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Clinical Integration

 

Billing Service

Robert Wood Johnson Health Network (RWJHN) offers professional Billing Services with a positive track record for increasing physician practice revenue.  RWJHN complements our full range of services with a highly competitive pricing structure.  There can be volume discounts for large, multiple physician practices. The fee includes access to all the capabilities of the GE Healthcare’s GroupCast system (formerly IDX) as well as:

  • Over 35 years combined experience in billing for Physician Practices
  • Certified Coders on Staff
  • Perform all billing, follow-up, and receivables management reporting
  • Maximize the practice’s cash flow through daily billing and follow-up efforts.
  • Produce and maintain easy to understand and accurate accounts receivable reports.
  • Provide meaningful feedback concerning the status of accounts.
  • Assist with collection efforts to improve cash flow to the practice is also available.

 

RWJHN uses the latest technology, GE Healthcare’s GroupCast System, to ensure that our clients are positioned to realize tangible benefits through the application of our programs. Additionally, RWJHN has the ability to interface with Electronic Medical Record software to seamlessly collect patient data. Key elements of the overall system are as follows:

    1. Appointment Scheduling
      Multiple Physicians - Multiple Sites - Flexible, Easy to Use
    2. Registration
      Built-in edits to ensure accurate data collection and up to date insurance database
    3. Charge entry

      a. Specialty specific procedure and diagnosis codes

      b. Medicare fee schedule updated annually

      c. Capitation or contracted fee schedules can be entered by procedure code

    4. Third Party and Patient Balance Billing

      a. Claims submitted electronically 5 days a week

      b. Customized Patient statements sent on a weekly basis

    5. Reports

      a. Reports Generated Daily and Monthly - Customized Reports Available

 

The following is a list of clients we have provided services to in our 7 years of business:
Multi-Specialty Billing for Practices consisting of

  • 4 Primary Care practices
      • - 22 Providers
  • 1 Orthopedic practice
      • - 5 Providers
  • 1 Obstetrics practice
      • - 1 Provider
  • 1 Neonatology practice
      • - 5 Providers
  • 2 Surgery practices
      • - 7 Providers
  • 1 Pathology practice
      • - 5 Providers
  • 1 Psychiatric practice
      • - 1 Provider
  • 2 Podiatry practice
      • - 4 Providers
  • 1 Ambulatory SurgiCenter

Affiliated Physicians Health Plan

Affiliated is a self-funded physician health insurance company.  It is organized as a Multiple Employer Welfare Arrangement (MEWA) under ERISA on behalf of private attending physicians working at Robert Wood Johnson Health Network hospitals.  It began in 2002, in partnership with QualCare, a state-wide PPO.  It has experienced a number of mergers and additional institutional members outside RWJHN and now has over 1,600 covered lives.  It is also set to send out refunds to Network physicians at the end of 2006.  Thus far it has never issued a premium increase by as much as 10% in any year.  Network hospitals are now incorporating this company as a benefit for becoming a credentialed physician on its medical staff. 

Group Purchasing

While there are Group Purchasing Organizations (GPO’s) available to our Network members for hospital supplies and drugs, the Network has worked in other areas where GPO’s do not operate.

The Network convened a meeting of all facility managers and agreed to purchase electricity and natural gas as one unit.  The results have been astounding.  The Network signed a five and half year contract for electricity in 2001 for 2001 rates.  This contract alone has saved the hospitals more than $2.0m for the last two years over what collectively they would have spent.  Over one-half million dollars has been saved on natural gas purchases.

Joint purchasing has also resulted in savings on contracts with Press Ganey, QuadraMed and other software companies.  The Network will continue to seek opportunities using the leverage of its members.

 

Case Management

In partnership with the Developmental Disabilities Health Alliance, the Network has developed a state-wide case management capability for the developmentally disabled.  Originally, the Network contracted directly with the State Medicaid program to provide these services.  In 2002 the State moved to Medicaid managed care using private Medicaid insurors.  Currently, the Network has contracts with two of the four Medicaid managed care companies, providing case management to 3,800 developmentally disabled people. Through six offices and using nurse practitioners and social workers, they visit homes and use phone contact to assess clients.  At their disposal is a real time laptop computer programmed with all of the client’s pertinent information.

For more information on this program, you can go to Health Cares Most Wired On-line, November 16, 2004, hhmostwired.com