To date, because of the monetary incentives built into the RAC program, services paid under Medicare Part A have been the preferred target of the four regional RAC contractors. Hospitals and other facilities paid by Part A continue to deal with the ever-expanding demands of the contractors in the realms of both DRG validation and medical necessity. Simultaneously, individual physicians and groups have been existing in a world seemingly beneath the radar of the RAC’s.

The new world under PPACA is about to change this set of circumstances, with RAC’s gearing up to train their sights on a distracted physician population that after years of federal warnings and compliance guidance, remains ill-prepared to weather the storm. The planned expansion of the RAC program into avenues currently traveled by Medicaid Integrity Contractors (MIC’s) only makes the need for data on practice vulnerabilities, and opportunities for coding and documentation improvement, that much more important.

Stepping into this information void comes…….The RAConteur.

As the RAC contractors begin to circle above the heads of the individual and group physician populations, there are steps that can be taken pre-emptively to:

• Identify probable RAC audit targets;
• Determine practice vulnerability based on these targets; THEREBY
• Strengthening your practice’s defenses against your RAC contractor.

Every Wednesday, The RAConteur will focus on RAC information specifically tailored for the physician practice. In future posts, it is my hope that I can assist practices to begin to view the paper trail that accompanies their daily work product with the same highly trained critical eyes developed and possessed by all physicians as part of their medical training. Rather than leaving physicians to continue guessing about where their vulnerabilities may exist. Instead it is my mission to empower the physician to detect errors and modify long-held thinking and behaviors, which will hopefully lead to decreased risk and increased peace of mind.

The paved-over swamp that is official Washington, D. C. has decided that increased audit recoveries are the pathway to offsetting the cost of healthcare reform for the next decade. While the opportunities to weed out the fraud in the American healthcare system is a task for which we all have a positive financial stake, The RAConteur will relate as much information and advice as possible to ensure that you are not the physician providing a high percentage of this healthcare funding.

As we go forward together, I look forward to your comments and questions on specific elements of physician RAC audits, coding, documentation and best practices in a world of hyper-investigation.

Welcome to The RAConteur!

In the more than 20 years following, Spencer’s expertise won him job offers in claims analysis, consultation, and coding and compliance supervision at top healthcare organizations like SmithKline Beecham and Aurora Advanced Healthcare – as well as committee appointments for process improvements, planning, and technology quality control. He earned his CPC and CPC-H designations through the American Academy of Professional Coders (AAPC) in 1998. His experience spans the full spectrum of medical billing, from the fine detail of coding and auditing to big-picture policy interpretation and planning.

In 2008, with the finely-tuned, wide-ranging knowledge and experience from those 20 years in tow, Spencer arrived at Fi-Med Management, Inc. to take the helm as Compliance and Denial Management Officer. Quickly recognizing the talent and leadership they had acquired, Fi-Med designated Spencer as the company’s chief industry blogger – helping clients, payors and other medical billing professionals to navigate fast-changing industry regulations. In-depth coverage of topics like electronic medical records, e-prescriptions, documentation, new coding rollouts, and the changing healthcare billing landscape positioned Spencer as a go-to resource for Fi-Med clients and staff.

Challenging in any revenue cycle management firm, Spencer’s work at Fi-Med is doubly demanding in an environment experiencing full-throttle expansion, from organic market growth to strategic acquisitions. When he’s not passing along critical information on the official Fi-Med blog, Spencer is training new coding and compliance personnel, coaching current personnel on industry changes, trouble-shooting client denials and counseling them on best practices to stay one step ahead in the reimbursements arena.

Spencer lives in the Milwaukee area with his wife and son. An accomplished local folk rock singer/songwriter, he’s recorded two albums, plays live at local venues around eastern Wisconsin, and is a co-founder of a Milwaukee songwriters group.

As Fi-Med’s certified compliance consultant and operations leader, Christine has brought to independent medical practice’s a re-engineered “billing” office, expanding it into the efficient and compliant business management of accounts receivable. Christine worked alongside Adrian Velasquez to form and build Fi-Med Management, Inc. in 1993 with the common vision: aiding independent physicians in increasing profits, reducing compliance risk and creating, and maintaining, a healthy practice.

Christine brings to Fi-Med a unique and powerful blend of healthcare and business experience, along with a double major in accounting and business management at Lakeland College where she graduated magna cum laude. She is a certified compliance consultant and member of the Medical Group Management Association, American College of Healthcare Executives, Healthcare Compliance Resources, and Comprehensive Medical Practice Analysts.

Her contributions to the community include serving on the board of NewCastle Place, Inc., EastCastle Place, Inc. and Milwaukee Protestant Home, Inc. She also volunteers her time as an election official in Elm Grove, WI.

