10/10/2012. Goals. The Exciting Future of Practice Management. Practice Management. Practice Management. The Future. Practice Management

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1 Goals The Exciting Future of Practice Management Define practice management Current expectations of practice managers How practice management is changing Finding success as a practice manager Looking to the future 2 Practice Management What is management? Managing, directing, leading a business Day to day work getting done Customer satisfaction Financial management Marketing selling your services Purchasing Technology. Practice Management What is practice management? Billing/ Claims submissions Revenue streams Compliance Owners that often times don t understand business Clientele Technology challenges 3 4 Practice Management What is exciting about practice management? Variety Challenging Rewarding The Future Health care is changing Technology Payment structure Quality Models of care Understanding the past and present helps us to meet the challenges of the future

2 Manage the Financials of the practice Accounting Income Payables Manage the Financials of the practice Accounting Income Payables Taxes Financing Cash Flow 7 8 Income Statement XYZ Medical Clinic Income Statement 2012 Income Patient Revenue $1,500, Other Revenue $50, Refunds ($4,000.00) Income Total $1,546, Expenses Physician Wages $900, Staff Wages $250, Benefits $200, Statement of Cash Flow Operations Collections Payments of expenses Cash from operations Cash from investing (equipment) Contracted Staff wages $10, Supplies $35, Pharmaceuticals $26, Purchased Services $6, Rent $80, Utilities $18, Maintenance $9, Marketing $8, Total Expenses $1,542, Net operating Income $3, Cash from financing (partner buy in) 20,000 Increase/ Decrease in cash 18,000 Beginning Cash 15,000 Ending Cash 33, Budgets Feb Mar Jan Yearly Totals (annualized) Yearly Budget Actual Variance Budget Actual Budget Actual Budget Actual Income Patient Revenue 125, , , , , , ,500, ,482, (18,000.00) Other Revenue 4, , , , , , , , Refunds (333.33) (100.00) (333.33) (100.00) (333.33) (700.00) (4,000.00) (3,900.00) Income 128, , , , , , ,546, ,528, (17,650.00) Total Expenses Physician Wages 75, , , , , , , , Staff Wages 20, , , , , , , , , Benefits 16, , , , , , , , Contracted Staff , , , , , , wages Supplies 2, , , , , , , , Pharmaceuticals 2, , , , , , , , Purchased Services , , , Rent 6, , , , , , , , Utilities 1, , , , , , , , (125.00) Maintenance , , , Marketing , , Total Expenses 128, , , , , , ,542, ,551, , Manage the Financials of the practice Receivables Collecting money that is due for services provided Working with insurance companies and patients t Policies and processes Denials, ABN s, Clean Claims Using reports to gauge success Net operating Income (5,666.67) (8,216.67) (12,546.67) 3, (23,432.26) (27,429.26)

3 1. Pre-registration (appt sched) 2. Insurance verification 3. Patient check in (collect pt payments) 4. Documentation of services 5. Assignment of codes 6. Patient check out 7. Code verification and review Claims Submissions 8. Prior Authorization/Certification 9. Claim generation 10.Claim review (scrubber) 11.Claim processing, adjudication, and payment 12.Collections / claim follow-up 13.Posting insurance payment 14.Claim appeal A/R Tools TOTAL Primary Insurance Carrier Name Amount Amount Amount Amount Amount Amount Percentage %age over of Total 90 days Blue Shield $203, $12, $4, $6, $8, $236, % 6.65% Champus $1, $ $ $ $2, $4, % 46.34% Commercial $41, $26, $15, $7, $36, $128, % 34.42% Empire $16, $17, $ $ $3, $37, % 8.85% HMO $226, $39, $22, $15, $52, $356, % 18.93% LEGAL $0.00 $0.00 $ $1, $0.00 $2, % 66.27% Medicaid $ $3, $ $4, $12, $21, % 80.78% Medicare $43, $11, $13, $4, $35, $108, % 36.78% No AOB on $0.00 $0.00 $0.00 $0.00 $0.00 $ % #DIV/0! File No Fault $75, $57, $20, $10, $111, $276, % 44.19% OTHER $ $1, $1, $97.00 $3, $6, % 65.88% PATIENT ($784.74) $56, $47, $25, $35, $163, % 37.09% PATIENT $0.00 $2, ($22.90) $ $10, $13, % 83.40% (payment plan) RR Medicare $1, $0.00 $2, $1, $1, $6, % 32.48% Workers Comp $46, $42, $20, $20, $113, $243, % 54.97% $656, $270, $151, $99, $426, $1,604, % 32.78% TOTAL Compliance HIPAA, OSHA, CLIA Coding and Billing Stark, Anti-kickback Financial Arrangements Physicians in your office own an ASC and get monthly distributions Safe harbor laws Wanting to lease office space to a specialist that t would use your facility. Lease rates, office resources Contracts Technology EHR Health Information Exchange (HIE) Interfaces Technology EHR Health Information Exchange (HIE) Interfaces Portable devices Practice management and accounting software, etc

