DEANNA L. HOLMES

Overview of Consulting Experience:
Ms. Holmes has either consulted or billed for almost all practice types. She is very adept at both identifying and then analyzing shortfalls within a practice. She has analyzed claims and all areas related to the collection of data, billing policies and procedures and staff utilization. She is adept at analyzing contracts, fee schedules and all strategies related to negotiating the most optimal insurance contracts. Her overall experience and knowledge in the medical profession, along with her passion to help, make her an outstanding consultant and speaker.

No matter what the specialty or how big the practice is, it is the missing details that create the problems. One missing digit from a diagnosis code, an incorrect date of birth, or a missing admission date can stop the flow of money. It doesn't take much to suspend or delete a claim. It is up to the practice to make sure that they are maximizing their revenue by capturing all data and then making sure that all billable items are properly billed and collected within the contracted time frame. With the onset of the NPI in 2007, many practices have learned just how important these details are.

Contracts and Fee Schedules:
Very few small and medium sized practices have policies and procedures in writing, and if they do, they are often vague. Many practices mishandle their cash flow by not having set procedures for handling daily cash, checks, and credit card payments from patients. There is often no mechanism in place for confirming that electronic funds were received. (The billing service receives and posts electronic remits but is not typically in charge of confirming that the practice actually received the funds). As small practice revenue declines with the tightening of billing rules and regulations, employees can expect to earn less for working harder; this is true for physicians and staff members. The true key to profitability is fair compensation for all within the practice. When the practice is profitable, employees can be paid more. When employees are paid more, they work harder than ever. This is a never ending cycle.

Ms. Holmes has found that many small and medium sized practices are under educated about contracting, fee schedule analysis and contract re-negotiation. There is a lot of poor information being passed around regarding this key issue.

Providers must occasionally stop and take a look at practice history. Do you change the practice back to the way it was or do you work at creating the practice desired from the beginning? Taking on the right contracts is critical to making this decision. Doctors, who work too hard, tend to burn out too fast. Patients need doctors to take care of their current and future health. To do that, doctors must make enough money, and their staff must be given the opportunity for continuing education.

Personal Experience:
Years in the clearinghouse business (1991-1997) created Ms. Holmes' desire to help the medical industry. Her book, "Practical Guide To Medical Billing," provides a practical resource for the small and medium sized practice. So many practices needed help with understanding "clean claims" and how to more efficiently work with insurance carriers, which led to her consulting profession. She has been able to help many clients, not only in the state of Arizona but, California, Oregon, Washington, Nevada, Colorado, New Mexico, Florida, Georgia, North Carolina, Washington DC, Indiana, Michigan, and Illinois. She currently owns a successful billing company and has developed Advanced Practice Training, offering her knowledge and assistance to a larger audience of practitioners and their staff. Ms. Holmes' personal goal is to help the practice gain efficiency and profitability.

Medical Writing Experience:
Books & Manuals
Practical Guide To Medical Billing © 1997 Deanna L. Holmes. All rights reserved. This book was published by the U.S. Department of Commerce, National Technical Information Service in 1997, and has been in print since March of 1998. (ISBN: 0-934213-53-4) ($89.00). This publication details the information and requirements to perform medical billing in a practice environment, while limiting personal liability. It outlines the fundamentals for developing a medical compliance program. This book also covers areas of medical forms development, billing rules, coding conventions, claim preparation, and results management, including how to set up internal audit procedures. This book was featured in 'What To Write For' in the AMA News in March, 1998. (Search for Practical Guide To Medical Billing at Amazon.com)

Articles
Kassebaum-Kennedy And Your Practice, © 1997 Deanna L. Holmes. All rights reserved. Published August 1997, The Medical Office Journal, by A. R. G. Denver, Colorado.

