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3. Disclaimer and Background Co-Founder and President Aesyntix Health. Healthcare services for Dermatology and Cosmetic Surgery.
Aesyntix Billing Solutions Revenue Cycle Management, Dermatology Medical Billing
Aesyntix Physician Network Group Purchasing Organization (GPO) specializing in Dermatology and Cosmetic Surgery. Also, exclusive GPO for ADAM.
4. Agenda Basic review of financial statements
The next step: Analyze and Present
Benchmarking- Sneak Preview - First ever Denial Management Database in Dermatology
Questions
5. Financial Statements Income Statement (I/S), also know as Profit and Loss Statement (P/L)
Balance Sheet (B/S)
Statement of Cash Flow (C/F)
6. Income Statement Income Statement (IS) can also be called the Profit and Loss Statement (P/L)
Practice Revenue: Net increase in assets due to sale of goods or services.
Operating Expenses: Costs expired during the reporting period related to production of income.
Non-Operating Revenues and Expenses: Investment income such as dividends and interest as well as interest expense and depreciation.
7. Sample Income Statement
8. Bottom line Profit or Loss
Revenues Expenses = Profit or Loss
9. Profit and Loss Statement Revenues:
Collections
Fees
Revenues
Receipts
Other
10. Revenues Clinical Collections
Consulting Fees
Clinical Studies
Cosmetic Receipts
Other or Miscellaneous
11. Revenues Clinical Collections
Commercial
Medicare
Fee for Service
Surgery/MOHs
Cosmetic Revenues
Injectables
Botox
Fillers
Lasers
Aesthetic
Surgery
Products
12. Revenues expanded
13. COGS COGS (Cost of Goods Sold)
Medical Supplies (not a bucket)
Resell (Toxins, fillers, products)
Revenues COGS = Gross Profit
15. I/S or P/L Revenues
Minus COGS
Gross Profit
Minus Expenses
Profit or Loss
16. Expenses How do you categorize?
Payroll (Large number)
Wages (Break it down)
Administration
Providers
Front Staff
Back office
Payroll Taxes
Benefits
17. Balance Sheet The Balance Sheet (BS) is a statement listing the total assets, liabilities and owners equity indicating the net worth of the company at a certain point in time.
18. Balance Sheet ASSETS = LIABLITIES + OWNERS EQUITY
Most will break A and L into short term and long term
Balance Sheet must balance.
Assets = (cash, inventory and accounts receivable)
Liabilities and Owners Equity (OE) = are claims to those assets
The value of everything owned minus the money owed to others leaves the value of the owners rights to the business.
19. Sample Balance Sheet
20. Cash Flow Statement Cash flow statement is produced to show how the enterprise generates and uses cash and cash equivalents.
Cash flow statement should report cash flows, during the period classified by operating, investing and financing activities.
21. Cash Flow Operating Activities
Cash generated or paid out through the normal cash generating activities of the enterprise.
Investing Activities
Cash flow on capital expenditure incurred which will generate future operating cash flows
Financing Activities
Cash flow received from or repaid to outside providers of finance.
22. Simplest terms Cash came in
Collections
Interest income
Other incoming cash
Cash went out
Accounts Payable
Any outgoing cash
23. Analyze and presenting
24. Financial Benchmarking Standard Reports
Profit and Loss Statement
Balance Sheet
Statement of Cash Flow
Production Report
Aging Analysis
Create a benchmarking report
Charges, Collections and Adjustments
Accounts Receivables and Aging Analysis
Patient encounters
Expenses
26. Benchmarking Ratios Net Collections
Net Collection Ratio
Overhead
Aging Analysis A/R
Number of FTE support staff
Net Collections per FTE provider
Net Collections per FTE support staff
Net Collections per patient
Non provider payroll ratio
27. Time to Look Deeper - Dashboard Dashboard (Benchmarking)
Key metrics/Ratios that show trends, performance and allows you to identify what needs to be reviewed or how you are improving or getting worse.
Needed:
Collections,
Charges,
Adjustments,
A/R,
Patient Encounters.
