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A Healthcare Consulting Division of Vero Orthopaedics & Neurology
Business Plan
June 10, 2019
This business plan is being submitted in partial fulfillment of the requirements of Fellowship in the American
College of Medical Practice Executives
Table of Contents
I. Project Summary ……………………………………………………………………………………………………………………………………3
II. Executive Summary………………………………………………………………………………………………………………………………..3-5
The Company
Market Opportunity
Capital Requirements
Mission Statement
Vision Statement
Values
Management
Competitors/Competitive Advantage
Financial Projections
III. Summary Description of the Business…………………………………………………………………………………………………….6-12
Mission
Business Model
SWOT Analysis
Strategy
Strategic Relationships
Key Stakeholders/Key Decision-Makers
Products and Services
Administrative Plan
Operational Plan
IV. Marketing………………………………………………………………………………………………………………………………………………….12-17
Market Analysis/Target Market
Competition
Market Trends
Marketing Strategy
Pricing
V. Financial Documents………………………………………………………………………………………………………………………………..17-19
Financial Needs
Pro Forma Cash Flow
Income Statement
VI. Innovative Elements and Expected Business Outcomes ………………………………………………………………………….19
VII Appendix 1 (Documents Needed for Analysis for new client)/The Core Group Marketing Flyer
Project Summary
Vero Orthopaedics & Neurology (VOVN) is an Orthopedic and Neurological establishment looking to enhance and
develop ancillary service lines of business outside of the usual and customary lines of business. VOVN is the largest
Musculoskeletal group in Indian River County. The practice has been in existence since 1976 and has a stellar reputation
in the community from both a medical and business standpoint. Jennifer Davison, the CEO for Vero Orthopaedics has
been with the practice for 21 years. She currently holds a bachelor’s in healthcare administration and is certified in
practice management through the Medical Group Management Association. She was the Business Office Manager, as
well as, the Director of Operations for several years prior to taking on the CEO role. Her passion for helping smaller
practices in the community started when asked to analyze the revenue cycle of an Urgent Care practice. Smaller
practices face challenges in having the appropriate resources available. Physician practices and healthcare organizations
are experiencing ever-increasing pressures in pursuit of efficiently managing services such as: human resources,
financial analysis, purchasing, compliance, MIPS and Electronic Health Record selection and implementation to name a
few. The Core Group was founded by me and is an extension of my current practice to provide day to day overall
operational management, as well as, financial management and unique expertise to smaller practices in the community.
Executive Summary
The Company
VOVN is located on the East Coast of Florida in Vero Beach. With a vastly growing population, Vero Orthopaedics
& Neurology is only five minutes from the Atlantic Ocean. Vero Beach is home to beautiful coastlines, fishing,
boating, tennis and an overall great family and retirement community. Since 1976, the practice has provided
comprehensive Orthopaedic and Neurological care within the community.
The initial founder, Dr. James Cain, who was a foot and ankle orthopedic surgeon had a vision of providing a
private subspecialized Orthopedic Group to provide quality care to all musculoskeletal areas, as well as, state of
the art treatments to the Indian River County community. His vision quickly became a reality as we grew
exponentially from one physician to fifteen physicians, all subspecialty specific, and developed the ancillary lines
of business to provide a one stop shop for the surrounding patients. Currently the practice has onsite MRI,
Physical Therapy, X-Ray, IV infusion suite, Neurodiagnostics, Durable Medical Equipment and a Dietary program
for our patients. This expansion led to a satellite office opening in Sebastian, FL (approximately 20 miles north of
the current location) so that we can further serve the needs of the ever-growing Indian River County population.
To put it in perspective, the population of Indian River County has grown 183% since Vero Orthopaedics &
Neurology’s inception, and we continue to be the preferred Orthopedic provider in the area. VOVN’s tradition of
excellence and strength in experience has been a cornerstone to the organization as it continues to grow. With
such rapid expansion, the practice has held on to a solid management team for over 20 years with additions along
the way and maintained 25 days in Accounts Receivable throughout its transitions. Collections steadily increase
year after year and staff turnover is minimal.
The Core Group was a concept that began in 2018 when smaller practices began to request consulting assistance
for Revenue Cycle and EMR selection and implementation assistance. Since VOVN had implemented and been on
3
an EMR since 2004 and had done so successfully, we wanted to find a way to offer assistance to the surrounding
smaller practices. Jennifer Davison CEO, began networking with the surrounding practices to discuss what their
current needs were. Working in the healthcare field with VOVN for over 20 years, running a successful practice
and wanting to share the knowledge with others was the beginning of what started the concept of The Core
Group.
Market Opportunity
Current population within Indian River County is 157, 413. As the population continues to increase annually, the
need for more physicians increases. New practices, as well as, mergers and expansions are on the rise. This will
further increase the demand for Healthcare Consulting services in our community. With a current 57% Medicare
population, and the complexity of MIPS, this also opens a market opportunity to assist the surrounding smaller
practices.
Capital Requirements
No capital funding was needed. All infrastructure was in place to get started. Should expansion needs occur there
may be an additional member of the management team salary added to help offset.
Mission Statement
To share our healthcare management expertise with a focus on delivering high quality solutions through aligning
technology and operations with an emphasis on efficiency in financial performance.
Vision Statement
As an extension of our practice, we are committed to providing our clients with a team of healthcare professionals
who combine current industry knowledge and practice experience to create effective practice management
solutions with the highest level of integrity.
Management
The business partners of The Core Group combined provide a wealth of knowledge in the Healthcare industry,
Management Consulting, Operations, Revenue Cycle, as well as IT solutions. Jennifer Davison is the current Chief
Executive Officer of Vero Orthopaedics & Neurology. Jennifer has over 20 years in of healthcare management
experience, holds a Bachelor’s Degree in Healthcare Administration, and is certified through MGMA’s practice
management accreditation program. She is a member of the Medical Group Management Association, the American
Academy of Orthopedic Executives, and currently serves on the Board of Directors for the Bones Society of Florida.
Lindsey Reed is the current Chief Operating Officer for Vero Orthopaedics and Neurology. She holds a Master’s Degree
in Healthcare Administration and is a member of the Bones Society of Florida, as well as, the American Academy of
Orthopaedic Executives. Sandra Katzor, current Business Office Manager, has her coding certification and has been
leading the business office at Vero Orthopaedics for over 10 years. She is well versed in financial metrics, accounts
receivable summaries and payor contracts and credentialing. Jordan Jankoviak, current IT Director, provides a wealth of
knowledge in Network Securities, Server Development, EMR support and program development. Dr. Seth Coren is the
current President of VOVN and serves as the physician director of the program and EMR Champion and trainer within
the practice.
