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Enhancing Services to New and Existing Physician Clients Suzanne Denzine, CPA, CHCC sdenzine@Kolb. Co. Enhancing Services to New and Existing Physician Clients Suzanne Denzine, CPA, CHCC sdenzine@Kolb. Co. com

Your Presenter • Suzanne Denzine, CPA, CHCC – Shareholder and Health Care Consultant – Your Presenter • Suzanne Denzine, CPA, CHCC – Shareholder and Health Care Consultant – Expertise in operations and personnel management, physician compensation arrangements, business analytics, HIPAA regulations and assessments, OSHA compliance, fee analysis, compliance programs, physician/hospital relationships, third-party payer contracts and negotiations, and practice start-ups www. Kolb. Co. com

In Addition to Physicians… • Expand your definition of Health Care owners/stakeholders – MDs, In Addition to Physicians… • Expand your definition of Health Care owners/stakeholders – MDs, DOs, Behavioral Health Practitioners – Advanced Level Practitioners (NPs and PAs) – Dentists – Veterinarians www. Kolb. Co. com

Why I Don’t See Value in My CPA • From the client perspective – Why I Don’t See Value in My CPA • From the client perspective – Current on upcoming Health Care reform issues – Proactive planning ideas included with financial statements not just historical financial data – What are the numbers telling me? – Value of service not demonstrated www. Kolb. Co. com

How to Enhance My Services to New or Existing Medical Clients? • Add value How to Enhance My Services to New or Existing Medical Clients? • Add value to existing services • Understand their Revenue Cycle challenges; be proactive • Additional “Specialty Services” to consider for building on your health care niche www. Kolb. Co. com

Current Services • Change Management – 2012 -2013 substantial changes occurring in health care Current Services • Change Management – 2012 -2013 substantial changes occurring in health care • SGR - Potential Medicare reduction in reimbursement rates again for 2013 – How will practices be able to absorb a 30% reduction in Medicare reimbursement? – Commercial payers fee schedules at less than 100% of Medicare reimbursements • Implementation of electronic medical records – How practices meet 1 st stage meaningful use in 2012 or 2013 www. Kolb. Co. com

Current Services • Change Management – Health care consolidation choices – Requires in-depth knowledge Current Services • Change Management – Health care consolidation choices – Requires in-depth knowledge • Of the organization • Of the health care industry • Of the medical practice model – Knowledge-base to work through changes in critical parts of a practice www. Kolb. Co. com

Current Services • Look for other ways to add value – Do you review Current Services • Look for other ways to add value – Do you review the financial reports with your clients in person? – Are your statements presented in a format specific to medical practices? – Is a production analysis report part of your business analysis? • Example: provide gross and net collection rates global and by provider www. Kolb. Co. com

Polling Question Polling Question

Management with SMART Ideas • • • S M A R T Systems Management Management with SMART Ideas • • • S M A R T Systems Management Outsourcing Accounts Receivable Revenue Cycle Targeting the low hanging fruit www. Kolb. Co. com

Management with SMART Ideas • S Systems – EMR systems – Recall systems – Management with SMART Ideas • S Systems – EMR systems – Recall systems – Collections fees – Desktop power station www. Kolb. Co. com

Management with SMART Ideas • M Management Outsourcing – Be an adviser on what Management with SMART Ideas • M Management Outsourcing – Be an adviser on what is right for a practice – Is there a right answer? – Examples: • • www. Kolb. Co. com Coding expert Business analytics consulting Cost accounting Transcription

Management with SMART Ideas • A Accounts Receivable – Basic Tenets of a Good Management with SMART Ideas • A Accounts Receivable – Basic Tenets of a Good Collection Strategy • • www. Kolb. Co. com Developed written financial policies Verify patient’s insurance coverage Set clear expectations Collect at time of service Make easy and convenient to pay Offer flexible payment options Create team responsibility and incentive to collect

Management with SMART Ideas – What are the benchmarks that count? • Net collection Management with SMART Ideas – What are the benchmarks that count? • Net collection rate – 99% or better is a STAR • Days in A/R – Under 35 days in total is a STAR • Exhibit A www. Kolb. Co. com

Management with SMART Ideas www. Kolb. Co. com Management with SMART Ideas www. Kolb. Co. com

Management with SMART Ideas • R Revenue Cycle – Is a practice leaving money Management with SMART Ideas • R Revenue Cycle – Is a practice leaving money on the table? • • www. Kolb. Co. com Managed care contract analysis Payer mix, service codes Constantly changing payer requirements Missing patient encounter information

Management with SMART Ideas • T Targeting the low hanging fruit – Staffing per Management with SMART Ideas • T Targeting the low hanging fruit – Staffing per FTE physician vs. provider – Co-payment collection rates – Surgery deposits prior to the encounter – Denial percentage • Scrubbers/PPM prior to submitting to insurance • Knowledgeable coding staff www. Kolb. Co. com

