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Rocky Mountain AAHAM & CO HFMA JOINT CONFERENCE March 25, 2011
Economic Challenges
5010
HealthCare
RAC Audits
ICD-10
Physician Leadership
3. Job satisfaction
4. Increased annual income 5. Consistent income
Source: PricewaterhouseCoopers 2010 Report
Does
Possible revenue:
$1,890,000.00 ($105.00 per patient)
Length of visit increases More legal exposure Employee liability is direct to the hospital, group keeps liability if separate entities Difficulty implementing production based models
Eventually employee physicians always want detailed financial information and profit sharing
Problems with scheduling and recruitment are now hospital issues Disciplining the doctor(s) becomes a hospital issue
Hospital may feel they have more control Implement a benchmarking tool to increase productivity and tie directly to incentive program.
Benefits
Control of Staff
Control of Costs Bundled payments One patient statement for global charges
Risks
Strain on current staff HR issues, vacations, medical leave, etc. Limited hiring pool
Space limitations
Lack of clinical knowledge
Risks
Keeping up with current coding regulations,
state rules and regulations, changes with the payer rules, etc. ICD-10 challenges RACs, etc. HIS limitations
Risks
EMRs!!
Compliance Concerns: Cloning (reference handout) Templates Over documentation Automated coding
Risks
Financial Impact Certified Coders arent cheap 2009 AAPC estimates $53,700 (loaded) Revenue decrease with no lobbying efforts by provider organizations
(HBMA,EDPMA)
Benefits
Reduced liability No HR issues, ongoing training, certifications, space management, etc. No management of other services: Physician credentialing Billing statements
Benefits
Fees based on revenue collected
No claims clearinghouse cost Coding and billing expertise in the specialty Peer to peer physician documentation training
Risks
Lack of control
Cost of collection
Medical Insurance
Work Comp Unemployment Personnel Turnover/Training Costs Non-labor costs (furniture, equipment, space, utilities, etc.)
** average nationwide expense of employing someone, depending on the benefits package35-40% over the annual salary amount
Resources Needed
Management of Staff Salary for Certified Coder (CPC) Salary for Biller Claims Clearinghouse Cost Mailing Costs ($1.25 per statement)
1.5 statements per account
4,500
Total:
$202,171
In-House
$105 avg. patient collection Deduct 25% lost reimbursement due to inaccurate documentation & inexperienced coders Deduct 20% lost revenue for A/R holding costs and inconsistent f/u
Outsource
$105 avg. patient collection 8% contingency fee (Range 7-9%) All inclusive fee
$931,829
$1,738,800
Possible revenue:
$1,890,000.00 ($105.00 per patient)
RVU/Pt increase
@ 18,000 visits
0.10 RVU/pt
$54,400 increase/year
$63,300 increase/year
$72,200 increase/year
0.33 RVU/pt
$178200 increase/year
$207900 increase/year
$237600 increase/year
0.50 RVU/pt
$270000 increase/year
$315000 increase/year
$360000 increase/year
red-headed stepchild