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Revenue Cycle Performance Eric Burgmaier, CPA 505-299-8383 www.myabqcpa.com

Revenue Cycle Performance Eric Burgmaier, CPA 505-299-8383

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  • Revenue Cycle Performance Eric Burgmaier, CPA 505-299-8383 www.myabqcpa.com
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  • Eric Burgmaier, CPA Managing Partner of Burgmaier & Helton, CPAs Named to New Mexico Business Weekly top 25 CPA firms in the state Previously the CFO for UNM SOM Physician Group VP Finance & Revenue Cycle for ABQ Health Partners Regional Executive Elect for HFMA Region 10 I am NOT a coder, I am not a biller, I do enter charges, and I do not post payments
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  • the current unrestrained [fee for service] payment system has created a rate of volume growth that is unsustainable -The Medicare Payment Advisory Commission, June 16, 2009, Letter to Congressional Budget Office
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  • Bending the Cost Curve Affordable Care Act aka Obama care Massachusetts Reform aka Romney Care Be prepared for: Global Payments, Bundled payments, Risk sharing or Gain sharing, Capitation Payments
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  • Are one of these in your future? ACOs IPAs MSOs Clinically Integrated IPAs PCMH
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  • Top ten most challenging issues 1.Dealing with rising operating costs 2.Managing finances with the uncertainty of Medicare reimbursement 3.Maintaining physician compensation levels 4.Collecting from self-pay, high deductible plans 5.Negotiating contracts with payers 6.Modifying physician compensation plans MGMA Connexion, Medical Practice Today July 2010
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  • The Medical Group Management Association (MGMA) estimates that payers underpay practices in the U.S. by an average of 7%-11%.
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  • Increasing Revenue Not always about better contract terms Improving revenue cycle performance Measuring Key Performance Indicators Reducing denials Improving collection efforts with self pay accounts
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  • Carrier contracts Review contract terms annually, renegotiate when it makes sense, How are your fees determined? Who pays GRT, who doesnt? Do they comply? Lots of reasons insurance companies screw up claim adjudication
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  • Know how you are reimbursed Contracts with carriers are usually negotiated based on a percentage of New Mexico Medicare Sometimes there is only a single multiple Sometimes the multiple is separately negotiated for E&M, Surgical, radiology, pathology Sometimes you might have a contract with a carrier that uses an internally developed RBRVS model Could also see a fee schedule that spans multiple years, i.e., surgical on a 2001 NM Fee Schedule and all other services on the current NM Fee Schedule RBRVS could be held constant on a given year but the conversion factor is negotiated
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  • What is RBRVS? Resource based relative value scale (RBRVS) is a schema used to determine how much money medical providers should be paid. It is currently used by Medicare in the United States and by nearly all Health maintenance organizations (HMOs).schema MedicareUnited StatesHealth maintenance organizations RBRVS is the source for RVUs
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  • What are RVUs? Work RVUs: Physician component to value salary and benefits Practice RVUs: Office expenses including depreciation, rent, office supplies, support staff and benefits Malpractice RVUs: Both practice and physician insurance
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  • Seven components to reimbursement Conversion factor RVUs Work Practice Malpractice Geographic Practice Cost Index Work Practice Malpractice
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  • 99213 Fee Development
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  • Contract Summary
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  • Pay attention to rates
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  • How much Free Service? According to a recent study by CMS Only 70% of claims are paid correctly the first time they are submitted The remaining 30% are denied, lost, or ignored Of those a full 60% are never resubmitted or appealed In summary 18% of medical claims simply go unpaid, Free Service of about $125 billion annually provided by medical practices
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  • Accounts Receivable KPIs If you cant measure it, you cant manage it Most common Key Performance Indicators Gross Collection Rate Days in Accounts Receivables Accounts Receivable Aging Cash in the door Build goals, compare to best practices
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  • Gross Collection Rate GCR-on average what is collected against the billed amount, By payer, by month, year to date, Compared to prior yearto an expectation? Consistently measure overtime to develop trends
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  • Reasons for changes in GCR Staff and system performance New staff, untrained/undertrained staff, inefficient and poor communication, lack of guidance and leadership Payer performance Sudden increase in denials Decrease in reimbursement No pay or slow pay
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  • Gross Collection Rate
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  • Days in Accounts Receivable How long on average does is take for a claim to turn into cash? High performing practices take on average 35 to 38 days to collect Objective is to drive this number down, the longer and older the A/R is the less likely it is to be collected
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  • A/R Aging Review and understand the system generated aging report, Aged from date of service or date of claim submission? Summarize to A/R less than 90 days and A/R greater than 90 days old. Best performer practices have less than 20% of A/R greater than 90 days old
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  • Aged AR by month
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  • AR Aging
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  • Plain old cash
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  • Monthly Cash Do you know what your total monthly collections are by source? Do you trend collections? Is there an expectation? Based on payer mix Based on Accounts Receivables Based on Production
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  • It becomes immediately obvious that the Master Mind principle holds the secret of the powers wielded by men who surround themselves with other men of brains. When a group of individual brains are coordinated and function in harmony, the increased energy created through that alliance becomes available to every individual brain in the group. Think and Grow Rich Every Day by Napoleon Hill
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  • Best practices for Self Pay Develop written financial polices, post them and educate patients Verify insurance coverage ahead of scheduled appointments When reminder calls are made, if there is an outstanding balance collect over the phone Collect co-pays and o/s balances at time of registration
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  • Best Pract Denials Management Three reasons why denials are not appealed 1.The denial is correct 2.No staff time to available to appeal 3.Responsible staff does not know what to do Understand why they occur and to the extent possible correct P&Ps to mitigate Get claims out clean, high pass rate of 95% to 98% Staff can then work claims in the 30 to 60 day bucket
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  • Examine your EOBs closely! When reviewing EOBs First, get your contracts together, make sure you have your current amendments Are individual line items, if denied, followed up on? What is the process to follow up? Is the practice ever getting paid 100% of the billed amount?
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  • Podiatry Facts
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  • Upcoming speaking events Feb 9 th, Improving Net Income in Turbulent Times May, Effectively Using QuickBooks June, Using RVUs To Measure and Manage Costs July, Year end Tax Planning, Session One August, Year end Tax Planning, Session Two September, Year end Tax Planning, Session Three October, Physician Compensation Planning Dates and times will be posted on my web page www.myabqcpa.com