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Table Contents Improving accounts receivable collections Current trends for accurate claims submission. Claims follow up techniques Winning appeals How to evaluate you’re A/R The new regulations and provider compensation for EHR.

Improving accounts receivable collections A/R Collections starts at the front desk 1. Accurate collections of client information. 2. Confirmation, is there another insurance, name of insured? 3. Obtaining required signatures 4. Up-dating client information 5. Collecting co-pays Accurate claims submission can only happen when there is accurate data to submit.

Improving A/R Collection Ratios. Step #1 Insurance Verification. Current Trends Verify patient’s plan benefits for services you plan to offer. Verify the billing address. Estimate cost for services, insurance payment and patient balance. Document the information obtained and make it available to follow-up/collection staff.

Documentation Patient Registration Form Area to list more then 1 insurance. Emergency contact information Assignment of benefits Financial responsibility Release of medical information Statement of patient confidentiality.

American collections association and the US Department of Commerce surveys have concluded A accounts receivable collections depreciation Months Past Due 1 MO. 3 MO. 4MO. 6MO. 12MO. Amount Collected 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% Losses 5% 26% 35% 70% 90% Early A/R collections is a major key to limiting profit lost and increasing profit gain. $

Verification of Benefits Sample Doctor ordered a endoscopic procedure. Estimated cost $1400 (outpatient, in the office procedure). Per insurance verification, patients benefits are as follows. With authorization from the insurance benefits are as follows. Deductible: $250 (to-date -0- met). Then Insurance will pay $80% Patient 20% of allowed amount. Procedure $1400 less deductible, which is patient’s responsibility. Total Billed Ins pymt Pt Bal $1400 less $250 ded = $1150 x 80% (estimated ins bnfts) $920 $480 (patient’s balance is $250 deductible + $230 (the 20% of 1150). Using the above estimate, the office staff can make payment arrangements with the patient before services are rendered.

A/R Collections Tips Follow-up to insurance carriers on the status of a claim. Respond to inquiries for information timely. Complete request for authorization to treat, immediately!

Definition: Clean Claim CMS 1500 for Professional Provider Claims A accurately completed CMS-1500/ UB04 claim form submitted within the timely filing period, as required of the insurer. Current trends for accurate claims submission

Improving A/R Collection Ratios. Step #2 Accurate and timely claim submission. Communicate claim timely filing limits with staff, per payers. Bill electronically using a clearing house. Review acknowledgement reports Complete CMS 1500 per Medicare regulations Follow-up submitted claims with- in days.

Resources to Stay Up-to-Date Insurance company provider manuals Seminars and continuing education Federal Register document Government published updates, revisions changes, and deletions in laws. November and December issues contain outpatient facility updates. Reference Materials CPT, ICD, HCPCS Guidelines.

Winning Appeals Step One Compare the EOB/RA with the insurance verification information. Step Two Review the reason for denial or short pay Step Three Determine if an appeal is warranted. Step Four Call insurance carrier for denial explanation. Or review denial on web site of carrier. Step five Ask what is the best way to appeal.

Items needed A time period Total A/R (billed amount) for that time period Total payments collected for the same time period. Example: Jan 1, 2008 – December 31, 2008 Total Collected ÷ Total Billed = Collections Ratio 226, , % How to calculate the collections ratio of your practice. How to Evaluate Your Facilities Accounts Receivable

ELECTRONIC MEDICAL RECORD ELECTRONIC HEALTH RECORD YOU MUST START NOW. MAXIMUM INCENTIVES (INCLUDING $3,000 BONUS) WILL BE PAID AS FOLLOWS: $18,000 FOR THE 1ST YEAR $12,000 FOR THE 2ND YEAR $8,000 FOR THE 3RD YEAR $4,000 FOR THE 4TH YEAR $2,000 FOR THE 5TH YEAR QUALIFYING UNDER THE MEDICAID PROVISION PROVIDERS QUALIFYING UNDER MEDICAID ARE ELIGIBLE FOR UP TO $63,750 OVER SIX YEARS. YOUR PAYMENT IS CALCULATED AS 85% OF THE EHR COST (UP TO $25,000 FOR THE FIRST YEAR), AND 85% OF ANNUAL COST (UP TO $10,000) OVER THE FOLLOWING FIVE YEARS. TO QUALIFY FOR THE MEDICAID PROVISION, AT LEAST 30% OF YOUR CASES MUST BE ATTRIBUTABLE TO MEDICAID. FOR PEDIATRICIANS, THE MINIMUM PERCENTAGE OF MEDICAID PATIENTS IS REDUCED TO 20%. HOWEVER, OFFICE-BASED PEDIATRICIANS ARE ONLY ELIGIBLE TO RECEIVE UP TO TWO THIRDS OF THE MAXIMUM PAYMENT. EMR/EHR are here to stay!

