Filling the Payer Gap Steve Swanson, CPA Jon Thoms, CPA Accounting - PDF document

9/13/2018 Filling the Payer Gap Steve Swanson, CPA Jon Thoms, CPA Accounting Supervisor Partner Top 100 Top 100 CPA and business CPA and business consulting firm consulting firm in the U.S. in the U.S. (62nd out of 53,000+ firms!) (62nd out of 53,000+ firms!) Largest Largest Iowa-based Iowa-based CPA firm CPA firm *Accounting Today, March 2018 *Accounting Today, March 2018 50 states 50 states and thousands of and thousands of U.S. cities served U.S. cities served Jon Thoms, CPA Steve Swanson, CPA Partner Accounting Supervisor  Extensive experience in the following  Over 20 years of experience assisting industries: health care, retail, service, independent medical groups in nonprofit, manufacturing, agriculture, maximizing profits, analyzing and warehousing operations, construction improving practice productivity and and trucking revenue cycle management  Specializes in accounting, auditing,  Works with various medical groups to general business consulting, management review, modify or create compensation advisory services, corporate, partnership, structures for physicians and staff individual and farm tax returns, financial planning, and internal auditing  Creates internal accounting and reporting procedures  Establishes enhanced financial reports specific to client needs  Review efficiencies within the financial data to ensure accurate and timely reporting Honkamp Krueger & Co., P.C. 1

9/13/2018 Today’s objective Use your own data to: 1. Identify areas of improvement based on chargemaster 2. Identify key revenue lines to target in contract negotiations for higher reimbursement rates or other competitive advantages 3. Monitor billing and collections from third party payers 4. Understand how chart audits can improve your collections 5. Understand why patient collections at access point is critical What is payer gap? Shortfalls in practice receipts as a result of… 1. Insufficient charges 2. Improper reimbursements 3. Insufficient contract terms 4. Incorrect billings and codings 5. Patient collection problems (Weak controls at patient access point) What is payer gap? Data analysis will fill the gap. Honkamp Krueger & Co., P.C. 2

9/13/2018 What tools are needed? You will need…  One motivated employee  One practice management system  One license to Microsoft Excel  Basic Excel knowledge or ability to learn  One supportive owner or boss  Time to pull, analyze and report on data within your practice What is data analysis? “Data is useless without “Data is useless without analysis. Analysis is analysis. Analysis is impossible without data.” impossible without data.” - Anonymous - Anonymous “It’s never too late to learn a new skill. That is, unless your employer needs someone who possesses that skill in your position right now.” - Anonymous Report Running vs. Data Mining Honkamp Krueger & Co., P.C. 3

9/13/2018 Report running vs. data mining  It takes little skill to run a report and print  It takes thoughtful skill to extract report, test the data, archive the information for future use  Printed reports are static and are difficult to cross-check  Extracted data can be tested and tied to other reports electronically Report running vs. data mining  Printed reports are difficult to archive and retrieve  Extracted data can be archived easily and retrieved instantaneously  Printed reports are usually “canned” and based on what someone else thinks you need  When extracted as data, reports can be manipulated and specified to your needs Report running vs. data mining 04-2016 05-2016 06-2016 07-2016 08-2016 09-2016 10-2016 11-2016 12-2016 01-2017 02-2017 03-2017 04-2017 Honkamp Krueger & Co., P.C. 4

̶ ̶ ̶ ̶ 9/13/2018 Report running vs. data mining 04-2016 05-2016 06-2016 07-2016 08-2016 09-2016 10-2016 11-2016 12-2016 01-2017 02-2017 03-2017 04-2017 Starting with the basics  This table tells a story, but not the whole story Medical Practice Charges and Payments Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17 Charges $288,225 $228,605 $268,934 $260,916 $257,680 $268,425 $288,345 Payments $86,954 $83,214 $145,526 $250,818 $180,170 $181,070 $153,742 Which report or reports were run to obtain these numbers? Are charges based on date of service or accounting date? Are payments based on date of service or accounting date? Are the variations in charges based on variations in volumes? Starting with the basics Medical Practice Charges and Payments Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17 Charges $288,225 $228,605 $268,934 $260,916 $257,680 $268,425 $288,345 Payments $86,954 $83,214 $145,526 $250,818 $180,170 $181,070 $153,742 Kept Visits 1,478 1,166 1,358 1,352 1,328 1,398 1,491 Charges per Kept Visit $195 $196 $198 $193 $194 $192 $193  Written, step-by-step documentation to include reporting specs  Addition of kept visits and a mathematical control measure automatically enhances the value of this report Honkamp Krueger & Co., P.C. 5

