20 WAYS TO GET
PAID FASTER
11.15.2012
THRIVING DURING
TIMES OF CHANGE
Shelly Guffey
Special thanks to the Medical Group
Management Association (MGMA) for use
of their data
2
OBJECTIVES
• Discover direct and indirect areas of your
business operations that are costing you money
• Use key benchmarks to help you take action to
increase your bottom line
• Identify technology tools to automate
operations, enhance your service to patients
and help you get paid quickly and efficiently
3
Appointment
Scheduling
Accounts
Receivable &
Collections
Registration &
Certification
Denied Claims
Management
Claims & Patient
Payments/Proces
sing
Patient
Reception
The Revenue
Cycle
Patient
Statements &
Claim Production
Patient Clinical
Visit
Documentation &
Coding
Charge
Processing &
Check Out
4
WHERE THE MONEY GOES
STAFFING IS THE BIGGEST EXPENSE
Staff
25%
I/T
46%
Drug Supplies
Building
5%
3%
Admin Supplies/Services
Prof Liability Insurance
14%
4% 3%
Other ancillary services
Source: Medical Group Management Association, Cost Survey for Orthopedic Practices,
2010. Report based on 2009 data.
5
HIRING
STAFF TO SUPPORT YOUR SPECIALTY
Median Support Staff
Per FTE
Physician
Multispecialty
4.54
Internal medicine
3.19
Pediatrics
3.94
Cardiology
5.60
Hematology Oncology
5.77
Source: MGMA Cost Survey: 2009 Report
Based on 2008 Data
6
MGMA ASSESSMENT & RECOMMENDATIONS
• Evaluate staffing
• Understand if staffing supports
productivity
• Utilize technology for increased revenue
7
STAFFING TURNOVER SURPRISE
Turnover
Better
Performers
Others
Receptionist and medical records staff
30.00%
25.00%
Nursing and clinical support staff
20.00%
16.67%
Billing/collections and data entry staff
13.81%
4.00%
Source: Performance and Practices of Successful Medical Groups: 2008 Report
Based on 2007 Data
8
REMOVE OBSTACLES TO PROVIDER PRODUCTIVITY
MINIMIZE TIME DEVOTED TO NON-PATIENT CARE
KEY PROVIDER
DISTRACTIONS
•
Administrative time
•
Occasions requiring long travel
between sites during the
middle of the day
•
Time off during peak patient
volume cycles
9
EFFICIENT STAFFING
STAFF TO SUPPORT THE BUSIEST TIME OF DAY
STAFFING IS CONSTANT BUT
WORKFLOW IS NOT.
RESULT IS OFTEN OVERTIME!
Fixed Costs Utilization by Hour of Day
100%
90%
80%
Overtime
70%
60%
50%
40%
Regular
30%
20%
10%
0%
10
EFFICIENT STAFFING
STAFF YOUR OFFICE BASED ON SCHEDULE LOAD
Volume v. Staffing
160
12
140
10
120
8
100
80
6
Patient Volume
Staff Hrs per Day
Staff Hrs per Visit
60
4
40
2
20
0
0
Monday
Tuesday
Wednesday
Thursday
Friday
11
KEY PERFORMANCE INDICATOR (KPI) TO MEASURE
NO SHOW RATE
You can’t inventory time!
TIPS TO REDUCE
NO SHOW RATE
•
Appointment cards given at
previous appointment
•
Email reminders and portal
tools
•
Snail mail reminders
•
Automated reminders – phone,
text, etc.
•
Follow-up file for noting and
contacting those who do not
keep appointments
12
IMPACT OF A HIGH NO SHOW RATE
CASE STUDY: 75 PTS/DAY, $85 FEE/PT
Daily 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
=
$5,760
Assume 30% decrease in
no-shows; additional
monthly revenue
=
$5,610
ROI
=
One month
13
KEY PERFORMANCE INDICATOR (KPI) TO MEASURE
ACCOUNTS RECEIVABLE
ACCOUNTS
RECEIVABLE
•
•
•
•
•
•
•
Percent of A/R >120 days
Days gross FFS charges in A/R
Adjusted FFS collection percent
Patient accounting support
staff/FTE physician
Total medical revenue per FTE
physician
Percent of claims submitted
electronically
Percent of claims denied on first
submission
14
BETTER PERFORMER KPI MGMA CASE STUDY
INDICATORS SHOW OPPORTUNITIES
KPI
Better Performer
Case Study Data
% of A/R >120 days
10.69%
36.18%
Days gross FFS charges in A/R
29.40
51.51
100.00%
97.33%
.87
1.09
$1,242,630
$1,073,456
% of claims submitted electronically
95%
81%
% of claims denied on first submission
4%
19%
Adjusted FFS collection %
Patient accounting support staff/FTE
physician*
Total medical revenue per FTE physician
*Includes coding, charge entry, cashiering.
Source: Performances and Practices of Successful Medical Groups - 2009;
Orthopedic Surgery.
