1. RHC Benchmarking and Performance
Jim L Creamer, Sr CPA CFE

2. Ready
Set
Perform

3. Benchmarking Considerations
Does a need exist?

4. Benchmarking Considerations
Understand the competition
90 RHC’s in Georgia

5. Benchmarking Considerations
Know the advantages
Higher reimbursement from Medicare and Medicaid
Higher reimbursement for Flu and Pneumonia shots
No payment reductions for Nurse Practitioner and Physician Assistants
(Potential) reimbursement for Medicare Bad Debts

6. Benchmarking Considerations
Know the requirements
Medical Director physician must be on staff
Must employ either nurse practitioner or physician assistant
Afterwards, may employ other professionals including certified nurse midwife
Mid – level must be present 50% of the clinic hours (exceptions exist)

7. Benchmarking Considerations
Know the services
Physician and “incident to “
NP, PA, CNM, CP, CSW and “incident to”
Medicare Pt B covered drugs
Visiting nurses to homebound patients in CMS designated HHA shortage area
Basic laboratory services
Preventive health services

8. Benchmarking Considerations
Perform Due Diligence
Understand Patient Demographics
Medicare, Medicaid, Insurance, Self Pay %’s
Understand Enrollment Process
Understand reimbursement impact on entity as a whole
Often overlooked component of a new service area

9. Monitoring Performance
Understand productivity standards and FTE’s
Productivity standards are used to determine the average cost per patient for Medicare Reimbursement.
Full Time Physician = 4,200 visits
Full Time Mid-Levels = 2,100 visits
FTE’s – Reported time spent seeing patients or scheduled to see patients and does not include administrative time

10. Monitoring Performance
Understand overhead cost allocations if provider-based
Capital Costs
Employee Benefits
Administrative and General
Maintenance of Plant
Laundry
Housekeeping
Dietary
Cafeteria
Nursing Administration
Central Supply
Pharmacy
Medical Records
Social Service
CRNA

11. Hospital Overhead Allocations
Why is this important?

12. Monitoring Performance
Understand Vaccine reimbursement
Pneumococcal – H1N1 – Influenza
Reimbursement on cost per injection
Reimbursement through cost report only
Required log of injections to Medicare patients
Capture supply cost for each injection
Capture time spent giving injection

13. Monitoring Performance
Understand Medicare bad debt reimbursement
Traditional – Crossover – Indigent
120 day reasonable collection efforts
Reduced by recoveries
Maintain detail patient log
Expect to be audited

14. Look For opportunities
340 B Drug Pricing
RHC’s qualify for provider – based location and are eligible
for participation in the discount drug pricing program

15. Jim L Creamer, Sr CPA CFE