acumen insight Physician Accounting & ideas Finance 101 – Best attention reach Practices for Physicians & expertise Clinics depth agility Presented by: Robbie M. Connell, CPA talent
acumen Agenda insight ideas ▪ Standard Practice Management Reports attention ▪ Industry Benchmark Data reach ▪ Basic Financial Overview expertise depth agility talent
acumen Practice Management Reports insight ▪ Accounts Receivable (A/R) Aging ideas attention ❖ Summary reach ❖ By Payer ❖ By Provider expertise ▪ Denials Report depth ▪ Activity by Provider & Location agility ▪ Top CPT Codes talent
acumen Sample A/R Aging Report insight ideas Amt 31-60 61-90 91-120 121-150 151-180 attention Totals For AETNA $55.00 $55.00 $0.00 $0.00 $0.00 $0.00 Totals For Aetna Life Co Mngd Choice Acces $55.00 $0.00 $55.00 $0.00 $0.00 $0.00 Totals For AETNA MEDICARE $115.00 $0.00 $0.00 $0.00 $0.00 $0.00 Totals For AETNA OPEN ACCESS $135.00 $95.00 $0.00 $0.00 $0.00 reach $0.00 Totals For AETNA POS $1,116.42 $0.00 $60.00 $651.42 $0.00 $0.00 Totals For AETNA PPO $60.00 $0.00 $0.00 $60.00 $0.00 $0.00 Totals For Aetna Student Health $1,279.72 $0.00 $1,279.72 $0.00 $0.00 $0.00 expertise Totals For Assurant Health/ASA $600.77 $0.00 $0.00 $0.00 $0.00 $0.00 Totals For BCBS TEXAS PPO $14,933.69 $455.00 $900.00 $2,395.37 $0.00 $132.56 Totals For Caprock - PHCS $110.00 $0.00 $0.00 $0.00 $0.00 $0.00 depth Totals For CHRISTIAN BROTHERS SERVICE $210.00 $0.00 $0.00 $0.00 $0.00 $0.00 Totals For CIGNA $1,243.62 $0.00 $0.00 $50.00 $25.00 $0.00 Totals For Cigna HealthSpring Prospect $150.00 $0.00 $0.00 $0.00 $0.00 $0.00 Totals For Cofinity $430.00 $0.00 $0.00 $0.00 $0.00 $0.00 agility Totals For COMMUNITY FIRST $986.83 $0.00 $0.00 $66.83 $0.00 $0.00 Totals For COMMUNITY FIRST CHIP $420.00 $0.00 $0.00 $0.00 $0.00 $0.00 Totals For COMMUNITY FIRST MEDICAID CHIP $1,350.00 $225.00 $230.00 $0.00 $0.00 $0.00 talent Totals For FEDERATED INSURANCE $1,097.00 $0.00 $0.00 $0.00 $0.00 $1,097.00
acumen insight ideas attention reach expertise depth agility talent
acumen Sample Claims Rejections (i.e. Denials) insight ideas Patient : Entity not eligible for benefits for submitted dates of service Acknowledgement/Rejected for Invalid Information-The claim/encounter has invalid information as specified in the Status details and SHEET METAL WRKS NATL has been rejected. 1 $235.00 SUPERIOR HEALTHPLAN CHECK MEMBER ID OR ELIGIBILITY. CONTACT PAYER FOR FURTHER INFORMATION. 1 $402.00 attention Payer : Cannot provide further status electronically Acknowledgement/Returned as unprocessable SUPERIOR HEALTHPLAN claim-The claim/encounter has been rejected and has not been entered into the adjudication system. 1 $402.00 UNITED HEALTHCARE Admission Date is required on inpatient medical visits. 2300.DTP*435 1 $2,850.00 reach Patient : Entity not eligible for benefits for submitted dates of service Acknowledgement/Rejected for Invalid Information-The claim/encounter has invalid information as specified in the Status details and CIGNA has been rejected. 2 $600.00 expertise MEDICARE Re- Submit the claim by appending the suffix to Other Payer Id's, when Other Payer Id's are same. 5 $1,087.00 Adjudication Date required either at the claim level or on all service lines for COB and Tertiary claims. MEDICARE 2330 / 2430 DTP*573 1 $300.00 depth MEDICARE The COB information does not balance at the claim level. 1 $300.00 MEDICARE The COB information does not balance at the service level. 1 $300.00 MEDICARE The COB information does not balance. 1 $300.00 agility Subscriber and subscriber id not found Acknowledgement/Returned as unprocessable claim-The AARP- UNITED HEALTHCARE claim/encounter has been rejected and has not been entered into the adjudication system. 5 $1,439.92 talent Investigating existence of other insurance coverage Pending/Patient Requested Information-The claim AETNA or encounter is waiting for information that has already been requested from the patient. 2 $547.46
acumen Sample CPT Code Chart insight ideas attention reach expertise depth agility talent
acumen Sample CPT Code Chart insight ideas attention reach expertise depth agility talent
acumen insight ideas attention reach expertise depth agility talent
acumen Benchmarks insight ▪ Days in Accounts Receivable ideas attention ▪ Entry Lag – Avg number of days from encounter to charge entry – 0-48 hours reach ▪ Charge Entry to date of bill release to expertise Clearinghouse/Payer – 24-72 hours depth ▪ Denial Rate – Less than 5% agility ▪ Industry Overhead Comparison talent
