1. Shelly Guffey 20 WAYS TO GET PAID FASTER 11.15.2012 THRIVING DURING TIMES OF CHANGE

2. Special thanks to the Medical Group Management Association (MGMA) for use of their data 2

3. OBJECTIVES 3 Discover direct and indirect areas of your business operations that are costing you money Use key benchmarks to help you take action to increase your bottom line Identify technology tools to automate operations, enhance your service to patients and help you get paid quickly and efficiently

4. Appointment Scheduling Registration & Certification Patient Reception Patient Clinical Visit Documentation & Coding Charge Processing & Check Out Patient Statements & Claim Production Claims & Patient Payments/Proces sing Denied Claims Management Accounts Receivable & Collections The Revenue Cycle 4

5. STAFFING IS THE BIGGEST EXPENSE WHERE THE MONEY GOES 5 Source: Medical Group Management Association, Cost Survey for Orthopedic Practices, 2010. Report based on 2009 data.

6. STAFF TO SUPPORT YOUR SPECIALTY HIRING 6 Median Support StaffPer FTE Physician Multispecialty4.54 Internal medicine3.19 Pediatrics3.94 Cardiology5.60 Hematology Oncology5.77 Source: MGMA Cost Survey: 2009 Report Based on 2008 Data

7. MGMA ASSESSMENT & RECOMMENDATIONS 7 Evaluate staffing Understand if staffing supports productivity Utilize technology for increased revenue

8. STAFFING TURNOVER SURPRISE 8 Source: Performance and Practices of Successful Medical Groups: 2008 Report Based on 2007 Data TurnoverBetter Performers Others Receptionist and medical records staff30.00%25.00% Nursing and clinical support staff20.00%16.67% Billing/collections and data entry staff13.81%4.00%

9. MINIMIZE TIME DEVOTED TO NON-PATIENT CARE Administrative time Occasions requiring long travel between sites during the middle of the day Time off during peak patient volume cycles REMOVE OBSTACLES TO PROVIDER PRODUCTIVITY 9 KEY PROVIDER DISTRACTIONS

10. STAFF TO SUPPORT THE BUSIEST TIME OF DAY EFFICIENT STAFFING 10 Overtime Regular STAFFING IS CONSTANT BUT WORKFLOW IS NOT. RESULT IS OFTEN OVERTIME!

11. STAFF YOUR OFFICE BASED ON SCHEDULE LOAD EFFICIENT STAFFING 11

12. NO SHOW RATE Appointment cards given at previous appointment Email reminders and portal tools Snail mail reminders Automated reminders – phone, text, etc. Follow-up file for noting and contacting those who do not keep appointments KEY PERFORMANCE INDICATOR (KPI) TO MEASURE 12 TIPS TO REDUCE NO SHOW RATE You can’t inventory time!

13. CASE STUDY: 75 PTS/DAY, $85 FEE/PT 13 IMPACT OF A HIGH NO SHOW RATE Daily no-show rate=13% (10 no shows) Annual cost of staff making reminder calls = $14,850 ($15/hr with benefits) Annual cost mailing reminders cards =$5,760 Assume 30% decrease in no-shows; additional monthly revenue =$5,610 ROI=One month

14. ACCOUNTS RECEIVABLE Percent of A/R >120 days Days gross FFS charges in A/R Adjusted FFS collection percent Patient accounting support staff/FTE physician Total medical revenue per FTE physician Percent of claims submitted electronically Percent of claims denied on first submission KEY PERFORMANCE INDICATOR (KPI) TO MEASURE 14 ACCOUNTS RECEIVABLE

15. INDICATORS SHOW OPPORTUNITIES BETTER PERFORMER KPI MGMA CASE STUDY 15 KPIBetter PerformerCase Study Data % of A/R >120 days10.69%36.18% Days gross FFS charges in A/R29.4051.51 Adjusted FFS collection %100.00%97.33% Patient accounting support staff/FTE physician*.871.09 Total medical revenue per FTE physician$1,242,630$1,073,456 % of claims submitted electronically95%81% % of claims denied on first submission4%19% Source: Performances and Practices of Successful Medical Groups - 2009; Orthopedic Surgery. *Includes coding, charge entry, cashiering.

16. 16 MGMA CASE STUDY GAP ANALYSIS WHAT THIS MEANS TO THE PRACTICE An additional $733,466 would have flowed into the practice ($29,338/FTE physician) if the practice had collected like better performing orthopaedic practices. Adjusted fee-for-service charges 1/1/09-12/31/09$27,445,597.05 Net fee-for-service collection 1/1/09 – 12/31/0926,712,131.52 Practice net collection rate97.33% Better performers net collection rate100.00% Expected revenue at better performers net collection rate of 100% $27,445,597.05 REVENUE GAP$733,465.53

17. WAYS TO MANAGE PATIENT PAYMENT 17 Review cycle times for claims submission and reimbursement Maintain a date of entry, a date of service, and a date of submission with a practice management system Submit charges on a timely basis Determine time lapse between date of entry and date of submission Process claims more frequently Monitor time from date of submission until date of reimbursement Identify payers slow to process payments

