MCV PHYSICIANS ANNUAL MEETING

MCV PHYSICIANSANNUAL MEETING OCTOBER 25, 2007 Part 2

MCV PHYSICIANSANNUAL MEETING OCTOBER 25, 2007 Revenue Cycle and Billing Systems Greg V. Strickland, MHA, CMPE Director of Revenue Cycle Services

Topics • Annual Performance Update • P4P: Impact on MCVP • Health Professional Shortage Area (HPSA) • National Provider Identification Program • Things That Keep Me Awake at Night

I. Performance

Accomplishments (Since May 2007 Semi-Annual Meeting) • Investigated and implemented HPSA payment program. • Reviewed (with Orthopaedics) and began negotiations for additional compensation for Worker’s Compensation. • Reallocated Bad Debt Placements with Collection agencies to maximize collections (Increase “Seasonal Program”). • Investigated and implemented PQRI program with Compliance and Clinical Departments. • Realigned payor reporting for consistency with MCVP and MCVH (pending HPA).

Accomplishments (Continued) • Investigated and planned implementation of automated eligibility product (will reduce FTEs and improve verification process to less than 10 seconds). • IMaCs update – implemented in July 2006. • Identified $459k in underpayments. • Received $230k in additional payments. • Also found $100k in “false positives”. • Obtained approval to begin e-statements for patients (Cost = current statements). • Realigned Referral Management activities to transition focus on pre-authorizations as referral requirements decrease.

Accomplishments (Continued) • Developing Teams to address HPA impact on MCVH and MCVP. • Reduced billing cost as a percent of collections. • Savings passed to Departments monthly.

II. MCVP Billing Expenses(As a % of Net Collections)

III. Pay for PerformanceImpact on MCVP Billing • P4P for physicians is still in it’s infancy. • Anthem • Limited programs (Cardiology, Primary Care) • < $50,000 for MCVP • Other payors (United, Cigna, etc) have “gold star” programs but data are flawed. e.g., Limited number of MCVP providers since payor claims many MCVP providers are not Board Certified.

P4P- PQRI • Medicare PQRI program began July 1, 2007 • CMS refers to PQRI as “Value Based Purchasing” • Data are submitted via the billing process using CPT II and G-codes with appropriate diagnosis • Hospital data submitted retrospectively; Physician data submitted concurrently • Submitted with $0.00 charge • (Required GE-IDX BAR programming)

P4P-PQRI Example- Melanoma • CPT: 99203 (Outpatient; New) • ICD-9: 172.0 • CPTII: 2029F

P4P - PQRI And if that was not complicated enough… In order to receive the bonus, each provider who participates must: • Pick at least 3 Quality Measures. • Report on at least 80% of the Medicare patients that meet the criteria of the 3 Quality Measures.

P4P- PQRI Risks • “No good deed goes unpunished” • CMS has indicated that it WILL Audit providers who participate in PQRI. • CMS reserves the right to not only review the PQRI measure, but the service that was provided.

P4P-PQRI Risks Providers have asked: • If they are more likely to be audited if they don’t meet the 80% threshold? (to be determined) • If CMS finds issues with the documentation, will other audits follow? (most likely)

P4P-PQRIMCVP’s Approach • A “slow and deliberate approach”. • Not prepared to manage a P4P approach. • This is a “quality” initiative more than a “revenue” initiative. • Estimated Revenue for MCVP – less than $80,000. • The costs to fully implement would most likely be greater than the incentive. • Developed Methodology

P4P-PQRIMCVP’s Approach • Prior to starting PQRI: • Must select only 3 Quality Measures • Must review documentation with Compliance • Must pilot process and pass review from Compliance on encounter and PQRI (e.g., PQRI, attestation, etc.) • If Compliance cannot validate documentation, no PQRI data are submitted to CMS. • Once PQRI data are submitted, Compliance will continue periodic review and PQRI will discontinue if validation is not met.

P4P – PQRISummary of MCVP’s approach MCVP… • has implemented a slow and deliberate approach to PQRI. • will gain limited experience in PQRI (i.e., P4P) on a larger scale. • will need to determine a response to P4P if this trend continues.

IV. Health Professional Shortage Area (HPSA) • CMS provides additional compensation to providers who work in HPSAs. • CMS utilizes 3 different “tests” to determine HPSAs. • One test is reviewing the ZIP codes of the patients that are served. • The main VCUHS Campus was identified as a HPSA based on the ZIP code test.

HPSAs Too good to be true? • Received notification in Spring 2007. • Reviewed Regulations for HPSA. • Obtained Clarification from Trailblazers (CMS Medicare Carrier) in writing. • Requires a modifier to be added to claims. • Business Office adds programming logic to add modifiers . • The payment calculation is an additional 10% above what Medicare pays (not allows).

HPSAs • Not paid with claim but a separate quarterly payment • Impact for MCVP- > $1 million/year for FY 2008 • Received ~$165,000 to date • (received ~ ½ of quarterly payment due to timing)

V. Things That Keep Me Awake at Night • National Provider Identifier (NPIs) • CMS gave original deadline of May 23,2007. • On May 15, 2007 delayed final deadline to May 23, 2008. • CMS gave providers option to begin May 23, 2007 but no later than May 23, 2008. • MCVP began using NPIs May 23, 2007. • CMS was not ready. • Result: 2 weeks of claims (~$1.2 million delayed).

NPIs Impact of NPIs • Delayed billing in 2007. • Potential delayed billing in 2008. • NPIs required also for referring physicians for consultative services (e.g., Consults, Radiology, Pathology, etc). • MCVP sent ~3,500 letters to referring providers to obtain their NPIs. • Down from 3,500 to < 200 providers. • Will need help from Departments to obtain 100%.

NPIs Impact of NPIs (Continued) • Impact for Individual Providers. • You now have one NPI that will follow for the rest of your career. • Treat it as your DEA number. • Changing information on your NPI may have a negative impact in MCVP’s ability to bill for your service. • Please coordinate with Medical Staff Services.

Things That Keep Me Awake at Night(continued) • HPA (New Hospital Billing System) MCVH will use GE-IDX. • “Joined up to the hip”. • MCVH’s success will be MCVP’s success. • Process changes are all ready starting. • When the HPA conversion occurs, MCVP Billing may be “down” for 2-3 days. Current staff are “rising to the occasion” • Need to maintain the momentum. • Retaining and Rewarding Staff While Simultaneously Reducing Costs.

MCV PHYSICIANS ANNUAL MEETING