Billing Experience

Medical Specialties:
Cardiology, Dermatology, Family Practice, Gastroenterology, Internal Medicine, Neuro-Psychology, Obstetrics and Gynecology, Ophthalmology, Orthopedic Surgery, Pediatrics, Physical Therapy, Plastic Surgery, Psychiatry, Psychology, Pulmonology, Rheumatology

Plan Types:
All major HMO, PPO, POS Plans (i.e. Aetna, BCBS, Cigna, TPA's, Humana, UHC, Pacificare, Health Net, Kaiser), National and State IPA Networks (i.e. CCN and ASPA), Local Carve Out Plans (i.e. BPHO and Nexus), Medicare, Railroad Retirement, DEMERC, AHCCCS, Champus, Tricare, Workers Compensation Plans, Auto Liens and AZ Superior Court

Place Of Service:
Office, Home, Inpatient Facilities, Outpatient Facilities, Emergency Room, Out-Patient Surgery Centers, Skilled Nursing Facilities, and Psychiatric Units

Types Of Service:
Hyaluran products for osteoarthritis, cortisone, and other special and routine medications. Office infusions, including the set up and tracking of systems to ensure prompt and accurate payment. Neuropsychological, psychological, military and competency to stand trial assessments. 'Incident- to' services for both Nurse Practitioners and Physician Assistants. Professional components such as cardiology testing, cardiac catheterization, radiology, and other special procedures with professional components.

Clearinghouse Experience:
In 1992, served as President and CEO of Providers Data Interchange, Inc. (PDI), a HFCA-1500 claim service bureau (clearinghouse). Received claims from 926 practices and billing companies; responsible for all marketing, client development, training development and sales, managing 65 independent dealers and an overall client base of 3,100 customers in 47 states. The development of billing industry software along with coding and billing support strategies for practice clients.

Consulting Experience

Medical Specialties:
Cardiology, Gastroenterology, Internal Medicine, Neuro-Psychology, Obstetrics and Gynecology, Ophthalmology, Pain Management, Pathology, Pediatrics, Psychology, Pulmonology and Sports Medicine. Surgical specialties include General, Orthopedic, Spinal, and Thoracic.

Types Of Consulting:
Contracting, credentialing, development of fee schedules, software utilization, staffing, billing policies and procedure assessment and implementation. Her primary function has been to identify problems that create financial shortfalls in the practice. She is extremely intuitive, and her knowledge has helped many clients to increase revenues. Many small practices fall short of their financial goals due to a lack of meaningful continuing education for employees. Knowledge is power, and yet, there is almost always a "lack of knowledge" about things in virtually every practice. Ms. Holmes has the knowledge, and when it comes to your practice's revenue, a tune-up is worth its weight in gold.

Consulting History:
August, 2003
Claims and coding analysis for a small Orthopedic practice to determine which claims can be appealed by plan and plan type. Single payments were made for multiple procedures for the period of one year due to incorrect code linkage and modifier use. Tempe, Arizona

July, 2003
Assessment of practice procedures for a large Orthopedic group to find areas where there are gaps in communication that were creating gaps in billing and coding processes. Upon completion of the assessment an education program is provided for physician coding and procedures. Phoenix, Arizona

May, 2003
Provided continuing education and insight regarding the billing of multiple Orthopedic procedures, both for shoulder and knee areas. Mesa, Arizona

October, 2002
Claims analysis for a small Orthopedic group to help determine payment shortfalls on multiple procedures. Mesa, Arizona

July, 2002
Fee assessment and guidance for a single gynecologist Chicago, Illinois

June, 2002
Engaged by a Big Six accounting firm in Chicago, Illinois to provide code auditing for a spine surgery client. This audit included chart review, coding, fee assessment, and claim layout. Chicago, Illinois

April, 2002
Assessment of the billing and reimbursement processes for a single Orthopedic surgeon and his off-site billing contractor. Multiple issues were found that resulted in billing education, new encounter forms, and continuing education for the doctor and staff. Tempe, Arizona

March, 2002
Hired by the Medical Director of a 15 surgeon Orthopedic group to assess billing communication shortfalls and the coordination or capture of charges between surgeons and the central billing office. Included billing coordinator placement help and updated billing education for the central billing office. Phoenix, Arizona

January, 2002
Engaged by a Spine surgeon to assess billing performance of an outside billing agency. The issues uncovered included under pricing, lack of aggressive collection, and unauthorized insurance and patient adjustments. Phoenix, Arizona

