Agenda
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Introduction
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Objectives
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About Us
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Overview
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Benefits
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Process
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Analysis
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Reporting
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Investment
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Next Steps
Introduction
John Boland
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John Boland is vice president at MedSynergies
(MSI) and responsible for advising healthcare
billing organizations on selecting services to
enhance their revenue cycle.
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Prior to joining MSI in 2005, John directed national
and regional client services with IDX Systems
Corporation, where he provided revenue cycle
outsourcing solutions to medical group practices.
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He received a bachelor of arts in economics from the University of
Objectives
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Describe MedSynergies’ service for processing old AR.
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Show examples.
MedSynergies – About Us
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Founded in September 1996 by physicians
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13 years of investment in processes and technology to
optimize Centricity Group Management
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Business service provider to medical billing organizations
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Billing optimization consulting
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Payment processing services
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Denial management services
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Business analytics
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Technology services
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Including ASP hosting of
GE Centricity® Group Management
(formerly IDX® Groupcast®)
MedSynergies – About Us
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Headquarters: Irving, Texas
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Regional offices: Little Rock, Chicago, Orlando and Phoenix
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240 Employees
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Serving over 3,600 providers and 55 specialties in 37 states
and supporting more than 4,500 concurrent end users
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Providers like:
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Physician practices
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Hospitalists
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Corporate
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Home healthcare/Infusion therapy
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Surgery centers
Service Overview
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Work 100% of your aged insurance receivables!
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Sorting through old accounts receivable (AR) is time-consuming and labor
intensive for most physician groups.
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You specify which receivable accounts need to be worked – 90 days or
older.
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Comprehensive analysis will classify all aged accounts by status including:
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Denial reasons
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Balance type
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No response
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You can choose to purchase the comprehensive aged AR analysis or both
the analysis and the processing of the accounts.
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The service is offered as either a one-time project or on an ongoing basis.
Benefits
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Some of the benefits to working your old AR:
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Process unresolved accounts in an accelerated time frame
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Increase revenues with an average positive return on investment of over 200%
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Eliminate unnecessary write-offs
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Focus your management time on caring for patients
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Understand and address root causes for aged AR trends
Benefits
"Our A/R collections have increased and our business
office costs have decreased significantly!"
Wesley Jones
Chief Financial Officer
Central Utah Clinic
The Process – High Level
Initiation
Analysis
Research
Follow-up
Ongoing
Follow-up
Analysis – A/R Inventory “Waterfall”
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The source of the waterfall is
MedSynergies’ consulting
business:
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Practice assessments
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System configuration
assessments
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Process redesign
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Financial assessments
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The A/R waterfall is a financial
and operational assessment tool.
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Used to align human resources
with the workload.
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Provides guidance on where to
invest in automation.
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Manufacturing view of every CPT
with touches and stopping points.
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Total A/R at a given point in time.
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< 60 days from charge posting
date and > 60 days from charge
posting date.
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While specific to A/R, it can be
used as a process map for your
organization.
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As a result, we’ve divided our own
organization into various
operational units to better align
our staff with the work.