acumen Distribution of A/R insight ideas Days In A/R Cardiology Family Med. OBGYN Orthopedic attention 0-30 Days 37.42% 58.73% 55.91% 54.74% 31-60 Days 10.78% 10.54% 11.29% 12.15% reach 61-90 Days 7.21% 6.90% 6.56% 8.82% expertise 91-120 Days 4.68% 4.99% 4.84% 6.49% 121+ Days 36.81% 15.84% 14.95% 17.03% depth Southern Region Specific Data agility Median %s used talent Source: MGMA Report, Cost Survey: 2017 Report Based on 2016 Data
acumen Overhead as a % of Total Medical Revenue insight ideas Category Cardiology Family Med. OBGYN Orthopedic Total Support Staff 24.08% 27.87% 26.94% 22.69% attention Drug Supply N/A 8.36% 5.35% 3.48% Building & Occupancy 7.22% 9.40% 6.49% 6.32% reach Prof Liability Ins 1.41% 1.61% 3.81% 2.63% Info Technology 1.12% 1.48% 1.42% 1.85% expertise Medical Supplies .48% 1.12% 1.98% 1.54% depth Total Operating Cost 58.69% 71.96% 61.47% 55.05% Southern Region Specific Data agility Median %s Used talent Source: MGMA Report, Cost Survey: 2017 Report Based on 2016 Data
acumen Staffing per FTE Physician insight Category Cardiology Family Med. OBGYN Orthopedic ideas Clinical Support 1.51 1.99 1.66 1.40 Staff attention Front Ofc Support 2.09 2.00 1.53 1.87 Med Assistant, .84 1.50 1.01 1.00 reach Nurse Aides Total Support Staff 3.95 4.14 3.52 4.05 expertise depth agility Median FTEs Used talent Source: MGMA Report, Cost Survey: 2017 Report Based on 2016 Data
acumen Other Useful Benchmarks insight ▪ Percentage of insurance verified – 98% ideas ▪ Number of patients cleared (demographic & insurance data necessary for claims processing prior to visit) – 90% attention ▪ Error rates due to front-end billing – Less than 2% reach ▪ Time of Service Collections Copayments – 100% ❖ expertise All other – 75% ❖ ▪ Follow-up notes documented on the account – < 30-45 days depth ▪ Identification and return of unidentified or overpayment refunds – < 60 days ▪ Date of charge entry to date of claim release – 0-72 hours agility ▪ Claims Submission – Daily talent Source: “The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid” by Deborah Walker Keegan, PhD, FAC MPE; Elizabeth W. Woodcock, MBA, FACMPE, CPC; and Sara M. Larch, MSHA, FACMPE
acumen Purpose of Accounting insight ▪ Accounting helps you understand where ideas you have been, so you can decide where attention you are going reach ▪ Information systems, which measure, expertise process and communicate information, are depth useful for decision makers agility talent
acumen insight ideas attention reach expertise depth agility talent
acumen Definitions insight ▪ Asset – Something you own ideas Cash ❖ attention Accounts Receivable ❖ ✓ Charges vs. Net Adjusted Collectible Charges reach Property, plant & equipment ❖ expertise ▪ Liability – Something you owe Accounts Payable ❖ depth Long-term equipment loans ❖ agility ▪ Equity – The difference between the two above. Assets – Liabilities = Equity ❖ talent
acumen Financial Statements – The Big 3 insight ▪ Balance Sheet ideas ▪ Income Statement attention ▪ Cash Flow Statement reach expertise depth agility talent
acumen Visual summary – Financial Statements insight Reporting of Balance Sheet Balance Sheet Business Activity ideas Financial condition at a Financial condition at a point in time point in time Income Statement attention Summary of activity for a period of time reach expertise Statement of Cash Flows depth Summary of activity for a period of time End of Year Beginning of Year agility December 31, 2017 January 1, 2017 talent
acumen Basis of Accounting insight ▪ Cash Basis ideas attention ❖ Income is recognized when cash is collected reach ❖ Expense is recognized when cash is paid ▪ Accrual Basis expertise depth ❖ Income is recognized as it is earned ❖ Expense is recognized as it is incurred agility talent
acumen Balance Sheet insight ideas The balance sheet will tell you what the company owns (its assets) and what it owes (its liabilities) and what is left over attention for the owners (equity) Key Points reach ▪ Snapshot at a fixed point in time expertise ▪ Not necessarily current market values depth ▪ Current financial health of the company agility ▪ Focus on the quality of the assets – e.g. is the company sitting on a pile of cash - or is everything sitting in past due talent receivables?
Recommend
More recommend
