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John V. Guiliana, DPM. MS. “I feel like I’m working harder and harder for less and less”

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Presentation on theme: "John V. Guiliana, DPM. MS. “I feel like I’m working harder and harder for less and less”"— Presentation transcript:

1 John V. Guiliana, DPM. MS

2 “I feel like I’m working harder and harder for less and less”

3 What’s Costing You? Reduced Reimbursements? Rising Expenses? Ridiculous Regulatory Issues? Mi$$ed Opportunities!

4 Thinking “Surgically” and Keeping Your Fingers on the Pulse of Things…

5 Our Theoretical Practice

6 Total Visits

7 Total vs New Target should be greater than 10.0%. Lower than benchmark might mean that the practice is not offsetting the typical attrition rate of a medical practice.

8 New Patient Coding

9 Established Patient Coding

10 New vs Established Weighted Average Coding A weighted average compares coding level to it’s utilization. For example, equal numbers of level 2 codes to level 3 codes = 2.5

11 Accounts Receivables - Percentages Target is to have less than 15% of total A/R in buckets greater than 90 days. This looks excellent

12 Total Visits vs Services Industry

13 Our Priorities and Action Plan

14 Priority 1.???Aged Claims Marketing2.??? 3. ???Coding 4.Services???

15 Action Plan Assign most qualified staff member the duty of investigating the details of claims over 60 days old. a.Re-file b.Appeal c.Write Off Remember the Who, What, When Rule!

16 Action Plan Assign most qualified staff member the duty of initiating a Marketing Plan a.Budget b.Design c.Execute Outsource?

17 Action Plan Attend Coding Seminars and institute a Coding Compliance and Auditing Policy

18 Action Plan Develop and Adhere to EB Clinical Protocols Assign Protocol Compliance Officer

19 Protocol Adherence and Measurement

20 Rationale for protocols Uniquely similar Consistent quality outcomes Perceptual credibility Anticipatory staff Streamlined processes Cost reduction Improved revenues

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22 Measuring an Effect of Clinical Protocol Adherence The Per Visit Value (PVV)

23 Measuring The Effect of Clinical Protocols Foot Care Associates Per Visit Value PVV = Total collections / Total Patient Visits

24 Action Plan For Foot Care Associates (if clinical protocols are being complied with) Payer Reimbursements ? Billing and Collection Protocol ? ? ?

25 Third-party payer collection timetable DayAction 1 Mail or electronically submit the CMS-1500 claim to the appropriate payer. 30 Review the account. If no third-party payment has been made, telephone the carrier. Be sure to obtain the name of the person with whom you are speaking and the status of the claim. If the carrier indicates that the claim hasn’t been received, confirm the address and refile the claim to the attention of the representative you spoke with. Verify that the new claim has been received. Request a statement showing the status of the account. 60 Send the patient a letter stating that payment has not been received from his carrier and the practice is requesting assistance in obtaining payment. Determine if the account will be referred to an outside source for follow-up with the insurance company and/or the patient. 75 Telephone the patient to discuss payment arrangements. Send the patient a written affirmation of any agreement. 90 Send the patient a past-due letter. 120 Send a final collection letter to the patient, and follow up with a telephone call. Prepare the account for outside collection.

26 Action Plan For Foot Care Associates (if clinical protocols are being complied with) Payer Reimbursements ? Billing and Collection Protocol ? Volume and Physician Extenders ? ?

27 A look at our practice’s payroll The Payroll Ratio ( payroll / collections ) x 100

28 Foot Care Associates Payroll Ratio Payroll Ratio = (Total Payroll / Collections) X 100

29 Cross Referencing Data to Improve the Puzzle

30 Foot Care Associates Heel Pain versus Orthotics

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32 Summary of Reports Monthly A/R Report P/L Statement CPT Analysis ICD Analysis Total Charges Total Adjustments Annual Per Visit Value Quarterly Random fee schedule cross reference (10-15 claims per top 5 carriers)

33 Your Challenges Cash Flow Human Resources Critical Decisions Revenue Expenses Billing/ collection Productivity Attitude Work ethic Labor Laws Training Contracts Technology and other investments

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