Billing Service Profile: East Meadow Management Group, Westbury, NY
Specialties Served: Ob/Gyn, faculty practice plans, hospitalists, radiology, anesthesia, and virtually any practice providing a service that a patient receives at a hospital.
Company Size: 75 FTEs
Client base: East Meadow Management Group bills for 1500 physicians totaling about two million claims per year.
Platform Selected: East Meadow Management Group uses MedicsPremier as well as their original Medics II system, both of which are from ADS.
Gary Roth, President and CEO of East Meadow Management Group (EMMG), a practice management and revenue management company, came to the billing business by way of a previous career as a healthcare industry consultant for Peat, Marwick, Mitchell & Company, a leading accounting firm which became KPMG in 1987.
As a consultant, he and his team were involved in numerous engagements where they were responsible for selecting billing vendors or software platforms for their clients. “We evaluated a lot of billing companies and a lot of billing systems,” recalled Mr. Roth.
That is why, in 1992, when Mr. Roth formed EMMG, he had a very clear vision about the mission of his new revenue collections company, and the selection criteria for his billing platform. “Keeping it simple is all I care about, then and today,” said Mr. Roth, “because for us, it’s about collecting revenue for our clients as quickly and efficiently as possible.”
Regarding his vendor selection criteria, cost effectiveness, simplicity, reliability and dependability were at the top of his list. “One of my big issues was reliability. Does the system work, does it do the job every day?” asked Mr. Roth.
Another key requirement in selecting the system for EMMG was whether or not the management reports reconcile. “You would be surprised,” remarked Mr. Roth, “at how many systems do not have reliable reports, resulting in unreliable, incorrect data.”
During his years as a healthcare consultant, Roth became familiar with Advanced Data Systems (ADS) while working for a radiology group that was using the Medics II system from ADS. When it came time to select a billing platform for his new revenue management business, Mr. Roth selected Medics II. It met all his criteria, and in his words, “I felt comfortable with the system.”
Today, 20 years later, EMMG is still an ADS client providing a full range services to its clients with ADS’ MedicsPremier solution, along with its integrated scheduling tool.
In addition to MedicsPremier, EMMG still uses elements of their Medics II system. Mr. Roth noted, “Not many vendors would allow their clients to use their original systems all these years, but ADS is different and it’s one of the reasons we value ADS as our vendor. While ADS might no longer provide Medics II to new clients, they do continue to keep it updated and supported for their existing Medics II clients. We find that to be extraordinary and a prime example of ADS’ dedication to its clients.”
Mr. Roth went on to say, “The entire Medics PM Suite from ADS is incredibly efficient, which is what we want. The object is to minimize keystrokes in collecting and posting payments, especially since we process thousands of patient claims per day, or roughly 2 million claims per year.”
Other systems can support about 400 to 450 chart tickets per day, estimated Mr. Roth. On the Medics systems from ADS, his team can enter 800 to 1000 per day. “Our team basically works in a “heads-down” environment. From one window they enter all the necessary data for one superbill, enter, and go to the next line. Once they complete work on approximately 100 claims, in one keystroke the system takes that batch data and posts it to each individual’s account. There is no need to enter a set of data for one individual account, post it, then open another account, enter and post.”
On the backend, as part of the analysis work EMMG conducts using their Medics system are a series of reports where physician offices and carriers are analyzed to determine carriers who are not paying. They can take that analysis one step deeper and also analyze non-payments by physician and by CPT code. “We can see where particular carriers do not pay certain CPT codes for a particular physician,” said Mr. Roth.
Mr. Roth explained, “This might be an indication that a certain physician’s qualifications or credentials are not right. Other times a carrier may simply not pay that code for anyone. It also happens that certain providers are reimbursed for a certain codes but others are not. There seems to be no rhyme or reason, but regardless, our team can track “carrier behavior” through regular analysis of data from our Medics systems, and adjust our activities to maximize collections for each client.”
“System capabilities such as this are incredibly powerful, and help make EMMG more than simply a billing company to its clients,” said Mr. Roth. “At the end of the day”, summarizes Mr. Roth, “ADS helps us consistently and reliably deliver revenue to our clients. EMMG continues to be very satisfied ADS clients after 20 years and we would not hesitate to recommend ADS highly to any revenue cycle management company seeking a new vendor with new solutions.”