RAOps, dba Reimbursement Associates
Orland, CA - - Founded in 1991
REIMBURSEMENT
ASSOCIATES (RA) WHAT ARE WE?
A medical billing service with clients in thirty states across the
United States, processing health care claims totaling approximately $36 million
per year.
Our Focus:
Billing for clients who provide home care, specializing in infusion drug
therapies, prosthetics, orthotics, durable medical
equipment, skilled services and medical supplies.
OUR MISSION:
"Collect the maximum amount reimbursable in the least amount of
time on behalf of our healthcare provider clients while maintaining the highest
standards for our work and professional relations."
We bill all commercial lines of third party insurance plus Medicare,
Worker's Comp, the VA and CHAMPUS.
But, billing is NOT all we do.
We also verify insurance benefits and follow each and every claim until
it has fully resolved. In addition,
we are often required to provide patient estimates and calculate deductibles
and patient coinsurance amounts; then make financial arrangements with patients
to collect these amounts. We also
negotiate discount rates with insurance case managers and it is not uncommon
for one single negotiation process to consume four to five hours of a manager's
day.
We educate professionals of the home and personal care industry having
had articles accepted for publication by the National Home Infusion
Association, the CA Pharmacy Association, the National Association of Home Care
Management, the National Association of Medical Product Suppliers and
more.
We have also provided speakers on a national level in various forums on
topics related to home and personal care receivables management.
In addition, we publish a periodic Newsletter out of our Orland office
which goes out to our national clientele and professional associates.
We are proud to have a fully functional Medicare Compliance Plan as
well as Compliance, Privacy and Security Officers who provide management and
staff with perpetual information, training, monitoring and quality assurance
pertaining to the work done by our staff on behalf of our clients nationwide.
HISTORY OF THE COMPANY
We opened for business on October 21, 1991, with one infusion client in
Racine, Wisconsin, and projected annual revenues of $30,000.00. The Company was founded by Cindy Ussery, CPAM, CCAM.
Presently, RA employs twenty-six full and part time employees who
together produce revenues in excess of $1.8 million annually.
WHY AN AGENCY LIKE OURS?
To begin with, the home infusion drug therapy
industry (historically) had a difficult time getting paid for services, for
many reasons:
-The price charged for home infusion therapy is significant. This is because even though the home
care takes the place of an inpatient stay, the most expensive part of the
hospital stay is often what they call "MED/SURG" and PHARMACY. Home Infusion Therapy is the
equivalent of Med/Surg and Pharmacy in the
hospital. Consequently, when the
patient goes home on an infusion therapy, the only thing the plan really
"saves" is the cost of the hospital room.
-Because of the large dollar amount of each claim, our claims must go
to the senior claims examiners as entry level staff are often not authorized to
pay claims in excess of as little as $200.00.
-In the early years of the home infusion therapy industry, insurance
companies would not pay for infusion therapy at home because their medical
directors did not believe it was safe to conduct these therapies at home. Back then, much time was spent on the
phone trying to convince insurance companies that there was money to be saved
by them if they would authorize the home care versus continued hospitalization.
-Most insurance plans have different benefits for different types of
service: (Hospital, medical, dental, DME, Vision, Home Health, and
Rx…). Each portion of the
insurance plan may be subject to it's own deductible
and coinsurance percentages. Along
comes home infusion and it effectively forces the insurance carrier to evaluate
four or more different parts of the health insurance benefit before making payment
because home infusion therapy includes drugs (Rx plan); supplies (Major
Medical); electronic and durable medical devices (DME); and, skilled nursing
(Home Health). In addition, because
our claims are paid from various portions of the insurance plan, communicating
the charges has required employees to posess high
skill levels in medical claiming because until very recently, we used HPCPS
codes for drugs and DME, Revenue codes for skilled services, and CPT4 codes for
supplies. This is absolutely
unheard of in the medical billing industry, but was quite necessary for
successful reimbursement due to the absence of standardized coding mechanisms
for these and related services prior to the standardization of transaction code
sets brought about under HIPAA.
These obstacles contributed to the fact that the average days of sales
outstanding for the average provider doing billing in-house could be as high as
150!
Our expertise has allowed us to offer our clients a DSO of sixty or
fewer days. We expect this to
improve when HIPAA is fully implemented and payers are forced to accept claims
electronically from ALL health care providers.
We watched the Centers for Medicare and Medicaid Services (CMS,
formerly HCFA) consolidate the administrative functions for providers of
durable medical equipment, prosthetics, orthotics and
supplies in the mid 1990's and now work with all four Regional DMEPOS Carriers
contracted to CMS for Medicare Part B claims administration. This consolidation led us to expand our
outreach to include durable medical equipment in 1999 and we added full service
claims management for prosthetists and orthotists in 2001.
We now provide claims management services for all DMEPOS providers and
suppliers nationwide and have established a successful and cooperative relationship
with all four DMERCs.
OUR CULTURE and STAFF RETENTION EFFORTS:
Each year, our Company celebrates National Patient Financial Management
week the third week of October. It
is during this week that the staff are honored for
their contributions to the work of the Company. We give productivity awards for
"top producer", "best DSO" and
"most improved". We also
give President's Awards for overall Excellence in Management, Technical
Assistance and Operations.
Each month, staff nominate one another for
Positive Person of the Month. The
monthly winners are then judged and the overall winner is named Positive Person
of the year.