4
Competitors
In Indian River County, there are currently no other practices offering consulting services. The closest competitors would be the larger consulting firms outside of the area such as Doctors Management and ECG Management Consultants.
Competitive Advantage
The company has a competitive advantage as it is linked to a successfully run business which has been in existence
since 1976. There are no other practices in the area that are providing this type of service or who has the
infrastructure to do so.
Financial Projections
Revenue projections based upon clientele
Year 1 Goal – 3 New Consulting Clients
1 New Ongoing Management Client
Year 2 Goal – 6 New Consulting Clients
3 New Ongoing Management Clients
Year 3 Goal - 10 New Consulting Clients
6 New Ongoing Management Clients
5
43000
$15,000 $28,000
$89,000
$20,000
$69,000
$180,000
$25,000
$155,000
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
$160,000
$180,000
$200,000
Annual Revenue Annual Expense Net Income
The Core Group Income Projection
Year 1 Year 2 Year 3
Summary Description of the Business
Mission
The Core Groups mission is to share our healthcare management expertise with a focus on delivering quality solutions
through aligning technology and operations with an emphasis on efficiency in financial performance.
Company Goals:
✓ To provide affordable and quality service to our clients
✓ To maintain professionalism by conducting our business with the highest degree of integrity.
✓ To deliver quality products and services that provide value to those with whom we work, our
associates and clients.
✓ To meet our clients’ needs and to ensure processes are smooth, efficient and transparent
✓ To provide the highest quality in customer service.
✓ To provide our clients with the most technological advancements as possible.
✓ To provide up-to-date current information regarding government legislation and Medicare Incentive
Programs.
✓ To provide revenue cycle management and strength in financial performance.
✓ To provide training and management support with open access for our clients.
Long term goals consist of continuing to build clientele and adding additional services as needed. Continuing
to build a physician liaison service for training and program development.
Business Model
Physician practices and healthcare organizations are experiencing ever-increasing pressures in pursuit of efficiently
managing services and resources. The Core Group is a small specialty-consulting firm formed for the purpose of helping
physicians with Healthcare Management, Government Incentive Programs, Electronic Health Record implementation
and IT services with a specific expertise in practice management and revenue cycle solutions. The Core Group provides a
comprehensive suite of services designed to maximize practice efficiency, while reducing overhead and increasing
revenue. This model is a unique service in the fact that it allows smaller practices to have the resources of a larger
practice while maintaining their independence and saving on costs they would with hiring a larger company to get the
more top-level management and IT support.
6
SWOT Analysis
INTERNAL STRENGTHS
• Years of knowledge in the industry
• Good understanding of Healthcare Management
• Significant IT experience
• Available resources
• Recruitment
• Credentialing
• Contracting
• Financial Management and Compensation strategies
• Revenue Cycle Management
• Electronic Health Record Implementation
• Up-to-date on current legislative issues as well as incentive programs
• Ancillary Service development and implementation
• Marketing expertise
INTERNAL WEAKNESSES
• Staffing resources to start business
• Training challenges
• Time that can be dedicated to projects
• Marketing
• Pricing structure for clients
EXTERNAL OPPORTUNITIES
• Enhance business community relationships to market the service
• Conduct seminars to educate the community on healthcare incentive programs.
• Opportunity to market with small group practices who are interested in EHR but cost restricted.
• Significant need for EHR in the community
• Significant need for practice development
EXTERNAL THREATS
• Increasing complex requirements of government regulators such as CMS and OIG.
• Growth of hospital based employed physicians
• Decreasing Medicare and commercial reimbursements making it difficult for physicians to purchase
additional services.
• Physician slow adoption to trust cloud and modern technology.
7
Strategy
Goal/Objective Action Timeline Desired Outcome
Marketing Create website and develop marketing plan to capture and educate the community about our services
Immediate Capture new business
Customer Service Provide quality services to
our clients. Manage
quantity of clientele so we
can provide excellent
service
Ongoing Doing business with the
highest degree of integrity
Education Continue to stay up-to date
on government legislation,
programs and NextGen
Healthcare should client
choose to be licensed
through VOVN Enterprise.
Ongoing Always be on the cutting
edge of technology
advancements
Implementation
Provide a smooth
implementation transition
for physicians and practices
creating an efficient and
stream-lined workflow and
training process.
Ongoing
Creating an efficient
workflow solution for
practices increasing
revenue and keeping
current with ever-changing
healthcare needs.
Technology Deploy Test environment for demo, production environment as well as NG test environment.
Immediate Delivery system with maximum up time and SLA agreements being met
8
Strategic Relationships
The Core Group is part of Vero Orthopaedics & Neurology which is a mid-size orthopedic and neurology group.
There are two locations approximately 15 miles apart from each other, both serving a different demographic area
one being Vero Beach and the other being Sebastian. VOVN has many relationships with the other provider
practices in the area and plans to utilize those relationships to build out clientele.
Key Stakeholders/Key Decision-Makers
VOVN is comprised of a board of directors of 6 physicians with Dr. Seth Coren being the President and Dr. John
Peden Vice President. They have assigned Jennifer Davison, CEO, as The Core Group President with Dr. Seth Coren
as the acting Physician Director. Her role will be to recruit new providers to the entity and oversee all decisions
both financial and operational.
Products and Services
The Core Group provides a comprehensive suite of services through all phases of Healthcare Management,
Practice Management, Electronic Health Records implementation and optimization, Financial analysis, Billing
and IT. These services include:
EHR
Project Management Workflow Analysis Implementation and Training System Configuration System Customization Go Live Support
EPM
Project Management Workflow Analysis Implementation and Training Report Creation Revenue Cycle Management System Configuration Go Live Support
Healthcare Management
MIPS training and assistance E-prescribing set up Risk Management Policies and Procedure Development Management Consulting Services Billing Revenue Cycle Analysis Human Resources 9
Compliance Start up practice Credentialing Contracting IT Solutions
360 IT Service coverage and consulting Server management Purchasing, planning and budget Cloud management & service Communications (Exchange, spam, etc) Software & Security protection (virus, spyware, intrusion protection Virtualization & Consolidation Administrative Plan
As the Physician Director, Dr. Seth Coren, will work closely with CEO Jennifer Davison on all new physician
practices. Dr. Coren has been a physician in Indian River County for over 35 years and has built several
relationships with surrounding physicians. He is trusted in the community by many. He will be the first point
person for the new physician to speak with. Once initial point of contact has been established and Dr. Coren
outlines Vero Orthopaedics business history and how The Core Group was formed will Jennifer Davison delve into
the first analysis (Appendix 1 contains the Documents Needed for Analysis and checklist). Following this
analysis, a detailed report will be provided to the Physician for review to include a brief financial analysis, and IT
Analysis performed by Jordan Jankoviak, IT Manager, as well as, an executable plan with a detailed contract and
pricing sheet outlining options. Once this has been signed, Jordan Jankoviak, IT Manager, will then analyze the
current IT structure to ensure appropriate access to the system and security measures are implemented.
