HCM 302

Financial Management

in the Healthcare Industry

NO MORE THERE

WEEK II OUTLINE HCM 302

- Syllabus Update - Group Project

Week II Updates - C-Corp S Corp LLC - NP and PA - Procedure Codes (CPT-4) - Glasgow Family Practice 2011 - You Tube:

Why are the HC costs so high? Healthcare Systems America vs. India?

GROUP A

  1- Dana 3- Deja 2-Theresa

4- Nancy   Medical Practice Name: Women’s Specialty Care

  Details : Specialty: OB-GYN # Of Employees: 10 # Of Physicians: 6 # Of PA's :2 # Of MW‘s: 2   # Of Offices: 3 # Org Type: C-Corp  

GROUP B

  1- Diana 3- Hana 2- Devon

4- Cailin   Medical Practice Name: Community Care of New Castle County   Details : Specialty: Family Medicine # Of Employees: 14 # Of Physicians: 9 # Of PA's :3 # Of NP‘s: 3   # Of Offices: 2 # Org Type: LLC  

GROUP A

  1- Natalia 3- Irene 2-Norberto

4- Alyssa   Medical Practice Name: Pediatric Physician Care   Details : Specialty: Pediatric # Of Employees: 10 # Of Physicians: 6 # Of PA's :2 # Of MW‘s: 2   # Of Offices: 3 # Org Type: C-Corp  

GROUP PROJECT UPDATES

01/26/2012

FROM WEEK I HCM 302

I. 1) Name of the practice – reserve the name and document things like how much the fee is

I. Outline the initial stepsII. 2) Register with the stateIII. 3) Obtain a business license IV. 5) Articles of Corporation

GROUP PROJECT WEEK II

I. 1) Start up budget

Draft a business model 2) Corporate agreements (between partners)

I. 3) Loans (most practices have a credit line)

II. 4) Payer mix – what % of patients pay out of pocket, insurance, Medicare, Medicaid

III. 5) Who will do billing?

I. In-house vs. UM (UM charges 4-8%)

IV. 6) Buy furniture/computers/etc)

V. 7) How to grow business/what is the breaking point

WEEK III AND IV 1) Physician recruitment 2) Hiring of other office staff – LPNs/medical assistant/accountants/receptionist 3) Sample contracts for physicians 4) Contracts with hospitals 5) Hospital privileges 6) Contract with office space (rent/buy) 7) Insurance Credentialing 8) NPI numbers 9) Fee schedule – about 10 CPT codes 10) Schedule for physicians 11) Plan for how to grow patient base/how to receive more patients from local PCPs

Uninsured/unassigned/PCPs PCPs in Southern Delaware that still do not utilize hospitalists to the extent of Christiana area

12) Mission statement 13) Hire a lawyer 14) Cell phones/pagers for physicians 15) Retention strategy 16) Flow charts for structure of organization 17) Use specific dates for process; especially with hospital privileges and/or

credentialing 18) Immigration/J1 waiver application if applies 19) Website

BUNDLE PAYMENTS

GLASGOW FAMILY PRACTICE

01/26/2012

CPT-4 GUIDE FOR THE GROUP PROJECT

01/26/2012

CPT-4 OB-GYN

CPT-4 PEDIATRIC

CPT-4 FAMILY-INTERNAL MEDICINE

CPT-4 GUIDE FOR THE GROUP PROJECT

01/26/2012

SOLE PROPRIETORSHIPSSole proprietorships. This is the simplest, cheapest way to get started in practice. Setting up a sole proprietorship involves minimal paperwork. When you die, so does the proprietorship. You and your business are treated as a single entity for tax purposes, so you simply report your practice's profits on Schedule C of your Form 1040. You also pay its debts from your own bank account. The downside—and it's a biggie—is that your personal assets can be claimed to settle any lawsuit against the business.

C CORPORATIONS

C corporations. This structure has three levels of authority: shareholders (owners), a board of directors, and officers. C corporations can issue stock, which means physicians can buy into the practice or sell their shares without dissolving the corporate structure. There are generally no restrictions on how many shareholders the corporation can have, or on the number of shares it can issue. C corporations can issue two types of shares: preferred, which have priority when the practice is liquidated, and common shares. C corps can also issue voting and nonvoting shares, to allow for differences in seniority

S CORPORATIONS

S corporations. Like a C corporation, an S corporation can issue stock. However, it's limited to 75 shareholders and it can't issue both common and preferred shares of stock. In addition, profits in an S corporation have to be distributed in proportion to each owner's stake in the business.

