Medical Practice Consulting
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Transcript of Medical Practice Consulting
ABC ASSOCIATES, P.C.
PRACTICE ASSESSMENT
2
ASSESSMENT
As-sess-ment-noun
Dictionary.com
1. the act of assessing; appraisal; evaluation.
2. the act of judging or assessing a person or situation or event.
Fairfield Consultants
1. analyzes where a practice has been, where it wants to be and creates a blueprint on how to get there.
Random House Unabridged Dictionary 2006
3
METHODOLOGY USED
• Interview Providers And General Staff
• Observe Practice Operations• Analyze Pertinent Financial And Productivity
Information• Compare Actual Practice Results To Industry And
Other Standards
4
FINANCIAL• Increase Revenues
• Accounts Receivable
• Coding
• Fee Schedule
• Billing Function
• Ancillary Services
• Extender Productivity
OPERATIONAL• Organizational Structure
And Decision-Making
• Communication
• Staffing
REPRESENTATIVE PRACTICE ISSUES
FINANCIAL
6
ABC ASSOCIATES, P.C. FINANCIAL
FINDINGS
• Revenues Have Declined In Recent Years; However, They Can Be Increased.
• Accounts Receivable Aging Must Be Improved And Outstanding Monies Should Be Collected.
• While There May Be No Loss Of Revenue Due To General Under Coding, Additional Coding Training Is Essential.
• The Practice Fee Schedule Should Be Updated And Fee Increases Sought Where Possible.
7
ABC ASSOCIATES, P.C. FINANCIAL FINDINGS (cont.)
• A Billing Service Should Be Engaged.
• Ancillary Services Are Profitable.
• Extenders Should Be More Productive.
8
PROVIDERS
• Physicians Can Be More Productive.
• More Office Hours Should Be Made Available To
Patients (Early Morning, Evenings And Saturday).
• The Office Hours Provided By Extenders Exceed
Those Needed.
9
ABC ASSOCIATES, P.C. NET REVENUE ANALYSIS
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
$3,000,000
$3,500,000
$4,000,000
$4,500,000
$5,000,000
NET REVENUES
PERIOD
2009201020112012 Annualized
2009 $4,715,928
2010 $4,444,864
2011 $3,452,808
2012 Annualized $4,143,370
Net Fee Revenue
Source: ABC Associates, P.C. Internal Data2012 Data Represent The Period January 1-October 31Annualized
10
REVENUE GROWTH
• Revenues Can Be Increased By:
• Increasing Physician Office Encounters
• Decreasing Physician Days Out Of Office
• Improving Collections Of Accounts Receivable
• Implementing A Practice Marketing Program
11
Source: MGMA Physician Compensation & Production Survey-2011 Report Based Upon 2010 DataABC Associates, P.C. Internal Data-Drs. A, B & C Ambulatory Encounters For Any Three Representative Months Of The Year Multiplied By Four
12
Doctors A & B Increased To MGMA MedianAssumes Each MD Office Visit Generates $70.00 Revenue (Primarily E&M Codes) Source: ABC Associates, P.C. Internal Data-CY 2012Assumes Each Lab Visit Generates $200.00 Source: ABC Associates, P.C. Internal Data-CY 2012Assumes A 3:1 Ratio (Office Visits To Lab Visit)
13Source: MGMA Physician Compensation & Production Survey-2011 Report Based Upon 2010 DataABC Associates, P.C. Internal Data
14
PHYSICIAN TIME OUT OF OFFICE ANALYSIS
Increase Weeks Worked To 75%Tile/90%Tile:One Week Two Weeks
Dr. A $10,000 $20,000Dr. B $11,000 $22,000
Dr. C $12,000 $24,000
Revenue Increase:
$33,000 $66,000
Source: ABC Associates, P.C. Internal Data Revenue Calculated By Using CY 2012 Data For Each Physician Divided By 46.
15
ACCOUNTS RECEIVABLE
• There Are Excessive Monies Uncollected In The 121+ Days Aging Category For Both Patients And Insurance Companies.