10
Physician Director
Seth Coren, MD
Lindsey Reed
Chief Operating Officer
Sandra Katzor
Business Office Manger
Jordan Jankoviak
IT Manager and Training Officer
Jennifer Davison
Chief Executive Officer/President
Lindsey Reed, COO, will review the current operations and completed analysis by Jennifer Davison to learn where
the operational inefficiencies are and what enhancements need to be made.
Sandra Katzor will then review the billing and revenue cycle and formulate a plan of action to correct or get them
placed under our billing modules should they so choose.
Vero Orthopaedics Core Group team will assist with all policy and procedure development, HR, group purchasing
analysis and ongoing management for all clients.
Operational Plan
All operations will be run through the parent company Vero Orthopaedics & Neurology. We will work with
NextGen our current EMR/EPM Vendor to enterprise our license out for any clients that would like to utilize our
Vendor for their current system. Since we have been a client since 2004 and are well versed in the system we
would play a fundamental role in training and system development at an affordable price.
We will begin with an advertisement on social media and an email blast to all surrounding physicians. Jordan
Jankoviak will develop a website www.coregroupvero.com so that we can route potential clients there to submit
inquiries. Key milestones as follows:
11
Develop Website April 2019
Second Client May 2019
Strategic Planning Meeting
June 2019
Nextgen Licensing
January 2019
Social Media/Email Blast
Feb 2019
First Client March 2019
Possible roadblocks to include:
• Nextgen enterprise licensing taking longer than anticipated.
• Technical resources being limited on the client side making it difficult to provide adequate services should
they need to purchase any capital expenditures for IT.
• Due to Vero Orthopaedics & Neurology’s current growth, there is concern of not having enough resources
to manage clientele should more than one request services.
• Marketing dollars are limited, therefore, we need to rely on social media and email advertising no print
articles will be done.
• Dr. Coren takes a significant amount of time off during the summer months, therefore, t here is concern of
access to him should a new client need him onsite.
Marketing
Vero Orthopaedics & Neurology’s branding is well established in Indian River County. Since The Core Group is an
extension off the current practice we will utilize the same marketing tactics to help grow the business. Our goal is
to ensure our clients’ practices will be treated like our own. The same philosophies we apply in our own practice
is what we will apply to all clientele. Since the practice is known by the community physicians as a leader in the
Healthcare business for over 40 years we will utilize these principles as we market this extension of the practice.
The current practice utilizes S.M.A.R.T Objectives when evaluating marketing strategy and will carry this strategy
with The Core Group.
Specific: Clarifying the who, the what and the when while marketing the services.
Measurable: Measuring our objectives is critical. This instills accountability into all subseque nt decisions and
also guarantees learning as you move forward.
Acheivable: Marketing goals must be achievable and setting aside the commitment to devote the time needed to
these goals.
Relevant: Objectives must be relevant. “Should it be done?” and “What will be the impact?” . Is the objective
aligned with the strategic plan.
Time-Limited: Time constraints are imperative for an objective to be clear, accountable, and achievable.
The Core Group understands the current struggles Independent physician practices are faced with in this era of
medicine. We want to market the ability to ease those fears. To give physicians the tools and guidance needed to
successfully make informed business decisions. Whether it is consulting only or full suite management we want to
provide value in all that we do.
With the rise of social media our first target will be to advertise on Facebook, as well as, establish a Linked In
profile.
Below are samples of the email blast/Social Media blast, as well as, a services flyer we will utilize for Marketing.
12
13
Social Media
Email Blast
Flyer to be distributed
outlining services
Market Analysis
Indian River County is a county located in the Treasure Coast region of Florida. With a population of over 150,000
people, it is Florida’s 7th richest county and in 2000 was the 87 th richest county in the US by per capita income.
Indian River County includes both the Sebastian-Vero Beach area. Both areas continue to grow in population
annually.
As the market continues to expand and grow, more and more physician practices are opening and/or expanding or
recruiting. The Core Group’s target market are as follows:
✓ Physician Practices of all specialties and sizes.
✓ Physician practices in need of assistance with Regulatory Programs.
✓ Physician Practices in need of Healthcare Management Consulting
✓ Physician Practices in need of Financial performance analysis
✓ Physician Practices in need of Revenue Cycle Management
Competition
In the current market, there is no area competition aside from the larger consulting companies outside of the
surrounding area. The larger companies can potentially provide a larger pool of resources than what we can
provide which can be an advantage. The disadvantages to these larger companies are access. The Core Group has
the ability to offer a more hands on personalized approach with direct access to our physician liaison Dr. Seth
Coren, MD, as well as, onsite support when needed.
Market Trends
As the population increases so do the number of physicians. The Indian River County Medical Society is the hub
for physicians in the county. As new physicians and practices join the society, we will partner with the society to
provide new physicians The Core Groups information for assistance.
Market Research
Since provider market research is limited in our area for this type of business, we relied upon evaluating the
current number of smaller private practice, the current growth trends of physicians in the community which
consists of about 2% annually. Since we have had two practices who have reached out to our physicians
requesting an internal analysis be done, we anticipate once we begin to market our services word of mouth will
expand.
Marketing Strategy/Implementation of Marketing
The plan is to utilize limited marketing dollars on advertising The Core Group. Since the practice spends a flat rate
with the current marketing company we will utilize them to create the advertisements. We want to focus on
marketing to Indian River County specifically, with a plan to develop this market in the next five years. Due to our
longtime history, this extension of the practice can be developed into a niche opportunity.
Since we actively do a lot of social media advertising and email advertising, we will continue this extension off of
Vero Orthopaedics & Neurology, as well as, some print materials such as those displayed above to deliver to the
surrounding practices. Furthermore, the development of a website will be a key component to receive secure
inquiries, as well as, a potential practice management blog section.
