8 Revenue Cycle Concerns For Orthopaedic Practices &

How to Fix Them

8 revenue cycle concerns for Orthopaedic

practices and ways physician practices can fix them.

Orthopaedic practices are in a time of constant change with reimbursements, patient volumes and utilization of diagnostic imaging all declining. These changes are

forcing physician practices to reevaluate processes and tackle inefficiencies.

Why we are here ?

1 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

HIS is a physician management organization that specializes in Revenue Cycle Management and Technology services for

Orthopaedic practices.

“You put your patients first… we put your business first”

Dave Wold, CHBC, Founder and CEO, Healthcare Information Services

• Founded HIS in 1999. Under Mr. Wold’s leadership, HIS’ corporate infrastructure has significantly expanded over the past seven years. HIS has grown from 40 employees in one location to an organization which now employs over 225 employees operating in two locations. To date HIS bills out over $800 million and collects over $300 million on behalf of our clients

David D’Silva, COO, Healthcare Information Services RICHARD• Has been with HIS for 3+ years and is accountable for organizational strategy, execution and P&L. Prior experience was in Banking for 25+ years that included responsibility for a $300MM line of business with 2000 employees globally. Specifically skilled in P&L management, product strategy and development, acquisitions, workflow design, productivity measurement and management, quality metrics development and risk management.

Who we are?

2 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

“It is more important now than ever to assess your practices health”

• Orthopaedic practices should routinely reevaluate the management of their revenue cycle • Too often overlooked. 

• There is a huge correlation between your practice's profitability and the management of your revenue cycle

• An efficient and effective revenue cycle is the bloodline of a successful practice.

Correlation to Profitability

3 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

One: Accounts Receivable – CPI & Trending

Two: Charge Capture & Reconciliation

Three: 2013 Coding Changes

Four: ICD-10 – Are you going to be ready?

Five: Managing Insurance Denials

Six: Payor Contracts & Tracking Reimbursements

Seven: MPPR

Eight: Collection of Small Balances

Nine: Importance of Communication

Ten: Physician’s Involvement

What we will cover

4 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

Poor Cash Flow can be due to improper A/R Management

• Too many Days and Dollars are tied up in accounts receivable.

• CPI – key to managed success•Critical Performance Indicators •HIS looks at more than just the A/R Aging Buckets

•120+ should be 14.4% or better RAD**(according to RBMA standards)

• Billing must be sent out promptly, accurately

• Aggressive follow up procedures must be in place•Appeals•Denials

“Any unnecessary delay will cost a practice its profit.”

Accounts Receivable – CPI & Trending

1

5 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

Even some of the best practices will lose

revenue from neglecting to bill a visit.

• Lost Encounter Forms• It's amazing how many encounters get lost from the clinic to the billing office.

• Reconciliation each day• Patients seen vs. Encounter Forms

• Simple process but can have large impact• Ensuring patient is appropriately charged for the practice's services.

Charge Capture & Reconciliation2

6 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

2013 Coding Changes

• Another prominent area where physicians are leaving money on the table is neglecting to charge for each piece of durable medical equipment distributed. • Most practices do not have good systems for distribution of DME or allow DME vendor to

• A break in the chain… charges never captured• A physician will recommend DME for a patient and one assistant will give the product to another assistant, and somehow the patient is never charged for the product.

2013 Coding Changes

3

7 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

• HIS recommends a daily reconciliation• Capture of inventory versus billing to see what exactly your practice spends in terms of inventory and amount profit made. Figure out a way to

• Centralize DME • Develop a process for distributing inventory• Proper and verified process for billing

•Deal with increased requirements for authorization and payment• ABN - Advance Beneficiary Notice• CMN - Certificate of Medical Necessity • LMN - Letter of Medical Necessity

Proper management of your DME inventory and billing can

Provide significant revenue for the practice

ICD-10 – Are you going to be ready?

3

8 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

The number one reason for a controllable denials is inaccurate and/or incomplete insurance

information

• The Good ole’ days (are long gone)• Procedures were getting paid in high volumes and physicians could afford to pay less attention to the insurance denials.

• The New Norm• Declining reimbursements along with increased denial rates• Focusing on why denials are happening will save a practice significant money.

If you have the wrong insurance information and perform surgery, your cost to collect quadruples.

Managing Insurance Denials4

9 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

• Create and implement Front-End processes for improved results• Rather than losing money on insurance denials, do extra work on the front end to avoid sending improper information to your payors.

• Eligibility verification before a patient comes in

• Implement technology to verify coverage for patients procedure• Integrate with Practice Management system for work-flow efficiencies• As soon as the patient has been scheduled for a procedure, the insurance verification process should begin.