EHR Incentive Program

EHR Continued

To Qualify for the Incentives (Continued) There are two ways you can qualify for the incentive. Qualified providers can qualify under either incentive, but not both. You can qualify either under Medicare or Medicaid. Physicians qualifying under the Medicare portion can receive up to $44,000 and those qualifying under the Medicaid incentive can qualify for up to $64,000. You can receive your incentive payments starting in January of Physicians who do not implement EHR technology by 2015 will suffer from a 1% reduction in Medicare Payments (reductions will continue to increase after 2015 up to 5%). Qualifying Under the Medicare Provision Physicians qualifying under the Medicare provision are eligible for up to $44,000. The total amount that you receive is based on how early you adopt and your Medicare Part B billings. (You must submit Medicare Part B claims to qualify.) You will receive the lesser amount of either 75% of your Medicare Part B charges or $44,000 over a five year period from 2011 to You can also qualify for an early adopter incentive of $3,000 (if you qualify for either 2011 or 2012.) Remember, to receive your maximum payment

Summary of the EHR Incentive How you can Qualify for your Incentive Payment: The stimulus package passed for the year 2009 pumps $19 billion into the medical industry to help implement technology that makes healthcare safer and more connected. Those who prove meaningful use of Electronic Health Records can receive an incentive reimbursement of up to $64,000 over six years. Hospitals can qualify for $2-8 million in funding. Remember, 70% of the incentive comes within the first two years. This means that in order to receive the maximum reimbursement, you must start early. It is believed that the definition of meaningful use will be very similar to the CCHIT certifications. For more information on CCHIT certifications, see cchit.org or click here.cchit.org or click here. The definition of "meaningfull use" includes: Use EMR software at point of care Prescribe electronically Choose an EMR that ensures interoperability or data sharing Use an EMR capable of clinical reporting

EHR Continued qualification criteria also includes: 90 day reporting period to prove meaningful use through required measures At least one clinical decision support rule relevant to a specialty or a high clinical priority Electronic claim submission to payors Electronically check insurance eligibility (when possible) Provide patients with timely electronic access to their health information; Provide patients, upon request, with an electronic copy of their discharge instructions and procedures at the time of discharge; and Require the capability to exchange health information where possible in 2011, with participation in a national health information exchange by 2015 *By 2013, it is also expected that criteria will extend to include the ability to provide patients with access to their personal helath records populated in real time. Here's How it Works: There are two ways you can qualify for the incentive. Qualified providers can qualify under either incentive, but not both. You can qualify either under Medicare or Medicaid. Physicians qualifying under the Medicare portion can receive up to $44,000 and those qualifying under the Medicaid incentive can qualify for up to $64,000. You can receive your incentive payments starting in January of Physicians who do not implement EHR technology by 2015 will suffer from a 1% reduction in Medicare Payments (reductions will continue to increase after 2015 up to 5%). Qualifying Under the Medicare Provision Physicians qualifying under the Medicare provision are eligible for up to $44,000. The total amount that you receive is based on how early you adopt and your Medicare Part B billings. (You must submit Medicare Part B claims to qualify.) You will receive the lesser amount of either 75% of your Medicare Part B charges or $44,000 over a five year period from 2011 to You can also qualify for an early adopter incentive of $3,000 (if you qualify for either 2011 or 2012.) Remember, to receive your maximum payment,

CONCLUSION/QUESTIONS