John V. Guiliana, DPM. MS. “I feel like I’m working harder and harder for less and less”
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Transcript of John V. Guiliana, DPM. MS. “I feel like I’m working harder and harder for less and less”
“I feel like I’m working harder and harder for less and less”
What’s Costing You?
• Reduced Reimbursements?• Rising Expenses?• Ridiculous Regulatory Issues?
Mi$$ed Opportunities!
Thinking “Surgically” and
Keeping Your Fingers on the Pulse of Things…
Our Theoretical Practice
FootCare Assoc. PC
10000
0
2000
4000
6000
8000
10000
12000
Total Visits
Total Visits
FootCare Assoc. PC
FootCare Assoc. PC3%
0
2000
4000
6000
8000
10000
12000
Total Visits Total New Visits
Total vs New
Target should be greater than 10.0%. Lower than benchmark might mean that the practice is not offsetting the typical attrition rate of a medical practice.
FootCare Assoc. PC
240
25
00
50
100
150
200
250
300
99202 99203 99204
New Patient Coding
FootCare Assoc. PC
0
100
200
300
400
500
600
700
800
99211 99212 99213 99214
Established Patient Coding
FootCare Assoc. PC
1.7
1.75
1.8
1.85
1.9
1.95
2
2.05
2.1
2.15
New Established
New vs Established Weighted Average Coding
2.10
1.85
A weighted average compares coding level to it’s utilization. For example, equal numbers of level 2 codes to level 3 codes = 2.5
FootCare Assoc. PC
27.8%
9.3%8.3%
22.2%
32.4%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
AR-Current AR-30 AR-60 AR-90 AR-120
Accounts Receivables - Percentages
Target is to have less than 15% of total A/R in buckets greater than 90 days. This looks excellent
FootCare Assoc. PC
Total Visits vs Services
1.6%
1.2%
1.5%1.4%
1.8%
0.4%
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1.2%
1.4%
1.6%
1.8%
2.0%
Ortho AFO X-Ray Injections Shoes PAD
Industry 3.0 1.5 22.0 4.0 3.0 1.5
Our Priorities and Action Plan
Priority
1. ???Aged Claims
Marketing2. ???
3. ???Coding
4. Services???
Action Plan
Assign most qualified staff member the duty of investigating the details of claims over 60 days old.
a.Re-fileb.Appealc.Write Off
Remember the Who, What, When Rule!
Action Plan
Assign most qualified staff member the duty of initiating a Marketing Plan
a.Budgetb.Designc.Execute
Outsource?
Action Plan
Attend Coding Seminars and institute a Coding Compliance and Auditing Policy
Action Plan
Develop and Adhere to EB Clinical Protocols
Assign Protocol Compliance Officer
Protocol Adherence and Measurement
Rationale for protocols
• Uniquely similar
• Consistent quality outcomes
• Perceptual credibility
• Anticipatory staff
• Streamlined processes
• Cost reduction
• Improved revenues
treatmentInjection
(20550 J code)Strapping (29540)
Third Visit With Improvement
(99211)Cast for Orthotics
(L3010)
Third VisitWithout Improvement
(99211)Cast for Orthotics
(L3010)
Fourth VisitWith Improvement (99212 or 99213)
Orthotic Dispensing Visit
Fourth VisitWithout Improvement
(99212 or 99213)Orthotic Dispensing Visit
Fifthh VisitWith Improvement (99212 or 99213)
Orthotic Recall Six Months
Fifth VisitWithout Improvement
(99212 or 99213)Additional PT
Consider alternative therapiesSurgery
EPF
DME-IODCam Walker
L1930
DME - IODFoot Orthotics
First Visit
Second VisitWith Improvement
99212 or 99213Discuss Etiology Leading to Orthotics
Begin Authorization ProcessReappoint for Orthotic Casting
Second Visit Without Improvement
99212 or 99213Consider Another Injection
(20550)Refer Patient for Physical Therapy
Conisder MRI or Cat scanDiagnostic Ulrasound
Reappoint for Orthotic casting
DME-IODAchilles Wrap
(L1920)OTC Orthotic
Biofreeze
Heel PainPlantar Fasciitis
Heel Spur
DME -IODDispense Night Splint
(L4396)
AssessmentHistory and Physical (99203 or 99243)
XRAYS (73620 or 73630)
consider blood work
(possible 25 modifier)
Measuring an Effect of Clinical Protocol Adherence
The Per Visit Value (PVV)
Measuring The Effect of Clinical ProtocolsFoot Care Associates Per Visit Value
PVV = Total collections / Total Patient Visits
Action Plan For Foot Care Associates (if clinical protocols are being complied with)
• Payer Reimbursements ?
• Billing and Collection Protocol ???
Third-party payer collection timetable
Day Action
1 • Mail or electronically submit the CMS-1500 claim to the appropriate payer.
30 • Review the account. If no third-party payment has been made, telephone the carrier. Be sure to obtain the name of the person
with whom you are speaking and the status of the claim.• If the carrier indicates that the claim hasn’t been received,
confirm the address and refile the claim to the attention of the representative you spoke with.
• Verify that the new claim has been received. • Request a statement showing the status of the account.
60 • Send the patient a letter stating that payment has not been received from his carrier and the practice is requesting assistance
in obtaining payment.• Determine if the account will be referred to an outside source for
follow-up with the insurance company and/or the patient.
75 • Telephone the patient to discuss payment arrangements. Send the patient a written affirmation of any agreement.
90 • Send the patient a past-due letter.
120 • Send a final collection letter to the patient, and follow up with a telephone call.
• Prepare the account for outside collection.
Action Plan For Foot Care Associates (if clinical protocols are being complied with)
• Payer Reimbursements ?• Billing and Collection Protocol ?• Volume and Physician Extenders ?
?
A look at our practice’s payroll
• The Payroll Ratio
( payroll / collections ) x 100
Foot Care Associates Payroll Ratio
Payroll Ratio = (Total Payroll / Collections) X 100
Cross Referencing Data to Improve the Puzzle
Foot Care Associates Heel Pain versus Orthotics
Summary of Reports
• Monthly A/R ReportP/L StatementCPT AnalysisICD AnalysisTotal ChargesTotal Adjustments
• Annual Per Visit Value
• Quarterly Random fee schedule cross reference(10-15 claims per top 5 carriers)