• Typically, Once Accounts Receivable Reach The 91 Day Aging Category, The Net Collection Ratio Can Decline To :
• 50% Of The Practice’s Overall Net Collection Ratio For The Insurance Company Segment
• 25% Of The Practice’s Net Collection Ratio For The Patient Segment
16
ACCOUNTS RECEIVABLE AGING
Source: ABC Associates, P.C.
Categories 0-30 Days 31-60 Days 61-90 Days 91-120 Days 120+ Days Totals
patient $25,000 $20,000 $15,000 $10,000 $430,000 $500,000
patient % 5.00% 4.00% 3.00% 2.00% 86.00% 100.00%
insurance $975,000 $180,000 $45,000 $30,000 $270,000 $1,500,000
insurance % 65.00% 12.00% 3.00% 2.00% 18.00% 100.00%
total $1,000,000 $200,000 $60,000 $40,000 $700,000 $2,000,000
total % 50.00% 10.00% 3.00% 2.00% 35.00% 100.00%
17Sources: ABC Associates, P.C. Internal DataMGMA Cost Survey-2011 Based Upon 2010 DataBilling Service: XYZ Billing Service, LLC
18
ACCOUNTS RECEIVABLE COLLECTIONS OVER 90 DAYS OLD
Source: ABC Associates, P.C. Internal Data-Assumes Normal 50% Net Collection Ratio
91-120 Days 120+ Days Totals
Patients Accounts Receivable $10,000 $430,000 $440,000
Projected Collection Ratio 12.50% 12.50% 12.50%
Projected Revenue Collected $1,250 $53,750 $55,000
Insurance Accounts Receivable $30,000 $270,000 $300,000
Projected Collection Ratio 25.00% 25.00% 25.00%
Projected Revenue Collected $7,500 $67,500 $75,000
Total Projected Collected Revenue $8,750 $121,250 $130,000
Total "Lost" Revenue $11,250 $228,750 $240,000
19
MARKETING
InvestopediaThe activities of a company associated withbuying and selling a product or service. Itincludes advertising, selling and deliveringproducts to people……..
The four “Ps” of marketing are product, place, priceand promotion.
Investopedia Inc. June 6, 2007
20
MARKETING AND PUBLIC RELATIONS PROGRAM
Sample ProgramMinimal Outlay• Community Programs (Speaking Engagements,
Practice-Sponsored “Topic For An Evening”)• Newspaper “Women’s Health” Special Inserts• Supermarkets• Insurance CompaniesHigher Outlay• Advertising (Radio Commercials, Movie Theatres,
Etc.)• Periodic Breakfast/Lunch Meetings With Referring
Physicians
21
EVALUATION & MANAGEMENT-HOSPITAL IN-PATIENT CODING
• There Appears To Be Over Coding Of Certain Evaluation And Management And Hospital In-Patient Codes When Compared To The MGMA Model.
• There Appears To Be Under Coding Of Hospital In-Patient, Subsequent Care Codes When Compared To The MGMA Model.
• Financially, There Is A Nominal Financial Gain For ABC Associates, P.C. When Compared To The MGMA Models.
