Speaker Elizabeth W. Woodcock, MBA, FACMPE, CPC

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Elizabeth W. Woodcock, MBA, FACMPE, CPCSpeaker, Author, Trainerwww.elizabethwoodcock.com MBA, Wharton School of Business, University of Pennsylvania BA, Duke University Fellow, American College of Medical Practice Executives Certified Professional Coder Author, 16 books and more than 500 Articles Founder and Principal, Woodcock & Associates Former Consultant, Medical Group Management Association; Group Practice

Services Administrator, University of Virginia Health Services Foundation; Former Senior Associate, Health Care Advisory Board

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Call to Action Financial Clearance Patient Collections Charge Capture and Finalization Insurance Follow-up Account Audit Payment Monitoring Bad Debt Avoidance Performance Monitoring

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Your Patient4

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Collecting from patients costs 2 times what it costs to collect from a payer!!

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1$7,931, based on 25 patients per day, 47 weeks per

year, 4.5 days per week, 2 statements per patient @

$.75 per statement in processing and mailing costs.

~$8,000 per provider

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The market has changed – so you must align your processes accordingly

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Verification of Coverage

Eligibility for Benefits

Financial Responsibility

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“Ms. Jones, our practice’s policy is to request payment at the time of service. Your insurance plan requires a copayment of $__________. Will you be paying with cash, check, or credit card?

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Source: E. Woodcock, Front Office Success, MGMA, 2010 (www.mgma.com)

How would you like to take care of your copayment today, Ms. Jones?

[Wait for card.] I also note that you have a small balance of $_______. Can we go ahead and run your card to take care of that balance?”

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www.mediabistro.com

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• Precede the question with a compliment• Use the patient’s name• Look the patient in the eye• Demonstrate that you expect payment

• Write out the receipt

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1.Automate the “flip” to patient accountability… and the entire dunning process

2.Transmit statements regularly3.Follow your own protocols for

managing collections

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24 to 72 hours

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Charge reconciliation protocol

Office visits

“Other” services in the office

Hospital visits, consults and surgeries/procedures

Other places of service

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Pay Correctly

Pay Incorrectly (Underprofile)

Deny

No Communication

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CO 15 - The authorization number is missing, invalid, or does not apply to the billed services or provider.

PR 1 - Deductible Amount

“Soft” Denial “Hard” Denial

http://www.wpc-edi.com/reference/

Claim Adjustment Reason Code

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CPT® You Billed Description Payment You Received

99214 Office Visit – Level 4, Established Patient

$87.64

80061 Lipid Panel $17.34

83036 Hemoglobin;glycosylated (A1c)

$12.98

81001 Urinalysis, by dip stick or tablet reagent; automated, with microscopy

$0.00

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MedicareMedicaid BCBS WC/Tricare

United Other

Commercial

Go Team!

Who?

What?

When?

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Worklist

Worklist Worklist

Worklist

Insurance Follow-up

Medicare

Medicaid BCBS United

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Audit1. Choose a single date of service

~nine months ago2. Query for all open invoices3. Randomly choose 50+/- of them4. Pull all activities and notes

associated with the invoices5. Evaluate

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Terrific approach to employees’ performance evaluations!

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Remember, this is a biased sample…• Who was responsible for non-payment?• Were appropriate and timely actions taken?• Were appropriate adjustments taken?• Is the invoice in the hands of the correct

financially responsible party now?• Did the notes explain the employee’s

actions? Can you understand them?

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100% Adjustment Report

[line item level]

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Identify Underprofile Payments

Load current allowables for all payers/products

Review at the line item level

Take action

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Line

item

Bulk

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Contracted Fee Schedule Match RateOn what percentage of claim lines does the payer’s allowed amount equal the contracted fee schedule rate excluding

the application of claim edits and payment rules (rules that adjust the fee schedule amount)

70.78%

62.08%

66.23%

84.20%

85.21%

61.55%

74.34%

99.95%

85.76%

Source: AMA Health Insurer Report Card.

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•Review language and structure

$100

Current 31 to 60 61 to 90 91 to 120 Over 120

$100

Maintain an open balance for the

business office manager; send to his/her

address

Place an actual due date on statements

(and letters)

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Statement at Check-out – or

Due

30 days Statement

Two

60 days Statement

Three

75 days Final

Notice

90 days Collections

Send twice-monthly statements

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Don’t want to go paperless? Not a problem. If you would like to continue to receive paper statements in the mail, you’ll be required to pay an annual fee of $20 which is due today. Please let us know! Yes, I want the environmentally friendly option; instead of paper, please send my

statements to: ___________________________________ . No, I would like to continue receiving paper statements, and will pay the annual fee of

$20.

Guarantor Signature/Name/Date

Dear Patient:In an effort to be more environmentally friendly, Rheumatology Practice Associates now offers eStatements. Choosing this option allows you to receive your statements electronically, sent to you via email. You no longer have to hassle with paper statements. In addition to being environmentally friendly, eStatements are convenient and secure. As soon as your statement is ready, you will be notified via email. The email will provide a link to a secure website where you can not only view your statement, but also choose one of several payment options.

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Key Performance IndicatorThe

PracticeHigh

PerformersExpected

Range

Days in Receivables Outstanding 28.45 30 to 40

Percent of Receivables Over 120 Days 9.62% 10 to 15%

Adjusted Collection Rate 99.30% 96 to 98%

Cash $? $?Source for “High Performers”: MGMA Performance & Practices of Successful

Medical Groups, 2015, median data for multispecialty, all practices.

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Every Employee is a Member of the

“Business Office”29

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Question &

Answer

Period

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Elizabeth W. Woodcock, MBA, FACMPE, CPCPrincipal, Woodcock & AssociatesAtlanta, GA 404.373.6195www.elizabethwoodcock.comelizabeth@elizabethwoodcock.com

None of this material may be reproduced without the written consent of Woodcock & Associates. Contact Ms. Woodcock at 404-373-6195 or elizabeth@elizabethwoodcock.com