About Our Services
Table of Contents
Introduction & Services Summary.....1
Privacy & Security Compliance.........1
Legislative Changes .....................2
Training...................................2
Leading Edge Technology..............2
Transmitting Data & Information......2
Ready For The Future..................2
Automated Case Management Software (ACM)....3
Skilled Eligibility Personnel
& Higher Productivity....3
Reporting Results........................................3
Third Party Assistance Eligibility Services (Medicaid, & more)......4
What We Do...........5
How We Do It.........5
We Customize Our Process for You .......................5
Patient Processing...........................................6
Home Visits & Courtesy Transportation...................7
Patient Advocacy............................................7
Account Follow-Up...........................................7
Billing Support.................................................7
Early Out Collections (Low Balances)......................7
What We Do..................................................7
How We Do It.................................................8
Executive Bios (Vitas) 9
INTRODUCTION
Who is The MARS Group? Financial Assistance & Billing (FAB)
Medical Accounts Receivables Services (MARS)
The MARS Group has been providing financial services for medical providers since 1989. Our services have allowed hospitals to recover lost opportunity for revenues and helped eliminate the total number of full-time employees (FTEs) in administrative staff positions.
1. Third Party Assistance – Eligibility screening for all uninsured patients, self-pay, indigent, etc., to process their applications for Medicaid, SSI/SSD, Crime Victims, state, county and other funds or charity programs. These services are provided through our FAB division. We are committed to patients as their advocate and representatives to identify funds to pay the hospital as well as providing information about possible household qualification for other programs, i.e., food stamps, WIC, etc. We handle all aspects of applications from beginning to end, including denials management. Our attention to detail and follow-up sets us apart from our competitors. Our communication with the hospital billing office when applications are approved includes immediate notification of approval and follow-through until account is billed and paid.
2. Early Out Collections – We will provide collection services for all patient accounts under a minimum of $5,000 so that your FTEs can focus on larger accounts. This includes all third party categories: insurance, Workers Comp, Medicare, Medicaid, etc.
3. Billing Services – We will provide billing office services on either a temporary basis or a long-term outsourcing basis (e.g. 1 or 2 employees for 2-weeks or 5 or more employees 1- to 3-years). We perform clean up projects, or routinely submit all electronic and paper claims to Medicare, Medicaid, Commercial Insurance; generate for all invoices and resolve payment problems; provide customized reports; handle all appeal processes; provide support including resolving questions from patients relating to billing and reimbursement; and Superbills with patient demographic forms including assignment and release statements. Our eligibility screening, early out collections and billing services are provided on a highly competitive contingency fee arrangement. Privacy and Security Compliance:
Each hospital customer receives required HIPAA documentation regarding our compliance at the beginning of each engagement. We have performed appropriate surveys and are complying with HIPAA Privacy requirements applicable to our Business Associate services. All employees have been trained, tested and certified online in the HIPAA Privacy rules by www.netraversity.com. Legislative Changes
Critical and important legislation affecting patient billing, collection or third party assistance programs is a vital part of our business. We communicate regularly with our state representative and other state officials. We are members of and actively participate as volunteers in various non-profit organizations and attend public meetings of many others not shown here:
Healthcare Financial Management Association (HFMA) which provides members regular e-mail updates containing direct links to read regulatory “just published” CMS Final Rules as soon as available, and a wealth of resources online for research of legislative initiatives and existing rules. HFMA schedules regular meetings for the purpose of hosting speakers who provide updates on new legislation and proposed legislation, e.g., American Hospital Association executives. American Association of Healthcare Administrative Management (AAHAM) actively represents the interests of healthcare administrative management professionals through a comprehensive program of legislative and regulatory monitoring and its participation in industry groups such as ANSI, DISA and NUBC. Training
Third Party Assistance Program Training: FAB hires experienced Caseworkers and reinforces third party assistance program education with review meetings conducted by their supervisor at the site, specifically for training in changes to existing program rules and legislation. Site Supervisors conduct on-going training for Caseworkers comprised of bulletins that publish legislative and rule changes from CMS, and state agencies when changes are finalized. We utilize each state’s Bulletins received from appropriate state websites for downloading them and federal manuals from the site provided, http://www.cms.hhs.gov/manuals. Collections Training: Our collections staff has acquired familiarity with the following main sources used in developing our collections knowledge base and training. ACA International, Fair Debt Collection Practices Act (FDCPA) Seminar Manual, ACA Minneapolis. ACA International, Professional Telephone Collectors' Techniques, ACA Minneapolis
ACA International, HSP Terminology Glossary, ACA, Minneapolis. Leading Edge Technology
Leading edge technology and custom-created software are used in the performance of The MARS Group’s line of services. We follow all the requirements of HIPAA. Any of our services can be conducted at our client hospital site or offsite across our VPN/LAN/WAN/Network. Transmitting Data and Information
Accounts referred to us can be transmitted using any electronic means the hospital designates. We can receive or transmit data utilizing highly automated, high speed data transmissions through Electronic Data Interchange (EDI), spreadsheets or any and all data formats hospitals use for this purpose. Ready for the Future with FAB
Our technology has been developed for screening self-pay patients to identify possible Medicaid qualification and has been used successfully several years. This development, created by our in-house dedicated team of computer professionals places us at the forefront of capability to submit electronic Medicaid applications whenever states announce the acceptance of electronic claims. Our current electronic links to state Medicaid agencies provide the means to check daily for patients who have existing Medicaid benefits. Automated Case Management Software (ACM)
