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Newsletter 2014 Q3

MyCare Ohio: An Overview

In December 2012 the State of Ohio and the Centers for Medicare & Medicaid Services (CMS) announced a partnership to develop MyCare Ohio, an Integrated Care Delivery System (ICDS) to improve the care experience for Medicare-Medicaid enrollees (dual eligible enrollees).

The goal behind the MyCare Ohio demonstration was to create a team approach to care coordination, provide a combined benefit package to include all benefits available through the traditional Medicare and Medicaid programs, have a single point of contact for dual-eligible individuals, and encourage person-centered care.

The demonstration includes 29 counties divided in 7 regions. This is expected to reach 62% of Ohio's dual-eligible population. The following five managed care plans were chosen for the demonstration: Benefits offered by the plans will include all those available through traditional Medicare and Medicaid programs. Plans may choose to provide additional benefits.

Enrollment for Medicaid services is being phased in by region from May - July 2014.

If a Medicaid plan is not chosen, one will be chosen for the individual. Members must enroll in a MyCare Ohio Medicaid plan if the following apply:

  • 18 years or older

  • Live in one of the 29 MyCare Ohio counties

  • Receive both Medicaid and Medicare

Receiving Medicare benefits through the MyCare Ohio plan is not required - enrollees can continue receiving Medicare benefits the way they currently do. Enrollees have until December 31, 2014 to decide on their Medicare enrollment. If no choice is made by January 1, 2015, the Medicare benefits will automatically be included in the enrollee's MyCare Ohio plan but the enrollee will retain the option to opt-out at a later date.

More information on the MyCare Ohio program can be found on theOhio Medicaid Website. For questions on credentialing, please contact Lacy Sharratt at (440) 808-3644 or lks@altapartnersllc.com

3 Tips for a More Productive Clinic Schedule

Creating a provider's clinical schedule can seem daunting, especially when considering how to most effectively maximize the productivity in one clinic day. When creating a new provider schedule, or overhauling an existing schedule, keep the following tips in mind in order to get the most out of your time.

1. How many available appointment slots for each appointment type?

It is important to know how many new and established patients are needed per year in order to meet budget goals. By determining how many of each type of patients need to be seen each week, the provider's schedule can be efficiently built to meet the budget. New visits should be calculated first to ensure enough spots for new patients in each clinic day. Next, if any procedures or surgeries are performed that require follow-up or post-op care within a designated time period, spots for these patients need to be reserved. You will also need to calculate the number of procedure or surgeries needed each year to meet budget targets, this way you can calculate how many post-op visits need to be done each week based on the number of surgeries & procedures being done each week. Some practices have patients that need to be added on within a certain amount of time (24 -48 hours) and often times there may not be available appointments with such short notice. It is helpful to set aside a few appointments each week for these patients to ensure that they can be seen in the timeframe needed.

Assume 3 8-hour clinic days/ week; 15 minute appointment times.

(32 patients/ clinic day)

**Surgeries/ Procedures become post-op or post-procedure visits*Assuming 48 weeks worked per year

***Assuming an average of 3 emergency add-on patients per week

2. Strategically Double-Booking Appointment Times

Each clinic has a percentage of patients who will not show up for, or will cancel, their appointment. In order to maximize revenue, this percentage should be calculated, so that the over-booking rate can balance out the number of patients that will not show. This will help to make up for lost revenue due to no-shows, and if all of the patients do arrive, then you will be earning extra revenue for the day.

When creating these additional, over-booked, appointments, make sure to do so where it will have the least impact on clinic workflow. Some visits, by the nature of their intended purpose, are very short in duration, and do not require a great deal of physician time (simple post-op checks, etc.), and are a valuable place to double-book an appointment. If a patient is not double-booked in these spots in advance, then these are ideal spots for patients to be added on throughout the course of the clinic day.

3. Filling Empty Appointment Slots

As you approach a clinic date, there may be unused spots in your schedule of appointments. Instead of leaving these spots empty, offer these spots to patients, particularly new patients, who have been waiting to get in, or are scheduled out several months. If clinics are frequently closed, and patients need rescheduled, these patients should receive priority when filling unused spots on a schedule.

