VISION ….. VALUE ….. RESULTS….. Service... · 3705 New Macland Rd., Suite 200-181 Atlanta, GA...

3705 New Macland Rd., Suite 200-181 Atlanta, GA 30127-1966 (O) 770.333.9405 (F) 770.333.9406 www.ppsosgroup.com

Where do you see your practice in 10 years?

We’ll help you get there! The Physicians Practice S.O.S. GroupTM is a healthcare consultingand education firm that provides long-range planning, practice assessment, new practice setup, auditing and training to physicians and their staff.

For over 20 years, our consultants have helped healthcare providers across the countrystreamline their billing process, improve patient flow, and keep current with ever-changingstate and federal guidelines.

Whether you’re preparing for a Federal, State, or Third Party Payer audit, searching for oppor-tunities to expand your practice or need educational services, our consultants can provide thetools and training you need.

Our extensive quantitative analysis generates comprehensive reports that identify yourpractice’s problem areas, as well as opportunities for expansion. Our consultants will help youand your staff fully understands the data collected and implement sustainable solutions.

Our Credentials: Over 20 Years in Experience Certified Medical Practice Managers Certified Professional Coders medical Billing Specialists Member of Medical Group Management Association (MGMA) Member of American Academy of Professional Coders (AAPC)

We hear your S.O.S. and will provide you with

VISION ….. VALUE ….. RESULTS…..


Baseline audits are preliminary assessments to develop a reference point. By performing anaudit in advance, your practice can identify improper billing and coding practices and makenecessary corrective actions prior to any government or third-party payer audit. This can helpyou save both time and money.

Our company is an approved government IRO (Independent Review Organization) which meanswe have been given the seal of approval from the government (CMS/OIG) as a complianceauditor.

What Does The Baseline Audit Package Include?

When we audit/review your records we look at the level of service billed as well as the ICD-9,and other CPT codes used. We will then provide you with a detailed report as to what we foundand give any recommendation as to what may need to happen moving forward.

In some cases we may recommend onsite group education and/or one-on-one provider trainingin which we may round/observe the visit with the provider and then guide/answer anyquestions after the patient visit.

Our process is easy and turn-around time is quick. After receiving the necessary information, areport will be delivered within 7-15 business days.

What We Need: 20-25 randomly selected records/progress notes per physician Copy of the printed CMS 1500 Form that goes with that days progress note Progress notes that are pulled should be from a range of services (i.e. new, established

office visit, consults and hospital visits) Include all applicable lab and/or diagnostic test results

Send Records Via: UPS or FedEx only (consultants must be provided with tracking information) Fax to 770.333.9406 (a secure eFax account)

Baseline Audit Package


Our Education Package includes:

One-on-One Education Now that you’ve had the opportunity to review the report, you can discuss the errors

and suggestions for compliance measures with your consultant. It’s our goal to not onlymake you aware of practice errors but to understand why they are errors and whatnecessary steps need to be made to correct them.

“Ask A Consultant” This is a new feature added to our website. As your practice strives to make the

necessary changes, you may have additional questions/issues. Feel free to call or emailyour consultant directly, FREE of charge for 30 days.

Additional Chart Audits Many practices find themselves saying, “I hope this is right”. It’s our policy to see you

through the transition and help you feel secure with your billing processes. Your first 5charts will be audited by your consultant FREE of charge.

Design of template, if recommended No two physicians are alike. Take advantage of a customized chart template to assist

your practice with efficiency and compliance. You consultant is trained to recognizepatterns, strengths and weaknesses in your physician’s documentation. At your request,a template will be designed to suit your practice and physician’s needs. (Additional feesmay apply)

Education Package


Baseline audits are preliminary assessments to develop a reference point. We provided thisservice for your practice in the past by completing a full audit. We identified improper billing,coding, and documentation practices. As you know, we strive to assist physicians withcompliance and reimbursement even after the initial audit. It has been recommend by theCenters for Medicare & Medicaid Services (CMS) that an audit be perform yearly.

It is also common for physicians to fall back into their “old ways” and again, this may lead toloss revenue and government or third party payor audits. This situation can be avoided byadhering to the recommendation by CMS. We perform follow-up services to ensure yourpractice’s continued compliance.