22
E & M CODING ANALYSIS
Source: ABC Associates, P.C. Internal Data For CY 2012; MGMA 2004 Coding Profile Sourcebook (General Surgery Patients Aged 65 & Over)-Based Upon 2002-2003 Data
99201 99202 99203 99204 99205 Totals
ABC Associates, P.C. 0 103 852 46 0 1,000
MGMA 217 271 321 150 41 1,000
Charges $90.00 $130.00 $200.00 $205.00 $230.00 n/a
Payments $45.00 $65.00 $100.00 $103.00 $115.00 n/a
MGMA Revenue $9,756 $13,455 $32,130 $15,399 $4,715 $75,455
ABC Associates, P.C. Variance ($9,404) ($8,385) $53,020 ($10,661) ($4,715) $19,856
99211 99212 99213 99214 99215 Totals
ABC Associates, P.C. 24 1,308 2,640 22 6 4,000
MGMA 193 1,650 1,728 362 69 4,000
Charges $45.00 $60.00 $87.00 $140.00 $200.00 n/a
Payments $23.00 $30.00 $44.00 $70.00 $100.00 n/a
MGMA Revenue $4,434 $49,488 $76,014 $25,312 $6,880 $162,129
ABC Associates, P.C. Variance ($3,882) ($10,248) $40,146 ($23,772) ($6,280) ($4,037)
Combined ABC Associates, P.C. Variance $15,819
23
HOSPITAL INPATIENT, INITIAL CARE
PATIENTS AGED 65 & OVER
Source: ABC Associates, P.C. Internal Data For CY 2012; MGMA 2004 Coding Profile Sourcebook (General Surgery Patients Aged 65 & Over)-Based Upon 2002-2003 Data
99221 99222 99223 Totals
ABC Associates, P.C. 0 0 50 50
MGMA 7 26 17 66
Charges $200 $250 $300 n/a
Payments $100 $125 $150 n/a
MGMA Revenue $700 $3,250 $2,550 $6,500
ABC Associates, P.C. Variance ($700) ($3,250) $4,950 $1,000
24
HOSPITAL INPATIENT, SUBSEQUENT CARE
PATIENTS AGED 65 & OVER
Source: ABC Associates, P.C. Internal Data For CY 2012; MGMA 2004 Coding Profile Sourcebook (General Surgery Patients Aged 65 & Over)-Based Upon 2002-2003 Data
99231 99232 99233 Totals
ABC Associates, P.C. 2,000 0 0 2,000
MGMA 1,203 584 213 2,000
Charges $65 $80 $95 n/a
Payments $35 $45 $50 n/a
MGMA Revenue $42,105 $26,271 $10,660 $79,036
ABC Associates, P.C. Variance $27,895 ($26,271) ($10,660) ($9,036)
25
FEE SCHEDULE
• A Preliminary Fee Schedule Analysis Indicates That Fees Paid By Certain Insurance Companies (Representing Over 80% Of Practice Charges) Should Be Negotiated Upwards
26
CPT Codes Volume ChargeCY 2012 Annual
ChargesCPT
Codes Volume ChargeCY 2012 Annual
Charges
99213 7,597 $80 $607,760 85025 845 $30 $25,350
90471 2,957 $25 $73,925 36416 820 $20 $16,400
92551 2,118 $25 $52,950 99391 811 $130 $105,430
99173 2,064 $20 $41,280 99000 709 $15 $10,635
81003 2,031 $20 $40,620 99394 682 $174 $118,668
87880 1,582 $25 $39,550 90633 631 $86 $54,266
99051 1,389 $80 $111,120 90669 580 $106 $61,480
90472 1,267 $20 $25,340 82465 532 $15 $7,980
87081 1,271 $15 $19,065 90658 500 $25 $12,500
99214 1,221 $150 $183,150 90723 435 $126 $54,810
99393 1,085 $160 $173,600 90715 432 $70 $30,240
99392 991 $150 $148,650 90647 419 $30 $12,570
Total $2,027,339
CY 2006 $2,402,870
ABC ASSOCIATES, P.C.