4 Marketing and Public Relations Referral base relationships Hospital relations Community relations Web site General business Payer and affiliate contracts Recruiting and business development Process Improvement skills Challenges So many things to know and keep track of Different backgrounds fill in gaps for the unknowns Physicians often times are not trained businessmen, however, they are your boss Regulated and frequently changing Reform HIPAA HITECH Meaningful Use ICD-10 Fraud and Abuse Compliance mandated Challenges More IT involvement Being pushed hard by federal policy More interactions are electronic New physicians are come from age of technology Efficiency and accuracy Ownership structures Small single specialty offices Large single specialty Multispecialty clinics (some very large) Hospital owned

5 New care models ACO s (Accountable Care Organizations) Real or virtual integration among providers with payment and performance measures leading to accountability Interoperability is important Medical Homes Health care coordinated by a team of professionals Hospital affiliations Employment Close affiliation with insurances and services Payment models Most practices function within fee for service now Greater share of financial risk and accountability Fee for service with shared savings for lowered costs Bundled Payments (episode-of-care based pmnts) Capitation (partial and global) Understanding cost structures Coding and Billing compliance Audits and fraud investigations are a success Compliance audits will increase Compliance Plans More complete compliance plans required Not just running a practice anymore Additional focus on outside relationships ACO relationships Hospitals Insurance payers Other health care professionals The Success Pyramid Customer Satisfaction Marketing How we portray or sell our services Business Development Services we provide, relationships with others, new developments Processes Efficient, effective, quality focus, no errors, good communication, standards, documentation Employees and Culture Right people, good training, respect, integrity, belief in mission

6 The Success Pyramid The Success Pyramid Customer Satisfaction Marketing How we portray or sell our services Business Development Services we provide, relationships with others, new developments Processes Efficient, effective, quality focus, no errors, good communication, standards, documentation Right people, good training, respect, integrity, belief in mission Employees and Culture Right people, good training, respect, integrity, belief in mission Needed What does practical skills mean? Not just know about a concept, but having hands on ability to get work done. Why is it important? t? To be effective need to understand how work gets done. Hands on when needed Credibility with other staff A/R management Compliance Concept Vs. Application 35 Concept Keep days in A/R low Send out clean claims Collect all the money possible 36 Detailed process of identifying denied claims, why denied, can we re-file, how to prevent in the future. Detailed process of how to work aging receivables by insurance type, aging, who will work what and what reports will be used to track all claims are reviewed. Identify good claims scrubber, identify errors and process for correcting them. Clear expectations of when charges are expected and when claims should be sent. 6

7 37 Concept Don t violate Stark and Anti-kickback statutes 38 Concept Don t violate Stark and Anti-kickback statutes Practical Don t accept really low rent from a business associate Referring patients to a business owned by the spouse of one of your physicians. Arrangement with ancillary provider where you are paid for services you send over. Best chance of success Experience Education / Training Attitude (4 components) Finding Success Finding Success Experience Years of hands on experience (trial and error) Experience in one area (CPC, CMA, MT, etc) Watching people around you Finding Success Education College degrees (Associates, Bachelors, Masters, etc) Certifications Training courses (more specific the better) 91% of physicians gave preference to a credential Finding Success Attitude Understand your purpose Work hard (enthusiasm) Live the values (integrity) Communicate often

8 Succeed in the Future Think you can or think you can t, Either way you ll be right -Henry Ford Potential Manager Role Identify ACO participation Negotiate with hospitals, health plans, other providers Understand financial impacts to your practice I.T. knowledge for interoperability discussions Ability to discuss compliance and quality issues Ability to understand reimbursement options Business development (buying, selling, partnering) Exciting Results Improve efficiency and quality of work Improve employee satisfaction Improve bottom line of clinic Improve patient satisfaction Improve the health and well being of community Maintain security and confidence of owners Succeed in the Future Be solid in the basics (practical skills) Financial Acumen Revenue cycle management Compliance HR Marketing and revenue enhancement Information Technology Succeed in the Future Keep the basics as simple as possible Clear policies and standards for everyone Lead others with clear direction Succeed in the Future Keep the basics as simple as possible Clear policies and standards for everyone Lead others with clear direction Time for the future Continue with pertinent information (don t get lost) Keep abreast of new regulations Develop good network

9 CPPM Commitment to quality training Focus is on understanding practical skills in physician practice management The CPPM credential Verifies a manager understands the vital components of managing a practice Provides confidence and marketability Conclusion Thank You