14
Our implementation focus will be geared towards private practices and our success will depend solely on our
ability to show adequate results and benchmarking success. By providing the local practices with some
transparency of current VOVN metrics this will give them the confidence needed.
Website Development in Progress: (coregroupvero.com)
Marketing Budget/ROI (Annual):
Beginning Balance $3000
Expenses
Flyers $500
Facebook Monthly Advertisement ($75/month) $900
Website Development (performed internally by IT with a Bonus) $1000
Pens (distribute with flyers) $600
_________________________________________________________________________________
Total Expenses $3000
Ending Balance $0
Year 1 : 3 New Consulting/1 Ongoing Management Revenue $40,000
Monthly Revenue $3333.33
Marketing Monthly Dollars $250.00
Total Net (Marketing expense only) $3083.33
15
Pricing
Hourly Rates
• Management Consulting Hourly Rate $125/hour
o Financial Analysis
o Compensation Models
o Marketing
o Risk Management
o Human Resources
o Policy and Procedure Development
o Credentialing/Contracting
• Physician Consulting Hourly Rate $375/hour
o EMR analysis and training
o Dragon Training
• Billing Office Hourly Rate $85/hour
o Training Manuals
o Coding assistance
Flat Rate Options
• Full Day onsite practice overview with analysis $1500 plus travel
• Billing Training Onsite at VOVN $500 per day
• Billing Training Offsite at their location $750.00 plus travel
• Full practice startup - $5000 one-time fee includes:
o Contracts and Credentialing (Medicare, Medicaid, and Commercial)
o Full EMR and Billing setup and advise
o Credentialing support for unlimited payors.
o IT Startup services advise
o Practice Consulting and Administrative support for the payor agreements
• Billing and Practice Administration – NextGen Client Cloud Based
o One-time fee of $5000 for setup
16
o $1500 per month for support and maintenance (no license fee, VOVN has a special arrangement with
NG for licensure. Enterprise license after year 1 paid in full.)
o Billing Services – 3% of total collections (can do tiered levels)
▪ Charge posting, claims submission, EOB posting, denial management, coding and compliance
▪ Guaranteed MGMA Benchmark AR revenue Cycle
Financial Documents
Financial Needs
Since The Core Group is a current extension of Vero Orthpaedics & Neurology, most of the staff are currently in
place. We would need to hire one additional core management team member to assist with the marketing, as
well as, be the front-line person to filter questions or respond to inquiries given.
Since the current structure is in place at VOVN, there would be no need for any large capital expenditure. The
discounted license fees should they request an extension off of our EHR would be paid by the client dir ectly.
VOVN will put an initial investment of $10,000 to start the project with some capital and for marketing.
The current managers involved in the project will be paid separately for any work related to The Core Group.
Hours will be submitted on a monthly basis and be compensated the payroll following the end of the month.
The following aspects will need to be outsourced at the client’s expense: Accounting, legal and building
maintenance, however, The Core Group and VOVN will assist clients with finding the appropriate individuals to
manage these items.
All net revenue will be distributed amongst the current partners of VOVN equally except for Dr. Seth Coren who
would be compensated separately in addition to any distributions for his consulting needs.
Proforma Cash Flow Statement (Budget)
Cash Flow Statement Proforma
The Core Group
For the year ending 2019
Cash at Beginning of Year $10,000
Operations
Cash Receipts from clients $43,000
Cash paid for
Marketing ($3000)
17
General operating and administrative expense ($2,000)
Wages ($10,000)
Net Cash Flow $38,000
Per partner distribution (6 partners) $6333.33
2019 2020 2021 [42]
Sales revenue 43,000 89,000 180,000
(Less sales returns and allowances)
Service revenue
Interest revenue
Other revenue
43,000 89,000 180,000 [42] [42]
[42]
Advertising 3,000 3,500 4,000
Bad debt
Commissions
Cost of goods sold
Depreciation
Employee benefits
Furniture and equipment
Insurance
Interest expense
Maintenance and repairs
Office supplies
Payroll taxes
Rent
Research and development
Salaries and wages 10,000 20,000 40,000
Software 300 300 300
Travel 500 1,000 1,000
Utilities
Web hosting and domains 200 200 200
Other
14,000 25,000 45,500
Net Income Before Taxes 29,000 64,000 134,500
29,000 64,000 134,500 {42} [42] [42]
Total Expenses
Income from Continuing Operations
The Core Group Income StatementProjection for Three Years (2019-2021)
Revenue
Total Revenues
Expenses
18
Essentially the Balance sheet, Break-even analysis and Profit & Loss statement is reflective of the Income Statement and
Cash Flow Statement. Since the current practice is in in place the revenue far outweighs the expenses due to the
current infrastructure already being in place. Expenses strictly consist of Marketing, Salaries and any travel related
expenses for conferences and or outside of the area referrals. The board will need to decide if they will run this through
the current compensation model or create a separate LLC versus a DBA.
Since the current Vero Orthopaedics business history is strong, we will apply the same philosophies to The Core Group
extension.
Innovative Elements and Expected Business Outcomes
The current challenges physician practices face in this era of healthcare are ongoing. Smaller practices lack the business
resources necessary at times to operate efficiently making it difficult to sustain financial viability. The ability to have a
larger pool of resources and analytics available will only add value to the smaller practices. Assisting them with added
ancillaries, new innovative ideas, MIPS, EMR selection, billing, and financial metrics to name a few will not only enhance
their business outlook but give them the tools needed to succeed.
One challenge imposed during this process are the anticipated expenses for additional layers of security that may be
needed to protect the other practices information and patient data should they choose to be an extension of our current
system. Another challenge would be resource allocation. Due to Vero Orthopaedics & Neurology being such a busy
practice a concern would be the ability to provide the needed services timely and efficiently for the other practices. In
order for The Core Group to succeed we need to allocate resources appropriately within the current practice to enable
the additional load of clients. To offset this, we would be selective in how many clients we take on at a time to ensure
we deliver the best service we can.
In order to proceed with this action plan, we will have a planning meeting with the current administrative team
members of Vero Orthopaedics & Neurology and begin outlining a plan of action. Roles will be defined, and tasks added
to a spreadsheet to complete prior to launching. Once this is in place, a meeting will be held with the current Board of
Directors of Vero Orthopaedics & Neurology to review the business plan, identify the key members and review resource
allocation and financial proformas.
