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Definitions and Descriptions

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Investor: An individual who purchased an interest in United Rheumatology at $2,500 per equity interest. Investors are entitled to an equity stake in the company, to be determined at a later date, commensurate with the size of their investment. The revenue generated from the initial group of investors was used in part to support United Rheumatology’s business planning and service offering development efforts.

Practice Participation: Practices may become members and users of United Rheumatology Services by purchasing an Annual Practice Membership to United Rheumatology at $2,500 per year for each full time practitioner in the practice. Members and member practices are entitled to access the following core services:

  • Access to policies, best practices, toolkits  and information services, including policy and payment;
  • Group purchasing services;
  • Practice diagnostic assessment and benchmarking services; and
  • Rheumatology-specific clinical pathways

Members may also have access to additional, optional services that are separately priced, including:

  • Detailed practice assessments;
  • Compliance audits;
  • Health plan contracting support;
  • Revenue cycle and practice management;
  • Super-group formation support; and
  • Health Information Technology (e.g., EHR)
  • Services will be added in the future in response to participant need

Annual Practice Membership Agreement and Standard Terms and Conditions: Describe the terms and conditions for participation and use of United Rheumatology services, including membership fees, core services included in the membership, and group purchasing compliance requirements. Individual and practice members are required to sign the Annual Practice Membership Agreement before receiving access to services through United Rheumatology. The initial agreement period shall last for a period of two years and will be automatically renewed for successive one year periods thereafter, unless the member notifies United Rheumatology of its intent not to renew within 90 days before the end of the agreement.

United Rheumatology Member ID: A unique identification number associated with each United Rheumatology individual or practice member used for administrative and billing purposes.

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Rheumatology Best Practices & Information Service: An online platform that supports a virtual network of independent rheumatology practitioners and administrators, disseminates and shares best practices, and informs constituencies of new developments that will impact practice vitality. The platform will have a number of services including:

  • Forums and discussions groups
  • A searchable library and archive of information and toolkits including:
  • Coding and compliance
  • Malpractice education and charting best practices
  • Practice amalgamation/clinical integration resources, including implementation steps & resources
  • Practice management case studies and best practices
  • Industry trends, including changes in public and private payer policies
  • Relevant industry alerts
  • Policies and procedures
  • Protocols/clinical pathways

Rapid Diagnostic Practice Assessments: provides key performance indicator data (e.g., days in A/R) on a semi-annual basis to be compared with peers and measured against industry standards, indicating areas of operational productivity and financial strengths and weakness.

Clinical Pathways: United Rheumatology leverages data and intellectual property assets (i.e., physician knowledge) to develop rheumatology-specific clinical pathways. The pathways will be informed by published research, practice pattern assessments and analysis of outcomes data.

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Detailed Practice Assessments: United Rheumatology’s detailed practice assessments include on-site, comprehensive operational analyses of practice operations & financial vitality, including:

  • Interviews and operational reviews with practice managers, physicians and administrative leads
  • Operational  data review, work flow analyses and recommendations
  • Staff and physician productivity analysis
  • Human resource management
  • In-depth financial, revenue cycle and operational benchmarking and process analysis
  • Managed care contracting
  • Policy and procedure (P&P) review
  • Additional services may be provided. The array of services needed will be individualized for each Detailed Practice Assessment in response to practice request.

Compliance Audits: Includes a comprehensive review of practice policies and procedures (P&Ps), adherence to those standards and observed P&P violations relating (but may not be limited) to:

  • Fraud and abuse,
  • HIPAA privacy and security,
  • CLIA, OSHA, workplace safety, disaster planning, and recovery
  • Workforce benefits including FMLA, state statutes and applicable labor laws & regulations.
  • Audit and reporting of compliance with contracting requirements, policies & procedures

Health Plan Contracting: This optional service supports practices in health plan negotiations. United Rheumatology members that purchase this service will receive individual contracting assistance including health plan negotiation support, development of contracting terms and conditions, and the development and incorporation of value-based payment arrangements.

Revenue Cycle Management: Provides administrative and operational support for charge entry, payment posting, claim status monitoring, accounts receivable management, scheduling, eligibility verification, coordination of benefits and overpayments, customized billing reports and analysis, claims audits, denial appeals, recoveries, payment logs, collection services, establishing and maintaining lock boxes and fee-schedule management.

Super-group formation support: Provides access to a cadre of professionals to support practice amalgamation through preferred vendor relationships for the following services:

  • Legal services to establish new practice corporation, bylaws and articles of incorporation, defining terms for provider partner owners and associates including revenue sharing and other provisions
  • Consulting, facilitation and project management support

Health Information Technology (e.g., EHR): United Rheumatology provides access to a preferred health information technology vendor, TSI Healthcare, which specializes in implementing and supporting the NextGen EHR platform for rheumatology practices.

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