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20 WAYS TO GET PAID FASTER. THRIVING DURING TIMES OF CHANGE. Shelly Guffey. 11.15.2012. Special thanks to the Medical Group Management Association (MGMA) for use of their data. Objectives. Discover direct and indirect areas of your business operations that are costing you money - PowerPoint PPT Presentation

Transcript of 20 WAYS TO GET PAID FASTER

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Shelly Guffey20 WAYS TO GET PAID FASTER11.15.2012THRIVING DURING TIMES OF CHANGE1Special thanks to the Medical Group Management Association (MGMA) for use of their data22Objectives3Discover direct and indirect areas of your business operations that are costing you moneyUse key benchmarks to help you take action to increase your bottom lineIdentify technology tools to automate operations, enhance your service to patients and help you get paid quickly and efficiently3The Revenue Cycle44Staffing is the biggest expenseWhere the money goes5Source: Medical Group Management Association, Cost Survey for Orthopedic Practices, 2010. Report based on 2009 data.5Staff to support your specialtyHiring6Median Support StaffPer FTEPhysicianMultispecialty4.54Internal medicine3.19Pediatrics3.94Cardiology5.60Hematology Oncology5.77Source: MGMA Cost Survey: 2009 Report Based on 2008 Data6MGMA Assessment & Recommendations7Evaluate staffing Understand if staffing supports productivityUtilize technology for increased revenue7Staffing Turnover Surprise8Source: Performance and Practices of Successful Medical Groups: 2008 ReportBased on 2007 DataTurnoverBetter PerformersOthersReceptionist and medical records staff30.00%25.00%Nursing and clinical support staff20.00%16.67%Billing/collections and data entry staff13.81%4.00%8Minimize time devoted to non-patient careAdministrative timeOccasions requiring long travel between sites during the middle of the dayTime off during peak patient volume cyclesRemove obstacles to provider productivity9Key provider distractions9Staff to support the busiest time of day

Efficient Staffing10OvertimeRegularStaffing is constant but workflow is not. Result is often overtime!10Staff your office based on Schedule LoadEfficient Staffing1111no show rateAppointment cards given at previous appointmentEmail reminders and portal toolsSnail mail remindersAutomated reminders phone, text, etc. Follow-up file for noting and contacting those who do not keep appointmentsKey Performance Indicator (KPI) to Measure12Tips to reduce no show rateYou cant inventory time!12Case study: 75 pts/day, $85 fee/pt13Impact of a high no show rateDaily no-show rate=13% (10 no shows)Annual cost of staff making reminder calls =$14,850 ($15/hr with benefits)Annual cost mailing reminders cards=$5,760Assume 30% decrease in no-shows; additional monthly revenue=$5,610ROI=One month13Accounts receivablePercent of A/R >120 daysDays gross FFS charges in A/RAdjusted FFS collection percentPatient accounting support staff/FTE physicianTotal medical revenue per FTE physicianPercent of claims submitted electronicallyPercent of claims denied on first submissionKey Performance Indicator (KPI) to Measure14Accounts receivable14Indicators show opportunitiesBetter performer KPI MGMA Case Study15KPIBetter PerformerCase Study Data% of A/R >120 days10.69%36.18%Days gross FFS charges in A/R29.4051.51Adjusted FFS collection %100.00%97.33%Patient accounting support staff/FTE physician*.871.09Total medical revenue per FTE physician$1,242,630$1,073,456% of claims submitted electronically95%81%% of claims denied on first submission4%19%Source: Performances and Practices of Successful Medical Groups - 2009; Orthopedic Surgery.*Includes coding, charge entry, cashiering.1516MGMA Case Study Gap AnalysisWhat This Means to the PracticeAn additional $733,466 would have flowed into the practice ($29,338/FTE physician) if the practice had collected like better performing orthopaedic practices.Adjusted fee-for-service charges 1/1/09-12/31/09$27,445,597.05Net fee-for-service collection 1/1/09 12/31/0926,712,131.52Practice net collection rate97.33%Better performers net collection rate100.00%Expected revenue at better performers net collection rate of 100%$27,445,597.05REVENUE GAP$733,465.53