Feel confident in the service we provide as our company is an approved governmentIndependent Review Organization (IRO) which means we have been given the seal of approvalfrom the government (CMS/OIG) as a compliance auditor.

What Does The Audit Package Include?

When we audit/review your records we look at the level of service billed as well as the ICD-9,and other CPT codes used. We will then provide you with a detailed report as to what wasfound. A comparison from the previous audit is made along with any recommendation as towhat may need to happen moving forward.

In some cases we may recommend onsite group re-education and/or one-on-one provider re-training in which we may round/observe the visit with the provider. We will or answer anyquestions after the patient visit.

Our process is easy and turn-around time is quick. After receiving the necessary information, areport will be delivered within 7-15 business days.

What We Need: 10-15 randomly selected records/progress notes per physician Copy of the printed CMS 1500 Form that goes with that days progress note Progress notes that are pulled should be from a range of services (i.e. new, established

office visit, consults and hospital visits) Include all applicable lab and/or diagnostic test results

Send Records Via: UPS or FedEx only (consultants should be provided with tracking information) Fax to 770.333.9406 (a secure eFax account)

Follow-Up Audit Package


Recruiting and Human Resources

The Physicians Practice S.O.S. Group empowers individuals and organizations. We work as acareer agent for healthcare professionals and assist with the development of employees whilemaximizing the performance of both the individual and the organization. We work with in-tegrity and are committed to innovation. We are here to provide unparalleled service to meetyour career and organizational needs!

About Us

As a private practice consultant group that provides Healthcare Recruiting, OrganizationalEffectiveness, and Talent Management services for organizations. Our job is to helporganizations recruit and hire the best, provide insightful employee assessments to helpdevelop and retain their talent, and to provide tools for applicant tracking and employeebackground checks. The services that we provide can save organizations administrative timeand hundreds of thousands of dollars while having a high impact on the performance andeffectiveness of the organization.

We have a team of Healthcare Recruiters and Organizational Consultants who provide qualityhuman capital management and services in the areas of recruiting, program development andorganizational effectiveness, executive and management development, talent managementand employment assessments for your organization.

Healthcare Recruiting

Services that The Physicians Practice S.O.S. Group provides include Retained (flat fee deposit toengage search for critical positions) and Contingency Search Services (fees are contingent onsuccessful placement) for mid/high level positions and Medical Staffing (contract services;hourly rates) for low/mid/high level positions that include C-level positions, physicians, prac-titioners, nurses, therapists, and medical office staff. Contact us to determine which serviceswill best fit your needs.

Services and Set-Up Healthcare Recruiting, Applicant Information systems, and Employee Assessment services canbe set up for your organization in less than five days! Contact us right away so we can serveyou!


The fee schedule is the single most important financial tool within the medical practice. As withany other business, the fees charged reflect the value of the products and services delivered.

It is surprising that so many practices create and maintain their fee schedules without a solidunderstanding of the basic methodology involved. Most practices find themselves guessing orasking other physicians, which in turn, significantly lowers your chances for having a reasonablefee schedule. Others try to “make it up in volume” when they find they are losing money on aparticular procedure.

A proper and thorough fee schedule analysis involves much more than raising fees and mayactually have nothing to do with fee adjustments at all. The methods for establishing a de-fensive fee schedule are a lot more complex. The Physicians Practice S.O.S. Group can assistyou with this process.

Our Insurance Contracting Package includes:

Fee Schedule Analysis and Comparison Revenue Analysis

When determining your fee schedule, we review the following:

Benchmarking using RBRVS Econometric models, such as cost plus markup Volumetric methods, such as time and RVU – based methods Comparative analyses using national and local average fees Global analytical modeling using categorical conversion factors Acuity factors, which measure the level of complexity of the services and proced-ures provided to a patient population

What We Need:

Original Insurance Contracts Contract Info for Provider Relations Representative, Contracting Manager, and/or

Network Manager Current Fee Schedule (from insurance carrier) Top 25 CPT Codes

Insurance Contracting Package


Measuring your practice’s performance and effectiveness is a critical component of effectiveand successful practices. The Physicians Practice S.O.S. Group will provide a thoroughassessment of your practice’s finances and operational performance and provide you with ablue print for achieving a greater efficiency and profitability.