August, 2001
Contracted by a Pharmaceutical representative to present billing, coding and collection issues to a single Orthopedic practitioner. This project included specific education in the area of local Arizona payor contracts and credentialing, and ways to measure profitability by plan. Discussion of the importance of practice-wide billing knowledge from front desk to physician, especially as it relates to local carve out PHO plans that create a double contracting situation. Mesa, Arizona

July, 2001
Engaged by a Pharmaceutical representative to present billing, coding and collection issues to a single Orthopedic practitioner. This engagement included specific education in the area of local Arizona payor contracts and credentialing, and ways to measure profitability by plan. Issues of insurance coverage types were discussed regarding the differences between pharmacy benefits and major medical benefits as they apply to injectable drugs and devices. Mesa, Arizona

July, 2001
Hired by a Thoracic surgery group to perform claim and fee analysis to provide insight for administration regarding claim filing practices and practice pricing shortfalls. Thirty percent of all CPT codes billed in the examples were under-priced based on the Illinois RBRVS fee with minor claim issues, primarily in the area of diagnosis and treatment code linking and modifier use. Peoria, Illinois

July, 2001
Engaged by a Pharmaceutical representative to present billing and coding issues to an Orthopedic practice. Issues of authorization verification and contracting with local HMO plans were discussed, with a plan of action for resolving these issues. Chandler, Arizona

June, 2001
Engaged by a Pharmaceutical representative to present billing and collection concepts to an East Valley Orthopedic surgical practice. Issues included LPHO collection techniques and injectable drug billing and collection issues. Mesa, Arizona

May 2001
Hired by a National CPA firm to perform a claim analysis for a pathology laboratory. A few areas for claim improvement were identified to help this lab meet compliance standards. Toledo, Ohio

May, 2001
Engaged by a Pharmaceutical representative to present billing and collection concepts to a single Rheumatology practitioner. Issues regarding HMO contracting and the use of code modifiers were identified and discussed to resolve reimbursement issues. Glendale, Arizona

April, 2001
Engaged by a Pharmaceutical representative to present billing and collection concepts to an Orthopedic practice. Mesa, Arizona

March, 2001
Hired by a Pharmaceutical sales representative to identify billing processes of a Rheumatology practice and to help problem solve communication shortfalls found between the physician and the physician's employees. Fine tuned further communication between the practice and the outside billing service. Phoenix, Arizona

January, 2001
Engaged by a Pharmaceutical sales representative to investigate and resolve reimbursement issues with an Orthopedic practice. This resulted in on-site communication between management and the coding and billing department to verify that multiple procedures were accurately linked with the correct and dictated diagnosis codes. Mesa, Arizona

November, 2000
Engaged by a Pharmaceutical sales representative to investigate medication-billing problems for a specific product and to provide billing instruction and education to increase reimbursement and decrease payment denials. This engagement involved 7 site visits in two days, meeting with 4 Orthopedic practices, 2 Internal Medicine practices and one Rheumatology practice. Tucson, Arizona

July, 2000
Engaged by a National CPA firm to perform a HCFA-1500 claims analysis for an Obstetrics and Gynecology practice experiencing reimbursement problems. Diagnostic coding quality and linking issues were found and recommendations were made to correct these problems to promote payment. Chicago, Illinois

July, 2000
Contracted by a CPA firm to assess a medical management system for potential installation at their medical client sites. The assessment provided them with confidence to make their decision. Little Rock, Arkansas

May, 2000
Hired to investigate billing and collection problems for a Rheumatology, Internal Medicine and Gastroenterology practice. This included fee assessment (with price increases), contract review, internal physician to employee communication, and communication with the outside billing service. When problems were found at various levels, a team education approach was taken to enlighten each level of staff from the front desk to physicians. New strategies for forms and internal processes were set up to enhance the appropriate capture of information and ways to confirm that the quality of information was getting through to the appropriate billing parties. Phoenix, Arizona

April, 2000
Engaged to provide practice management oversight for a single Psychiatry office to prevent theft and inappropriate employee practices. Provided 4 months of oversight to include education, implementation of policies and procedures, and culture development strategies. Scottsdale, Arizona

March, 1999
Served as a senior consultant and project manager overseeing practice assessment, new policies and procedures and technology upgrades for a Psychiatry practice. This engagement also included extensive financial as well as documentation auditing. Scottsdale, Arizona

October, 1999
Engaged by an International Medical Technology representative to work with their health care facility clients to provide health information security education and coordination of device and policy implementation, both on the technology side (computers) and the hard copy side.