• Pre-Authorization• Requirement for more and more procedures to have this (especially for PT and MRI)• No longer will allow for retroactive authorization• If you don’t do this, the service is “FREE”!!

“Denied claims due to unauthorized patient procedures or services can be a major loss in revenue that should not be taken lightly.”

4 Managing Insurance Denials

10 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

Payor Contracts & Tracking Reimbursements5

“Am I being paid correctly?”

• Verify accuracy of each and every payment• Monitor the amount reimbursed by payors versus the negotiated pay rate• Compare to all fee schedules and contracts

• Insurance Companies make mistakes• Incorrect fee schedules loaded• Underpayment

• Dedicated Resources and Technology• Can be challenging for smaller practices• At HIS, we have found even in large practices several examples where payors have underpaid to the tune of $100,000.

11 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

5

• If possible, a practice should use an enterprise system to run payments through for comparison with the negotiated rate.

• Even if you don't have the technology• Perform random and thorough audits.

• If you see a pattern of under payment, allocate additional resources to fix the problem.

In 2010, HIS collected over $1.5M in underpayments on behalf of our clients

Payor Contracts & Tracking Reimbursements

12 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

Small charges slip through the cracks

Collection of Small Balances6

“You have already paid your overhead… That's lost profit”

A way to avoid this is to assign resources to pursue balances totaling $100 or less. Designating time for small claims will add up in the long run.

13 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

“Are the lines of communication truly Open?“

• Do you listen ?• Employees

•Administration and Billing Staff

• Do your physicians listen ?

• It should be a two-way street

• A well managed open-communication policy and process can positively impact the efficiencies and profitability.

Importance of Communication7

14 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

• When none of the physicians in a practice are involved with the company's billing side, it can create problems.

• Disconnect on importance of complete documentation and timeliness of submission

• Designate a lead physician to stay involved and be a point person • This can greatly benefit the entire practice.

• Having an interested physician who is educated about billing matters makes the entire practice more efficient.

• The Revenue Cycle starts with the physician.• Leadership and Admin staff then needs resources to complete the process

Physician’s Involvement8

15 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

• Orthopaedic practices must be aware of changes in reimbursements, regulations and coding-guidelines that have a direct impact on your practice’s profitability.

• Physician practice must re-evaluate their processes to hone in and position their practice for a more profitable future.

• Make sure you can answer the all important question…

Are you getting Paid what you are supposed to be Paid ?

Conclusion

16 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

About HIS HIS is a physician management organization that specializes in

Revenue Cycle Management and Technology services for Orthopaedic practices.

“We worry about your business so you don’t have to”

Partnership Philosophy• Based on mutually shared success

Experts in Orthopaedics• Manage the revenue cycle of over 450 providers (including well over 100 Orthopaedic Surgeons)

We are not just a billing company• Comprehensive Service Beyond Expectation.

17 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

We understand that our success is directly tied to the success of our Clients

“We do not succeed unless you do!”

Service that goes above and beyond: For us it is not just about increasing reimbursements and profitability but also about the service we provide. We partner with each client to understand their business needs intimately and position their practice for a more stable and profitable future.

Improved Reimbursement and Profitability: HIS clients typically see an increase of 11.2% or better of their average reimbursements through proper coding, aggressive appeals & denial management, in-house collections and expert approach. In addition, HIS can help you achieve operational efficiencies and provide group purchasing power lowering your overhead and boosting your bottom-line.

Expert partner for the future: With 30+ years of experience, HIS' staff of 225 professionals, including over 65 certified coders, understand the most complex management systems and clinical issues. HIS is a thought-leader in the industry and with an expert knowledge and experience in Orthopaedics is a valued partner in these troubling times.

What you can expect from HIS

18 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

Future Webinar Topics

HIS is a physician management organization that specializes in Revenue Cycle Management and Technology services for

Orthopaedic practices.

“We worry about your business so you don’t have to”

ICD-10-CM• Are you going to be ready ? •Start preparing now and have a plan for the monumental transition

Coding issues affecting your revenue and compliance• Insufficient or Lack of Appropriate Documentation• Inaccurate or Incomplete Coding

• Under-coding is just as bad as over-coding

Cut costs and boost profitability• Partnering for increased purchasing power – PurchasingMD

19 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

Questions ?

20 | 8 Revenue Cycle Concerns for Orthopaedic Practices & How to Fix Them

For follow up questions feel free to contact us:

Andy Salmen, Business Development HIS P: (847) 720-7007 E: asalmen@healthinfoservice.comwww.HealthInfoService.com

Contact HIS:

350 S. Northwest Highway, Suite 200

Park Ridge, Illinois 60068(855) RING-HIS