Documents Needed for Analysis
1. Annual income and expense statement and balance sheet for last two years plus YTD
2. Computer printout or manual summary of physician productivity reports on procedures
and services performed
3. Copy of fee schedule
4. Listing of employees, their wages, hours they work per week and position title and date of
hire.
5. Compliance policy
6. Report on charges, adjustments and receipts for last two years and year to date
7. Copy of encounter form (charge ticket, superbill)
8. Any patient satisfaction surveys and results
9. Any previous consultant reports, auditor reports or health care plan evaluations
10. Report on payor mix of practice
11. Accounts receivable aging report
12. Personnel policy
13. Job descriptions
14. Any written policies and procedures
15. Office forms, clinical forms and sample of medical chart
EMR/EPM Software
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Copy of agreement with
EMR/EPM vendor.
Rank:______ Comments:
What is the relationship
between software and
intermediary?
Rank:______ Comments:
Once chgs posted, is the fee
automatically adjusted in
computer according to payor?
Rank:______ Comments:
Who is the clearinghouse the
software program uses?
Are claims scrubbed prior to
being transmitted.
Is the practice currently set up
for Digital Radiography or
Computerized Radiography?
Does the EMR/EPM vendor do
the billing and if so what is the
percentage?
Patient Information & Scheduling
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Lobby Image: neat, clean,
comfortable, magazines, TV, etc
Rank:______ Comments:
How does the receptionist greet
the patient?
Is there eye contact? Smile? By
name? Professional appearance?
Rank:______ Comments:
How is the back office notified
that the patient has arrived? Is
it an efficient method?
Rank:______ Comments:
Patient arrives, signs in. Take
10 patients and check waiting
time in lobby.
Rank:______ Comments:
What is the policy on patients
arriving late
Rank:______ Comments:
Are the forms prepped and
ready for patient to be seen by
provider?
Who preps the items needed for
physician?
Rank:______ Comments:
Patient Information & Scheduling
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
What is length of time for new
patient to be scheduled for
appointment? Is it beyond 1-2
weeks?
.
Rank:______ Comments:
Are patient info pulled the day
before appointments with a
copy circulated to other staff?
Rank:______ Comments:
Are there protocols for
receptionist on how to schedule
patients based on their reason
for visit? How complete are
they? Are there triage policies?
Rank:______ Comments:
Are policies and procedures
explained to patients when
calling for appointment? Are
they asked to bring insurance
verification? Are they told
some payment, co-payment or
deductible required? Are they
given directions to the office?
.
Rank:______ Comments:
What is the average waiting
time for patient to be seen by
doctor from the time they come
into the office? Does it exceed
15–20 minutes?
Rank:______ Comments:
Does the office see patients
consistently after regular office
hours requiring staff overtime?
.
Rank:______ Comments:
Patient Information & Scheduling
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Do the physicians, nurse
practitioners and physician
assistants begin seeing patients
on time as scheduled?
Rank:______ Comments:
How does practice record and
handle cancellations, no-shows
and walk-ins? Is there
documentation and patient
follow-up?
Rank:______ Comments:
Do appointment scheduling
protocols allow for adequate
number of patients to be seen
based on patient visit industry
norms by specialty?
Rank:______ Comments:
What are procedures for after
hours emergencies? Does
system provide adequate
communication to patients?
Rank:______ Comments:
Do office staff request updated
information from established
patients – change of address,
insurance coverage,
employment, etc.?
Rank:______ Comments:
Are employees reviewing
appointments aware of
Rank:______ Comments:
managed care requirements
and protocols?
Does office have appointment
reminder system?
.
Rank:______ Comments:
Patient Information & Scheduling
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Is there overbooking or double
booking appointments causing
delays?
Rank:______ Comments:
Does physician notify office
when he/she will be running
late for office appointment so
patients can be advised?
Rank:______ Comments:
Is there a patient recall system
based on health care follow-up
needs?
Rank:______ Comments:
Are there adequate protocols
for staff regarding patient calls,
prescription refills, phone
messages and handling urgent
calls?
Rank:______ Comments:
Do patient registration
procedures consist of
completion of patient
information form, authorization
for medical records, assignment
of benefits, and health history
form completion?
Rank:______ Comments:
Is there a clear procedure for
patient checking out of office by
seeing receptionist/cashier?
Rank:______ Comments:
Are all patient questions
answered regarding billing and
insurance?
Rank:______ Comments:
Patient Billing, Collecting & Fees
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3 Deficient
Are all charges and
payments posted daily?
.
Rank:______ Comments:
Are co-payments and
deductibles collected at time
of service?
Rank:______ Comments:
Does office staff have written
procedures or scripts to use
for effectively requesting
patient payments in person
and by phone?
Rank:______ Comments:
Does staff obtain insurance
verification for new and
established patients?
Rank:______ Comments:
Does billing encounter form
include up to date CPT &
ICD-9CM codes for
procedures and diagnoses
pertinent to practice
specialty?
Rank:______ Comments:
Patient Billing, Collecting & Fees
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Are statements on accounts
outstanding sent consistently
on billing cycle, at least
monthly? Are there written
procedures for handling
accounts 30 – 60 – 90 – 120
days old?
Rank:______ Comments:
What percent of total accounts
receivable are 30 – 60 – 90 –
120 and how do these
percentages compare to the
norms in the industry for this
specialty?
Rank:______ Comments:
What is system for retrieving
information on charges for
hospital and other out of office
services by provider?
Rank:______ Comments:
Are insurance claims processed
at least 2 – 3 times a week?
Are they reviewed for amount
paid, denials, under payments
and rejections?
Timely submission and follow-
up procedures by staff?
Adequate staff for keeping up
to date?
Rank:______ Comments:
What are reasons for denials?
Coding errors? Electronic
claims utilized for carriers that
have capability?
Rank:______ Comments:
Patient Billing, Collecting & Fees
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Does practice have good claim
appeals procedures? What
result does practice get? 50 –
70% favorable appeal on
incorrect payments?
Rank:______ Comments:
Does practice use all
capabilities of its computer
billing software? Is staff
adequately trained to utilize?
Software updated with multiple
fee schedules and capability to
track managed care plan
payments?
Rank:______ Comments:
Does practice have the most
recent CPT, ICD-10CM &
HCPCS reference books for
coding? Does computer
software have updated codes?
Are there organized files on
insurance carrier
requirements?
Rank:______ Comments:
Is timetable for collection steps
followed? Does staff have
guidelines and scripts for
collection phone calls and
collection letters that adhere to
state regulations regarding
collecting?