June, 1998
Engaged by a National Medical funding company to perform on-site assessment and problem solving for an Obstetrics and Gynecology practice. Significant documentation, communication and billing problems were found, resulting in an extended stay to correct problems, education of all levels of staff; from the front desk to physicians and other ancillary providers. Technology upgrades, contract review and fee schedules had to be performed, as well as strategies and plans developed to capture over $1.7 million in collectable outstanding receivables. Lanham, Maryland

June, 1993
Performed and co-presented a gastro-pulmonary procedure/provider market utilization study for an international surgical device manufacturer to focus their R&D product selection committee. This study enabled them to accurately select specific product changes and enhancements based on their ability to be reimbursable by Medicare and third party payors. This product study was recommended to blend with their active market strategy to enable their customers to understand how to be reimbursed correctly for new device usage. The findings were presented to the corporate officers and upper management team. Winston-Salem, North Carolina

Speaking Engagements:
November, 2007
Billing and Practice Profitability Phoenix Rheumatology Association Phoenix, Arizona

February, 2004
Billing and Coding Education: Modifier use, timely reporting issues, internal practices and processes Phoenix Orthopedic Group - Surgeons and staff Phoenix, Arizona

May 3, 2003
Orthopedic Update Orthopedic practice personnel Sponsored by Wyeth Pharmaceuticals Phoenix, AZ

October 9, 2002
Medicare Appeals: Outlining the time limits and a step by step process for correcting problems and preventing future appeals Annual Physician's Billing and Coding Convention Las Vegas, Nevada

September 14, 2002
Effective Billing Techniques: Payor and payor types, contracting, and communication techniques between physicians and billing departments Maricopa Medical Center's Orthopedic residents and teaching surgeons Phoenix, Arizona

September 11, 2002
Billing examples: Helping to reach internal assessment goals and to augment external communication with billing contractors Orthopedic physicians Mesa, Arizona

September 4, 2002
Denials of Claims: Goals to help self-assess external billing processes to verify accuracy, track costs of supplies and services. Rehabilitation Physicians Phoenix, Arizona

August 8, 2002
Documentation - The effects on billing Maricopa Medical Center's Orthopedic residency program Phoenix, Arizona

May, 2002
Update: Billing and health coverage information as it relates to Orthopedics Major Orthopedic Group - physicians, administration, and billing staff Requested by a pharmaceutical representative Seattle, Washington

April, 2002
UB-92 and HCFA-1500 claim issues Annual Conference for the Florida Institute of CPA's as part of their annual CEU course Orlando, Florida

April, 2002
Update: Billing and health coverage information as it relates to Orthopedics Major Orthopedic Surgery Group - physicians, administration, and billing staff Requested by a pharmaceutical representative Long Beach, California

March, 2002
Update: Billing and health coverage information for the purpose of broadening their view of offering education to their employees Orthopedic surgeons Requested by a pharmaceutical representative Denver, Colorado

March, 2002
Update: Billing, coding and health coverage information Billing and collection employees for a large Orthopedic practice Requested by a pharmaceutical representative Denver, Colorado

February, 2002
Update: Billing and coding information Orthopedic Practice Managers Requested by a pharmaceutical representative Tucson, Arizona

November, 2001
Continuing billing education Orthopedic and Rheumotology Billing Managers Requested by a pharmaceutical representative San Jose, California

October, 2001
Continuing billing education Western region pharmaceutical representatives Requested by a large pharmaceutical company Newport Beach, California

June, 2001
Market considerations for injectable and infusion devices and medications: Developing better customer support for drug reimbursement for providers Major pharmaceutical company upper management Denver, Colorado

March, 2001
Surviving the insurance maze for stroke survivors: Helping stroke survivors and their families troubleshoot medical billing problems often associated with stroke patients, due to the emergency room admissions First Survivors Conference Presented by the American Heart Association and the American Stroke Association Phoenix, Arizona