Industry Benchmarks • Available through the MGMA and other outside sources – RVUs by Industry Benchmarks • Available through the MGMA and other outside sources – RVUs by specialty and geographic area – Production, Cost and Compensation data – Overhead (See Exhibit B) – Revenue Cycle www. Kolb. Co. com

Industry Benchmarks Exhibit B www. Kolb. Co. com Industry Benchmarks Exhibit B www. Kolb. Co. com

The Business of Medicine • Incorporate financial statement format aligned to the health care The Business of Medicine • Incorporate financial statement format aligned to the health care practice (see Exhibit C) – Income tax basis – Health care nuances – Owner/Doctor segregation www. Kolb. Co. com

The Business of Medicine Exhibit C www. Kolb. Co. com The Business of Medicine Exhibit C www. Kolb. Co. com

Flaws in the Analysis • Bundling of owners’ benefits into operating cost • Comparative Flaws in the Analysis • Bundling of owners’ benefits into operating cost • Comparative analysis missing from the financial statements www. Kolb. Co. com

Overhead Analysis • • • Personal costs Practice development costs Malpractice insurance Bank Charges Overhead Analysis • • • Personal costs Practice development costs Malpractice insurance Bank Charges Staffing/Benefits Rent Computer service related expenses Repair & maintenance expenses Miscellaneous expenses Other income www. Kolb. Co. com

Developing New Specialty Services • Add value to services • Services independent of one Developing New Specialty Services • Add value to services • Services independent of one another • Identify additional skill sets/tool box – Employee benefit costs – Forensic accounting analysis – Internal control analysis – Revenue cycle system analysis – HIPAA privacy & security assessments www. Kolb. Co. com

Polling Question Polling Question

Merging Medical Practices • Consolidation in the independent physician group practice to: – Specialty Merging Medical Practices • Consolidation in the independent physician group practice to: – Specialty groups merging (Ex. , cardiologists, cardiac surgeons and electro physiologists or ortho with physiatry and podiatry) – Larger, multi-specialty groups – Hospital system purchase – Accountable care organizations www. Kolb. Co. com

Merging Medical Practices • Reasons – Accountable care organizations benefits and organization – Lower Merging Medical Practices • Reasons – Accountable care organizations benefits and organization – Lower payer reimbursements – Payer contracting efficiencies • Payment methodologies – Fee for Service – Episodic payments www. Kolb. Co. com

Merging Medical Practices • Reasons – Overhead cost reductions • Eliminate duplication of services Merging Medical Practices • Reasons – Overhead cost reductions • Eliminate duplication of services and site costs • Gain multiple service discounts (malpractice insurance etc. ) – Issues • • www. Kolb. Co. com Site(s) maintain or eliminate Governance Personnel reduction Production and profit distribution formulas

ACO/MSO/IPA Formation/Utilization • Accountable Care Organizations – New type of organization • Members can ACO/MSO/IPA Formation/Utilization • Accountable Care Organizations – New type of organization • Members can be health care organizations and/or employed physicians, independent providers – Addresses accountability for new HC reimbursement type(s) • Episodic care reimbursement (global payment inclusive of all care provided) – Quality initiative components www. Kolb. Co. com

ACO/MSO/IPA Formation/Utilization • Accountable Care Organizations cont. – IPAs (Independent Physician Associations) • Many ACO/MSO/IPA Formation/Utilization • Accountable Care Organizations cont. – IPAs (Independent Physician Associations) • Many merging to ACO structure • Primary purpose of IPAs are: – Payer contracting – Quality Initiatives w/ Medicare or other commercial payers – Service arrangement cost reductions – Provider system support » PM system » EMR system www. Kolb. Co. com

ACO/MSO/IPA Formation/Utilization • MSO (Managed Service Organizations) – Specialty specific – Payer contracting – ACO/MSO/IPA Formation/Utilization • MSO (Managed Service Organizations) – Specialty specific – Payer contracting – Not as viable in the current insurance environment www. Kolb. Co. com

Adding a Physician or Other Ancillary Staff • Basis for – Volume expansion • Adding a Physician or Other Ancillary Staff • Basis for – Volume expansion • New sites • Payer or service areas – Expansion into another service • Ex. Ortho - foot & ankle – Next generation • Owners are five or less years to retirement www. Kolb. Co. com

Changing the Physician Compensation Formula • Reasons for change – Fairness – Current formula Changing the Physician Compensation Formula • Reasons for change – Fairness – Current formula is not working – Stark provisions – Other client service issues www. Kolb. Co. com

Changing the Physician Compensation Formula • Factors in change – Base formula factors; shared Changing the Physician Compensation Formula • Factors in change – Base formula factors; shared vs. direct compensation and expenses • Managing physician director – % change in baseline factors • 90/10 to 70/30 equalization • Meeting Stark provisions for ancillary services • Volume considerations – Maximum OH allocations www. Kolb. Co. com

