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FAQ: Definitions and Descriptions

FAQ: Definitions and Descriptions

Investor: An individual who purchased an interest in United Rheumatology.

Practice Participation: Practices may become members and users of United Rheumatology Services by purchasing an Annual Practice Membership to United Rheumatology.  Members and member practices are entitled to access the following core services:

  • Group purchasing services;
  • Practice assessment and benchmarking services;
  • Rheumatology-specific clinical pathways;
  • Other products and services as may be offered form time to time.

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

  • Detailed practice assessments;
  • Compliance audits;
  • Health plan contracting support;
  • Revenue cycle and practice management;
  • Health Information Technology (e.g., EHR);
  • Other services added in the future.

Annual Practice Membership Agreement and Standard Terms and Conditions: Describes 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 12 months and will be automatically renewed for successive one year increments thereafter, unless the member notifies United Rheumatology of its intent not to renew within 60 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.

Core Service Descriptions

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:

  • A searchable library and archive of information and toolkits including:
  • Coding and compliance
  • 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

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.

À La Carte Service Descriptions

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

Health Plan Contracting: This optional service supports practices in health plan negotiations. United Rheumatology members that utilize 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.

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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