuracy of CPT/HCPCS and Revenue Codes assigned on the CDM;
  • Accuracy of CDM line item descriptions relative to services provided;
  • Identification of procedures or supplies used in various departments with different charges;
  • Identification of services provided and not charged;
  • Missing or inaccurate codes necessary for proper payment of devices;
  • Elimination of duplicate or unused items in order to reduce the charge master to a manageable size;
  • Meet with hospital leadership, department directors and appropriate staff regarding the recommendations and implementation of proposed changes.

Comparative Pricing Review – Hospital

Based on third party external pricing information we will develop a comparative schedule of charges by procedure for up to 15 selected facilities.  For each line item comparative charges will be arrayed by selected percentiles to which hospital’s existing charges may be compared and analyzed on a procedural level. The hospital’s CDM charges may then be adjusted by line item to fall within a specified range of the market levels identified.

In addition to the market analysis, we will also review all line items for the following parameters:

  • Same CPT in different departments
  • Time-based
  • With or without contrast
  • Right/left/bilateral
  • Medicare/Medicaid Fee Schedule
  • Logical – For example, that a 2 view chest x-ray is priced more than a 1 view chest x-ray.
  • Incorporate hospital’s internal cost data (if available) into model in order for cost to become one of the parameters in which the pricing is set, if requested.

Provide management with detailed reports regarding the gross and net impact of any changes that are recommended based upon the parameters set above and by management.

Assist hospital management via on-site meetings or conference calls with department directors to discuss the assumptions, parameters, and outcome of the comparative pricing project.

Outpatient Coding Review

Review hospital outpatient coding for accuracy and compliance.  Generally, we would look at a sample of claims to include Emergency Room, GI, Chemotherapy (if applicable) and outpatient surgical coding.  We would indicate if additional revenue opportunities exist or if there are needed changes in coding for compliance.

Loaned – Staffing

Temporarily assisting hospitals with coding & billing staff to assist in edit resolution and claim back log or other key positions in a hospital coding & billing department that needs filling while permanent hiring is in process.

Services to Hospital-Owned Physician Groups

Acquisition

  • Cash flow Projections for Community Need Physician Recruitment
  • Due Diligence and Practice Valuations

Compensation

  • Physician compensation Design and Modeling
  • Calculation or review of Physician Compensation Calculations

Compliance

  • Billing Department Reviews
  • Medicare Coding & Compliance
    • HIPPA Reviews and Training
    • Compliance Program Development & Implementation
    • Chart Audits by Experienced Certified Coders
      • Physician Education Audits
      • E&M Guidelines
      • Medical Necessity Rules
      • Incident To Rules 

Revenue Cycle

  • Revenue Cycle analysis to maximize collections
  • Operational Process Reviews
  • Accounts Receivable Management
  • Fee Schedule Analysis
  • Payer Mix Analysis
  • Overhead Production analysis
  • Benchmarking

Additional Services

  • Internal Control Review and Design
  • Third Party Administration of 401 (k)/Profit-sharing and other retirement plans
  • Retirement Plan Audits and Preparation of Form 5500
  • Concierge Services for physicians to include:
    • Benefits
    • Tax Planning
    • Financial Planning
    • Asset Protection Strategies