IMPLEMENTING A MEDICAL BILLING MODEL: STUDENT HEALTH CENTER REVENUE POTENTIAL Donna Hash & Merry Lawrence

Presentation Overview Background Getting Started Terms & Definitions Fee Schedule Planning Process Operational Changes Key Considerations Implementing the Process Evaluation Monitoring & Reporting Lessons Learned Next Steps

Background: Motivating Factors Our Previous Approach Financial Considerations University Administrative Charges Student Fees Organizational Aims Improve Services to Students Recruit & Retain Quality Clinicians Data In 2008, ~90% of students surveyed were insured* *Based on spring 2010 NCHA data (1,632 student respondents)

Getting Started: Exploring New Opportunities Health Services Fee Ongoing cost increases and budget/resources decreases Medical Billing Model (old vs. new) Provide cost-effective services & generate revenue Consistent with industry billing standards Establish a Fee Schedule What to charge? How much? Conversion factor

Getting Started: Learning the Lingo

In-house Billing vs. Billing Service EMR/EHR Establishing a Fee Schedule Conversion factor CPT, E&M Codes RBRVS Operational Changes: Preliminary Decisions

CodeDescription Work Value Non Fac PE FAC PEMalpractice Non Fac Total Fac Total Global Gap 15952Excision, trochanteric pressure ulcer, w/ skin flap closure; with ostectomy Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with ostectomy Initial treatment, first degree burn, when no more than local treatment is required Dressings and/or debridement of partial- thickness burns, initial or subsequent; small (less than 5% total body surface area) Medium (eg, whole face or whole extremity or 5% to 10% total body surface area) Large (eg, more than 1 extremity., or greater than 10% total body surface area) Escharotomy; initial incision Each additional incision (list separately in addition to code for primary procedure) zzz 17000Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), first lesion

CodeDescription Work Value Non Fac PE FAC PEMalpractice Non Fac Total Fac Total Global Gap Deconstruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other thank skin tags or cutaneous vasular proliferative lesions; up to 14 lesions Fee for Service Example: Non FAC Total (code value) = 3.26 Sample Conversion Factor = $50.00 Code Value x Conversion Factor 3.26 x 50 = $163.00

Contracting with insurance plans Top 3 Clearinghouses Electronic medical claim submission (ERA) Staffing Billing Manager Payment processing Check ICD/CPT codes Create billable claim forms Submit claims (electronically) Correct/re-bill claims Post payments Manage accounts receivables Patient responsibility charges to patient accounts Operational Changes: Key Considerations

Utilize Practice Management Software/EMR Document patient information (e.g., store ID cards) Use reporting tools 3 Primary Reports: Accounts Receivable Aging Report Payer Mix Analysis Summary of Charges Analyze by transaction code Operational Changes: Insurance Aging A/R

A/R Report: Patient charges detailed by plan Aging “buckets” Focus on oldest claims Analysis of aging conducted by the Billing Manager Evaluation: Monitoring & Reporting

Evaluation: Payer Mix Analysis

Evaluation: Summary of Charges

Provider Cooperation & Coordination Clinical staff buy-in Management support Billing Office Staff Professional development Reporting Process Payment codes, adjustment codes, charting system, missed charges etc. Monitor reimbursements for errors Annual Technology Upgrades Plan for changes & train staff Lessons Learned

Next Steps Adapt to ACA Contract with additional insurers Adjust fee schedule Consider the value of an in-house patient advocate Student advisory board Financial assistance plan Prepare for ICD 10 October 1, 2015 expected implementation Continue to support the health & well-being of students

Contacts & Resources Contacts at WSU: Donna Hash, Administrative Manager Health & Wellness Services Merry Lawrence, Billing Office Manager Health & Wellness Services Online Resources: Resource-Based Relative Value Scale managing-your-practice/coding-billing-insurance/medicare/the- resource-based-relative-value-scale.page Medical Group Management Association American Medical Association Credentialing & Contracting Article practice039s-financial-health-focus-on-the-four-ps-in-a-pod- patients-payers-payments-and-productivity html