Analysis – The Waterfall
Open Credit Balance Total I 42,896 4,751 47,647 W 1,953 91 2,044 P 25,615 429 26,044 C 228 50 278 Total 70,692 5,321 76,013 Open Credit Balance Total 44,849 4,842 49,691 59.00% 6.37% 65.37% 33.70% 0.56% 34.26% 0-30 Days 0.30% 0.07% 0.37% 93.00% 7.00% 100.00% 0 > 60 Days from D.O.C.P. <=60 days from D.O.C.P. I 20,693 22,203 31-60 Days W 718 1,235 Total 21,411 23,438 0Printed On Hold Not Printed Printed On Hold Not Printed
I 15,008 4,522 163 18,133 3,978 92 W 427 9 283 513 37 685 Total 15,435 4,531 446 18,646 4,015 777 % of bucket 72.09% 21.16% 2.08% 79.55% 17.13% 3.32% % of Total 21.83% 6.41% 0.63% 26.38% 5.68% 1.10% 0-30 Days
Response No Response Response No Response
I 10,684 4,324 5,593 12,540 W 195 232 39 474 0 Total 10,879 4,556 5,632 13,014 31-60 Days % of bucket 70.48% 29.52% 30.20% 69.80% % of Total 15.39% 6.44% 7.97% 18.41% 0 C R A P D C R A P D I 0 3,931 609 7,144 0 2,017 1,666 1,910 W 95 3 97 20 1 18 Total 0 0 4,026 612 7,241 0 0 2,037 1,667 1,928 % of bucket 0.00% 0.00% 37.01% 5.63% 66.56% 0.00% 0.00% 36.17% 29.60% 34.23% % of Total 0.00% 0.00% 5.70% 0.87% 10.24% 0.00% 0.00% 2.88% 2.36% 2.73%
Insurance A/R world Insurance % of total Self Pay % of total Pending Exhaust % of total
Example: Multi-Specialty Practice
Denials 52% Adjustment with Payment 35% Straight Payments 13% Straight Payments Adjustment with Payment DenialsComposition of A/R (Units)
Composition of
the Workable % (Units)
No Response <=60 17% Credit Balance 7% Claims Issues 13% Workable 23% Self Pay 34% No Response > 60 6% Collections 0% Self Pay Workable No Response <=60 Claims Issues Credit Balance No Response > 60
Straight Payments 11% Adjustment with Payment 18% Denials 71% Straight Payments Adjustment with Payment Denials
Example: Multi-Specialty Practice
No Response <=60 27% Collections 0% No Response > 60 6% Self Pay 24% Workable 23% Claims Issues 15% Credit Balance 5% Self Pay Workable No Response <=60 Claims Issues Credit Balance No Response > 60
Composition of A/R (Dollars)
Composition of
Workable A/R (Dollars)
Example: Analysis AR Categories
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Initial Analysis
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Denial transaction message codes
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Current balance type
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Age
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Root Cause Analysis
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Payer
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Provider
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Revenue center
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Department
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BRDHOS
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Place of service
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Insurance class
Analysis – Sample Recommendations
Sample Clinic Old A/R Summary Recommendations
Charges Greater Than 1.5 Years Project
PAYER OPTIONS RECOMMENDATIONS LOGIC HMO Primary-(540+ days from
date of service)
(Top six local carriers in which possible recovery of funds could occur) 1. GEMMA 2. HPUB 3. CDMM 4. ALTIMA PLAN 5. PRO HEALTH 6. BLUE CROSS BLUE
SHIELD
1. Send detailed report to payer for last chance of adjudication. The detailed report will include claim date and claim run number. 2. Provide physicians with a
breakdown report of accounts > 365 days from date of service for write-off approval.
1. Move forward with option 1 2. Work unidentified credit balances
prior to presenting A/R report to physicians for write-off approval. Move any possible to open A/R if match found.
Primary Insurance Type = HMO Charge 540 days+ since DOS Current Insurance = Primary Insurance Insurance Balance Type = Insurance Owed Amt > 0
MEDICAID- (540+ days from
date of service) 1. Write-off 1. Check for unidentified credit balances on Medicaid accounts. Move any possible to open A/R if match found.
2. Write-off
Primary Insurance Type = Medicaid Charge 540 days+ since DOS Current Insurance = Primary Insurance Insurance Balance Type = Insurance Owed Amt > 0
MEDICARE (540+ days from
date of service) 1. Write-off 1. Check for unidentified credit balances on Medicare accounts. Move any possible to open A/R if match found
2. Write-off
Primary Insurance Type = Medicare Charge 540 days+ since DOS Current Insurance = Primary Insurance Insurance Balance Type = Insurance Owed Amt > 0
BLUE CROSS BLUE SHIELD (540+ days from date of service)
1. Send detailed report to payer for last chance of adjudication. The detailed report should include claim date and claim run number. 2. Provide physicians with a
breakdown report of accounts > 365 days from date of service for write-off approval
1. Move forward with option 1 2. Work unidentified credit balances
prior to presenting A/R report to physicians for write-off approval. Move any possible to open A/R if match found.
