We strive to "communicate the value of emergency care" each and every day, and that has led us to our success. Our under-standing of the business of patient care allows us to provide valuable insight and consulting support to our client practices.

Teamwork characterizes our approach to client services. HBR seeks the client's input when making decisions that affect the client's business. But, partners must bring a valuable resource or asset to the relationship that cannot be found elsewhere. As a partner, the business venture of the client becomes a primary focus of the company.

HBR is nationally recognized for its expertise in emergency medical billing, as evidenced by the many invitations for company executives to speak at conferences held by national and regional healthcare associations and specialty organizations.

HBR has developed a particular reputation for unparalleled expertise in the area of emergency medicine coding.

• HBR was invited by the American College of Emergency Physicians, (ACEP) to participate in the development of the first ACEP publication on professional service coding and billing, Procedural Terminology for Emergency Medicine.
• HBR assisted ACEP in the development of its publication, Independent Emergency Physician Billing.
• HBR contributed a chapter to ACEP's publication, Reimbursement Strategies.
• HBR contributed to St. Anthony Publishing's Guide to E/M Coding and Documentation, 2nd Edition
• HBR most recently participated in ACEP's workgroup on proposed Documentation Guidelines.
• HBR contributes many articles to various monthly publications on coding and emergency medicine practice.

A valuable business partner is one who knows where the enterprise should be headed and is able to take the business in that direction. Our clients expect us to be proactive in this complex health care environment. As payers, such as Medicare, reduce their payments to physicians, practices must rely on their billing operations to increase billing effectiveness.

Our clients not only expect us to "know the rules", they expect us to impact the rule makers, as well.

• When one Pennsylvania payer began enforcing unreasonable audit standards for emergency physicians statewide, HBR took a leadership role in resolving these issues by meeting with the payer and providing written support that restored over $800,000 annually for several practices and saved the specialty as much as $29 million annually statewide in reduced payments.
• When a Maryland payer threatened emergency physician reimbursement for the highest level of service, HBR assumed the responsibility of challenging this Medicare carrier's erroneous determination and won the right for emergency physicians to bill for these services.
• When North Carolina payers recently put up restrictive rules for critical care, denied prudent layperson claims and denied EKG payments, HBR led the fight to restore thousands of dollars appropriate payments statewide.

Healthcare organizations are faced with pressures from many external sources: government regulations, increased competition, intensified cost pressures and finite resources. As your service partners, HBR will provide the leadership, ability and commitment to meet the challenges and changes that lie ahead.

A good billing company must realize that it is in the communications business. The participants in the Emergency Department reimbursement arena, for the most part, are speaking a language that each other cannot understand; physicians do not understand what third-party payers need to justify payment; patients do not understand the extent of physicians' services and fees; and the government sometimes seems not to understand any of these various issues.

HBR's philosophy, as a valued business partner, is to understand each party in the reimbursement process, and then to facilitate communication and understanding among the various parties. Proper reimbursement can only be achieved when physicians, patients, hospitals, and payers are able to effectively communicate.

HBR's documentation training program gives physicians the practical charting techniques that allow for appropriate reimbursement without requiring extraneous information that is unimportant for patient care. Training is done from the physician's perspective, emphasizing what is good patient care.

HBR's unique training approach has spawned a national course, Emergency Medicine Money Matters - Issues & Answers about Coding and Reimbursement. It is held in various cities annually, helping emergency physicians deal with reimbursement realities. This is HBR's way of giving back to the emergency physician community some of what we have learned and taught our clients over the years.

Effective communication also requires the ability to listen. HBR's executives and managers stay in constant contact with our clients, to ensure that we are achieving our clients' expectations. From client meetings at the support level to executive discussions, HBR is committed to understanding our clients' needs and responding in a professional manner.

HBR is a founding member of the Health Ethics Trust and has been a member of the National Council of Ethical Organizations since 1994. The Company is committed to the principles of honesty, integrity, and professionalism and has processes in place to reinforce these principles throughout our operations. A Corporate Compliance Program was adopted in 1994, making HBR the first national billing company to voluntarily adopt a Compliance Program, and its peers in the industry recognize it as a leader in compliance.

