1. Leaders 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

2. Leaders in Allergy & Asthma Care for
Over 30 Years
Who Manages the contracts at CAAC?Who Manages the contracts at CAAC?
• Managed Care Sub-Committee
– Consultant
– COO,
– PFO Director
– Business Office Manger.
– President

3. Leaders in Allergy & Asthma Care for
Over 30 Years
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

4. Leaders in Allergy & Asthma Care for
Over 30 Years
Managed Care Matrix 2008Managed 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

5. Leaders in Allergy & Asthma Care for
Over 30 Years
Payor MixPayor 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%

6. Leaders in Allergy & Asthma Care for
Over 30 Years
Example of Utilization Data andExample 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%

7. Leaders in Allergy & Asthma Care for
Over 30 Years
Payer Resource ManuelPayer Resource Manuel
CPT
Code
Description
MED.200
8
MCD.
(2007)
Alpha
HMO
(008
RBRVS)
eff.
7/1/200
8
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

8. Leaders in Allergy & Asthma Care for
Over 30 Years
Negotiation StrategiesNegotiation 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

9. Leaders in Allergy & Asthma Care for
Over 30 Years
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.

10. Leaders in Allergy & Asthma Care for
Over 30 Years
TreasuryTreasury
• Cash payments & Credit Card Payments –
– $ goes to bank daily.
– Batch sent from clinic daily to PFO to reconcile

11. Leaders in Allergy & Asthma Care for
Over 30 Years
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)

12. Leaders in Allergy & Asthma Care for
Over 30 Years
Claims SubmissionClaims Submission
• Navicure – Clearing house.
• On-Line adjudication through Navicure & Payor
Web-Portal

13. Leaders in Allergy & Asthma Care for
Over 30 Years
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

14. Leaders in Allergy & Asthma Care for
Over 30 Years
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

15. Leaders in Allergy & Asthma Care for
Over 30 Years
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 $1,663,374
Net Income -$242,254

16. Leaders in Allergy & Asthma Care for
Over 30 Years
Cash FlowCash Flow
Principal 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

17. Leaders in Allergy & Asthma Care for
Over 30 Years
ComplianceCompliance
• HIPAA –
• Policies
– Self Pay Discounts
– Write Off policies
• QA audit on coding
• Coding and Denial Committee

18. Leaders in Allergy & Asthma Care for
Over 30 Years
Allows one to hold their head up.Allows one to hold their head up.