16Ways to manage patient payment17Review cycle times for claims submission and reimbursementMaintain a date of entry, a date of service, and a date of submission with a practice management systemSubmit charges on a timely basisDetermine time lapse between date of entry and date of submission Process claims more frequently Monitor time from date of submission until date of reimbursement Identify payers slow to process payments17Prepare in anticipation of the appointment18

The further an error travels along the revenue cycle, the more costly revenue recovery becomes. Some industry experts charge a cost of $25 to rework a claim.Moore, P. Fix your denial problems, Physicians Practice, April 2004.Verify eligibility, copay and deductible statusAutomate via batch submission of daily scheduleWeb-based payer sites issuesNote/alert for reception1819Increase patient satisfaction & reduce internal costsInsurance verificationTaskApprox durationCost *Insurance verification via payer Web site2 minutes$.40Insurance verification via payer Web site including log on2 4 minutes$.40-$.80Insurance verification via telephone5 7 minutes$1 - $1.40*Based on $9.00/hour, $12.00/hour with benefits which is $.20/minute. Generally the hourly rate is higher when performed by RCM staff.19Percentage of CopayBetter PerformersOthers90-100%47.15%36.63%75-89%32.52%29.07%50-74%9.76%15.12%0-49%10.57%19.19%Better practices collect more upfrontCopayments Collected at Time of Service20Source: Performance and Practices of Successful Medical Groups: 2008 Report Based on 2007 Data79.67%65.70%20Patients Share of Medical Bills to Skyrocket21Sources: Hewitt Associates survey of 340 employers that represent more than 5 million works. Medical Economics, April 17, 2009. The Retailish Future of Patient Collections. Celent.com.

2007: Patients responsible for 12% of their healthcare bills.2012: Patients will be responsible for 30% of their healthcare bills.Employer BenefitsPercentageEmployers that intend to shift more health insurance costs to employees next year65%Employers that plan to reduce the number of health plan options49%Employers that plan to increase the number of consumer-directed health plans40%21Effective Use of Resources: Automate22E-statementsCosts 58% of the price of a paper bill to produce*

*Source: Gartner Group, HFMA, and HH&N Research22Patient Online Bill Payment23

*Source: MGMAPlace Pay online at www.your-practice.com on your statementPay a credit card processing feeProcessed directly to your merchant account10% reduction in accounts receivable*Increased cash flow

23Performance at a glanceWhat can your system tell you?24

24Analyze Rejections25

25Tools to Recover Revenue26Reimbursement managerUpload claim and remittance dataFee schedule underpaymentsMisuse of clinical editsCreates formatted appeal letters26Annual costs of unnecessarily complex or redundant tasksAdministrative tasks quickly add up27Source: Administrative Complexity in Medical Practices Research, September 2004. MGMA Center for Research. Funded by AHRQ.Administrative TaskSolo Physician10 Physician GroupPhysician time in response to pharmacy phone calls$12,532$125,316Staff time in insurance verification, copays/ deductibles$3,876$38,761Support staff time to appeal denied claims$925$9,248Credentialing applications $809$8,08527ERA and automated payment postingImproves cash managementFaster, more accurate generation of payment dataFaster payment processing means staff get to denial and exception management faster tooNo distraction for routine data entry dutiesReduced data entry errorsEnhanced business intelligence increases profitability that can be measured

Better Performers Automate Processes28Source: MGMA Consultant Rosemarie Nelson28Case Study: Saved time = moneyDays to hours and hours to minutesPayer with 30% of practices volume implemented ERAManual payment posting took 5 days each monthERA reconciliation took 4.5 hours each monthLabor savings: $7,668 annually ($1,917 per FTE physician)

29Electronic Remittance BenefitsSource: MGMA Consultant Rosemarie Nelson29Practice check up3030Drop in payment, commercial payersFalling reimbursement31$47AVERAGE REIMBURSEMENT, 99213$45AVERAGE PRICE, HAIRCUTKey takeaways32Leverage technologyUnderstand industry landscapeTake action on daily, weekly, monthly basisQ + A33Shelly guffey800.969.3666 ext 1450sguffey@GatewayEDI.com3434Thank you.The Bedside manner your revenue deserves11.15.201235