The hospital had previously contracted an outside service to handle physician assistant (PAT) billing but was not recovering costs. PAT Services was asked to review the PAT practice and make suggestions. PAT Services was then asked to manage the physician and provide billing services. By retraining the physician in documentation and billing codes, and conducting chart audits, PAT Services increased the hospital's annual PAT collections from $142,502 to $289,584, transforming the department from a cost center to a revenue generator.

1. Case Study
Current PAT Services Client
Scenario
• For several years PAT Services provided the PAT physician to the hospital as an
independent contractor but had no other involvement.
• Hospital had previously contracted with an outside service to handle PAT billing.
• Eventually the hospital began billing for the service but did not recover cost.
• PAT Services was asked to review PAT practice performance and made multiple
suggestions regarding improving results.
• PAT Services was asked to manage physician & provide billing services
Notes
1) Current PAT practice payor mix used
2) Estimated patients are annualized from current PAT volumes
3) Reimbursement Rates for Medicare based upon 2009 Ohio Fee Schedule to create accurate comparison
4) Reimbursement Rates for Medicaid based upon 2009 Ohio Medicaid Fee Schedule to create accurate comparison
5) Used Ohio Medicaid rates for self-pay rates
6) Place of Service = Outpatient Hospital

2. Base Assumptions Outpatient Hospital Visits
Total Annual PAT Exams: 2,580 10 @ 258 Days per year
Annual Ambulatory Exams: 3,870 15 @ 258 Days per year
Total Department Cases: 6,450
% Examined 80% * 20% were examined by other fill-in physicians that billed for their own services
Actual # of Examinations / Cases 5,160
Avg Cases per month 430
Avg PAT Cases per Day 8.0
Avg Ambulatory Cases per Day 12.0
Avg Total Patients per Day 20.0

3. New Patients Established Patients Projected Annual
Collection
Before After Before After Before After Before After Before After Before After Before After
Description Payor Encounters 99201 99202 99202 99203 99203 99204 99211 99212 99212 99213 99213 99214
Mix
Commercial 24.41 46.89 46.89 71.10 71.10 118.68 22.89 24.06 43.38 46.42 67.80 71.90
Rates
Commercial 30% 1,548 $26,453 $39,925 $10,889 $27,514 - $18,372 $1,772 $1,862 $6,715 $2,156 - $2,226 $45,828 $92,054
Reimbursement
Medicaid 21.81 48.03 36.05 68.82 53.48 70.32 13.43 24.75 24.75 40.38 40.38 61.24
Rates
Medicaid 4% 206 $3,151 $5,452 $1,116 $3,551 - $1,451 $139 $255 $511 $250 - $253 $4,917 $11,213
Reimbursement
Medicare 23.25 44.66 44.66 67.71 67.71 113.03 21.80 22.91 41.31 44.21 64.57 68.48
Rates
Medicare 58% 2,993 $48,708 $73,512 $20,049 $50,661 - $33,828 $3,262 $3,428 $12,363 $3,969 - $4,099 $84,382 $169,497
Reimbursement
Self Pay Rates 16.36 36.02 27.04 51.62 40.11 52.74 10.07 18.56 18.56 30.29 30.29 45.93
Self Pay 8% 413 $4,727 $8,179 $1,674 $5,327 - $2,177 $208 $383 $766 $375 - $379 $7,375 $16,820
Collections
Other 0% - 58.33 58.33 94.76 94.76 131.27 131.27 29.16 29.16 47.49 47.49 67.48 67.48
Total 100% 5,160 $83,039 $127,068 $33,728 $87,052 - $55,828 $5,380 $5,929 $20,355 $6,750 - $6,957 $142,502 $289,584
% of Care Assumption 70% 55% 15% 25% 0% 10% 5% 5% 10% 3% 0% 2%

4. 300,000
Before
280,000 After
260,000
240,000
220,000
200,000
180,000
160,000
140,000
120,000
100,000
80,000
60,000
40,000
20,000
0
Commercial Medicaid Medicare Self Pay Collections Total
Reimbursement Reimbursement Reimbursement

5. Conclusion
• PAT Services previously provided physician to client hospital as an independent contractor
but had no other involvement
• Hospital previously contracted with an outside service to handle PAT billing & eventually began handling
billing internally but could not recover cost
• PAT Services was asked to review PAT practice performance and made multiple suggestions
regarding improving results
• PAT Services was asked to manage physician & provide billing service.
• Upon engaging in management of PAT department the same physician was retrained in E & M code
selection & correct documentation by PAT services experts.
• PAT Services initated quarterly internal chart audits with results communicated back to physician
• PAT Service increased annual collections by more than 100% for client hospital from $142,502 to $289,584,
which in turn transitioned the hospital’s PAT department from a cost center to a revenue generating center