Rank:______ Comments:
Are changes in rules and
regulations on third party
payments and contracts
monitored and communicated
to staff?
Rank:______ Comments:
Patient Billing, Collecting & Fees
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Are credit card payments
accepted by practice and
encouraged? Is payment plan
arrangements setup for
accounts with large balances or
those needing assistance?
Rank:______ Comments:
Are refunds, discounts and
other adjustments to patient
accounts posted and approved
daily?
Rank:______ Comments:
What level of training and
experience does billing staff
have on coding? What
education programs attended?
How often? Is extensive
attention given to procedure
and diagnosis coding?
Rank:______ Comments:
Are HCFA 1500 claim forms
completed accurately by staff?
Rank:______ Comments:
Are there clear and consistent
policies on adjustments and
write-offs? Does staff follow
policies timely?
Rank:______ Comments:
Patient Billing, Collecting & Fees
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Does office have complete fee
schedule for services by CPT
codes? Is this updated
annually? Has there been a
complete fee schedule analysis?
Are fees within the norm and
competitive? Does practice
have multiple fee schedules of
carriers? Are they updated?
Rank:______ Comments:
How do fees compare to
Medicare fee schedule?
Rank:______ Comments:
Does practice have up to date
fee schedules from health care
plans?
Rank:______ Comments:
Has practice analyzed it’s
discounted fees with managed
care plans?
Rank:______ Comments:
Are physicians and providers in
the practice charging correct
level of service fees for
treatment given?
Rank:______ Comments:
Are fees for all ancillary
services (lab, diagnostic testing)
Rank:______ Comments:
being charged and recorded on
patient encounter?
Financial Management
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Does practice monitor and
review expenses monthly? Who
reviews and what information
reports are generated?
What is practice’s overhead
(non-physician expenses as a %
of total collected revenue)?
Rank:______ Comments:
Are expense categories –
personnel, supplies, rent,
utilities, etc. – measured as a %
of revenue? How do these
percentages compare to the
norm for the specialty?
Rank:______ Comments:
Are deposits made daily or a
lock box utilized?
Rank:______ Comments:
Is there more than on person
who receives mail-in payments,
onsite cash payments and
makes deposits for the practice?
Is there daily reconciliation
manually or by computer?
Is there a record of checks and
cash received daily and
compared to deposits? Are
employees handling money
bonded?
Rank:______ Comments:
Are bank statements
reconciled? By Manager or
physician? Are credit balance
refunds verified and approved?
Rank:______ Comments:
Financial Management
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Are accounts payable up to
date? Are there vendor files
with invoices and payment
records? Are all checks in
check register accounted for
and monitored?
Rank:______ Comments:
Who has check writing
authority? Are there
supportive documents for check
writing? If signature stamp
utilized, is it secure?
Rank:______ Comments:
Is there a system to account for
all voided checks?
Rank:______ Comments:
Is chart of accounts used set up
by accountant or similar to
MGMA standards?
Rank:______ Comments:
Are pre-numbered purchase
orders and checks used?
Rank:______ Comments:
Is there system for controlling
petty cash? All expenditures
itemized with receipts and
reconciled?
Rank:______ Comments:
Financial Management
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Do physicians and manager
review the following at least
monthly: financial statements,
total collections, accounts
receivable, write-offs,
adjustments and expense ratio?
Rank:______ Comments:
Does the practice have an
annual cash budget? Has
manager or accountant
prepared cash flow analysis?
Are capital equipment needs
planned and budgeted?
Rank:______ Comments:
Is there an inventory control
system – manual or
computerized? Are there
policies to avoid over ordering?
Rank:______ Comments:
Are purchase orders used?
Who has authority to purchase
and is there a limit to the
amount authorized?
Rank:______ Comments:
When supplies are delivered to
practice, are packing slips
checked and matched to
invoices?
Rank:______ Comments:
Does practice take advantage of
any group purchasing
arrangements for discount
pricing? Are vendors pricing
compared periodically by
manager?
Rank:______ Comments:
Financial Management
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Does office maintain an
inventory list of equipment and
furnishings? Does accountant
have up to date list and
depreciation schedule?
Rank:______ Comments:
Is the practice’s bank statement
reconciled monthly?
Rank:______ Comments:
Does practice conduct any type
of business planning annually?
Rank:______ Comments:
Does practice have contracts,
leases, agreements, employee
contracts and corporation
papers in organized filing
system?
Rank:______ Comments:
Are there proper tax reporting
systems and filing?
Rank:______ Comments:
Does practice’s financial
statement and balance sheet
reflect cash flow problems or
extreme liabilities?
Rank:______ Comments:
Is practice taking advantage of
discounts and avoiding late
payment charges on bills due?
Rank:______ Comments:
Compliance & Risk Management
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Does practice follow informed
consent with forms or
guidelines indicating what is
discussed with patient
regarding their treatment and
procedures performed and the
risks involved? Are discussions
and decisions noted in medical
chart?
Rank:______ Comments:
Are office lab and x-ray licenses
displayed?
Rank:______ Comments:
Is complete malpractice
insurance in effect for providers
and the practice?
Rank:______ Comments:
Does office have policies on
release of information and
confidentiality of medical
records? Are authorization
forms signed and dated?
Rank:______ Comments:
Does the office routinely inspect
and maintain equipment?
Rank:______ Comments:
Is there a written OSHA policy?
Are all staff trained for OSHA
Rank:______ Comments:
requirements? Has there been
correspondence from OSHA?
Do they know how to respond to
OSHA inspection?
Compliance & Risk Management
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Is there a complete written
compliance plan for the medical
practice covering the 7 key
elements of HCFA
requirements? Who is
compliance officer?
Rank:______ Comments:
Is there a system to periodically
audit medical charts and
charges for compliance?
Rank:______ Comments:
If office has in-house lab, does
it comply with CLIA
requirements? Is there a
certificate posted?
Rank:______ Comments:
Are there quality assurance
procedures and policies
regarding patient care? Does
practice adhere to managed
care plan requirements for
quality assurance?
Rank:______ Comments:
Is there a policy to report and
resolve patient complaints?
Are there written standards?
Rank:______ Comments:
Rank:______ Comments:
Are notices of privacy practices
(HIPAA) provided to patients?
Is notice posted in office? Are
authorizations obtained for
disclosure of protected health
information for non-routine
requests? Are signed
agreements being obtained
from all service vendors of the
practice? Have all employees
been oriented to HIPAA
policies?