Source: ABC Associates, P.C. Internal Data
27
CPT Codes Charge Anthem
United Health Oxford Aetna Healthnet Connecticare CIGNA
99213 $80 $64.01 $51.86 $49.79 $56.53 $53.40 $66.14 $60.23
90471 $25 $21.96 $9.59 $11.77 $11.55 $15.16 $14.80 $11.92
92551 $25 $13.61 $13.93 $6.85 $12.88 $18.77 $10.07 $12.74
99173 $20 $15.26 $0.47 $3.23 $0.61 $8.81 $0.00 $12.54
81003 $20 $3.18 $3.20 $2.91 $0.39 $1.61 $3.17 $2.56
87880 $25 $17.65 $16.52 $6.02 $10.58 $8.25 $16.38 $14.66
99051 $80 $7.48 $2.94 $16.47 $18.83 $4.20 $0.00 $42.77
90472 $20 $13.62 $8.20 $8.19 $12.10 $9.15 $15.56 $12.05
87081 $15 $9.80 $4.24 $6.85 $5.90 $4.56 $9.25 $8.02
99214 $150 $106.28 $80.24 $75.77 $93.56 $85.80 $108.95 $59.09
99393 $160 $139.02 $82.68 $91.30 $104.16 $129.10 $129.10 $108.56
Source: ABC Associates, P.C. Internal DataBold Italics Indicates Fees That Should Be Negotiated Upward
ABC ASSOCIATES, P.C.FEE SCHEDULE ANALYSIS
PAGE 1
28
ABC ASSOCIATES, P.C.FEE SCHEDULE ANALYSIS
PAGE 2
Source: ABC Associates, P.C. Internal Data
CPT Codes Charge Anthem
United Health Oxford Aetna Healthnet Connecticare CIGNA
99392 $150 $138.27 $86.99 $88.79 $104.81 $130.62 $121.87 $106.99
85025 $30 $11.75 $3.47 $11.90 $6.47 $5.47 $10.63 $9.52
36416 $20 $0.29 $2.93 $11.35 $1.13 $0.13 $5.36 $7.18
99391 $130 $123.60 $76.36 $78.75 $97.99 $112.22 $106.07 $98.46
99000 $15 $0.00 $0.39 $1.85 $0.00 $0.00 $0.00 $1.61
99394 $174 $150.50 $94.65 $101.78 $123.21 $146.13 $127.66 $118.55
90633 $86 $24.80 $33.19 $32.16 $32.09 $33.90 $34.54 $36.08
90669 $106 $73.90 $75.81 $77.74 $75.11 $75.81 $64.65 $86.36
82465 $15 $4.95 $2.20 $0.19 $3.39 $0.00 $0.00 $0.00
90658 $25 $12.60 $12.70 $13.78 $10.78 $12.52 $13.19 $17.31
90723 $126 $75.52 $77.28 $78.72 $66.34 $78.72 $82.00 $70.73
90715 $70 $37.39 $39.77 $39.15 $39.58 $39.56 $43.89 $43.43
90647 $30 $21.62 $24.84 $25.45 $27.37 $25.63 $28.27 $30.53
Bold Italics Indicates Fees That Should Be Negotiated Upward Note: CPT Code 90647 Charge Should Be Increased
29
ABC ASSOCIATES, P.C.FEE SCHEDULE ANALYSIS
PAGE 3
CPT Codes Maximum Increase 10% Increase CPT Codes Maximum Increase 10% Increase
99213 $64,376 $6,438 85025 $2,463 $246
90471 $18,265 $1,827 36416 $6,208 $621
92551 $10,946 $1,095 99391 $16,258 $1,626
99173 $15,265 $1,527 99000 $725 $73
81003 $1,200 $120 99394 $15,317 $1,532
87880 $5,484 $548 90633 $2,829 $283
99051 $35,255 $3,526 90669 $5,321 $532
90472 $4,435 $444 82465 $1,000 $100
87081 $2,924 $292 90658 $2,079 $208
99214 $21,824 $2,182 90723 $2,979 $298
99393 $27,393 $2,739 90715 $1,534 $153
99392 $22,130 $2,213 90647 $1,888 $189
Total Annual Charge Increase: $230,000 $23,000 Total Annual Revenue Increase: $150,000 $15,000
Source: ABC Associates, P.C. Internal DataRevenue Calculated At 65% Net Collection Ratio
BILLING
31
OUTSOURCE BILLINGADVANTAGES
• Reduce Operating Expenses– Staff Salaries– Taxes– Employee Benefits– Seminars/Continuing Education– Billing Software Technical Support– Supplies– Postage– Computer Hardware/Maintenance
• Improve Billing Cycle• Improve Accounts Receivable