Our technology team has designed, written and implemented a highly customized eligibility software program that performs Automated Case Management (ACM) functions specifically for our FAB division’s eligibility caseworkers’ use, whether onsite or offsite. There is never any charge to clients for the use of this software. Our software was created to assess self-pay patient eligibility using screening functions to identify possible Medicaid recipients and keep records for the hospital in real-time accessibility for reporting purposes. We have the capability to perform all necessary review functions for case or account management, including reviews of medical records and application processing, tracking, reconciliation and reporting. One ACM feature generates letters in English or Spanish:
1. Any required letters to patients in either English or Spanish
2. Letters to reiterate the list of appointments between patient and state Medicaid staff
3. Letters to the patient’s physicians containing approved Medicaid certifications
Caseworker’s case notes are automatically updated in the hospital system’s patient record via data from our ACM records for daily accessibility by hospital staff. In addition, our ACM software and its reporting capabilities allow daily reviews by FAB Operations Supervisors for purposes of identifying any unforeseen peaks or valleys in accounts handled at any one site by any one caseworker. Operations oversight is the key to maintaining high productivity and preventing any one caseworker from experiencing over- or under-utilization. Caseworkers are monitored for both productivity and quality. Skilled Eligibility Personnel & Higher Productivity
After 15 years in the eligibility field, FAB’s management and seasoned caseworkers have accumulated a vast body of eligibility knowledge that can be easily shared in answers to any questions from any caseworker via our network. Plus, our leading edge technology provides the tools for higher productivity among our skilled caseworkers. Reporting Results for Eligibility Services
Reporting results for our Eligibility Services is the outcome of our ACM software utilization. Our reports quickly identify our successes in managing self-pay accounts starting with the screening process up through final payments to the hospital. Value added features of ACM allows reconciliation of accounts for hospital reports and more importantly, the ability to track accounts from receipt through final determination and verification that each account has been billed and paid. Our highly detailed reporting and follow-through with the hospital billing staff has been the most significant contribution to our success with clients who want quantifiable results. Reporting from our ACM software has been made simple and meaningful for hospital business offices and their upper management. We customize both frequency and content of our reports to fit the needs of each client. Over the years we have developed some standardized reports that most hospitals find useful, however, there are always specialized needs that we can quickly satisfy through “slice and dice” the data capabilities in our reporting software. A few standard reports are listed below and can be provided Daily, Weekly, Monthly, Quarterly, Annually:
Accounts Referred to MARS
Aging Reports
Net Conversions
Inventory
Certifications by Payer
Reconciliation
Home Visits
Returned Accounts
And many others
Sorts or filters for any data elements to create reports the hospital needs can be quickly accomplished, e.g., patient name, Social Security number, account referred date, medical record number, etc. Reconciliation reports or any customized reports can be provided easily. Often, hospitals desire reports that are sorted by data elements we use to track application processing and approvals/denials, e.g., date of Medicaid certification, certification number, date of denial, denial code, Medicaid Add date, and many, many more. Third Party Assistance (TPA) for Self Pay Patients
Financial Assistance & Billing (FAB) case workers screen self-pay patients at admission to become the patient’s advocate to find Third Party financial assistance from Medicaid and all other sources. We distinguish ourselves from our competition by providing detailed follow-up plus by offering a slightly different yet highly competitive contingency fee arrangement that allows the hospital to realize higher returns on overall total payments made to the hospital. Our highly skilled eligibility case workers can help patients — and hospital staff — navigate the myriad programs and multitude of forms that can be necessary to maximize the hospital’s Third Party reimbursement. Our success has been accomplished by using skilled personnel and advanced technology that produces high productivity levels in obtaining certifications and approval of funding. We maintain a patient sensitive approach while guiding them through the process of applying for medical public assistance. The only requirement of the patient is their cooperation throughout the screening and eligibility process in order to receive the public assistance available to them. We let the patient know that we are there to assist them on behalf of the hospital and that we want to help. FAB utilizes a unique approach to assist self-pay patients in obtaining benefits to all third party resources available. After the patient is screened, FAB becomes an authorized representative of the patient when dealing with Medicaid and all other resources available. FAB’s representation includes the following activities:
home visits to assist in gathering information (if necessary)
forms processing
acquiring proper verification
denial appeals
assistance with applications for any charity programs the hospital may offer
assisting patients with applications for food stamps, WIC, or other government financial assistance
guidance and counseling through the entire process
Our philosophy has been to build long lasting and productive relationships with our clients based upon personal service and dedication to quality. This philosophy has earned us an excellent reputation in the healthcare industry. We deliver the verifiable results that make strong relationships. Our agreement contains a “Hold Harmless Clause,” that indemnifies our hospital clients against any claims arising from our third party assistance procedures. Our company and our employees are fully bonded and insured for the protection of our clients. What We Do:
We will screen all self-pay patients to determine eligibility for one or more medical third party assistance programs and provide extensive follow-up through final determination. This includes all federal, state and local funding sources and local charity programs. FAB will furnish all personnel, information technology hardware and software, and materials to fulfill our obligations. We assume sole responsibility for all aspects of the eligibility screening process, including problem resolution with denials and appeals. FAB will:
1. Screen all referred accounts.
2. Perform all necessary follow-up work.
3. Submit monthly reports as required.
4. Provide written receipt of referred accounts.
5. Coordinate all efforts with the business office. Our Automated Case Management (ACM) software creates customized reports for management, i.e., Administrative Reports, Productivity Reports, and Financial Reports upon request. Other reports can be custom designed to your specifications. This software can be made available on designated hospital staff’s computers at no charge. This will allow the business office to run reports at their convenience from live data on all referred accounts. We assist you in determining which reports you want and their frequency. The following are some of the standard reports available:
Master Status Report
Accounts Receivable Report
Social Security Status Report
Approval Status Report (Itemized Invoice)
Account Pending Status Report
Return and Denial Report
Custom reports as needed
How We Do It:
We customize our process for you
As one of our initial tasks FAB will review your policies and procedures for admitting, billing, collections, bad debt and charity write-offs. Our review allows us to design our work plan best suited for your hospital’s unique needs. The objective of this work plan is to have a smooth transition with the hospital and staff at implementation time and thereafter. Our caseworkers will coordinate our efforts with your financial counselors and/or State caseworkers. Always our shared objective is getting patients screened, processed and certified for medical public assistance expeditiously. We will concentrate on increasing efficiencies in areas such as verification of residency, citizenship, income and resources. FAB is able to do this through the skills of our caseworkers. FAB will provide all the appropriate hardware, software, manuals, and on-site expertise to ensure that all patients are screened for every potential program available. You will need to provide appropriate workspace and access to a telephone. Once all this is in place, FAB will be able to begin screening and getting patients certified for assistance. FAB is proposing to position our eligibility caseworkers as close as possible to your business office operation or admitting area. This will prove to be a great asset to the success rate for eligibility by allowing immediate contact with the patient and family. Immediate contact with the patient increases our success rate by increasing patient participation. This also helps assure that no deadlines will be missed. We are proposing to process all patients referred to us in the most efficient manner possible. The type of admission is going to dictate the priority in which the account will be worked. Inpatients are be the highest priority because of accessibility to the patient. In order for our workers to effectively and efficiently process all referred patients, the following data is imperative and needed from the hospital; copy of general patient demographic screen, copy of hospital case notes, copy of financial screen, and hospital daily census report. FAB should receive its daily referrals via admissions or the business office upon registration. Our case worker(s) will process all patients referred within a twenty-four (24) hour period from the point of referral. This timely processing is vital, as our success rate relies on early patient participation and cooperation. We will provide the Business Office, on a scheduled basis, a complete copy of all patients referred. Upon need or request, we can also staff the Hospital/Emergency Room on weekdays, weekends, and holiday schedules as mutually agreed upon. Patient Processing
FAB will attempt an initial screening at one of the following; patient’s bedside, FAB Office, after discharge through phone contacts and/or home visits. Timeliness in processing of the referred accounts is a critical factor to complete the application and filing of the account with the appropriate agency(s). Upon contact with the patient or family, Informed Consent For Release Of Confidential Medical Records / Medical Information allowing FAB to be the representative of record will be signed. We will also request that the patient, guardian, or immediate family member also sign an Authorization To Release Information (Department of Human Services), Permission To Release Facts About Social Security Record and other necessary forms. At this point our caseworkers will begin the screening of referred patients to identify which third party programs will be applicable to the patient as well as the patient’s household. Screening for eligibility will be accomplished by the workers knowledge of programs. After completion of the initial screening, our case worker(s) will make the determination as to the necessary action to be taken. At the successful completion of all necessary steps, we will supervise the submission of the application to the appropriate local, county, state, federal or private funding source. FAB structures the application for maximum coverage on the patient’s behalf and for the most favorable position, as well for your maximum reimbursement. If an account is denied SSI, FAB will take the appeal to the Administrative Law Judge hearing if necessary. Home Visits & Courtesy Transportation