28. Dashboard Look deeper
Monthly comparison
Quarterly comparison
Compare to monthly averages
Departments (Revenues/Expenses)
*Closer look at expenses
29. Sample Dashboard
30. Dashboard Template Example
31. Quarterly Comparison
32. Production
33. Billing Performance
34. Expense Tips Manage payroll (overtime, dead weight, efficiency)
Renegotiate space
Reduce costs (5-10% makes a difference)
Medical - Surgical Supplies
Office Supplies
Credit Card Processing
All services/products purchased
Join a GPO (Group Purchasing Organization) let them do the work Specialty specific is always a plus
35. Revenue and Expense Tips Collect what you have earned!
Bill it out
Work the A/R
Track the denials
Paid faster (ERAs, Clean claims)
Collect at time of visit (copay, deductible)
Providers engaged (maximize efficiency)
Staff engaged
Recruit medical patients (internal marketing)
Customer Service 101
36. Revenue Cycle Management(Technology) Denial Management
(PaidRight, TotalView, EOBresolve)
Collect on Unpaid Claims
Identify patterns with insurance carriers (denial management is incredibly helpful)
Identify patterns with your billing team
37. Information that is groundbreakingSneak Preview Denial Management
Dermatology Benchmarking,
39. Scenario today Practices operate in fiercely independent manner
Payers are HAPPY to divide and conquer
No one knows How does Blue Cross reimburse my 17110 versus my peers?
No Good Specialty-Specific Payer Benchmarks
You cant MANAGE what you cant MEASURE! 01967 is procedure code for an epidural during childbirth01967 is procedure code for an epidural during childbirth
40. Sneak Preview of First Ever Dermatology Benchmarked Denial Data
41. PaidRight Benchmarking database for Dermatology Aesyntixs PaidRight powered by RemitData is the first ever to introduce Denial Benchmarking data.
Sneak Preview data being scrubbed further for data April release
Over 100 Dermatologists
National
42. First look at unscrubbed Benchmark data 4th quarter 2009 - Denial Rates
Dermatology aggregate: 9%
Medicare: 11%
BCBS: 8%
United: 12%
Top Reason Codes for denial:
18 - Duplicate Denial
24 - Charges covered under a capitation agreement/managed care plan
97 - "The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated..."
43. Age of Claims Age of Claims (from DOS)
Medicare: 41 days, 72% paid in 30 days
BCBS: 27 days, 81% paid in 30 days
United: 32 days, 62% paid in 30 days
44. Top procedures denied Top Procedures and denial reasons:
99213 - Office/Consult
18 - duplicate
27 - Expenses incurred after coverage terminated
24 - charges are covered under a capitation agreement
17311 - Mohs
97 - benefit is included in the payment/allowance for another service/procedure that has already been adjudicated
18 - duplicate
16 - claim lacks info
88305 Tissue Exam by Pathologist
18 - duplicate
24 - charges are covered under a capitation agreement
140 - Patient health identification number and name do not match
45. Key Takeaways
Practices need better coding education:
Are you being denied for lack of coding expertise? Capitation denials ( 97 & 24 codes) & claims lacking information can be eliminated with better coding & education.
Watch your duplications! Denial code 18 duplicate denials are #1 trigger for OIG & RAC audits. Are you at risk of being above average for this type of denial reason? Duplicate denials often are the result of "working harder" but not smarter, resubmitting hoping for a different result.
Eligible but you still have old info. Denial code 27 if you are getting high rates of eligibility denials, re-evaluate your check-in processes and information flow within practice.
46. Key Takeaways Payers need a progress report, from you!
Payers are glad to slow pay & no pay. Address denial and cash aging concerns with your payer representative. Bring reports to the meeting that prove your point. Unfair denials? Which procedures, how often, what period? Address their end of the speed equation, how long is it taking them to pay you once they receive a claim?
Hold payers accountable for poor reimbursement. Address your average allowable for each payer contract, by procedure. Show reports that unsatisfactory averages.