3. Increasing Revenues to Offset Expenses
• Coding the visit or service (Refer to Jean Acevedo Presentation)
– Get up to date with 2015 Coding changes
– Maximize your office visits coding levels
• Are you using an EHR????
– Document everything you do
4. Increasing Revenues to Offset Expenses
• Maximizing your Billing & Collections
– Determining and collecting patient responsibility
• Co-pays
• Deductibles
• Co-Insurance
– Determining your expected amounts
• Contracted Rates
• EOBs
5. Increasing Revenues to Offset Expenses
• Maximizing your Billing & Collections (Continued)
– Communicate with your patients in advance
• Patient Financial responsibility Forms/Documents
• Exceptions
– Clean Claims (Scrub)
• Modifiers
• Verify/Correct Patient Demographics
6. Increasing Revenues to Offset Expenses
• Maximizing your Billing & Collections (Continued)
– Insurance Collections
• Don’t wait for EOB/Denials
• Not-on-file
– Patient/Guarantor Collections
– Collection Agencies
7. Increasing Revenues to Offset Expenses
• Benchmark your Practice (MGMA)
– Net Collection Rate
• >90% (After 6 Months of service)
>95% (After 9 Months of service)
– Account Receivables Aging
• 0-60 >70%
• 120 & Over (15% or less)
8. Increasing Revenues to Offset Expenses
• Contracting
– Payors
• Are you contracted with all Payors & lines of Business?
• Healthcare Marketplace
• HMO’s/Capitated
• Medicare/Medicaid opportunities
– Providers
• Are all your Providers linked to your contracts?
9. Increasing Revenues to Offset Expenses
– Pediatric Physician Rate Increase (Medicaid)
• Effective January 1, 2015, Current Procedural Terminology
(CPT®) codes 99201 through 99496 will be reimbursed with
an enhanced rate to pediatric physicians billing fee-for-
service with one of the following specialty codes: 001, 019,
023 035, 036, 037, 038, 039, 043, 049, 059, 101,102. The
Physician Evaluation and Management Fee Schedule will be
amended to reflect this change.
• Providers receiving reimbursement through a Medicaid managed
care plan should refer to their contract with each plan to determine
whether this change will impact their reimbursement from the plan.
10. Increasing Revenues to Offset Expenses
• New Services for appropriate patient population (CMS)
– New Chronic Care Management Program authorized by CMS
and taking effect in 2015, you can bill for care that you are
probably already providing to patients with two or more chronic
conditions.
– Patient-Centered Medical Home is a way of organizing primary
care that emphasizes care coordination and communication to
transform primary care into "what patients want it to be." Medical
homes can lead to higher quality and lower costs, and can
improve patients’ and providers’ experience of care.
11. Increasing Revenues to Offset Expenses
• New Services for appropriate patient population (CMS)
– Transitional care refers to the coordination and continuity of
health care during a movement from one healthcare setting to
either another or to home, called care transition, between
health care practitioners and settings as their condition and care
needs change during the course of a chronic or acute illness.
Older adults who suffer from a variety of health conditions often
need health care services in different settings to meet their many
needs. For young people the focus is on moving successfully
from child to adult health services.
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-
Network-MLN/MLNProducts/Downloads/Transitional-Care-
Management-Services-Fact-Sheet-ICN908628.pdf
12. Increasing Revenues to Offset Expenses
• New Services for appropriate patient population (CMS) (Continued)
– Preventive services (Co-pay & Co-Insurance waived) 100% Medicare:
http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/
MPS_QuickReferenceChart_1.pdf
– Annual Wellness Visit (AWV)
– Initial Preventive Physical Examination (IPPE)
– Bone Mass Measurement
– Cardiovascular Screening
– Colorectal Screening
– Counseling to Prevent Tobacco Use
13. Increasing Revenues to Offset Expenses
• New Services for appropriate patient population (CMS) (Continued)
– Diabetes Screening
– Diabetes Self-Management
– Glaucoma Screening
– Hepatitis B Vaccine & Administration
– HIV Screening
– Influenza Vaccine & Administration
– Intensive Behavioral Therapy for Cardiovascular Disease (IBT)
– Intensive Behavioral Therapy for Obesity
– Medical Nutrition Therapy
14. Increasing Revenues to Offset Expenses
• New Services for appropriate patient population (CMS) (Continued)
– Pneumococcal Vaccine and Administration
– Prostate Cancer Screening
– Screening for Depression
– Screening and Behavioral Counseling Interventions in Primary Care to
reduce alcohol misuse
– Screening for Mammography
– Screening Pap tests
– Screening Pelvic Examinations
– Sexually Transmitted Infections Screening
– Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)