9/13/2018 Drilling Down Drilling down / mining the data Dt of Svc Proc Dt Name Pat Type Sv It Sv It Desc Unit Price Count Chg Amt Payer Name 01/03/2017 01/03/2017 Patient, Ima 99499O Chart Copy $0.00 1.00 $35.00 Self Pay 12/23/2016 01/03/2017 Patient, Ima Standard 99214 OFFICE VISIT, EST PT $240.00 1.00 $240.00 SISCO 12/23/2016 01/03/2017 Patient, Ima Standard 99214 OFFICE VISIT, EST PT $240.00 1.00 $240.00 Medicare Iowa 12/23/2016 01/03/2017 Patient, Ima Standard 99214 OFFICE VISIT, EST PT $240.00 1.00 $240.00 Blue Card Of Iowa 12/23/2016 01/03/2017 Patient, Ima Standard 99214 OFFICE VISIT, EST PT $240.00 1.00 $240.00 Iowa XIX AmeriHealth Caritas 12/23/2016 01/03/2017 Patient, Ima Standard 99213 OFFICE VISIT, EST PT $160.00 1.00 $160.00 Iowa XIX UHC Community Plan 12/23/2016 01/03/2017 Patient, Ima Standard 95811 POLYSOMNOGRAPHY W/CPAP, BILEVEL VENTILATION, $2,024.00 1.00 $2,024.00 Blue Card Iowa 12/27/2016 01/03/2017 Patient, Ima Standard 95800 HOME SLEEP STUDY, UNATTENDED W/SLEEP TIME $497.00 1.00 $497.00 John Deere Choice 12/27/2016 01/03/2017 Patient, Ima Standard 95800 HOME SLEEP STUDY, UNATTENDED W/SLEEP TIME $497.00 1.00 $497.00 Blue Card Iowa 12/28/2016 01/03/2017 Patient, Ima Standard 99213 OFFICE VISIT, EST PT $160.00 1.00 $160.00 BCBS Iowa 12/28/2016 01/03/2017 Patient, Ima Standard 99244 OFFICE CONSULTATION $452.00 1.00 $452.00 United Medical Resource 12/28/2016 01/03/2017 Patient, Ima Standard 95886 MUSCLE TEST, EACH EXT., COMPLETE W/NCV $236.00 2.00 $472.00 United Healthcare 12/28/2016 01/03/2017 Patient, Ima Standard 95911 NCV Studies, 9‐10 $825.00 1.00 $825.00 United Healthcare 12/28/2016 01/03/2017 Patient, Ima Standard 99214 OFFICE VISIT, EST PT $240.00 1.00 $240.00 Medicare Iowa 12/28/2016 01/03/2017 Patient, Ima Standard 99213 OFFICE VISIT, EST PT $160.00 1.00 $160.00 BCBS Iowa 12/28/2016 01/03/2017 Patient, Ima Standard 95886 MUSCLE TEST, EACH EXT., COMPLETE W/NCV $236.00 1.00 $236.00 GWH Cigna 12/28/2016 01/03/2017 Patient, Ima Standard 95910 NCV Studies, 7‐8 $700.00 1.00 $700.00 GWH Cigna 12/28/2016 01/03/2017 Patient, Ima Standard 99213 OFFICE VISIT, EST PT $160.00 1.00 $160.00 Medicare Iowa 12/28/2016 01/03/2017 Patient, Ima Standard 99213 OFFICE VISIT, EST PT $160.00 1.00 $160.00 BCBS Iowa 12/28/2016 01/03/2017 Patient, Ima Standard 95885 MUSCLE TEST, EACH EXT., LIMITED W/NCV $151.00 1.00 $151.00 Iowa XIX UHC Community Plan 12/28/2016 01/03/2017 Patient, Ima Standard 95909 NCV Studies, 5‐6 $550.00 1.00 $550.00 Iowa XIX UHC Community Plan 12/28/2016 01/03/2017 Patient, Ima Standard 99213 OFFICE VISIT, EST PT $160.00 1.00 $160.00 BCBS Iowa 12/28/2016 01/03/2017 Patient, Ima Standard 99214 OFFICE VISIT, EST PT $240.00 1.00 $240.00 Medicare Iowa 12/28/2016 01/03/2017 Patient, Ima Standard 99214 OFFICE VISIT, EST PT $240.00 1.00 $240.00 Iowa XIX Amerigroup Inc Plans are part of networks Honkamp Krueger & Co., P.C. 6