Because each medical practice is unique with different consulting needs, our assessmentprojects are tailored to focus on those specific areas of concern to the client.

A practice assessment checklist tailored to the client's specific consulting needs is the primarytool utilized for assessing the operational areas included in the project.

Our Practice Assessment Report explains how the identified problem or deficiency affectspractice cash flow and/or profitability; offers recommendations for changes or improvementsthat should be implemented to resolve the identified problems; and discusses options on howto implement the recommended action(s).

Our Practice Assessment Package reviews the following areas:

Accounts Receivable Management Physician, Mid-level and Staff Productivity, Capacity & Staffing Scheduling, Patient Access & Patient Satisfaction Patient Flow, Operational Efficiency & Office Organization Coding, Reiiimbursement & Medical Records Patient Billing, Insurance

Processing & Collections Measurement and Benchmarking of Key Financial Indicators Compliance & Risk Management (HIPAA, OSHA, Red Flags Rule) Personnel Management, Interviews and Surveys of Physicians, Nurses & Staff Facility & Equipment

Practice Assessment Package


Poor documentation can have a serious impact on your practice. The lack of complete doc-umentation in patient medical records can result in errors in reimbursement, clinical data,and financial planning. Remember, the goal of the medical record is to provide sufficient andaccurate clinical data for correct coding and billing for all services provided to the patient.Missing or incomplete documentation can lead to unbilled or denied charges; which leads tosignificant lost revenue and audits.

The number of fraud and abuse allegations continues to rise each year. As a result of theseallegations and the corresponding corporate integrity agreement (CIA/IA), many providersengage an independent review organization (IRO).

Why Choose Us? The Physicians Practice S.O.S. Group adheres to the independence standards set forth by theOffice of Inspector General. We are an approved IRO by the Office Of Inspector General(OIG); which means we have received the seal of approval by the government agency.

What We Provide: As your independent review organization, we provide the following services:

• Conducts an independent review specific to the CIA/IA • Evaluates compliance with the CIA/IA • Derives a statistically valid sample consistent with the Office of the Inspector General’s

methodology • Performs specific review procedures listed in provider’s CIA/IA

What We Focus On: Many of the "risk areas" identified by the OIG depend on the level of documentation. We canassist in obtaining clear, complete, pertinent and accurate documentation. Our documentationreviews focus on:

• As defined by your Corporate Integrity Agreement (CIA/IA) we will perform: Discovery and Full Sample Systems Reviews Claims review report to the OIG Description of Source Data and Narrative Results

• Analysis of documentation for content and validity/medical necessity relationship • Analysis of documentation in relationship to coding and billing • Identification of patterns and trends in documentation • Identification of risk areas in documentation, i.e. illegibility or improper use of symbols

and abbreviations • Analysis of documentation for compliance issues • Education and training on documentation improvement opportunities

Independent Review Organization Package


Starting up a practice is ideally performed at least seven to nine months in advance of the startdate, but, the earlier the better. Some practices even come to us months after starting up! Itinvolves meetings with the providers/owners and making as many decisions as possibleregarding practice start-up and operations. The one-day consultation on starting up a practicecan be at any location you choose. If you have no private-practice experience and are startingfrom scratch, we can do it all for you. If you have some private practice experience or have a lotof preparation already completed, it could be that you will not need us six months in advance.Every practice set up is customized to the needs of the client.

What Does The Practice Start-Up Package Include?

Once your contract is signed our work includes but not limited to: A 100+ point checklist and calendar of pre-start-up activities are prepared and reviewedin detail. The doctor is referred for business loans, if needed, to help with the businessplan (easy-qualifying loans available to $250,000). The check list points are broken intocategories of: Facilities/Operational Issues Financial Issues Employee Issues Marketing and Business Development Billing Supplies, Office/Medical Equipment

Preliminary marketing strategies are discussed and planned in addition to fee setting,super-bill creation, practice budget, and tax/legal requirements Customization of:

o Templates o Employee handbook o Office brochure o Financial policies o General ledger/accounting

Selection of: o Staffing and hiring; o Billing and collections; o Computer and/or billing service

We are available by phone, email, or visit for further support.

Practice Start-Up Package

VISION ….. VALUE ….. RESULTS….. Service... · 3705 New Macland Rd., Suite 200-181 Atlanta, GA...

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