When all attempts to contact the patient have failed, our caseworker will attempt a home visit. When the worker makes the home visit and is unable to speak with the patient or family member, he will leave a letter. This letter will inform the patient that it is imperative that our office be contacted so that we may help in locating an assistance program to take care of their medical bills. In the event that the patient is available then the worker will screen the patient at home using a laptop computer. We will also perform a home visit when all that is needed for certification of a patient’s account is documentation. In the event that the patient informs our worker that they are in need of transportation to their appointments for certification purposes, we will provide that transportation to the patient at no cost. This applies to appointments and appeals for SSI, the Crime Victims Program as well as the Medicaid appointments. Patient Advocacy
After the screening we will inform the patient that they may be eligible to receive assistance for their medical bills as well as informing them of any other assistance identified. These other programs may include Hospital Charity, AFDC Grants, Food Stamps, and WIC. Account Follow-Up
FAB Caseworkers will perform follow-up functions necessary for tracking the status of applications at third party agencies. This follow-up is essential when the application is in a pending status and thus requires more verification of documentation before certification can be attained. The patient is given a list of all documentation needed for verification after the evaluation process. This is done to ensure that when the patient attends their appointment all necessary information and is presented for certification. There are several other circumstances that could arise causing the rejection of a patient’s application and we provide the diligent follow-up that is crucial in obtaining certification. When denials occur, we will submit to the appropriate agency the policy and guidelines that justify why the patient should qualify. Billing Support
At the point that third party certification is completed, FAB will verify the coverage information and obtain all the necessary billing data, which will be submitted to the appropriate billing staff. Approvals will be submitted to the business office on the FAB Inventory Report. Our case worker(s) will monitor all billing claims to insure timely processing by the hospital, thus assuring that no claims go beyond filing deadlines. Advantages to Hospital
Hospital staff can concentrate on the insured patient population insuring they are maximizing reimbursement and cash recoveries. MARS staff will insure they certify any eligible patient for some assistance. End Result to the Hospital
Increase in Cash Flow
Reduced Accounts Receivable Days
Reduced Bad Debt
Reduced Self Pay A/R
Improve community Relations because we are helping patients. Early Out Collections
What We Do:
The Early Out program allows The MARS Group to act as an extension of the hospital business office for accounts defined by the hospital as “small accounts.”
Early Out is meant to complement the collection efforts of your business office, allowing your staff to concentrate on the larger balances and may even reduce the number of full-time employees (FTEs) for the department. How We Do It:
After your staff bills all the accounts, which includes Medicare, Medicaid, and commercial insurance and then our personnel does the follow up on the small accounts. The accounts are transferred to our staff immediately after your staff bills them. Under the program our collectors will work all accounts:
Third Party Insurance (Workers Comp, Commercial, PPO, and Blue Cross)
Medicare & Medicaid
Our collectors will receive Third Party Insurance accounts at 14 days from the final bill. These accounts consist of with balances under a set amount, e.g. $5,000.00 to 7,500.00 or whatever amount the business office defines for the program. Medicare and Medicaid accounts will be worked at 21 days from final bill, with balances under, e.g. $500.00. Advantages to the Hospital
Hospital collection staff can concentrate on larger accounts while MARS staff works the small balance accounts. Usually, the hospital staff concentrates on large balance accounts due to cash flow. The small balance accounts will flow through the system and end up at a collection agency, which will inevitably charge
A contingency fee of up to 25%. MARS services will prevent these accounts from reaching the collection agency and our fee is half of what a collection agency would charge thereby, offering the hospital savings while maximizing cash flow. End Result to the Hospital
Better management of the Accounts Receivable
Reduced Bad Debt
Reduced Accounts Receivable
Improved Customer Relations
Increased Cash Flow
VITAS
The MARS Group
Joe Guzman, Vice-President
Joe graduated from South Texas Business College with an Applied Sciences Business Degree. Joe started his career as a patient accounts receivable collector. He later transferred to the health information services department. Joe became the health information services director of a UHS hospital and was promoted to business office director, where he served the hospital for 15 years. Joe is a former member of the school board of his hometown. Cecil Albrecht, Chief Information Officer
Cecil graduated from Texas A&M University with a BS and an M.Engineering in Nuclear Engineering. He worked for General Electric and a Dallas consulting firm in the nuclear field. He founded Centauri Computer Systems, a Rio Grande Valley computer firm, in 1982. He has extensive experience in computer applications design, and is a Novell Certified Netware Engineer. Cecil is charged with providing FAB with the “cutting edge” automated collections capabilities at all times. He is active in church and community affairs, including past President of the McAllen Rotary Club. Cecil currently is located at our Dallas office.