Do employees sign a
Confidentiality Statement and
is it located in their personnel
record?
Personnel Management
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Are there written personnel
policies? When last updated?
If not written, are there
enforced policies on vacations,
holidays, sick leave benefits,
employee evaluations, salary
increases, overtime,
attendance, training,
grievances, employee conduct,
personal calls, smoking,
bereavement leave, safety,
termination, discipline,
breaks, employee and patient
relations, adherence to
compliance rules, patient
confidentiality, non-
descrimination, workers
compensation and safety?
Rank:______ Comments:
Are there written job
descriptions? Do they need
updating? Applicable to
present employees?
Rank:______ Comments:
Are there adequate employees
based on number of physicians
and providers? Is practice
overstaffed?
Rank:______ Comments:
Compare the practice’s number
of employees to full time
Rank:______ Comments:
physician ratio with industry
averages.
Is employee turnover a
problem?
Rank:______ Comments:
Personnel Management
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Are new employees given
structured orientation and
training? How is training
handled and evaluated?
Rank:______ Comments:
Do employees receive
continuing education
throughout each year such as
coding, billing techniques,
insurance processing, clinical
skills for nursing or other
business training for manager
and other front office
employees?
Rank:______ Comments:
Are employee salaries and
benefits competitive to area and
appropriate to position and
responsibilities? Compare
salaries to industry averages.
Rank:______ Comments:
Is receptionist and nurse
pleasant and helpful to patients
and visitors in the office?
Rank:______ Comments:
Are personnel records in order
– payroll, taxes, documentation
of employee evaluations,
grievances; employment laws
Rank:______ Comments:
followed regarding wage and
record keeping?
Are employees given timely
performance evaluations?
Rank:______ Comments:
Personnel Management
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Are there regular
manager/employee meetings
and manager/physician
meetings? Are meetings
effective?
Rank:______ Comments:
Are any employees performing
duties that should be performed
by another position?
Example: Nurse doing what
nurse assistant or clerks should
do. Physician doing tasks that
nurse should do.
Rank:______ Comments:
Are employees given cross
training?
Example: Can nurse, billing
person or medical assistant
adequately fill in for
receptionist at front desk?
Rank:______ Comments:
Does office have time cards,
time clock or written
verification of employee hours
worked?
Rank:______ Comments:
Is there excessive overtime? If
so, what are reasons?
Rank:______ Comments:
Are employees aware of the
supervisory relationships, lines
of authority and decision
making within the practice? Is
there an organization chart?
.
Rank:______ Comments:
Medical Records
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Does the practice have medical
chart filing system that is
standard for the medical
practice industry? Do charts
contain patient information
forms, progress sheets, history
forms, authorizations and
correspondence?
Rank:______ Comments:
Are charts durable and have
alpha or numeric labels for easy
identification plus year
stickers? Are charts on shelf
easily accessible for staff?
Rank:______ Comments:
Does medical record
documentation follow a SOAP
or similar system? Are records
hand written legibly or dictated
by providers?
Rank:______ Comments:
Do medical records show the
following: patient name and ID
#, all entries dated, lab and x-
ray results and interpretation,
a problem list, allergies noted
are displayed, appropriate past
medical HX shown, pertinent
history & physical exam,
evidence of patient education,
provider ID # is shown,
standard medical abbreviations
are used and consent forms?
Rank:______ Comments:
Medical Records
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Are medical charts purged
every year as active or inactive?
Rank:______ Comments:
Are charts refiled daily, are
they scattered around office?
Rank:______ Comments:
Does practice follow strict
procedures on obtaining
authorization for release of
records?
Rank:______ Comments:
Are the medical forms printed
clear and up to date with
industry standards or are they
vague and very old with little
information requested?
Rank:______ Comments:
How long are records stored
and are they secure and
confidential?
Rank:______ Comments:
Does the practice adhere to
managed care organization
requirements for a medical
records system?
Rank:______ Comments:
Has there been an audit by
outside source and if so were
any deficiencies corrected?
Rank:______ Comments:
Patient Relations, Marketing & Managed Care
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Are all patients greeted by
receptionist as they enter
office?
Rank:______ Comments:
Does practice have updated
patient information brochure
outlining policies and
procedures for answering
routine questions?
Rank:______ Comments:
Does practice participate in
community events to promote
practice?
Rank:______ Comments:
Does practice provide patient
education handouts?
Rank:______ Comments:
Has there been a patient
satisfaction survey conducted?
If so, what were results?
Rank:______ Comments:
Are newspaper ads, yellow page
ads, t.v., radio and direct mail
ever utilized to promote
practice?
Rank:______ Comments:
Are thank you letters or calls
made to patient referral
sources?
Rank:______ Comments:
Does practice participate in all
essential managed care plans in
the area? Should some be
added or deleted?
Rank:______ Comments:
Patient Relations, Marketing & Managed Care
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Does manager/staff evaluate
feasibility, discounts, services
provided, costs, benefits, pros
and cons of plans? Is there
evidence that any plans are
detrimental?
Rank:______ Comments:
Has practice adapted to
increased patient volume from
referrals?
Rank:______ Comments:
Is there a completed manual or
notebook on each plan’s
requirements that is easy
reference for staff? Are all
correspondence on plans kept
with reference books? Is there
a summary of plan
requirements that gives basics?
Rank:______ Comments:
What are office hours and
employees work schedule? How
do they compare to the norm for
this medical specialty?
Does practice have extended
hours to accommodate patients
– evenings or Saturdays?
Rank:______ Comments:
Does practice have adequate
patient education with
materials and staff services? Is
there health prevention
counseling?
Rank:______ Comments:
Patient Relations, Marketing & Managed Care
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Does receptionist answer phone
in friendly manner? Evaluate
phone skills and staff/patient
interaction.
Rank:______ Comments:
When patients are referred to
other providers, does practice
assist patient with complete
information? Do they follow up
with provider referred to?
Rank:______ Comments:
How are patient complaints
reported to manager and
physicians?
Rank:______ Comments:
Have there been any training
programs for employees on
patient relations or managed
care plan requirements?
Rank:______ Comments:
Does practice have capability to
gather information on
capitation patients and costs to
monitor revenue?
Rank:______ Comments:
What is patient profile of the
practice – by age, sex,
Medicare, Medicaid, self-pay
and demographics? Is it typical
Rank:______ Comments:
of specialty or does practice
need to change?