C CORPORATIONS VS S CORPORATIONS

The biggest advantage S corps have over C corps is that profits can flow directly to the owners' personal tax returns. Because of this, an S corporation's profits aren't double taxed. In that respect, an S corp is similar to an LLP

The major drawback of an S corporation is that, with the exception of health insurance premiums, you can't write off the entire cost of benefits

LIMITED LIABILITY COMPANIES

Limited liability companies. Limited liability companies are a sort of hybrid; they offer the liability protection of a corporation, but are taxed like a sole proprietorship, if you practice alone, or a partnership, if you have associates. (Owners can choose to be classified as a corporation for tax purposes if they wish.) LLCs are generally structured like S corporations, but with a couple of twists. For one, an LLC can have an unlimited number of owners, which is great for a growing, multispecialty practice. There are also fewer restrictions on ownership of the practice. For instance, an LLC can be owned by another LLC, corporation, or a trust. Those aren't options for an S corporation

BUSINESS STRUCTURE

NON PHYSICIAN PROVIDERSNP-PA

01/26/2012

NURSE PRACTITIONER

All NPs are Registered Nurses (RN)

Masters degree trained in Nursing

Certified by a nursing specialty organization

Not possible for a non-RN to be a NP

PHYSICIAN ASSISTANT

Undergraduate degree from an approved PA program.

It is possible for an LVN, or RN to be a PA

SERVICES

Both NPs and PAs can perform Physician Services defined by their Scope of Practice as stated in state laws

Limited prescriptive authority NPs and PAs can perform services in;

In all settings Inpatient Outpatient SNF Home Nursing Home

PROTOCOLS: NURSE PRACTITIONERS Written authorization to provide medical aspects of

patient care are; Agreed upon and signed by the NP and the physician Reviewed and signed at least annually Maintained in the practice setting of the NP

Protocols or other written authorization shall be defined to promote the exercise of professional judgment by the NP appropriate with his/her education and experience

Such protocols or other written authorization need not describe the exact steps that the NP must take with respect to each specific condition, disease, or symptom and may state types or categories of drugs which may be prescribed rather than just life specific drugs

PROTOCOLS: PHYSICIANS ASSISTANTSIt is the obligation of each team of physician(s)

and PAs to ensure that: The PA’s scope of practice is identified; delegation of medical tasks is appropriate to the

PA’s level of competence; the relationship between the members of the

team is defined; that the relationship of, and access to, the supervising physician is defined;

a process for evaluation of the PA’s performance is established; and

The PA’s annual registration is current.

PROVIDER-BASED FACILITY VS.OFFICE-BASED FACILITY

PROVIDER-BASED FACILITY

Designation is determined by CMS Patient receives two bills: hospital and

a professional fee bill Hospitals bill DRGs for inpatient

services and APCs for outpatient services.

Certain clinics are designated as provider-based

OFFICE-BASED FACILITY

Designation if not provider based then you are office-based.

Patient one bill: a professional fee bill Office-based clinic bills the RBRVU

associated with the CPT code for a “non-facility”.

Global or both TC and CPT code are billed.

MEDICARE REIMBURSEMENTPROVIDER-BASED FACILITY

Nurse Practitioner and Physician Assistants Both receive Medicare Provider numbers Billed in the PA or NP name and provider

number Reimbursed at 85% of the fee schedule Supervision requirements are as stated in

state law Documentation requirements are same as

a “stand alone” note for an attending

MEDICARE REIMBURSEMENTPROVIDER-BASED FACILITY

“Incident to” billing “Incident to” billing is expressly

prohibited in any provider-based setting.

MEDICARE REIMBURSEMENTOFFICE-BASED FACILITY

Nurse Practitioner and Physician Assistants:

May bill either in the name of the PA or NP using their provider number

or

Bill “incident to” i.e., in the name of the physician.

“incident to” billing is reimbursed at 100% of the fee schedule.

MEDICAID REIMBURSEMENT

MEDICAID REIMBURSEMENT: NURSE PRACTITIONER

Option #1 Direct Billing 85% of fee scheduleNPs may apply for individual provider numbers for direct billing purposes. All covered services rendered may be billed using the NP’s direct provider number.

Option #2 As a physician service A NP may provide services as a

physician’s services using the physician’s provider number. This is similar to “incident to” billing.

MEDICAID REIMBURSEMENT:PHYSICIAN ASSISTANT

Option #2 As a physician service: A PA may provide services as a

physician’s services using the physician’s provider number. This is similar to “incident to” billing.

This is the only option for a PA under Medicaid

MEDICAID REIMBURSEMENT

Supervision Requirements Medicaid does not require supervision

of the NP or PA in the clinic.

Settings No limitations Can’t double bill or “double dip”