powerpoint presentation · overview: leak points charges collections & controls patient volume...

4/3/2015

© Capko & Morgan - Reuse with Permission Only 1

Capture Every Dime: Finding and Plugging Revenue Leaks

Presented By

Laurie Morgan Senior Consultant, Capko & Morgan

Overview: Leak points

Charges

Collections & Controls

Patient Volume

Graphic: AnalyticsHero.com

4/3/2015


Overview: Leak points

Charges


Patient Volume

Benchmarks: reality test volume

Gross Charges

Physician Work RVUs

Per FTE physician Mean $1,154,490 90th%ile $1,633,450 10th%ile $777,612

Mean 5,801 90th%ile 8,737 10th%ile 3,070

Per FTE provider Mean $997,208 90th%ile $1,423,445 10th%ile $660,331

Mean 4,693 90th%ile 7,521 10th%ile 1,774

Source: MGMA Cost Survey 2013, Pediatrics, all

Medscape: very useful, and it’s free

Source: MedScape 2014 OB/GYN Compensation Report

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Medscape: hours seeing patients

Source: MedScape 2014 OB/GYN Compensation Report

Benchmark resources

MGMA

Medscape

NSCHBC

Specialty management groups

Specialty societies

Consultants

Magazines (e.g., Physicians Practice)

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Scheduling

Access and awareness

Staffing

Patient volume drivers

1

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Track no-shows accurately

Practice management system

Phone reminders

More than one-two a day per provider is a problem

One per day = $25,000 per year

Measure, don’t rely on gut

Scheduling efficiency: no shows

Reduce no-shows/cancels

Examine your reminder process Explain need for follow-up visits: “even if

you’re feeling better…” Let patient know if visit carries no cost

Remind three days out

Text+phone, text+email better than vmail

Use technology – seek help from vendors

Reduce no-shows/cancels

Cover lunch – don’t turn away late arrivals

Avoid balance build-ups

Review reports and audit schedules regularly

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Audit a month periodically, check for gaps

All providers lightly booked or just some?

Cyclicality? Are other practices busy?

Is provider time being maximized?

Assess time spent on non-essential tasks

Audit scheduling efficiency

Instruct schedulers to avoid gaps

Offer soonest available

Keep a waiting list

Introduce scheduling rules, then check impact: is marketing needed?

If providers are booked but have down time, review slot lengths

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Make changes to increase capacity

No/low availability can be costly, too

Review clinic hours, division of labor

Teach staff to “sell” team approach, NPPs

Review slots, add shorter ones

Open-access time can serve urgent needs

Group visits can add capacity


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Don’t be passed over

Cover phones during times new patients will call in (e.g., lunch)

Don’t let emails, vmails go unanswered for more than a few hours

PCPs: recall for wellness on time

10 year visits

10-yr revenue

differential

Each patient @$100/visit

2000 patients /10 years

100% on time 10 - - -

Average six weeks late

9 10% $ (100.00) $ (200,000.00)

Average three months late

8 25% $ (200.00) $ (400,000.00)

Average six months late

6 40% $ (400.00) $ (800,000.00)

Average 18 months late

4 60% $ (600.00) $ (1,200,000.00)


Job One: verify/edit/enhance health plan directory listings

Locations, certs, availability, subspecialties

Claim, verify, customize your Google My Business listing

Claim, verify, update your medical directory listings: HealthGrades, Vitals, etc.

Make sure you’re found when patients search


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Directories like HealthGrades, Vitals publish availability stats

“Secret patient” phone calls

ZocDoc can bring patients in immediately, raise profile

Analyze market coverage


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Monitoring/analyzing referrals

How did you hear about us?

Were you referred by a physician?

Be sure you have a system in place for reporting back to referring physicians – and thanking them


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Patient surveys/feedback

Simple survey is best tool for understanding if/why people are leaving your practice

Learn/correct problems before they appear on Yelp, etc.

Just being asked may improve people’s views

Third-party services simplify, meet HIPAA


Staffing influences productivity

FTE Staff

FTE Clinical Supp

Staff

FTE Providers

Per FTE physician Mean 3.8 90th%ile 5.2 10th%ile 2.5

Mean 1.8 90th%ile 2.5 10th%ile 1.1

Mean 1.38 90th%ile 1.74 10th%ile 1.06

Per FTE provider Mean 3.2 90th%ile 4.3 10th%ile 2.4

Mean 1.5 90th%ile 1.9 10th%ile 1.1

Source: MGMA 2013 Cost Survey – Pediatrics, all


Overview: Leak Points

Charges

Collections

Patient Volume

4/3/2015


Know how your fee schedule compares with contracts – avoid under-billing

Spot-check payer contract fee schedules against EOBs

Review amendments immediately to avoid automatic implementations

Review your fee schedule(s) annually


Evergreen renewals may suppress your revenue

Review other contract terms to ensure compliance

Don’t assume you can’t negotiate Compare contracts

Identify key codes

Look for points of differentiation

Set a tickler to review contracts


Review coding performance

Defensive under-coding is costly Atypical distribution of E&M can still trigger an

audit 99212 versus 99213 or 99214 might sacrifice

$50/visit or more – thousands of dollars per year

Overly aggressive coding can also invite an audit – aim for accuracy, not conservatism

