Compliance

At NetMD Business, we understand the value of compliance across the revenue cycle. Our philosophy is that compliance is best handled through careful attention to four items:

1. Documenting Policies and Procedures
We consider well documented policies and procedures as the primary tool for ensuring an appropriate compliance environment. We measure, evaluate and systematically improve processes through audits of the policies for credentialing, registration, billing, collection and claims processing.

2. Establishing Clear Contracts
Contracts form the basis of compliance. NetMD Business requires contracts between providers and insurance companies that are both clear and well documented. A well documented contract contains detailed information regarding eligibility for payment and a detailed fee schedule (see below). The contract is also vital to the credentialing process. Finally, ongoing contract management is important to ensure that copies of documents are easily accessible and stored in a secure environment.

3. Managing Fee Schedules
When you consider the number of different insurance companies that a provider may work with and the detail of the fee schedules for each insurance company, it is no wonder people have difficulty in the revenue cycle. Fee schedule management is a process that requires careful attention to detail in order to ensure that proper amounts are billed and correct codes are used in each transaction.

4. Verifying Billing and Collections vs. Fee Schedules
Once contracts are established and fee schedules are completed, the claims process can be initiated. However, NetMD Business believes that the work to ensure compliance is not complete. True compliance is achieved when two important metrics are monitored over time. The first metric is to compare actual billing records to the contracted billing values to validate a provider's compliance. The second metric is to compare actual payments to the contracted billing values to validate that a provider is being properly reimbursed.

Organization

To ensure compliance, NetMD Business employs a Chief Compliance Officer with 30 years of experience to manage risk, withholds and other non-fee for service payments. The Chief Compliance Officer is qualified in maintaining the most current and accurate procedures that ensure compliance to all applicable laws, rules, and regulations governing healthcare, coding and billing. This position regularly monitors the quality measures, indicators and company performance, comparing revenue-tracking goals versus actual results.