Finally, the most prestigious award of all is our Randy Morgan Award
for "Astonishing" Customer Service. For those of you that have yet to hear
Randy Morgan speak, we offer the following:
Randy Morgan, Assistant General Manager at the Coeur d'Alene Resort on
the Lake in Coeur d'Alene, Idaho is single-handedly responsible for staff
morale and motivation at this world famous resort. Our GM had the opportunity to hear Randy
speak at a conference she attended in the Fall of
1994. She was so impressed with
Randy's "Attitudes for Astonishing Service" that she purchased his
video tape series and brought the concepts back to our Company in Orland, CA.
Randy believes that everyone gives good service and some companies even
give great service. BUT only the
companies that provide astonishing customer service will survive in the
future. Randy says this is because
the US population has come to "expect" good and even great service
and that means that "anything short of "astonishing" is nothing
more than mediocre." We
agree. Randy Morgan helped our
staff to see that providing excellent service is vital and that it is a matter
of "wanting" and "choosing" to and that we have more fun at
our work when we choose to "astonish" people. Hence, the
"Randy Morgan Award for Astonishing Customer Service".
Our clients submit nominations each year and an outside source provides
us with judging services. The
winner of this award receives a $400.00 cash prize plus a few other perks.
As you can see, we are "into" customer service. The more astonishing the better!
In addition to PFM Week:
We enjoy a family picnic or group event every summer and a Christmas
party every December (both are hosted by the Company).
We honor staff on their birthdays and have eleven paid holidays PLUS
two "floating" holidays for each staff member per year.
Staff elect
the "Positive Person of the Month" each month and the winner receives
$50 in cash. All monthly winners
are eligible for the annual award of $250.00!
We have a "good times" committee that organizes our monthly
pot luck lunches and other season events (like the Halloween costume contest)
and other fun things.
We "adopted" the residents of a local assisted living center
in our town and we celebrate the birthdays of each of the residents. At the end of each year, we coordinate
and sponsor a special Christmas party for all the residents who each prepare a
"wish list" for us in advance.
EMPLOYEE BENEFITS:
In addition to above-scale hourly wage, staff enjoy
a monthly spending credit (which can be applied toward the purchase of health
insurance, child care or other qualifying expense within our Section 125
Cafeteria Plan) and a 401K retirement plan. In addition, staff are eligible for flex
time and we often have at least a couple of elementary school age children in
our lunch room after school doing homework and enjoying an after-school snack
while their parents finish their work day.
Finally, we manage a Christmas Club account
for staff wishing to set earnings aside for this purpose.
How busy are we?
We make every effort to have fun, but we're very busy:
Our long distance
phone bill ranges from $5 to $6 thousand a month
We receive
more than three hundred pages of fax transmission daily
UPS makes
three stops at our office each day, Fed Ex one or two
We have more
outgoing mail (on a daily basis) than any other Company in the entire county
and we
rank among the top three in incoming mail
daily.
We maintain in
excess of six thousand open patient files on site on any given day and handle
close to
one hundred thousand patient files per year.
At any given
time, we are actively in pursuit of $6 to $8 million which has been billed but
not yet paid
by insurance.
MEET THE OTHER PEOPLE WHO MAKE IT HAPPEN:
Guy L Ussery, Director of Operations
Guy brings strong customer service skills to our team having been the
recipient of several national customer service awards for excellence in the
auto industry prior to joining our staff.
Guy is responsible for monitoring customer satisfaction, maintaining our
physical facilities, purchasing and payables, and oversees company
receivables. Tenure with the Company:
twelve (plus) years.
Kristie Ellis, Director of Patient Financial Services
Kristie
is an honor graduate of CSU Chico (majoring in economics). Kristie came
to us with a wealth of experience with EDS (the Medi-Cal
Fiscal Intermediary for the state of CA), Blue Shield of Northern California as
well as having worked for a local hospital and physician in her career. Kristie and
her staff of eight managers and eight assistant managers are responsible for
the actual work product of the Company, which is medical claiming and
receivables management. Tenure with the Company:
eleven (plus) years.
Emily Hansen,
Director of Systems and Information
Emily came to us, in April 2002, with four years of management
experience. She is responsible for
our systems maintenance, electronic claiming and e-communications, work audits,
regulatory compliance, regulatory development and implementation, and serves as
special projects coordinator. Emily
is also responsible for reception and operations staff. Tenure with the Company: two (plus) years.
Jennifer M
Sites, Director, Compensation and Benefits
Jennifer is an honor graduate of CSU Chico with a
major liberal studies. She
is primarily responsible for our Cafeteria Plan, Retirement Plan and other
staff benefits. Jennifer also works closely with our accountant and serves as
Chairperson of the RA Board of Trustees.
Tenure
with the Company: twelve (plus) years.
Other principals
include:
Sheila Ekis, Senior Patient Financial Manager
Jessica Allen, Senior Patient Financial Manager
AND: The friendly voice answering most of our incoming calls belongs to
Irene Landeros, Secretary of Operations.
Conclusion:
Our Company has seen tremendous growth since its inception in 1991, and
we have assembled an excellent team of professionals (many have been with us
for eleven or more years). We have
implemented many changes throughout our history which have had positive impact
on productivity and staff retention.
Our
President believes that if the Company takes care of the staff, the staff will
take care of the customers…
We look forward to being in business for a long time and to providing a
professional atmosphere for people who want to work hard, continue to learn and
grow and enjoy above scale wages for the work they produce. We also look forward to continuing to provide our
customers with "Astonishing Customer Service"!
We welcome your inquiries and will happily respond to all requests for
additional information about the Company and the comprehensive range of
services we offer.
Thank you.
Reimbursement
Associates
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Legal Notice 2005
Reimbursement
Associates a dba of RAOps,
Inc. All rights reserved