2009. 10 Allergy Asthma Revenue Cycle Pres

Leaders in Allergy & Asthma Care for Over 30 YearsLeaders in Allergy & Asthma Care for Over 30 Years

Bank/ Treasury

Managed Care

A/R Collections

Compliance

Navicure– Reports/Benchmarks

Revenue Cycle ManagementRevenue Cycle Management

Receipts Posting


Who Manages the contracts at CAAC?Who Manages the contracts at CAAC?

• Managed Care Sub-Committee– Consultant– COO, – PFO Director – Business Office Manger.– President


Set yourself up for Success.. Set yourself up for Success.. Get organized, manage the processGet organized, manage the process

1st Step: • Define your Payor Mix • Define your Product Mix

– HMO/POS/PPO/Medicare/

• Determine how are your participation agreements held – Individually, Group, IPA, discount houses,

• Determine contracted reimbursement terms by product – % of RBRVS, Conversion Factors, Discount off billed


Managed Care Matrix 2008 Managed Care Matrix 2008

Payor Contract Entity

Scheduled Change

Year of RBRVS

% of RBRVS

Reimbursement Updated

Alpha Payor IPA July 1st fixed 2007 130% 1/1/2008

Beta Payor Direct,

individual N/A fixed 2005 125% 9/1/2006

Delta Payor IPA Nov. 1 current 2008 140% 6/1/2008

Omega Payor Direct April 15th current 2008 110% 9/1/2005

Theta Payor Direct, Group Jan. 1st current 2008 125% 1/1/2008

Zeta Payor Direct,

individual 2nd Qtr current 2008 150% 1/1/2005


Payor Mix Payor Mix

Year to Percent of Date Total

Plan Name Receipts Business Alpha Payor 130,439 17.20%

Beta Payor 123,194 16.25%

Delta Payor 107,512 14.18%

Omega Payor 74,745 9.86%

Theta Payor 67,916 8.96%

Zeta Payor 42,207 5.57%

Other 29,077 10%

100.00%


Example of Utilization Data and Example of Utilization Data and Changes in RBRVS: Changes in RBRVS:

CPT Code Utiliz.

Current Fee

Schedule

Proposed Fee Schedule

% Change over

current rate

Wtd %

99201 10 $37.83 $41.00 108% 12%

99202 20 $67.47 $69.00 102% 23%

99203 30 $100.23 $98.00 98% 33%

99204 20 $141.57 $142.00 100% 22%

99205 10 $179.79 $185.00 103% 11%

90 Average: 102% 101%


Payer Resource ManuelPayer Resource ManuelCPT

Code Description MED.2008 MCD.

(2007)

Alpha HMO (008

RBRVS) eff.

7/1/2008

Beta PPO (2008

RBRVS)

99201 Office/visit, new $35.79 $24.78 $48.32 $46.53

99202 Office/ visit, new $61.85 $47.43 $83.50 $80.41

99203 Office/ visit, new $90.22 $83.27 $121.80 $117.29

99204 Office/ visit, new $137.39 $117.74 $185.47 $178.60

99212 Office/ visit, est $36.94 $32.82 $49.87 $48.02

99213 Office/o visit, est $59.59 $45.75 $80.44 $77.46

99214 Office/ visit, est $89.52 $71.46 $120.85 $116.38

99215 Office/ visit, est $120.88 $103.60 $163.19 $157.14


Negotiation Strategies Negotiation Strategies Set the stage, get in the sand box, Set the stage, get in the sand box,

don’t throw sand… don’t throw sand… • Introductions include:

– name, title, function • Distribute agenda • Establish parameters for negotiation • Present what you bring to the table • Present your data & Info about Organization• Ask for what you want • Be willing to listen and hear what they are saying • Be open to explore all options • Document interaction, task, assign dates and who is

responsible.• Summarize

“Taking initiative does not mean being pushy, obnoxious, or aggressive. It does mean recognizing our responsibility to make things happen.”

Stephen R. Covey


TreasuryTreasury

• Electronic Posting – – Major Carriers – ANSI 835..– 85% all payments are electronicallly posted.– Next step is developing a lock box to

• Electronicallly post self pay checks

Navicure – Clearing house.


TreasuryTreasury

• Cash payments & Credit Card Payments – – $ goes to bank daily.– Batch sent from clinic daily to PFO to reconcile


A/R controls…A/R controls…• Benchmarks Report – Monthly monitored.• A/R collection Ratios 60 days (89% or greater).• Insurance > 120% days ( 1% or less)• Self Pay A/R > 120% (5% or less)• Co – Pay Collection ( > 95%)• Productivity PFO – (38 accounts or more per hour)• Denial Rate ( 2% or less) • Fatal Error Rate (2% or less)• Lag Time (2 days)


Claims SubmissionClaims Submission

• Navicure – Clearing house.• On-Line adjudication through Navicure & Payor

Web-Portal


Cash FlowCash Flow

• Customized Cash Flow pulled together for BOD monthly.

• Provides to BOD to understand Cash Management

• Allows BOD to vote on – Distributions are voted on and paid.– Employee incentives are seen and then approved. – Other outlier expenses


Cash Flow - ExampleCash Flow - Example Projection

Updated: 2009 2009 2009

June July Aug

Beginning Cash Balance 1,254,488 1,058,261 740,449

Revenue:

Practice $1,344,328 $1,360,522 $1,250,982

Study $86,242 $491,777 $186,890

Refunds -$10,061 -$4,067 -$3,812

Other income $611 $1,210 $611

Total Revenue: $1,421,120 $1,849,442 $1,434,671


Monthly Cash Flow ReportMonthly Cash Flow Report

Updated: 9/10/09 2009

June

Beginning Cash Balance 1,254,488

Expenses:

Net Payroll - $520,731

Employee Taxes - $54,435

Phy.Bonuses & other Extraordinary. $591,424

Health, Disability and Life $45,798

Retirement Plan (401K match) $89,951

General & Adm. & Misc. $77,541

Mal Practice $0

Rent/Leases $133,597

Other Employee Expenses $29,801

Clinical Exp. $118,647

Other Misc.** $1,450

Total Expenses $1,663,374Net Income -$242,254


Cash FlowCash FlowPrincipal Payments on Loan (Wells Fargo) -$3,657 -$8,471 -$12,661

Profit sharing Plan accrual $42,914 -$472,116 B $42,914

Depreciation & Amt. $10,000 $10,000 $10,000

Misc.other -$2,274 -$77 $2,404

* Capital Improvements -$1,042 -$7,715 D -$2,880

Unposted funds $86 -$86 $169

Ending Cash Balance $1,058,261 $740,449 $541,982


ComplianceCompliance

• HIPAA – • Policies

– Self Pay Discounts– Write Off policies

• QA audit on coding• Coding and Denial Committee


Allows one to hold their head up.Allows one to hold their head up.

2009. 10 Allergy Asthma Revenue Cycle Pres

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