This document discusses revenue cycle management at a allergy and asthma care center. It summarizes that the managed care sub-committee manages contracts and includes the consultant, COO, PFO director, business office manager, and president. It also provides details on payor mix, utilization data, reimbursement rates, cash flow projections, and compliance policies to effectively manage the revenue cycle.
Голышев Евгений Константинович, backend-разработчик в TradingView, vk.com/id336575610
В докладе речь пойдет о том, как правильно привлекать различные низкоуровневые возможности операционных систем для решения тех или иных задач, будет рассказываться о разработке модулей расширения и других способах взаимодействие с кодом, написанном на C, из программ, написанных на Python. В качестве примера рассматривается питоновский подход к использованию специфических для файловой системы BTRFS возможностей, таких как создание и удаление снапшотов.
Голышев Евгений Константинович, backend-разработчик в TradingView, vk.com/id336575610
В докладе речь пойдет о том, как правильно привлекать различные низкоуровневые возможности операционных систем для решения тех или иных задач, будет рассказываться о разработке модулей расширения и других способах взаимодействие с кодом, написанном на C, из программ, написанных на Python. В качестве примера рассматривается питоновский подход к использованию специфических для файловой системы BTRFS возможностей, таких как создание и удаление снапшотов.
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Welcome to MGSI LLC. We are one of the leading providers of medical billing & coding services. Partner with us to manage your medical bills & revenue cycles.
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This presentation by Wayne Shirley was prepared for the Office of the Ohio Consumers’ Counsel. In this presentation on decoupling, Wayne Shirley discusses the different types of decoupling and how they work, how they are administered, risks and other issues faced by decoupling.
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Krismaine Maxicare Gold Healthluxe 150k InHealth Plan A Sprivate 100k.pdf
2009. 10 Allergy Asthma Revenue Cycle Pres
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.