For more information and to schedule a consultation to review and improve your provider schedules, please contact Susannah Selnick at sks@altapartnersllc.com or (440) 808-3649.

Alta Partners will provide a free consultation to all current billing clients who would like to review and improve their provider schedules.

Making the Most of your Provider Scorecards

Alta Partners provides its billing clients with a monthly Provider Scorecard. This scorecard summarizes key indicators that are useful to assess performance. By using this scorecard, you can ensure that performance is on-track, identify problems early, and see how changes have impacted operations (both positively and negatively). We wanted to offer a refresher on the different sections of the scorecard and how these measures can be used to improve performance to ensure that you are making the most of the Provider Scorecard.

Click here to download a sample report.

1. Production Summary

The production summary is the first section of the scorecard. This section includes two years of monthly figures for production measures such as charges, payments, wRVU's, and visits. Providing two years of data on a monthly basis allows you to compare performance month-to-month and also look for trends in the data or sudden changes. For example, if payments each month were stable but dropped suddenly one month, you would be able to easily recognize the decrease and take a closer look what may have caused the decline that month. While the scorecard cannot specify the exact issue, it helps you to identify where a problem may or may not lie. Changes may not be sudden; there may be a trend of slowly decreasing production over time that may be an indicator of issues such as lower patient volume or lower productivity. The production summary may also highlight positive actions that the practice has taken. Analyzing positive increases is also important because you can see the positive financial impact the actions have had on the practice as well as take steps to ensure that the upward trend continues.

wRVU's (work Relative Value Units) are an important measure to track because these reflect level of productivity. wRVU's are used by Medicare to determine the amount of work performed for each CPT code. Comparing wRVU's instead of visits is preferred because counting visits applies the same weight to each visit even though the workload can vary. Using wRVU's accounts for this difference and allows you to see the level of work being provided under a common standard of measurement.

The visit section of the scorecard can be used to see the number and type of visits being performed. As previously mentioned, changes can be sudden or slowly occur over time. If there is a sharp drop in visits, it may be due to seasonality or a physician's vacation time, with a possibility of being easily reversed back to normal. A slowly declining trend in visits may be an indicator of hidden issues that need addressed. You can also analyze visits by looking at New Patient Visits and Established Patient Visits (both preventative and office visits). If the practice is trying to grow, the new patient visit statistic can be used to see how many new visits are happening each month and how they are trending (upwards, downwards, or steady).

 2. Payer Analysis

 The payer analysis looks at different payers for the practice including commercial payers, Medicaid, Medicare, and Self Pay. Understanding your practice's payer mix is important because payer mix affects the production and reimbursement of the practice. For example, a high mix of Medicare may indicate an older patient demographic and drive different types of procedures and lead to different levels of office visits than a practice with a low mix of Medicare patients. A high Medicaid population may negatively affect payments as Medicaid typically has a lower reimbursement rate than commercial payers and/or Medicare.

Another important component of this section is the "Denial %" which shows what percentage of charges for each payer are denied. This allows you to quickly see which payer(s) has the highest denial rate from which you can examine closer to determine the cause. There may be something specific about claim submission for this payer that is not being done right or a step in the process that is being missed. This section also shows what the charges and payments for that payer are as a percent of Medicare (based on the Medicare allowable rate for the procedure codes charged to that payer). If payments are a low percent of Medicare, they may be issues such as low contract rates or not receiving full payments from this insurer. Finally, this section shows the average payments per wRVU for each insurer. Using wRVU's as a base makes it easier to compare different insurances, regardless of the procedure mix billed through each payer. Looking at the average reimbursement per wRVU is another way to easily and quickly identify if there is an insurance that is reimbursing lower than other insurers and whether it needs addressed.

3. Accounts Receivable Analysis

This section breaks down your accounts receivable (A/R) balance by payer and by the responsible party (insurance vs patient) along with the total A/R balance. Next to this are two figures that will help you to assess whether there is an issue that needs addressed. The "AR % of Total" column shows you how much of your A/R balance can be attributed to the different payers. Certain payers may commonly be a higher percentage of your A/R while others may not and serve as a red flag. The "AR % Over 90 Days" column total shows what percent of your total A/R is over 90 days old; it is then broken out to show you what percent is attributable to each payer. The total percent of A/R over 90 days is an important statistic to determine how effective your practice is at collecting payments for services. This section allows you to find red flags that may indicate difficulty in collecting from a particular payer.

