Aged Accounts Receivable

Agenda• Introduction

• Objectives

• About Us

• Overview

• Benefits

• Process

• Analysis

• Reporting

• Investment

• Next Steps

Introduction

John Boland• John Boland is vice president at MedSynergies

(MSI) and responsible for advising healthcare billing organizations on selecting services to enhance their revenue cycle.

• 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.

• He received a bachelor of arts in economics from the University of Chicago in Illinois.

Objectives

• Describe MedSynergies’ service for processing old AR.

• Show examples.

• Let you know how you can take advantage of the service.

MedSynergies – About Us

• Founded in September 1996 by physicians

• 13 years of investment in processes and technology to optimize Centricity Group Management

• Business service provider to medical billing organizations• Billing optimization consulting• Payment processing services• Denial management services• Business analytics• Technology services

• Including ASP hosting of GE Centricity® Group Management (formerly IDX® Groupcast®)

• Patient self-pay services

MedSynergies – About Us

• Headquarters: Irving, Texas• Regional offices: Little Rock, Chicago, Orlando and Phoenix

• 240 Employees

• Serving over 3,600 providers and 55 specialties in 37 states and supporting more than 4,500 concurrent end users

• Providers like:• Physician practices• Hospitalists• Corporate• Home healthcare/Infusion therapy• Surgery centers• Emergency departments

Service Overview

• Work 100% of your aged insurance receivables!

• Sorting through old accounts receivable (AR) is time-consuming and labor intensive for most physician groups.

• You specify which receivable accounts need to be worked – 90 days or older.

• Comprehensive analysis will classify all aged accounts by status including:• Denial reasons• Balance type• No response

• You can choose to purchase the comprehensive aged AR analysis or both the analysis and the processing of the accounts.

• The service is offered as either a one-time project or on an ongoing basis. The analysis can be completed in 2-3 weeks.

Benefits

• Some of the benefits to working your old AR:• Process unresolved accounts in an accelerated time frame• Increase revenues with an average positive return on investment of over 200%• Eliminate unnecessary write-offs• Focus your management time on caring for patients• Understand and address root causes for aged AR trends

• The chart below illustrates the return on investment for a recent client:

Benefits

"Our A/R collections have increased and our business office costs have decreased significantly!"

Wesley JonesChief Financial Officer

Central Utah Clinic

The Process – High Level

Initiation Analysis Research Follow-up OngoingFollow-up

Reporting

Analysis

Analysis – A/R Inventory “Waterfall”

• The source of the waterfall is MedSynergies’ consulting business:

• Practice assessments• System configuration

assessments• Process redesign• Financial assessments

• The A/R waterfall is a financial and operational assessment tool.

• Used to align human resources with the workload.

• Provides guidance on where to invest in automation.

• Manufacturing view of every CPT with touches and stopping points.

• Total A/R at a given point in time.• < 60 days from charge posting

date and > 60 days from charge posting date.

• While specific to A/R, it can be used as a process map for your organization.

• As a result, we’ve divided our own organization into various operational units to better align our staff with the work.

Analysis – The WaterfallOpen

Credit Balance Total

I 42,896 4,751 47,647W 1,953 91 2,044P 25,615 429 26,044C 228 50 278

Total 70,692 5,321 76,013

OpenCredit

Balance Total44,849 4,842 49,69159.00% 6.37% 65.37%33.70% 0.56% 34.26% 0-30 Days0.30% 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 DaysW 718 1,235Total 21,411 23,438

0

Printed On Hold Not Printed Printed On Hold Not Printed I 15,008 4,522 163 18,133 3,978 92W 427 9 283 513 37 685Total 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 ResponseI 10,684 4,324 5,593 12,540W 195 232 39 474 0Total 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 DI 0 3,931 609 7,144 0 2,017 1,666 1,910W 95 3 97 20 1 18Total 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 worldInsurance % of totalSelf Pay % of total

Pending Exhaust % of totalTotal

Analysis – The Waterfall

Example: Multi-Specialty Practice

Denials52% Adjustment with

Payment35%

Straight Payments13%

Straight Payments

Adjustment with Payment

Denials

Composition of A/R (Units)

Composition ofthe Workable % (Units)No Response <=60

17%

Credit Balance7%

Claims Issues13%

Workable23%

Self Pay34%

No Response > 606%

Collections0%

Self Pay

Workable

No Response <=60

Claims Issues

Credit Balance

No Response > 60

Straight Payments

11%

Adjustment with Payment

18%

Denials71%

Straight PaymentsAdjustment with PaymentDenials

Example: Multi-Specialty Practice

No Response <=6027%

Collections0%

No Response > 606%

Self Pay24%

Workable23%

Claims Issues15%

Credit Balance5%

Self Pay

Workable

No Response <=60

Claims Issues

Credit Balance

No Response > 60

Composition of A/R (Dollars)

Composition ofWorkable A/R (Dollars)

Example: Analysis AR Categories

• Initial Analysis• Denial transaction message codes• Current balance type• Age

• Root Cause Analysis• Payer• Provider• Revenue center• Department• BRDHOS• Place of service• Insurance class

Analysis – Sample RecommendationsSample 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…

• Research• Line item interaction with payer• Detailed steps to realize payment• Comprehensive, regular interval reporting on progress and success

• Follow-Up• MedSynergies can update and utilize Groupcast for next steps• One-time or continuous project• Comprehensive, regular interval reporting on progress and success

Research – Reporting Examples

• The service includes weekly and monthly status reports with specialty and/or regionally-specific benchmarks.

Research – Reporting ExamplesDate Accounts Units Revenue Accounts Units Revenue Accounts Units Revenue Accounts Units Payments Adjustments Owed AmountTotal 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 $228.887/14/2008 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 $2,075.497/21/2008 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 $4,243.717/28/2008 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 $4,920.368/4/2008 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 $3,829.928/18/2008 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 $7,775.768/25/2008 0 0 $0.009/1/2008 0 0 $0.009/8/2008 0 0 $0.00

9/15/2008 0 0 $0.009/22/2008 0 0 $0.009/29/2008 0 0 $0.0010/6/2008 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 $123,717.26Re-filed to 2ND/3rd Insurance; 1,993 units for $58,619.20Transferred to patient; 263 units for $56,085Transferred to next payer: 112 units for $9,013.00

Old AR ROI CalculationProject Yield for the week of August 18, 2008

299 accounts, 500 units, $28,403.72Paid Amount $28,403.72Contractual Adjustments $46,319.13 Per Account Fee 6.00$ $73,634.40Owed Amount $7,775.76 Analysis Fee $10,000.00

Total Investment $83,634.40Balance of $7,775.76

360 units with $0 balance Cash Collected TD $275,869.05106 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 AccountsAR Project Yield to DateAged ARAR Researched Write Offs/Adjust/Transfers

Research – Reporting Examples

8/11/2008 Actions/Updates

Write Offs for this week: CO55 SVC DEEMED EXPER/INVESTIGATIONALThese 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/researchedThis 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, 2008253 accounts, 414 units; $58,955.62Paid amount $58,955.62 Contractual adjustments $54,809.17Owed amount $3,829.92

Balance of $3,829.92352 units at $0 balance32 units for $3,201.48 sitting at Self-Pay32 units for $628.44 sitting at Insurance balance

The Process – High Level

Initiation Analysis Research Follow-up OngoingFollow-up

Reporting

Investment

• Analysis• $10,000 one-time investment

• Research• $6.00 per account

• Follow-up • $2.00 per account

Next Steps

1. Meet with your representative to review the process and agreement

2. Sign agreement

3. Data extract

4. Start analysis

5. Show results

Questions?