Members of its Compliance staff are often asked to write articles and give presentations on different compliance topics. HBR has co-chaired and participated in Healthcare Best Compliance Practices Forums since 1997. CEOs, Compliance Officers, and many senior government officials attend these conferences. Senior members of the Office of Inspector General for the Department of Health and Human Services, and many top-level officials from the Department of Justice, the Centers for Medicare and Medicaid Services, and the United States Sentencing Commission have participated along with HBR in these programs.

In the event of a third party audit, HBR vigorously defends the client's interests to ensure that auditors fairly evaluate each chart. HBR's audit defense has proven a valuable service to many emergency physician practices.

Ultimately, HBR's success will be measured by how effective we are at capturing all the revenue to which your practice is entitled. You need a company that will fight for your right to be fairly reimbursed for all your uncompensated care. In order to be a valued partner, HBR produces a more effective billing process than is obtainable by any other method.

To attain optimal emergency physician revenue levels requires HBR's unique approach to emergency physician billing. Our comprehensive package of services has been specifically designed to address several key elements in emergency physician billing. These elements play a critical role in the financial performance of an emergency medicine practice.

• Payer-Specific Clinical Service Coding: The HBR coding process utilizes HBR-employed coding professionals, many of whom have clinical training, to abstract the clinical record accurately for each payer based on that payer's reporting requirements. We approach coding from the physician's perspective. Payer-specific, clinical driven coding optimizes reimbursement while better managing risk in the event of a third party audit.
  
  Coders are trained to look at the clinical event from the physician's perspective. Charts are returned to physicians for additional documentation where appropriate and our Clinical Sendback program monitors these charts to assure that they are returned to be billed.
• Physician Documentation Training and Reporting: The HBR payer-specific coding process provides individualized feedback for each physician in the practice about the quality of chart documentation with examples of deficiencies and suggested improvements. Reports are generated monthly showing, by physician, how many ED charts failed documentation Q/A standards, for which patients and for what reasons. More than 20 types of documentation deficiencies are reported by volume and RVU loss per each physician. This can be a valuable part of an Emergency Department's overall Q/A program.
• Chart Accountability: How do you know that every patient you see is accounted for in the billing process? Studies show that an average of three to eight percent of all billable emergency physician visits go unbilled because the chart never makes it through the complex process of getting a copy to the billers. HBR has perfected an accountability process that tracks every patient from the ED log allowing you to see every account that remains unbilled. This process alone can dramatically improve practice income.
• Accounts Receivable Follow-Up: Third party claims are monitored for prompt and accurate payment and our Accounts Receivable Department uses technologically advanced tools to vigorously pursue claims without response.
• Patient Services: All contacts with patients are handled by well-trained patient service professionals who perform only patient relations functions. Calls are also randomly monitored by supervisory personnel to assure patient satisfaction. Electronic image processing provides instant access to a copy of the patient's payment document allowing quick and accurate resolution of patient calls.
• Reimbursement Expertise: HBR maintains a full time Reimbursement Department with the technical knowledge and operational capability to optimize reimbursement. Accounts receivable management is tied directly to the Reimbursement Department so that any payment deviation from the expected norm can be quickly researched and resolved. This function is critical to achieving optimum reimbursement.
• Payer Contracting Experience: HBR management devotes a significant portion of time to handling managed care contract issues for our billing clients. Specific contract negotiation and review of managed care reimbursement proposals are performed to assist our clients to enter into successful arrangements with managed care organizations.
• Reporting: HBR delivers a full range of monthly management reports designed to provide each client with a comprehensive means of analyzing practice management as well as reimbursement activity. HBR can deliver practice management reports directly to a client's personal computer, without the need for special software. The most useful financial management information can be made available to practices through electronic files, allowing the client to easily store and retrieve historical data and import it into spreadsheets for analysis.
• Clinical Operations and Productivity Reporting: Leading emergency medicine practices recognize that advanced practice management reporting is vital to their financial future. Data mining for business intelligence is necessary to analyze clinical operations, patient flow trends, and productivity potentials. HBR has available a full range of operational reports on paper and via the Internet, displaying trends over hours, days, months and years. Trended data includes, among other things, visit volume, acuity, procedures, diagnoses, admissions/discharges, registration and discharge time, patient flow, payer class, patients-per-hour, and RVUs.
  
  For those practices with advanced physician productivity incentive plans, a range of reports support monthly payroll calculations or quarterly or periodic bonus arrangements, using a variety of data elements. Physicians can analyze down to the individual patient level what was billed in their name.