4. Monthly Activity

Monthly activity offers a more detailed look at charges and payments. The first section shows charges and charge errors. If charge errors are high or there is an increasing trend, it would be beneficial to review the cause and meet with staff to resolve the issues causing the charge errors. Below this section is the breakdown of payment and adjustments. An important figure to watch is the denial adjustments. If denials are high or show an increasing trend, you should review the primary denial codes and work with your staff to clean-up the currently denied claims and prevent denials in the future. A detailed look at denial codes is provided in the "Other Statistics" section of the scorecard.

Charges less payments and adjustments will show the change in A/R for the month. A positive change in A/R indicates that your payments for the month were less than your charges; a negative change indicates that payments for the month were greater than charges. The monthly change in A/R affects the ending A/R balance or your outstanding accounts receivable. Below the ending A/R balance is your days revenue outstanding (DRO). A DRO of 50 days or less is considered good; the lower the number, the more effective your practice is at collecting revenues. Below this figure is your charge lag which represents how long it takes to enter the charge from the date of service. Lower numbers are better, with an average of 3 days or less being ideal. Both the DRO and Charge Lag figures have an average for your specialty provided for comparison purposes.

The final part within the monthly activity section is the Patient Coding Profile that uses graphs to compare your E&M coding to averages within the Alta Partners' database for your specialty. This is useful to see how your coding compares to others. When reviewing this, remember that this is an average of other physicians within your specialty and coding may vary based on patient demographics and provider preference.

5. Other Statistics

This section has two main components to it. The first part shows your average charge per visit and your average wRVU (work RVU) per visit. While it is good to know the average charge per visit, the important statistic here is the average wRVU per visit. As discussed above, wRVU's are a universal productivity measure that can be used to show the level of work being performed for each visit. This statistic is also important because it is tied to reimbursement. The Medicare allowable rate is determined based on RVU values, including wRVU. The higher the wRVU per visit, the higher the expected payment per visit.

The second part of "Other Statistics" is the denial breakdown. This section takes the information from the denial adjustments and shows your top denial codes. If your denials are high, you can use this breakdown to identify which denial code to tackle first. You can dig further to determine the pattern causing this denial code then work with your staff to develop a plan to reduce these errors.

Reviewing key indicators is an on-going process that should occur on a monthly basis. After review, any issues should be followed through on to understand why the variance is occurring and determining how to fix it if necessary. Changes may be sudden or occur over time. Either way, once a variance is identified, it is important to ask "why". Before a problem can be fixed, it has to be understood, from its cause to its effects. Once there is a firm grasp on what the problem is, you can move on to implementing changes to correct it. In an ever-changing industry such as healthcare, small and simple steps can make a difference in productivity and profitability. 

Introducing Susannah Selnick, New Consultant at Alta Partners

Alta Partners, LLC is pleased to announce the addition of Susannah Selnick as Healthcare Consultant to our team. Susannah specializes in long-term planning and goal-setting, operational assessments, and practice management.

Susannah has several years' experience in healthcare ranging from inpatient clinical care to practice operations management. She received her Bachelor's degree in Biology from Case Western Reserve University, and her Master's of Business Administration - Health Care Administration from Cleveland State University. Susannah has worked for local health organizations including Case Western Reserve University School of Medicine and University Hospitals.  

While at CWRU School of medicine, Susannah performed HIV, cancer, and influenza research. While at UH for the last several years, Susannah worked in project management, strategic planning, and practice management. Her project management experience includes cost analysis for various surgical subspecialties, long term strategic planning for academic departments and clinical institutes, and multi-million dollar business plans for launching new clinical institutes. As the supervisor for the UH Ear, Nose & Throat Institute, Susannah was responsible for the department's staff supporting 12 physicians and 1 nurse practitioner, practicing in multiple doctor's office and hospital locations. Susannah has led teams through on-boarding of new physicians, administrative and clinical space renovation and relocation, major staff recruitment and growth, and Electronic Medical Record planning and implementation.

Contact information:
Email:  sks@altapartnersllc.com 
Phone: (440) 808-3659