Primary Insurance Type = BCBS Charge 540 days+ since DOS Current Insurance = Primary Insurance Insurance Balance Type = Insurance Owed Amt > 0
Once the Analysis is Completed…
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Research
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Line item interaction with payer
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Detailed steps to realize payment
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Comprehensive, regular interval reporting on progress and success
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Follow-Up
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MedSynergies can update and utilize Groupcast for next steps
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One-time or continuous project
Research – Reporting Examples
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The service includes weekly and monthly status reports with
Research – Reporting Examples
Date Accounts Units Revenue Accounts Units Revenue Accounts Units Revenue Accounts Units Payments Adjustments Owed Amount
Total Aged AR 15,185 40,612 $6,099,672.10 7/7/2008 1,203 1,889 $281,031.82 38,723 $5,818,640.28 13 20 $1,133.45 $3,799.29 $228.88 7/14/2008 1,274 2,456 $367,519.72 537 841 $153,345.86 35,426 $5,297,774.70 104 173 $17,854.76 $16,085.14 $2,075.49 7/21/2008 1,092 1,998 $225,890.07 29 47 $24,880.61 33,381 $5,047,004.02 54 89 $10,909.40 $20,866.96 $4,243.71 7/28/2008 1,366 2,590 $301,458.72 1,640 2,458 $397,077.34 28,333 $4,348,467.96 268 446 $59,428.68 $54,294.96 $4,920.36 8/4/2008 1,095 2,490 $237,208.40 0 0 $0.00 25,843 $4,111,259.56 553 808 $99,183.43 $101,383.78 $16,158.18 8/11/2008 1,304 3,440 $362,757.23 17 18 $4,046.62 22,385 $3,744,455.71 253 414 $58,955.62 $54,809.17 $3,829.92 8/18/2008 1,391 2,404 $389,687.60 1,324 2,368 $123,717.26 17,613 $3,231,050.85 299 500 $28,403.72 $46,319.13 $7,775.76 8/25/2008 0 0 $0.00 9/1/2008 0 0 $0.00 9/8/2008 0 0 $0.00 9/15/2008 0 0 $0.00 9/22/2008 0 0 $0.00 9/29/2008 0 0 $0.00 10/6/2008 0 0 $0.00 Totals 8,726 17,267 $2,165,553.57 3,547 5,732 $703,067.68 1,543 2,450 $275,869.05 $297,558.43 $39,232.29
Transfers to next payers $123,717.26
Re-filed to 2ND/3rd Insurance; 1,993 units for $58,619.20 Transferred to patient; 263 units for $56,085
Transferred to next payer: 112 units for $9,013.00
Old AR ROI Calculation
Project Yield for the week of August 18, 2008 299 accounts, 500 units, $28,403.72 Paid Amount $28,403.72
Contractual Adjustments $46,319.13 Per Account Fee $ 6.00 $73,634.40
Owed Amount $7,775.76 Analysis Fee $10,000.00
Total Investment $83,634.40 Balance of $7,775.76
360 units with $0 balance Cash Collected TD $275,869.05 106 units with a balance of $9,599.17
71 with a P balance of $7,650.24 Return 330%
35 with an I balance of $1,948.93
34 units with a P credit balance of ($1,823.41)
Remaining Accounts
AR Project Yield to Date Aged AR
Research – Reporting Examples
8/11/2008 Actions/Updates
Write Offs for this week: CO55 SVC DEEMED EXPER/INVESTIGATIONAL These charge were first tagged as out of scope of the project
All were researched by CBO and the uncollectable open AR is reflected below 17 accounts, 18 units, for $4,046.62
All Out Of Scope charge messages codes have been reviewed/researched This portion of the project has been completed
All transfers, write offs, and adjustments have been completed from this portion of the AR project Per the direction of CBO, we have excluded the AR for the Neurology and Diagnostic Imaging for DOS prior to January 1, 2008.
The impact of this omission is reflected in the following breakout 3,608 accounts
$634,183.82 AR
6,072 units
The base of the new project total can be reflected in cells K4, L4, and M4
Project yield for the week of August11, 2008 253 accounts, 414 units; $58,955.62 Paid amount $58,955.62 Contractual adjustments $54,809.17 Owed amount $3,829.92 Balance of $3,829.92 352 units at $0 balance
32 units for $3,201.48 sitting at Self-Pay