How Does It All Work?

Do I need to have the same scheduling system or electronic medical record as MedFocus? 

No.  While many of our clients use the same software as MedFocus, our flexible work solutions allow clients to keep the system that makes sense for their practice work flow.  Read more about how we work with different systems here

 

How do I get my charges to MedFocus?

We can receive charges in multiple ways, depending on the processes in place at the clinic.  We have numerous data interfaces that stream data into our billing system from client software.  Other clients send a charge file from their software via a secure internet drop site.  Some clients scan and transmit their data, and still others transport registration forms and fee tickets via mail or courier.

 

Who does the coding?

We have certified coders on staff and offer full-extraction coding services for clients who choose this option.  Alternatively, many of our clients either code in-house or outsource their coding to a third-party coding company.  As an option, clients often choose to code their own claims and bring in MedFocus to periodically do chart audits or provide education on topics such as modifiers or incident-to billing for PAs and nurse practitioners. 

When clients provide us with codes, we work very closely with the physician or coder.  We request clarification if a code is caught in our pre-submission audit process or denied from the payor, so that we can correct or appeal the claim where appropriate.  We also send our clients regular denial summary reports so that the coder and practice leadership can ensure compliance and determine where true and accurate code methodologies can improve payment. 

 

Do I have to change my bank?

No, clients retain their existing banking relationship when working with MedFocus.

 

How are payments deposited?

As payers become more sophisticated, an increasing number of payments are deposited directly into the client's bank account, and EOB forms are sent to MedFocus for posting.  For other payments, we recommend that clients use a lockbox service from their bank, which allows for optimized cash flow and reduced processing. 

For clients who do not have a lockbox, payments are received at MedFocus.  Once we post and balance the funds, payments are deposited directly into the client's bank account.  We courier funds to all major banks daily (U.S. Bank, B of A, Key, Wells Fargo, etc).   If a client banks with a smaller local bank or credit union, the bank courier schedule determines the frequency, generally weekly or semi-weekly.

 

How are refunds processed? 

We thoroughly research all credit balance accounts to ensure that a refund is correct and necessary.  Once the refund has been verified, all relevant account information is forwarded to clients to finalize payment.  Clients retain total financial control on outgoing funds.   

 

Is MedFocus a collection agency?

We are not a collection agency.  We provide extensive collection services on patient balances until the account becomes delinquent.  Once it is clear that the patient is not going to meet payment obligations, the account is forwarded to the clinic for final account decision or collection determination.  For all accounts assigned to collections, we have interfaces in place to electronically transmit accounts to all major local collection agencies via a secure portal. 

 

We believe that billing companies should be independent from the collection agency, to avoid the possibility of a conflict of interest.  Therefore, MedFocus clients contract independently with their agency of choice. 

 

What controls are in place for adjustments? 

MedFocus will automatically process "contractual adjustments" as directed by the Explanation of Benefit forms received by payors.  If we believe the contractual adjustment to be incorrect, however, we route the claim and process for prompt appeal.  Additionally, clients authorize thresholds in writing for process-related adjustments such as aggregate small balance.  All other adjustments, including collections, bad debt and charity, are authorized in writing by the clinic.  MedFocus does not make discretionary adjustments to patient accounts. 


Does MedFocus negotiate contracts? 

We have extensive experience working with payor contracts.  However, legal counsel has repeatedly held that multiple, independent physician contracts with common payors should not be negotiated by a single party, to avoid the appearance or actuality of price fixing between the physicians.  The exception, of course, is messenger-model IPA organizations, where the physician panel and contracting efforts are transparent.

MedFocus works closely with clients to maximize their contracts.  We have tools for organizing, categorizing, and monitoring contracts, which is often the biggest step.  We also share experienced insight on negotiation strategies, and provide data on prior payor performance that can be an invaluable tool in the negotiation process. 

Measuring Performance

Starting the Revenue Cycle
Measuring Account Performance
Supporting Good Management

Will Outsourcing Work For Your Practice?

At MedFocus, we seamlessly integrate with your existing processes. 

Find Out How It Works Here

What Clients Say...

 

A note of thanks to MedFocus who has supported billing and reimbursement for our three clinics.  From the cost assessment process through implementation and ongoing services, staff members and the systems at MedFocus have provided us with excellent support.   

 

Multi-Specialty Surgical Practice