Are patients placed on
telephone hold excessively? Are
patients satisfied with voice
mail or perturbed?
Rank:______ Comments:
Facility & Equipment
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Is the office size adequate? Are
there at least two exam rooms
per provider, preferably three?
Is the waiting area
accommodating or crowded? Do
patients move through the
office with ease?
Rank:______ Comments:
Is the waiting room clean,
organized, uncluttered, good
lighting, attractive furniture
and décor, music or TV and
plants? Is there good selection
of current reading material?
Rank:______ Comments:
Are clinical exam areas
comfortable or cold and sterile?
Is there a sense of privacy in
exam rooms? Can staff voices
and comments be heard
through walls, hallways or from
open reception areas into
waiting area? Acoustic
privacy? Are there clothes
hooks, mirror and cloth/paper
gowns?
Rank:______ Comments:
Is there separate billing check
out area and private area to
review financial policies and
discussions?
Rank:______ Comments:
Does exterior office have good
signage, landscape maintained,
easily accessible and adequate
parking?
Rank:______ Comments:
Facility & Equipment
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Is the facility safe? Is there fire
inspection report and are
extinguishers inspected?
Rank:______ Comments:
Is office accessible to handicap?
If large practice, does office
adhere to ADA?
Rank:______ Comments:
Is there adequate space for
billing and insurance
processing? Are work areas
conducive for analytical work?
Rank:______ Comments:
Does office have security
system? Are drugs/narcotics
kept locked? Are medicine
samples stored out of reach to
patients?
Rank:______ Comments:
Does the lab area and employee
lounge appear neat and clean?
Rank:______ Comments:
Does the office have a signal
system or signs to alert staff on
status of patients in rooms? If
not, what is system for patient
flow?
Rank:______ Comments:
Does facility have up to date
computer system and software?
Is system efficient for business
and clinical staff?
Rank:______ Comments:
Facility & Equipment
Areas to Analyze Retrieving Information Ranking & Comments
1 Compliant 2 Marginal 3
Deficient
Does practice have service
contracts on major equipment?
Is there any equipment that is
considered obsolete? Is any
equipment under utilized?
Does the practice lack any basic
equipment or furnishings?
Rank:______ Comments:
Is there adequate telephone
system? Are patients getting
busy signal? Is voice mail
system needed? Additional
phone lines needed?
Rank:______ Comments:
Does the office have adequate
housekeeping and maintenance
of interior and exterior of
facility?
Rank:______ Comments:
Is there adequate storage and if
not, does it affect operations?
Rank:______ Comments:
Are there some general
procedures for emergencies or
evacuation presented to
employees?
Rank:______ Comments:
Are office employees prepared
for an OSHA inspection or is
retraining required?
Rank:______ Comments:
Financial & Productivity Indicators
Indicator
Total
Gross
Charges
Medicare Charges
Percentage
Medicare charges
÷ Total charges
Medicaid Charges
Percentage
Medicaid charges
÷ Total charges
Capitation
Percentage
Capitation charges
÷ Total charges
HMO/PPO
Percentage
HMO/PPO charges
÷ Total charges
Self Pay &
Commercial %
Self pay insurance
Charges
÷ Total charges
Lab Charges
Percentage
Lab charges
÷ Total charges
X-ray Charges
Percentage
X-ray charges
÷ Total charges
Adjustments
Percentage
Adjustments
÷ Total charges
Types of
Adjustments %
Total adjustment
amount by type
÷ Total adjustments
Charge Per
Encounter/Visit
Total charges
÷ Patient visits
Hospital Gross
Charges Percentage
Hospital gross charges
÷ Total charges
Office Gross
Charges Percentage
Office gross charges
÷ Total charges
Gross Collection
Percentage
Gross collections
minus refunds
÷ Total gross charges
Total Annual Net
Collections
(Receipts)
Net Collection
Ratio
Collections–refunds
÷ Charges–
adjustments
Total Accounts
Receivable
Accounts
Receivable Change
Accounts
Receivable Ratio
Total A/R
÷ Average monthly
charges minus
adjustments
Cash Collection
Ratio
Collections at
time of service
÷ Total gross charges
A/R 90 days & Over
Accounts outstanding
90 days & over
÷ Total A/R
Average Days
Receivable
Total A/R
÷ Average per
day charges
Over the Counter
Collection %
Collections onsite
÷ Total collections
Total Number &
Amount of All
Outstanding
Accounts Sent to
Collections
Bad Debt
(write-off) %
Bad debts
÷ Total adjusted
charges
Average Collections
per Office Visit
Total collections
÷ Total office visits
Total Collections
per FTE Physician
Total collections
in practice
÷ Number of FTE
Physicians
Managed Care
Income %
Managed care income
÷ Total practice
collections
Managed Care
Encounters per
Member
Total MC patient
visits
÷ Average # per month
Gross Collection
Ratio per Health
Care Plan
Collection from plan
÷ Gross charges
from plan
Contractual
Adjustment Ratio
by Health Care Plan
Bad Debt Ratio by
Health Care Plan
Total Capitation
Payments per
Member per Month
Indicator
Other Income
Net Income
Percentage
Income – expenses
÷ Charges
Profit Margin
(Income – expenses)
÷ Operating revenues
Return on Equity
Net profit
÷ Total equity
Return on
Investment
Net profit
÷ Total assets
Debt/Equity Ratio
Total liabilities
÷ Total equities
Current Ratio
Current assets
÷ Current liability
Debt Ratio
Total liabilities
÷ Total assets
Accounts Payable
Ratio
Total A/P
÷ Average daily
purchases
Number of Office
Visits
Number of New
Patients
Hospital
Admissions per FTE
Physician
Physician Office
Visits per Hour
Office Hours
Employee Costs as a
% of Total
Operating Costs
Employee salaries &
benefits
÷ Total costs
Employee Absentee
Rate
# of hours
Employee absent
÷ Hours employee
scheduled
No-Show Rate
# of no-shows
÷ # of appointments
scheduled
Accounts Receivable Summary
Accounts Receivable as of __________________________
Age Amount ($) Percent (%) of Total
0 – 30 days
31 – 60 days
61 – 90 days
120 days +
TOTAL
100%
Elements of Medical Practice Compliance Plan
1. Policies and procedures plus a written code of conduct
2. Designation of a compliance officer
3. Effective employee training
4. Method for employees to report wrongdoing
5. Conducting a periodic audit on performance of billing claims
6. Methods to enforce and discipline violators
7. Plan of activities to correct any offenses
85