September, 2000
Billing and coding for injectable drugs to enhance pharmaceutical representatives and their client relationships by helping them identify various issues that create payment denials with their product Arizona pharmaceutical sales representatives Chandler, Arizona

September, 2000
The Principals of Medical Billing: Developing a web-based product for claim editing to provide to practices nationally Physician Group Berkley, California

June 14, 2000
The Essentials of Billing and Collections: Four hour course teaching the problems commonly found in the area of medical billing, along with strategies for participants that enable assessment and action to resolve their physician/client problems Annual Mayer, Hoffman, McCann Medical CPA Organization. The 4-hour course provided Kansas City, Missouri

June, 1999
Medical Billing Essentials - Four hour coursework developed to help potential analysts easily identify collection and billing problems using claim copies, EOB's, and other information from clients for analysis; resulting in MPA certification American Academy of Medical Practice Analysts Tampa, Florida

1993-1997
Eleven-two day education seminars for PDI clients and their employees, which included subjects of medical billing rules, computer training, software training, EDI principles, and troubleshooting claim denials. Emphasis was placed on filing claims correctly the first time using the appropriate billing rules and coding conventions. Mesa, Arizona

Education

December, 2005
Cardiology Coding Update Seminar

October, 2002
Three day annual conference for physicians billing and coding strategies

April, 2002
Annual Medicare Part B update seminar for all specialties

August, 2001
Professional compliance course by the Fraud and Abuse Institute

August, 2001
Annual Medicare Part B update seminar for all specialties

June, 2001
Infusion therapy seminar presented by Centacor Inc., Covering issues of clinical requirements, authorization process, billing, coding and collections for infusion therapy services and medications. Arizona HMO plans were examined in depth to provide payment and appeal guidance for Remicade therapy.

November, 2000
Continuing education for the use of Synvisc presented by H. Royer Collins, M.D. This presentation enhanced the understanding of injecting a device, versus a drug, and the overall product efficacy, aiding Wyeth-Ayerst and Biomatrix/Genzyme physician clients. Tucson, Arizona

June, 2000
Three-day MHM medical conference covering areas of fee schedule calculation, contracting, and legal accounting issues faced by practices in present and future situations. Received continuing education credits for MPA certifiication Kansas City, Missouri

April, 2000
Annual Medicare Part B update for general medical practices

April, 2000
Psychology specialty billing seminar provided by Medicare Part B

June, 1999
Completed requirements and obtained credential of Medical Practice Analyst, Level II (MPA)

October, 1998
Completed coursework for Coding certification (CPC)

1996
Participated in the National Standard Format (NSF) analysis for software development through a national claims clearinghouse. (HBOC)

1995
Completed the 40-hour Management action program; Management strategies, problem solving, team building, business survey, applications and implementation processes to achieve higher profitability Laguna Beach, California

1992 - 1999
Yearly Medicare Part B update seminars

1992 - 1999
Attended a number of healthcare seminars and workshops (MGMA, HFMA, Medicare Part B of Arizona and BCBS of Arizona) including; billing, coding, reimbursement, medical records, medical law, the Clinton health care plan, HIPAA, the False Claims Act, the HIPAA security provision, auditing, et al.

1989
Completed and passed required coursework in the area of family law, ethics, and standards (25 hours) for appointment to the court appointed special advocate (CASA) project Johnson County, Kansas

1987
Completed coursework for marketing strategies by Southwestern Bell (40 hours), which included marketing strategies, methods and conventions

1984
Attended a number of Fred Pryor seminars that covered sales, marketing, team building, basic psychology, and office dynamics

1985
Completed additional business coursework at Johnson County Community College (business development, management, sales, marketing, etc.)

1978
Attended Indiana University (1 year) to begin a degree in business

Medical Organizations (Past and Present)

AAPC - American Academy of Professional Coders
HFMA - Healthcare Financial Management Association
National and State compliance forum and Managed Care forum
AZMGMA - Medical Group Management Association, Arizona Chapter (MGMA)
AAMPA - American Academy of Medical Practice Analysts
Mesa Chamber of Commerce

Contact Information

Deanna L. Holmes, MPA
PO Box 21075
Mesa, AZ 85277-1075

dholmes@advancedpracticetraining.com

480-830-7361 Office
480-830-7362 Fax