15
MGMA CASE STUDY GAP ANALYSIS
Adjusted fee-for-service charges 1/1/09-12/31/09
Net fee-for-service collection 1/1/09 – 12/31/09
Practice net collection rate
$27,445,597.05
26,712,131.52
97.33%
Better performers net collection rate
100.00%
Expected revenue at better performers net collection rate
of 100%
REVENUE GAP
$27,445,597.05
$733,465.53
WHAT THIS MEANS TO THE PRACTICE
An additional $733,466 would have flowed into the practice
($29,338/FTE physician) if the practice had collected like better
performing orthopaedic practices.
16
WAYS TO MANAGE PATIENT PAYMENT
• Review cycle times for claims submission and reimbursement
• Maintain a date of entry, a date of service, and a date of
submission with a practice management system
• Submit charges on a timely basis
• Determine 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 payments
17
PREPARE IN ANTICIPATION OF THE APPOINTMENT
• Verify eligibility, copay and
deductible status
• Automate via batch submission of
daily schedule
“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.”
• Web-based payer sites issues
• Note/alert for reception
MOORE, P. “FIX YOUR DENIAL
PROBLEMS,” PHYSICIANS
PRACTICE, APRIL 2004.
18
INSURANCE VERIFICATION
INCREASE PATIENT SATISFACTION & REDUCE INTERNAL
COSTS
Task
Approx duration
Cost *
Insurance verification via payer
Web site
2 minutes
$.40
Insurance verification via payer
Web site including log on
2 – 4 minutes
$.40-$.80
Insurance verification via
telephone
5 – 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.
19
COPAYMENTS COLLECTED AT TIME OF SERVICE
BETTER PRACTICES COLLECT MORE UPFRONT
Percentage of Copay
Better Performers
Others
90-100%
47.15%
36.63%
75-89%
32.52%
29.07%
50-74%
9.76%
15.12%
0-49%
10.57%
19.19%
79.67%
65.70%
Source: Performance and Practices of Successful Medical Groups:
2008 Report Based on 2007 Data
20
PATIENTS’ SHARE OF MEDICAL BILLS TO SKYROCKET
Employer Benefits
Percentage
Employers that intend to shift more health insurance costs to
employees next year
65%
Employers that plan to reduce the number of health plan options
49%
Employers that plan to increase the number of consumer-directed
health plans
40%
2007: Patients responsible for 12% of their healthcare bills.
2012: Patients will be responsible for 30% of their healthcare bills.
Sources:
- 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.
21
EFFECTIVE USE OF RESOURCES: AUTOMATE
• E-statements
• Costs 58% of the
price of a paper bill
to produce*
*Source: Gartner Group, HFMA, and HH&N Research
22
PATIENT ONLINE BILL PAYMENT
• Place “Pay online at
www.your-practice.com”
on your statement
• Pay a credit card
processing fee
• Processed directly to your
merchant account
• 10% reduction in accounts
receivable*
• Increased cash flow
*Source: MGMA
23
WHAT CAN YOUR SYSTEM TELL YOU?
PERFORMANCE AT A GLANCE
24
ANALYZE REJECTIONS
25
TOOLS TO RECOVER REVENUE
• Reimbursement manager
• Upload claim and remittance data
• Fee schedule underpayments
• Misuse of clinical edits
• Creates formatted appeal letters
26
BETTER PERFORMERS AUTOMATE PROCESSES
ERA AND AUTOMATED PAYMENT POSTING
• Improves cash management
– Faster, more accurate generation of payment data
• Faster payment processing means staff get to denial and
exception management faster too
– No distraction for routine data entry duties
• Reduced data entry errors
• Enhanced business intelligence increases profitability that
can be measured
Source: MGMA Consultant – Rosemarie Nelson
28
ELECTRONIC REMITTANCE BENEFITS
CASE STUDY: SAVED TIME = MONEY
• Days to hours and hours to minutes
• Payer with 30% of practice’s volume
implemented ERA
• Manual payment posting took 5 days each
month
• ERA reconciliation took 4.5 hours each
month
• Labor savings: $7,668 annually ($1,917 per
FTE physician)
Source: MGMA Consultant – Rosemarie Nelson
29
PRACTICE CHECK UP
Plan for changes and mandates before
deadlines (e.g. 5010, ICD-10, Meaningful Use,
PQRS)
Meet with claims processing team regularly to
evaluate workflow
Keep copies of contracted fee schedules and
contracts or store in Practice Management
System
30
FALLING REIMBURSEMENT
DROP IN PAYMENT, COMMERCIAL PAYERS
2005 to 2006: 10% drop
2006 to 2007: 6.5% drop
AVERAGE REIMBURSEMENT,
99213
AVERAGE PRICE,
HAIRCUT
$47
$45
31
KEY TAKEAWAYS
• Leverage technology
• Understand industry landscape
• Take action on daily, weekly, monthly basis
32
Q+A
33
SHELLY GUFFEY
800.969.3666 EXT 1450
[email protected]
34
THE BEDSIDE MANNER
YOUR REVENUE
DESERVES™
11.15.2012
THANK YOU.