Catherine Zito, FHFMA, CPA, CPC-A
Joette Derricks, CMPE, CPC, CHC, CSSBG
August 2, 2012
 Our
focus is the Business Office
◦ We will not be addressing many other
important and interesting aspects of
running a hospital-owned business
enterprise.
◦ For example, would you consider
physician recruitment as a Business Office
initiative?
◦ What about quality initiatives?
◦ Physician compensation?
1
Lesson #1
Collaboration, Coordination & Control
 Everything is related and integrated with the
Business Office functions
o The Business Office must know what services the new
physician will be providing and build the charge
schedule, practice management user tables, train
coders/billings ideally all before the first patient is seen.
o Many quality initiatives from PMH to Physician Quarterly
Reporting System to Meaningful Use are integrated with
the practice management software.
o What gets captured, billed and paid will impact physician
compensation.
2
Hospital leadership, physician partnership,
practice operations, managed care contract,
finance and accounting, information tech, etc.
o Responsibility (role definition)
o Accountability (performance expectations)
Lesson # 1
Collaboration, Coordination & Control
 Two basic models
1) Borrow or add on responsibilities to current hospital
executives
o On-the-job training to learn the differences between
hospital and medical practice enterprise
o Frustrating unless clear definitions of roles and
responsibilities
2) Hire a proven group practice administrator
o Transition from one to many sites—a single to group vision
o Understanding hospital bureaucracy and operating cultures
4
Lesson #1
Collaboration, Coordination & Control
What we learned:
o Established a management “leadership” team to set
priorities and establish responsibilities and
accountabilities to obtain common goals
- Business Office Director, HIM Director, Practice
Administrators, Compliance, Credentialing, HR
Representative, and IT Director
o Established a physician council with monthly meetings
to listen to concerns and respond
- Business Office Director attends and participates
5
Lesson #2
Physician Revenue Cycle Tools and Expertise
If you want to be successful you need to learn the
rules of the physician revenue cycle
Patient data gathering and verification (front-desk)
o A physician registration associate is responsible for
answering the phone, scheduling the patients,
checking them in, pulling their charts, updating data,
cleaning up the reception area after the sick kid,
collecting co-pays, balance dues, printing fee tickets,
scanning forms, etc.
6
Lesson #2
Physician Revenue Cycle Tools and Expertise
Documentation of services
o Capturing all revenue in all settings by all providers, e.g.
physicians, nurses, ancillary techs
- EMRs and paper forms
- Auto coding or coding experts
Claim processing
o Entry edits, clearinghouse edits, working outstanding
claims, patient statements, denial management, claims
resubmission and appeals
- 5010 format
- ICD-10 is still in play
7
Lesson #2
Physician Revenue Cycle Tools and Expertise
Practice Management System
o Your hospital vendor may not be the best vendor for
your physician enterprise
o Select one and only one practice management (PM)
system that supports the revenue cycle management
process
o Move all physicians/practices to a common
standardized platform
o A robust EMR is also critical; however, it doesn’t have
to be a product of either your hospital EMR or your
PM vendor
8
Lesson #2
Physician Revenue Cycle Tools and Expertise
What we learned:
o There are no shortcuts to the selection,
configuration and properly implemented IT system
o Dedicated IT associates
o Don’t skimp on training for IT, physicians, practice
and Business Office associates
o The PM and EMR systems impact clinical quality,
service, productivity, operational and financial
viability of the Business Office and the entire
physician enterprise
9
Lesson #2
Physician Revenue Cycle Tools and Expertise
What we learned:
o Develop in-house when possible, or supplement
with outside (outsourcing or consulting), coding
and physician revenue cycle expertise
-
Certified coders
Physician trainers
Regulatory and compliance specialists
Managed care contracts
Billing/denial management/appeals
10
Lesson #3
Hospital/Physician Challenges Impact on the
Business Office
 Physician recruitment lead time and due diligence
o The earlier in the process you know what is coming into the
Business Office the better
 Standardize compensation formula
o Often information needs to be added to the PM system to
capture data for the formula
o Modeling the formula and refining it works better before the
physician signed on the dotted line
 Financial, accounting and managed care contracting
considerations
o One tax ID number or separate tax ID numbers
o One group or multiple groups
11
Lesson # 3
Hospital/Physician Challenges Impact on the
Business Office
Inheriting physician staff and integrating
them into the Business Office
o New or different policies and procedures
o Spouses, long-term employees requiring training
o “That’s the way we have always done it”
12
Lesson #3
Hospital/Physician Challenges Impact on the
Business Office
What we learned:
o Planning is a key to doing it right
- Lack of adequate planning, controls resulted in many
downstream problems and issues which we are still
working through
- Difficulty with always playing catch up and “issue of the
day”
o Communication is key to priorities and lead time
o Don’t be afraid to let people go when they cannot
adapt to a new organizational structure
13
Lesson #4
What you Measure Counts!
Accurate management of data and reporting
o Make sure the PM and EMR have a robust report
writing capability
o Determine what standard reports the
physician/practice will see and when
o Ensure you understand the data
- Is the compensation based on work RVUs entered or
billed or paid
14
Lesson # 4
What you Measure Counts!
What we learned:
o We didn’t have the right management tools
o We suffered from a data deficiency dilemma
o Physicians were use to having all the information
they wanted at their finger tips
o Physicians micro-managed information especially
information that might impact their compensation
o We downloaded data into external report writing
software
o We worked with our vendor to fix the deficiencies
15
Lesson # 5
Learning is Ongoing!
The Business Office focus is on the revenue side
of the equation
o Improve charge capture techniques for out of office
sites, e.g. nursing homes, assisted living
o Train, train and train physician’s on documentation,
coding and billing
o Train, train and train your associates on
documentation, coding and billing
o Refine the receivables management system to
improve bottom line
o Build a management team around good leaders with
the ability to implement best practices
16
Lesson # 5
Learning is Ongoing!
Use outside resources (outsource/consultants) as
needed
Stay on top of regulatory changes
o The Medicare Physician Fee Schedule and new CMS
changes are released in October/November for the
following year
o Diagnosis coding changes are effective October 1
o CPT/HCPCS changes are effective January 1
o Impact of Hospital/Outpatient changes on your physicians
– 3-Day Rule for Wholly Owned or Wholly Controlled Practices
17
Lesson # 5
Learning is Ongoing!
Accept that while you had the hospital
revenue cycle under control – the physician
revenue cycle learning curve can be tough so
don’t be too hard on yourself!
Relax and embrace the challenges!
18
Questions???
Thank you!
19