Health Care in the CPA’s Future

1. Health Care in the CPA’s Future Keith Kamperschroer, CPA, CHCC kkamperschroer@KolbCo.com Robert Denkert, CPA rdenkert@KolbCo.com

2. Keith Kamperschroer, CPA, CHCC • Shareholder – Health Care Services • As Managing Director of Health Care Services at Kolb+Co., Keith works extensively with small and medium-sized medical practices providing assistance in all areas of accounting and practice management.

3. Robert Denkert, CPA • Accounting Senior Manager • Bob works extensively with small and medium-sized medical practices providing assistance in all areas of accounting, payroll and practice management.

4. In Addition to Physicians… • Expand your definition of Health Care owners/stakeholders • MDs, DOs, Behavioral Health Practitioners • Advanced Level Practitioners (NPs and PAs) • Dentists • Veterinarians

5. The Value of a CPA from the Client Perspective • Current on upcoming Health Care reform issues • Proactive planning ideas included with financial statements not just historical financial data • What are the numbers telling me? • Value of service demonstrated

6. How to Enhance My Services to New or Existing Medical Clients? • Add value to existing services • Understand their Revenue Cycle challenges; be proactive • Additional “Specialty Services” to consider for building on your health care niche

7. Current Services • Change Management • 2012-2013 substantial changes occurring in health care • SGR - No Medicare reduction in reimbursement rates again for 2013 • How will practices be able to absorb a 30% reduction in Medicare reimbursement in 2014 • Commercial payers fee schedules at less than 100% of Medicare reimbursements • Implementation of electronic medical records • How practices meet 1st stage meaningful use in 2012 or 2013

8. Current Services • Look for other ways to add value • Do you review the financial reports with your clients in person? • Are your statements presented in a format specific to medical practices? • Is a production analysis report part of your business analysis? • Example: provide gross and net collection rates globally and by provider

9. The Business of Medicine • Specialized Services and Revenue Generating Activities • Financial Statement formats specific to health care and agreement to profit distribution schedules

10. Statements of Revenue and Expenses – Income Tax Basis(With the accountant’s compilation report of September 18, 2012)For the months ended August 31, 2012

11. Profit Distribution and Physician Productivity – Income Tax Basis(With the accountant’s compilation report of September 18, 2012)For the one month ended August 31, 2012

12. The Business of Medicine • Industry statistics and benchmarking

13. Comparison to IndustryYear-ended 2012

14. The Business of Medicine • Tax preparation and planning • Corporate, Partnership and Individual • Not Too Soon to Plan for 2013 Tax Changes by Keith Kamperschroer and Jim Brandenburg in Physicians Money Digest • http://www.physiciansmoneydigest.com/personal-finance/Not-Too-Soon-to-Plan-for-2013-Tax-Changes

15. The Business of Medicine • Specialized Services and Revenue Generating Activities • Retirement Plans • The owner of a small business has two choices to consider when setting up a retirement plan: a qualified retirement plan or s Simplified Employee Pension (SEP). A qualified plan is any plan that is subject to the ERISA rules, such as a profit-sharing or money purchase plan or a defined benefit pension plan. An SEP is a simplified alternative to a qualified plan, in essence a group IRA with individual accounts.

16. Comparison of Features of Various Qualified Retirement Plans

18. The Business of Medicine • Specialized Services and Revenue Generating Activities • Practice management • operations review • CPA prepared reports • A/R analysis • Provider analysis • Service line revenue/cost analysis • Analysis of month-end reports • Accounts receivable

21. The Business of Medicine • Specialized Services and Revenue Generating Activities • Internal controls • Separation of Duties • Controls in systems • Dual access and management • Limitations on access • Time off requirements; require staff to take vacations • Workflow analysis and access • Determine weak areas in controls • Work with CPA to monitor and provide business physical

22. The Business of Medicine • Specialized Services and Revenue Generating Activities • Revenue Cycle

23. The Business of Medicine • Specialized Services and Revenue Generating Activities • Employment agreements • Buy/sell agreements • Structuring buy-in/buy-out • Merger and acquisition analysis and facilitation • Practice valuations • Accountable Care Organizations • Managed Service Organizations • Healthcare cooperatives

24. The Business of Medicine • Additional Specialized Services • Practice start-ups • On-going practice management • Accounts receivable management • Coding and documentation review • EMR strategic planning and implementation

25. The Business of Medicine • Additional Specialized Services • There are organizations that can help you with compliance plan development. • Separate certificates are also available

26. The Business of Medicine • Additional Specialized Services • HIPAA – privacy and security risk assessment • Fee reimbursement and utilization assessment • OSHA internal control plan development and training • Business/malpractice insurance evaluation • Personnel and human resource management • Employee benefit costs • Recruiting assistance

27. The Business of Medicine • Additional Specialized Services • Individual financial planning and wealth management • Risk management consulting – business and individual insurance analysis

30. The Business of Medicine • Additional Specialized Services • Retirement plan design and implementation

32. The Business of Medicine • Additional Specialized Services • Audit and assurance services • Technology advising

34. Kolb+Co.’s Health Care Niche • Development of the Health Care Industry Niche • Development of industry expertise and reputation • “Back office” for many practices

35. Keys to Success • Look for ways to add value • Go beyond the numbers • Look for opportunities that can be replicated in other practices • Compliance plan • Make your health care niche known • LinkedIn, Twitter, Facebook page etc. • Form an advisory group of professionals for your area – quarterly meetings

36. Health Care Today & Tomorrow • Health Care Industry today • Obstacles • Opportunities • Health Care Industry in the Future • Obstacles • Opportunities

37. Organizations to Join • HCAA (National CPA Health Care Advisors Association) • PVN (Physician’s Viewpoint Network) • MGMA (Medical Group Management Association) • State MGMA associations • HIMSS (Health Information and Management Systems Society) • Compliance Resources

38. Questions Thank you! Keith Kamperschroer, CPA, CHCC kkamperschroer@KolbCo.com Robert Denkert, CPA rdenkert@KolbCo.com