Aging/Cash Flow• Improve Effectiveness Of Claim
Appeals/Resubmissions
• Collections Automatically Deposited Into Client’s Bank Account
• Patient Statements/Collection Agency Process
• Comprehensive Management Reports
• No Employee “Turnover” Headaches
DISADVANTAGES
• Typically, Fees Paid A Billing Company Or Service Are Often A Flat % Of Collections Or Other Restrictive Arrangement, With No Or Limited Financial Incentive For You To “Grow” Your Practice
• Loss Of Control Of Billing Policies And Procedures
– How Collections Are Processed– How Patient Interactions Are Handled
– How Appeals And Resubmissions Are Handled
– How The Billing Cycle Works
– How Billing Policies And Procedures Impact Your Accounts Receivable Aging
32
BILLING DEPARTMENT VERSUS BILLING SERVICE
See EXHIBIT IV For Assumptions
Year 1 Year 2 Year 3 Year 4 Year 5 Cumulative
Annual Revenue $2,500,000 $2,600,000 $2,700,000 $2,800,000 $2,900,000 $13,500,000
Billing Department Year 1 Year 2 Year 3 Year 4 Year 5 Cumulative
Salaries $60,000 $63,000 $66,150 $69,458 $72,930 $331,538
Taxes, Benefits $15,000 $15,750 $16,538 $17,364 $18,233 $82,884
Computer Support $12,000 $15,000 $18,000 $21,000 $24,000 $90,000
Supplies $1,000 $1,000 $1,000 $2,000 $2,000 $7,000
Continuing Ed $2,000 $2,000 $2,000 $2,000 $2,000 $10,000
Overhead Allocation $15,000 $15,000 $15,000 $15,000 $15,000 $75,000
Total $105,000 $111,750 $118,688 $126,822 $134,163 $596,422
Billing Service Year 1 Year 2 Year 3 Year 4 Year 5 Cumulative
Service Fee $125,000 $130,000 $135,000 $140,000 $145,000 $675,000
Monthly Access Fees $26,460 $26,460 $26,460 $26,460 $26,460 $132,300
Total $151,460 $156,460 $161,460 $166,460 $171,460 $807,300
33
LOST REVENUE AGING FACTOR
See EXHIBIT IV For Assumptions---See Slide 18 For Lost Revenue Source
Year 1 Year 2 Year 3 Year 4 Year 5 Cumulative
Annual Revenue $2,500,000 $2,600,000 $2,700,000 $2,800,000 $2,900,000 $13,500,000
Billing Department Year 1 Year 2 Year 3 Year 4 Year 5 Cumulative
Salaries $60,000 $63,000 $66,150 $69,458 $72,930 $331,538
Taxes, Benefits $15,000 $15,750 $16,538 $17,364 $18,233 $82,884
Computer Support $12,000 $15,000 $18,000 $21,000 $24,000 $90,000
Supplies $1,000 $1,000 $1,000 $2,000 $2,000 $7,000
Continuing Ed $2,000 $2,000 $2,000 $2,000 $2,000 $10,000
Overhead Allocation $15,000 $15,000 $15,000 $15,000 $15,000 $75,000
Total $105,000 $111,750 $118,688 $126,822 $134,163 $596,422
Lost Revenue $240,000 $240,000 $480,000
Grand Total $345,000 $111,750 $118,688 $366,822 $134,163 $1,076,422
Billing Service Year 1 Year 2 Year 3 Year 4 Year 5 Cumulative
Service Fee $125,000 $130,000 $135,000 $140,000 $145,000 $675,000
Monthly Access Fees $26,460 $26,460 $26,460 $26,460 $26,460 $132,300
Total $151,460 $156,460 $161,460 $166,460 $171,460 $807,300
Outsource Savings ($269,122)
34
ANCILLARY SERVICES
35
ULTRASOUND FINANCIAL ANALYSIS
Amount %
Revenue $372,000 100.00
Expenses
Salary/Benefits $ 95,099 25.56
Equipment Lease $ 9,012 2.42
Supplies $ 2,947 .79
Overhead Allocation $ 84,600 22.74
Expense Total $191,658 51.52