18. PREPARE IN ANTICIPATION OF THE APPOINTMENT 18 “The further an error travels along the revenue cycle, the more costly revenue recovery becomes. Some industry experts charge a cost of $25 to rework a claim.” MOORE, P. “FIX YOUR DENIAL PROBLEMS,” PHYSICIANS PRACTICE, APRIL 2004. Verify eligibility, copay and deductible status Automate via batch submission of daily schedule Web-based payer sites issues Note/alert for reception

19. 19 INCREASE PATIENT SATISFACTION & REDUCE INTERNAL COSTS INSURANCE VERIFICATION TaskApprox durationCost * Insurance verification via payer Web site 2 minutes$.40 Insurance verification via payer Web site including log on 2 – 4 minutes$.40-$.80 Insurance verification via telephone 5 – 7 minutes$1 - $1.40 *Based on $9.00/hour, $12.00/hour with benefits which is $.20/minute. Generally the hourly rate is higher when performed by RCM staff.

20. Percentage of CopayBetter PerformersOthers 90-100%47.15%36.63% 75-89%32.52%29.07% 50-74%9.76%15.12% 0-49%10.57%19.19% BETTER PRACTICES COLLECT MORE UPFRONT COPAYMENTS COLLECTED AT TIME OF SERVICE 20 Source: Performance and Practices of Successful Medical Groups: 2008 Report Based on 2007 Data 79.67%65.70%

21. PATIENTS’ SHARE OF MEDICAL BILLS TO SKYROCKET 21 Sources: - Hewitt Associates survey of 340 employers that represent more than 5 million works. Medical Economics, April 17, 2009. - The “Retailish” Future of Patient Collections. Celent.com. 2007: Patients responsible for 12% of their healthcare bills. 2012: Patients will be responsible for 30% of their healthcare bills. Employer BenefitsPercentage Employers that intend to shift more health insurance costs to employees next year 65% Employers that plan to reduce the number of health plan options49% Employers that plan to increase the number of consumer-directed health plans 40%

22. EFFECTIVE USE OF RESOURCES: AUTOMATE 22 E-statements Costs 58% of the price of a paper bill to produce* *Source: Gartner Group, HFMA, and HH&N Research

23. PATIENT ONLINE BILL PAYMENT 23 *Source: MGMA Place “Pay online at www.your-practice.com” on your statement www.your-practice.com Pay a credit card processing fee Processed directly to your merchant account 10% reduction in accounts receivable* Increased cash flow

24. PERFORMANCE AT A GLANCE WHAT CAN YOUR SYSTEM TELL YOU? 24

25. ANALYZE REJECTIONS 25

26. TOOLS TO RECOVER REVENUE 26 Reimbursement manager Upload claim and remittance data Fee schedule underpayments Misuse of clinical edits Creates formatted appeal letters

27. ANNUAL COSTS OF UNNECESSARILY COMPLEX OR REDUNDANT TASKS ADMINISTRATIVE TASKS QUICKLY ADD UP 27 Source: “Administrative Complexity in Medical Practices” Research, September 2004. MGMA Center for Research. Funded by AHRQ. Administrative TaskSolo Physician 10 Physician Group Physician time in response to pharmacy phone calls $12,532$125,316 Staff time in insurance verification, copays/ deductibles $3,876$38,761 Support staff time to appeal denied claims$925$9,248 Credentialing applications$809$8,085

28. ERA AND AUTOMATED PAYMENT POSTING Improves cash management – Faster, more accurate generation of payment data Faster payment processing means staff get to denial and exception management faster too – No distraction for routine data entry duties Reduced data entry errors Enhanced business intelligence increases profitability that can be measured BETTER PERFORMERS AUTOMATE PROCESSES 28 Source: MGMA Consultant – Rosemarie Nelson

29. CASE STUDY: SAVED TIME = MONEY Days to hours and hours to minutes Payer with 30% of practice’s volume implemented ERA Manual payment posting took 5 days each month ERA reconciliation took 4.5 hours each month Labor savings: $7,668 annually ($1,917 per FTE physician) 29 ELECTRONIC REMITTANCE BENEFITS Source: MGMA Consultant – Rosemarie Nelson

30. PRACTICE CHECK UP 30 Plan for changes and mandates before deadlines (e.g. 5010, ICD-10, Meaningful Use, PQRS) Meet with claims processing team regularly to evaluate workflow Keep copies of contracted fee schedules and contracts or store in Practice Management System

31. DROP IN PAYMENT, COMMERCIAL PAYERS FALLING REIMBURSEMENT 31 2005 to 2006: 10% drop 2006 to 2007: 6.5% drop $47 AVERAGE REIMBURSEMENT, 99213 $45 AVERAGE PRICE, HAIRCUT

32. KEY TAKEAWAYS 32 Leverage technology Understand industry landscape Take action on daily, weekly, monthly basis

33. Q + A 33

34. SHELLY GUFFEY 800.969.3666 EXT 1450 SGUFFEY@GATEWAYEDI.COM 34

35. THANK YOU. THE BEDSIDE MANNER YOUR REVENUE DESERVES ™ 11.15.2012