Christine’s Awards & Nominations

Selected to receive “Wisconsin’s 2007 Small Business Person of the Year Award”
Received Certificate of Special Congressional Recognition in recognition of outstanding and invaluable service to the community.
Nominated for Women of Distinction Award
Nominated for Women of Influence Award

Armed with an extraordinarily successful career in the business of health care, Adrian E. Velasquez has successfully blazed new trails, taken risks, defied the odds, and in 1993 partnered with Christine Krause and formed Fi-Med Management, Inc. Their mission: to bring business acumen and compliance expertise to independent health care providers throughout the United States.

Prior to his work at Fi-Med, Adrian worked with health care providers across the country, mastering all areas of business function and management for medical organizations of all sizes. His previous experience as a system administrator, executive director of a 54-provider medical group, and health care consulting from New York to California formed the foundation that he harnesses today for Fi-Med clients.

Adrian is a member of the Medical Group Management Association and Comprehensive Medical Practice Analysts, and is currently working on enhancements to the paperless accounts receivable environment, further reducing operational costs to independent physicians and clinics.

Adrian’s Awards & Nominations

Selected to receive “Wisconsin’s 2007 Small Business Person of the Year Award”
Received Certificate of Special Congressional Recognition in recognition of outstanding and invaluable service to the community.
Selected to receive Small Business Times Bravo Entrepreneur Award

The offer followed others from companies like IBM and ITT in New York, but Usry, newly married at the time, didn’t want to relocate. The opportunity to work with General Medical Corporation’s 11 divisions in Maryland and Virginia came at the right time, on the heels of a fresh degree – a B.S. in business management with an emphasis in computer science– and the preparatory experience of his work during school as a computer operator and programmer assistant for the Federal Reserve Bank in Richmond.

Over the course of his 40-year career, lucrative job offers and opportunities followed, and Usry became sought after in the industry by companies like Medical Data Services, who were implementing similar health care processing systems and needed expertise that at the time was in short supply. Usry built a reputation for speed and precision, developing highly saleable systems in a fraction of the time typically required – once developing a complex prototype from scratch in less than a week. The first system sold within hours of final post-production testing, and Usry went on to close more than $1 million in system sales to hospitals around the country. Later, Usry would be instrumental in the development of one of the first medical billing solutions for physicians using the mini-computer.

Today Usry heads up Healthcare Management Systems (HMS), a software division of medical revenue cycle management firm Fi-Med Management, Inc. HMS software, built to be scalable to medical billing operations of any size, was first put into practice by the University of Virginia Hospital System’s new health services foundation in 1980. Under the direction of the university and Price Waterhouse, Usry and his team customized an HMS software installation to bring the foundation’s members – 270 independent physicians at that time – all under one billing umbrella.

Usry continued to develop and evolve HMS through changing technologies and healthcare regulatory landscapes in the 30 years following, its success attracting the attention of ArborMed Corporation, a medical billing firm led by well-know medical billing veteran Charles Morf. ArborMed purchased Health Management Systems in 2005, and both entities were later acquired by Fi-Med Management, Inc. in 2009.

At Fi-Med, Usry continues to expand HMS nationally, and will be instrumental in developing the company’s growing presence in the radiology market. As part of the executive management team, he’ll help to shape Fi-Med’s future as a leader in the fast-changing healthcare billing and revenue management industry.

Richard Usry is a long-time member of the Healthcare Billing and Management Association (HBMA), involved in numerous committees, including vendor and education. He and his wife, Betty, live in Richmond, Virginia, and have three daughters with successful careers of their own.

Here at Fi-Med, we are very competitive and so we have decided to take advantage of our competitive nature by splitting up the entire office into two teams to see which team can collect the most food items. We will be collecting food until January 25th.

Even though times are tough for all of us, let’s take a moment to consider all the other families that are struggling to put food on their tables and try to find ways that we can help. Below is a list of important facts that concern the Milwaukee area:

Food Facts

• Each year Hunger Task Force distributes more than 6 million pounds of food to Milwaukee’s hungry.
• Each month Hunger Task Force-affiliated food pantries serve 37,500 people, and soup kitchens and homeless shelters dish up more than 58,000 hot meals.
• Milwaukee suffers from the seventh-worst poverty in the nation, with a poverty rate of 24.4 %. More than 34% of Milwaukee’s children are living in poverty, the ninth worst in the nation.
• Nearly 40% of families who visit food pantries live on less than $800.00 per month. Many families, even food stamp recipients, are unable to sufficiently feed their families.
• Hunger Task Force advocates for well-run government programs that help people feed themselves and their families, including Food Stamps (FoodShare), School Breakfast and Lunch; Women, Infants and Children (WIC); the Fueling Young Minds Summer Meals Program and the Child and Adult Care Food Program.