Net Income $180,342 48.42Source: ABC Associates, P.C. Internal DataAssumptions: 250 Ultrasounds Per Month @$124 Payment Per Ultrasound; Overhead Allocation: Rent: $6,600 Rent Per Year, $3,000 For Telephone, Utilities And Office Supplies; $75,000 For Support Staff (2)
36
BONE DENSITY FINANCIAL ANALYSIS
Amount %
Revenue $85,680 100.00Expenses
Salary/Benefits $13,210 15.42Equipment Lease $15,811 18.45Supplies $ 300 .35 Rad. Install. Ann Fee $ 65 .08Overhead Allocation $16,000 18.67
Expense Total $45,386 52.97
Net Income $40,294 47.03
Source: ABC Associates, P.C. Internal DataAssumptions: 42 Tests Per Month @$170 Payment Per Test; Overhead Allocation: Rent: $5,200 Per Year,$2,400 For Telephone, Utilities And Office Supplies; $8,400 For Support Staff
37
EXTENDER ACTIVITY
Current APRN Weekly
Patient Volume 61.00*
Weekly Compensated Hours 72.00**
Weekly Hours Required 26.00***
Excess Weekly Office Hours 46.00
Annual Compensation “Cost” To Practice
$86,000**** * ABC Associates, P.C. Data For the Period _________________** From Internal Practice Information *** Assumes Weekly Productivity Level of 9 New OB Patients (.75 Hours Each), 5 New GYN Patients (.50 Hours Each) And 47 Established Patient Visits (3 Visits Per Hour)****Calculated as: ($49,998+$63,000*.35)*1.20 (Benefits, Taxes)
OPERATIONAL
39
ABC ASSOCIATES, P.C. OPERATIONAL FINDINGS
• There Is An Absence Of An Effective Organizational Structure.
• There Is No Effective Means Of Communication Within The Practice.
40
• Overall Staffing Level Is Higher Than The MGMA Median For This Specialty.
• If The Billing Function Is To Remain In-House, There Needs To Be Effective Billing Policies And Procedures To Ensure That The Aging Of Accounts Receivable Remains At An Acceptable Level.
OPERATIONAL FINDINGS (cont.)
41
ABC ASSOCIATES, P.C. ORGANIZATIONAL STRUCTURE
• Absence Of An Effective Organizational Structure– Need To Create
• Governance To Establish Clear Policies And Procedures
• Effective & Efficient Organizational Structure With Clear Reporting Lines
• Help Practice Manager Develop Leadership Skills
42
ORGANIZATIONAL STRUCTURE
PHYSICIAN OWNERS
PRACTICEMANAGER
RECEPTION SUPERVISOR
BILLING SUPERVISOR
BILLINGSTAFF
CLINICAL SUPERVISOR
EXTENDERSEMPLOYEE PHYSICIANS
RECEPTIONSTAFF
NURSESMEDICAL
ASSISTANTS
Source: ABC Associates, P.C.
43
COMMUNICATION
No Effective Means Of Communication Is
Currently In Place• Employee Handbook
• Job Descriptions
• Performance Appraisals
• Need To Institute Monthly Meetings (Type Of Which Deemed When And If Necessary):
– Physician Owners
– Physician Owners And Providers, Technicians
– Practice Manager And Physician Owners
– Practice Manager And Support Staff
44
PARETO’S LAW
Vilfredo Pareto-19th Century Economist80% Of Land In Italy Owned By 20% Of Population
• 80% Of Objectives (Effects) Are Achieved With 20% Of Means (Causes)
• Subsequently, It Takes 80% Of The Means To Achieve The Remaining 20% Of Objectives(Cost To Move From 80% To 100% 4X Greater Than Cost To Move From 0-80%)
45
ABC ASSOCIATES, P.C.
