Presented by:

Ron Anderson, CHMB Solutionswww.chmbsolutions.com

Founded in 1995, CHMB delivers Business, Clinical and Technology Solutions to Transform Physician Practices.

CHMB billing and revenue cycle management expertise includes a wide range of surgical, primary care, and internal medicine specialties for over 750 providers throughout California.

www.chmbsolutions.com

Ron Anderson, CPEHR, CPHIT

CHMB Director of Business Developmenta CHMB shareholder, has worked in healthcare since 1990. In addition to overseeing sales and marketing for CHMB, Mr. Anderson plays a key role in CHMB Client IT Projects and Internet based solutions.

ExpertiseRevenue Cycle ManagementReimbursement AnalyticsHealthcare Information Systems (HIS)

CertificationsCPHIT – Certified Professional Healthcare Information TechnologyCPEHR – Certified Professional Electronic Health Records

Healthcare Industry Participation:Co-Chair MGMA Information Technology Advisory Panel (since 2002)CAMGMA liaison to the California Medical Association (since 2004)CAMGMA Webmaster (since 2005)Past President of the California MGMA – CAMGMA (2003-2004)Past President of San Diego MGMA (2001 & 2002)

Front Office$ Reception and Scheduling

Back Office$ Billing and Collections

Reporting and Analytics$ Gather Data, Analyze, Take Action

Revenue CycleWhere does it start? Where does it end?

Gathering & Verifying Quality DataPoint of Service CollectionsAudit Revenue CaptureAccounts Receivable MetricsMonitoring Cash FlowDenials/UnderpaymentsMeasuring ProductivityAnalyzing Payer Contracts

Eligibility – Does you practice verify eligibility and obtain pre-authorization/referral for all appropriate patient services?

Patient Registration – Does your practice have (and monitor) basic data which is captured, verified and entered prior to or at the time of service?

Are you incorporating verified eligibility info to front office check-in staff?

How often do you update patient demographic information?

What percentage of patient co-pays are collected at time of service?

When are patients with outstanding balances being informed and/or requested to pay?

Notice to Our PatientsPlease be prepared to pay for all patient due amounts at time ofservice. This includes:

Co-PaymentsDeductiblesOutstanding Balances

For your convenience we accept cash, checks, credit and debit cards.If you are unable to pay at time of service there will be a $15.00 fee added to your account to cover our costs associated with preparing, sending and processing patient statements.

Thank you for your cooperation and helping us to keep our costs to patients at a minimum.

Family Practice Associates

Notice to Our PatientsPlease be prepared to pay for all patient due amounts at time ofservice. This includes:

Co-PaymentsDeductiblesOutstanding Balances

For your convenience we accept cash, checks, credit and debit cards.If you are unable to pay at time of service there will be a $15.00 fee added to your account to cover our costs associated with preparing, sending and processing patient statements.

Thank you for your cooperation and helping us to keep our costs to patients at a minimum.

Family Practice Associates

$10,000

$ 7,500

$ 5,000

$ 2,500

- 0 -

Contests / Challengeswith incentives & rewards

That which gets measured… gets done

Are you auditing the capture of all provided services?

Do you reconcile your days superbills against the appointment book?

Do you reconcile inputted charges against surgery logs (IP and OP)?

Average Charge per patient/encounter $ 200

Average Gross Collections Rate 55 %

Missing/Lost Superbills 1 %

Annual Lost Revenue per provider* $6,600

* Assuming 25 patients per day

When was the last time you updated your fee schedule and superbill?

Do you periodically audit coding to maximize revenue potential and ensure compliance?

Do you know which procedures provide the best and worst profitability?

Are you sending claims daily?

Can you diagnose where the delays are?

Date of Service

Date of Entry

Date of Billing

Date of Payment

Examples might include how many:- encounters per day- payments per day ($$ or count)- turnaround (DOS to Bill Date)- Use Days in AR to measure follow-up

If you outsource, measure date of sending batch to date of entry and claim creation

Track denials by payer, reason, and financial consequence and then prioritize activities

Have dedicated denials process in place

Must include “tickler” system so they don’t go unresolved

Must have access to contractual allowables

Are you tracking adjustments?

Do you compare EOB allowables or contractual write-offs against your actual contracts?

Create your key Payor/Procedure Matrix

99211 99212 99213 99214 99215Medicare 20.78 37.65 60.86 92.16 124.40

Blue Cross 21.82 39.53 63.90 96.77 130.62Blue Shield 20.34 36.98 59.74 91.15 123.15Aetna 19.74 35.77 57.82 87.55 118.18

How much of your over 90 day receivables is actually collectible?

Do you have a process for dealing with it?

By 120 days patient due it should be resolved. That means either:

• Paid in full • Payment plan

• Adjusted off • Sent to collections

3 statements (90- 120 days)

14 days letter #1

14 days phone

14 days letter #2

14 days request approvalfor outside collection

TOTAL: 160-190 days

2 statements (25-50 days)Phone Call #1 (64 days)Statement #3 (75 days)- Phone Call #2- Collection Letter #1- Pre-approvalStatement #4 (100 days)- Collection letter #2TOTAL: 110 days

Collection Policy A Collection Policy B

Revenue/Production

Benchmarking

Practice Dashboard

Charges, Payments, Adjustments and AR(by provider, payor and/or financial class)

Cumulative Month and Year to date with last month/year comparison

Identify and track key departments or high volume/$$ procedures(Surgeries, X-Ray, Deliveries)

Set benchmark based on month in whichYour Net Collections was average or good

Example:

Gross FFS Charge = $100.00Payment Total = $ 54.00Formula = Payment Total divided by Gross Charge($54 ÷ $100 = 54%)

Gross Collections Percentage = 54%

* Fee schedule, contracts and payor mix vary from practice to practice

Monthly Charges $80,000

Current Net Collections 93 %

Improved Net Collections 95 %

Annual Increase in Revenue $19,200

Do you measure and compare payors?(PPO and HMO)

1st step is to insure you have negotiated best possible rates for your practice

2nd, insure you are being paid your negotiated rates ENFORCEMENT IS KEY!

3rd, keep the process going

Build a better “front-end”“Do it right the first time”

Automate wherever possibleTechnology is great but “Keep It Simple”

Analyze production and performanceMeasure, decide, take action

Consulting• Ability to provide outsiders view and bring

alternative perspective to problem• Any one can point out problems, key is to offer

suggestions and plan to implement changes

Billing Services• 100% focus on Revenue Cycle Management• “TEAMWORK” approach with practice works best

as some areas must be handled internally• Concern over “Lack of Internal Control”• Reputable, Stable, Service Oriented

DEFINING EXPECTATIONS IS KEY!