Consider a coding refresher seminar to get everyone on the same page


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Check utilization versus CMS data

1%

21%

75%

1% 2% 0%

9%

67%

24%

0% 1%

90%

9%

0% 0% 0% 3%

55%

33%

9%

1% 4%

82%

12%

2% 2%

11%

35% 39%

13%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

code 99201 code 99202 code 99203 code 99204 code 99205

CMS avg

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AAPC offers free comparison tool using CMS E/M distribution data

Evaluate your data against national data to gauge audit risk and under-coding


Consider dropping “high hassle” contracts

Costly annoyances: Consistently slower processing More denials/down-coding Atypical referral or authorization rules Frequent patient complaints Poor support

Cutting an unprofitable payer creates room to add another plan Important to evaluate total revenue payer

represents to practice


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Graphs spotlight reimbursement differences . . .


. . . collection delays . . .


. . . and overall revenue contribution


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Use a grid to compare

Reimbursement Volume Collections New

Patients

“Hassle Factor”

BestPay Network 1st 4th 3rd 5th Low

So-So Plan 2nd 1st 2nd 1st Medium

Okay Insurance 3rd 3rd 4th 4th Low

Medicare 4th 2nd 1st 2nd Low

Lowball Health 5th 5th 5th 3rd High


Confirm the problem’s not on your end

Training issue?

Ask for new contact at payer

If many patients are irritated, too, urge them to go to HR

Work with benefits department yourself

Attempt reform


Overview: Leak Points

Charges


Patient Volume

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Time of service collections

Copay collection: minimum standard

Collect now or you automatically give up a percentage Plus, invoicing costs approach co-pay value

$20*25 appts=$500/day, $10,000/month, $120,000/year!

Waiving breaches contract

Audit weekly

Tablet tools like Phreesia may be helpful

Patient responsibility % of allowed amounts

Aetna Anthem Cigna UHC Medicare

20.40% 23.10% 25.90% 23.40% 24.60%

Source: 2013 AMA NHIRC

ACA Bronze ACA Silver ACA Gold ACA Platinum

40% 30% 20% 10%

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Time of service collections

Know eligibility, patient responsibility before procedures/visits – payer portals, your PMS

External credit for some practices (e.g., elective cosmetic surgery, bariatric)

Card-on-file/auto-payments for balances and pre-payment for surgeries, maternity, etc.

Investigate technology solutions

Prevent internal leaks

90% of practices will experience employee theft

Cash is biggest temptation First ‘test of the waters’ Keep petty cash petty – and separate Separate co-pay collection from daily

reconciliation Receipt stock

Reconcile superbills, appointment schedule against payments daily Split tasks Deposit daily

Prevent internal leaks

Credit, bank statements to physician or external accountant

Use EFT and lockbox EMR, billing system settings

Permissions, password hygiene

Get training from vendor

Look to integrate

Monitor refunds, write-offs, A/R

Background checks

Patient billing complaints


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Ensure charge and receipt data are clear

Integrate EHR and PMS if possible

Audit charges against schedule

Analyze denials and down-coding

Manage a 3rd party service as an employee

Revenue cycle starts with scheduling, front desk

Help your biller bill better


Ensure processes allow billing w/in 24 hours

Statement mailings – weekly runs are best

Email statements and payment portal!

Help your patients pay faster


Time is money

Charting: same day

Integrate EHR and PMS if possible

Posting charges: within 24 hours

Exception: hospital services for which approval or documentation from multiple surgeons is needed

Claims submission: within 48 hours

Hospital services 3-5 days

Payment: 30-45 days (insurance), 60-75 days (patient balances after insurance)


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Maximizing Collections

Compress schedule: two statements, ‘urgent’ letter, then collections

Remember, each additional statement costs $30 or more to send on average

The staff resources deployed for collecting could be more profitably doing other things


Closing thoughts

Variable #1: Patients Schedule optimally Be sure you’re found (phone, online) when patients search Track patient perceptions

Variable #2: Charges Monitor coding – it drifts – recalibrate when needed Avoid passivity with payers

Variable #3: Collections and controls Collect routinely at time of service – use technology to help Bill and collect promptly Establish and monitor internal controls


Feel free to contact me or my colleagues Laurie Morgan, [email protected]

Visit our blog at www.capko.com/blog

Facebook: www.facebook.com/capkoandmorgan

Twitter: @capkoandcompany and @managementrx

Management Rx: www.managementrx.biz

More Questions?

E-book series – ask for a free review copy!

mailto:[email protected]

http://www.capko.com/blog

http://www.facebook.com/capkoand

http://www.twitter.com/capkoandcompany

http://www.managementrx.biz/

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