POSITION ACTUAL* MGMA** VARIANCE
General Administrative 5.00 1.40 3.60Business Office 4.60 4.00 .60 Medical Reception 4.90 4.60 .30 Medical Sec./Transcription 0.00 1.20 ( 1.20)Medical Records 3.00 2.30 .70Other Admin. Support 0.20 0.50 ( .30)Total 17.70 14.00 3.70-----------------------------------------------------------------------------------------------Medical Assistant 0.00 4.60 (4.60)RN 2.90 2.50 .40LPN 3.00 1.05 1.95Total 5.90 8.15 ( 2.25)Overall Total 23.60 22.15 1.45
* 7 FTE Providers** Based on MGMA 2011 National Cost Survey Report-Median Results For Specialty
46
STAFF ROSTER
General Administrative:
Business Office:
Medical Reception:
Medical Sec./Transcription:
Medical Records:
Other Admin. Support:
Medical Assistant:
RN:
LPN:
47
SUMMARY OF FINANCIAL OPPORTUNITIES
OPPORTUNITIES IMPLEMENTATION RANGE
Revenue Increases
Increase Office Encounters $ -0- $ 240,000Reduce Time Out Of Office $ -0- $ 66,000Collect A/R Over 90 Days Old $ -0- $ 130,000Fee Schedule Increases $ -0- $ 15,000
Total Revenue Increases $ -0- $ 451,000
Cost Savings
Outsource Billing Function $ -0- $ 54,000Reduce Extender Hours $ -0- $ 86,000Reduce Staff Where Needed $ -0- $ 30,000
Total Cost Savings $ -0- $ 170,000
Total Financial Opportunities $ -0- $ 621,000
48
RECOMMENDATIONS
REVENUE ENHANCEMENT
• Increase Office Encounters• Reduce Physician Time Out Of Office• Begin Collecting Outstanding Accounts
Receivable• Review Fee Schedule And Seek Payer
Adjustments, Where Possible
49
RECOMMENDATIONS (CONT.)
COST SAVINGS
• Engage Billing Service• Reduce Extender Hours• Reduce Staff
50
RECOMMENDATIONS (CONT.)
OPERATIONAL IMPROVEMENT
• Create An Effective Organizational Structure• Institute Monthly Meetings To Improve
Communication• Create Job Descriptions, Employee Handbook
And Performance Appraisal System• Additional Physician Coding Training• Physician Succession Planning
51
ABC ASSOCIATES, P.C.TIMELINE
Month 1 Month 2 Month 3
Increase Office Encounters XReduce Extender Hours XReview Outstanding A/R XCollect Outstanding A/R XReview Fee Schedule XObtain Payer Fee Increases XReduce MD Time Out Of Office XBegin Process To Engage Billing Service X X XReduce Staff XInstitute Governance XCreate Organizational Structure XInstitute Monthly Meetings XCreate Job Descriptions XCreate Employee Handbook X X XCreate Performance Appraisal System XCoding Training XMD Succession Planning X
52
EXHIBITS
EXHIBIT I: OFFICE VISIT ANALYSIS BY PROVIDER
EXHIBIT II: OFFICE VISIT ANALYSIS BY LOCATION
EXHIBIT III: GROSS CHARGES ANALYSIS
EXHIBIT IV: ASSUMPTIONS FOR BILLING
ANALYSIS
EXHIBIT I
OFFICE VISIT ANALYSIS BY PROVIDER
NOTE: Counts Do Not Reflect Patient “No Shows”
54Source: Internal Data Months: December, 2011; January, 2012; February; 2012
55Source: Internal Data Months: December, 2011; January, 2012; February; 2012
56Source: Internal Data Months: December, 2011; January, 2012; February; 2012
EXHIBIT II
OFFICE VISIT ANALYSIS BY LOCATION
NOTE: Counts Do Not Reflect Patient “No Shows”
58Source: Internal Data Months: December, 2011; January, 2012; February; 2012
EXHIBIT III
GROSS CHARGES ANALYSIS
60Source: MGMA Physician Compensation & Production Survey-2011 Report Based Upon 2010 DataInternal Data
EXHIBIT IV
ASSUMPTIONS FOR BILLING ANALYSIS
62
ASSUMPTIONS
Billing Service– Actual Service Fee Based
Upon The Following Factors:• Specialty
• Financial Class• Volume• Terms• Aging• Delivery Method
– Monthly Access Fee• $165 1st Station; $120 Each
Additional Station For 18 Stations.
Billing Department– Actual Current Expenses
Adjusted For Annual Revenue Increase
– Overhead Allocation:• Portion Of Most Practice
Expenses Based Upon The
Billing Office Space As A % Of Overall Office Space
Billing Service: XYC Billing Services, Inc.(203)XXX-XXXXBilling Department: ABC ASSOCIATES, P.C. Internal Information