Changing the Physician Compensation Formula • Factors in change – Initiating more factors on Changing the Physician Compensation Formula • Factors in change – Initiating more factors on compensation on quality indicators, patient satisfaction and achieving certain disease quality indicators – Adding Quality metrics • RVU compensation models www. Kolb. Co. com

Polling Question Polling Question

Office Sharing with Another Practice • Assist a small practice to establish an office Office Sharing with Another Practice • Assist a small practice to establish an office with a shared overhead arrangement • Assist the client with analysis of the shared overhead arrangement • Establish the shared space www. Kolb. Co. com

Implementation of EMR • EMR implementation activity increasing due to government incentives • Practices Implementation of EMR • EMR implementation activity increasing due to government incentives • Practices need assistance with planning and project management www. Kolb. Co. com

Make Stakeholders out of the Employees • Driven by management – Promote TEAM environment Make Stakeholders out of the Employees • Driven by management – Promote TEAM environment • Merit bonus plans vs. COL increases • Mission statement driven • Patient quality and service areas – Patient surveys can facilitate the review – Hotline for patient complaints www. Kolb. Co. com

Help Build New Revenue Opportunities • Practice areas – Use of EMR • Meet Help Build New Revenue Opportunities • Practice areas – Use of EMR • Meet Meaningful Use attestation for incentive bonus – Adding physician extenders – Review specialty specific competitors • Ob/Gyn; weight loss clinic • Acupuncture; healing center (cancer treatment etc. ) • Ortho; add OT/PT, podiatry etc www. Kolb. Co. com

Review and Implementation of Practice Internal Controls • Separation of Duties – Controls in Review and Implementation of Practice Internal Controls • Separation of Duties – Controls in systems • Dual access and management • Limitations on access • Time off requirements; require staff to take vacations – Workflow analysis and access • Determine weak areas in controls – Work with CPA to monitor and provide business physical www. Kolb. Co. com

Look for Signs of Financial Problems • • • Declining revenue current and over Look for Signs of Financial Problems • • • Declining revenue current and over time Payer mix analysis No show rates Patient seen rates per day/provider A/R days outstanding increasing or higher than specialty specific benchmarks • Prior authorization issue; UHC/Humana www. Kolb. Co. com

Are You Taking Care of the Physician’s Personal Finances? • • Risk management; insurance Are You Taking Care of the Physician’s Personal Finances? • • Risk management; insurance review Retirement plan options Wealth management Tax planning – Huge for 2013 and going forward www. Kolb. Co. com

Examples of Specialized Service • • Physician compensation structure Billing revenue cycle audit Practice Examples of Specialized Service • • Physician compensation structure Billing revenue cycle audit Practice start-ups Practice on-going management Compliance plan development or update Strategic planning Shareholder code of conduct HR services; recruitment www. Kolb. Co. com

Examples of Specialized Service • • • HIPAA Privacy and Security assessments Technology deployment Examples of Specialized Service • • • HIPAA Privacy and Security assessments Technology deployment Employment agreements Buy/sell agreements Structuring buy-in/buy-out Merger and acquisition analysis and facilitation • Practice valuations www. Kolb. Co. com

Practice Management Reports • CPA prepared – A/R analysis – Provider analysis – Service Practice Management Reports • CPA prepared – A/R analysis – Provider analysis – Service line revenue/cost analysis • PM: dashboards – Daily A/R reports – Denial rates – Referral base tracking reports www. Kolb. Co. com

Clinical Encounters • Documentation and compliance • Utilizing extenders • Continuity of care www. Clinical Encounters • Documentation and compliance • Utilizing extenders • Continuity of care www. Kolb. Co. com

Provider Work RVUs • Portion of Medicare and other payer reimbursement formula • Used Provider Work RVUs • Portion of Medicare and other payer reimbursement formula • Used in physician compensation formula • Provider production analysis www. Kolb. Co. com

Referring Doctor Trends • How do new patients get referred to the practice? Do Referring Doctor Trends • How do new patients get referred to the practice? Do you know? • Is reporting available? • Why are referral patterns important? www. Kolb. Co. com

Organizations to Join • HCAA (National CPA Health Care Advisors Association) • PVN (Physician’s Organizations to Join • HCAA (National CPA Health Care Advisors Association) • PVN (Physician’s Viewpoint Network) • MGMA (Medical Group Management Association) • State MGMA associations • HIMSS (Health Information and Management Systems Society) www. Kolb. Co. com

Keys to Success • Look for ways to add value – Go beyond the Keys to Success • Look for ways to add value – Go beyond the numbers • Look for opportunities that can be replicated in other practices – Compliance plan • Make your health care niche known – Linked. In, Twitter, Facebook page etc. – Form an advisory group of professionals for your area – quarterly meetings www. Kolb. Co. com

Questions and Answers Thank you! • Sue Denzine – sdenzine@Kolb. Co. com • • Questions and Answers Thank you! • Sue Denzine – sdenzine@Kolb. Co. com • • 800/461 -8843 www. Kolb. Co. com