RHC Benchmarking and Performance Jim L Creamer, Sr CPA CFE 229-343-4511 jcreamer@draffin-tucker.com

Ready Set Perform

Benchmarking Considerations Does a need exist?

Benchmarking Considerations Understand the competition 90 RHC’s in Georgia

Benchmarking Considerations Know the advantages Higher reimbursement from Medicare and Medicaid Higher reimbursement for Flu and Pneumonia shots No payment reductions for Nurse Practitioner and Physician Assistants (Potential) reimbursement for Medicare Bad Debts

Benchmarking Considerations Know the requirements Medical Director physician must be on staff Must employ either nurse practitioner or physician assistant Afterwards, may employ other professionals including certified nurse midwife Mid – level must be present 50% of the clinic hours (exceptions exist)

Benchmarking Considerations Know the services Physician and “incident to “ NP, PA, CNM, CP, CSW and “incident to” Medicare Pt B covered drugs Visiting nurses to homebound patients in CMS designated HHA shortage area Basic laboratory services Preventive health services

Benchmarking Considerations Perform Due Diligence Understand Patient Demographics Medicare, Medicaid, Insurance, Self Pay %’s Understand Enrollment Process Understand reimbursement impact on entity as a whole Often overlooked component of a new service area

Monitoring Performance Understand productivity standards and FTE’s Productivity standards are used to determine the average cost per patient for Medicare Reimbursement. Full Time Physician = 4,200 visits Full Time Mid-Levels = 2,100 visits FTE’s – Reported time spent seeing patients or scheduled to see patients and does not include administrative time

Monitoring Performance Understand overhead cost allocations if provider-based Capital Costs Employee Benefits Administrative and General Maintenance of Plant Laundry Housekeeping Dietary Cafeteria Nursing Administration Central Supply Pharmacy Medical Records Social Service CRNA

Hospital Overhead Allocations Why is this important?

Monitoring Performance Understand Vaccine reimbursement Pneumococcal – H1N1 – Influenza Reimbursement on cost per injection Reimbursement through cost report only Required log of injections to Medicare patients Capture supply cost for each injection Capture time spent giving injection

Monitoring Performance Understand Medicare bad debt reimbursement Traditional – Crossover – Indigent 120 day reasonable collection efforts Reduced by recoveries Maintain detail patient log Expect to be audited

Look For opportunities 340 B Drug Pricing RHC’s qualify for provider – based location and are eligible for participation in the discount drug pricing program

Jim L Creamer, Sr CPA CFE 229-343-4511 jcreamer@draffin-tucker.com