In their own words

“I lost my job. All I get is FoodShare and it’s not enough. I came here because I ran out of food.”-Visitor, Salvation Army West Food Pantry

“I have three children. I’m a single parent trying to hold down a job and go to school.”-Visitor, House of Peace Community Center Food Pantry

“All around, there just isn’t enough food.”-Visitor, St. Benedict’s Community Meal Program

Preferred Food Items

• Fruit and Juice: canned pears, apricots, pineapple and peaches
• Breakfast Items: Dry cereal, oatmeal, grits, and pancake mixes
• Protein: Canned meat, poultry, fish, peanut butter, beans, nuts and high-protein main dishes such as chili and stews
• Vegeatbles: Canned corn, green beans, carrots and peas
• Baby Items: Powdered or concentrated infant formula (Nestle Good Start), food and diapers
• Dinner Items: Pastas, rice (plain or mixes), potato mixes, macaroni and cheese dinners
• Lunch Items: Canned or dry soups (vegetable, beef or chicken) and canned pasta items

Please join us as we all work together to really make a difference this holiday season by starting your own food drive!

Grand Hyatt, New York

At a time of year when many people are looking forward to being reunited with friends and family to celebrate the upcoming holidays–Adrian Velasquez and Christine Krause, at the request of Princeton University, will be in New York, attending the 35th annual Business Today International Conference at the Grand Hyatt in Times Square. There they will join over 70 of the nation’s leading CEO’s and executives while also contributing to the Harvard Business School Case Study “Weathering The Storm: The Challenges And Opportunitites Of A Global Slowdown”.

150 students representing over 100 colleges and 20 countries were selected to receive an all-expense paid trip to attend the conference which will focus on such themes as the business cycle, the competitive landscape as well as the evolving political environment. Adrian and Christine will be speaking on the topic “Weathering the storm: Proactively Blending Management And Technology To Keep From Being The Last Dinosaur In The Swamp”.  As keynote speakers, Adrian and Christine will share information about the changes Fi-Med is making, both strategically and culturally, to adapt to the current economic environment.

Founded in 1968 by Steve Forbes, Michael Mims, and Jonathan Perel during their undergraduate years at Princeton University, Business Today started as a magazine featuring student-written articles, executive-written articles, and executive interviews. Business Today has now expanded to include their Online Journal, Conference, and Seminar Series Programs, all with the aim of fostering dialogue between students and executives.

Did you find this information helpful? If you have information that you think would be of interest to the medical or business community and would like the information posted on our blog, please submit your request for review to my attention at or via DM on Twitter@fimed

Fi-Med Management, Inc. Ranks No. 1344 on the 2009 Inc. 5000 with Three-Year Sales Growth of 237.7%

NEW YORK, August 12, 2009–Inc. magazine today ranked Fi-Med Management, Inc. NO. 1344 on its third annual Inc. 5000, an exclusive ranking of the nation’s fastest-growing private companies. The list represents the most comprehensive look at the most important segment of the economy-America’s independent-minded entrepreneurs. Consumer electronics maker Vizio, Internet giant GoDaddy, rental car service Zipcar, and beverage maker Honest Tea are among the prominent brands featured on this year’s list.

“Savvy trend spotters and those who invest in private companies know that the Inc. 5000 is the best place to find out about young companies that are achieving success through a wide variety of unprecedented business models, as well as older private companies that are still expanding at an impressive rate, ” said Inc. 5000 project manager Jim Melloan. “That’s why our list is so eagerly anticipated every year.”

Fi-Med Management, Inc. is an award-winning financial management firm providing comprehensive claims, coding, billing, lockbox and financial reporting services to the medical industry.

The 2009 Inc. 5000, unveiled today on Inc.com, serves as a unique report card on the U.S. economy. Despite the ongoing recession, aggregate revenue among the companies on the list actually increased to $214 billion, up $29 billion from last year, with a median three-year growth rate of 126 percent. The Inc. 5000 are responsible for creating more than 1 million jobs since their founding, making the list perhaps the best example of the impact private, fast-growing companies can have on the economy. Complete results of the Inc. 5000, including company profiles and interactive database that can be sorted by industry, region, and other criteria, can be found on Inc.com.

Contact: Lisa Velasquez 714-935-0073

Posting payments from a high volume of paper EOBs is challenging, automating the manual process can be equally effortful. Adrian Velasquez, founder and President of Fi-Med Management, Inc. worked with four different solutions that failed to produce results. Finally, Fi-Med achieved automation of this onerous process. Learn what did not work and why, the pitfalls and shortcomings of certain approaches and ultimately what did work. For more information or to register for this event please visit www.tawpi.org.