Health Care in the CPA’s Future Keith Kamperschroer, CPA, CHCC Robert Denkert, CPA

Keith Kamperschroer, CPA, CHCC Shareholder – Health Care Services As Managing Director of Health Care Services at Kolb+Co., Keith works extensively with small and medium-sized medical practices providing assistance in all areas of accounting and practice management.

Robert Denkert, CPA Accounting Senior Manager Bob works extensively with small and medium-sized medical practices providing assistance in all areas of accounting, payroll and practice management.

In Addition to Physicians… Expand your definition of Health Care owners/stakeholders –MDs, DOs, Behavioral Health Practitioners –Advanced Level Practitioners (NPs and PAs) –Dentists –Veterinarians

The Value of a CPA from the Client Perspective Current on upcoming Health Care reform issues Proactive planning ideas included with financial statements not just historical financial data What are the numbers telling me? Value of service demonstrated

How to Enhance My Services to New or Existing Medical Clients? Add value to existing services Understand their Revenue Cycle challenges; be proactive Additional “Specialty Services” to consider for building on your health care niche

Current Services Change Management – substantial changes occurring in health care SGR - No Medicare reduction in reimbursement rates again for 2013 –How will practices be able to absorb a 30% reduction in Medicare reimbursement in 2014 –Commercial payers fee schedules at less than 100% of Medicare reimbursements Implementation of electronic medical records –How practices meet 1 st stage meaningful use in 2012 or 2013

Current Services Look for other ways to add value –Do you review the financial reports with your clients in person? –Are your statements presented in a format specific to medical practices? –Is a production analysis report part of your business analysis? Example: provide gross and net collection rates globally and by provider

The Business of Medicine Specialized Services and Revenue Generating Activities – Financial Statement formats specific to health care and agreement to profit distribution schedules

Statements of Revenue and Expenses – Income Tax Basis (With the accountant’s compilation report of September 18, 2012) For the months ended August 31, 2012

Profit Distribution and Physician Productivity – Income Tax Basis (With the accountant’s compilation report of September 18, 2012) For the one month ended August 31, 2012

The Business of Medicine – Industry statistics and benchmarking

Comparison to Industry Year-ended 2012

The Business of Medicine – Tax preparation and planning Corporate, Partnership and Individual Not Too Soon to Plan for 2013 Tax Changes by Keith Kamperschroer and Jim Brandenburg in Physicians Money Digest – Soon-to-Plan-for-2013-Tax-Changes Soon-to-Plan-for-2013-Tax-Changes

The Business of Medicine Specialized Services and Revenue Generating Activities – Retirement Plans The owner of a small business has two choices to consider when setting up a retirement plan: a qualified retirement plan or s Simplified Employee Pension (SEP). A qualified plan is any plan that is subject to the ERISA rules, such as a profit-sharing or money purchase plan or a defined benefit pension plan. An SEP is a simplified alternative to a qualified plan, in essence a group IRA with individual accounts.

Comparison of Features of Various Qualified Retirement Plans

The Business of Medicine Specialized Services and Revenue Generating Activities – Practice management operations review CPA prepared reports – A/R analysis – Provider analysis – Service line revenue/cost analysis – Analysis of month-end reports Accounts receivable

The Business of Medicine Specialized Services and Revenue Generating Activities – Internal controls Separation of Duties – Controls in systems » Dual access and management » Limitations on access » Time off requirements; require staff to take vacations – Workflow analysis and access » Determine weak areas in controls – Work with CPA to monitor and provide business physical

The Business of Medicine Specialized Services and Revenue Generating Activities – Revenue Cycle

The Business of Medicine Specialized Services and Revenue Generating Activities – Employment agreements – Buy/sell agreements – Structuring buy-in/buy-out – Merger and acquisition analysis and facilitation – Practice valuations – Accountable Care Organizations – Managed Service Organizations – Healthcare cooperatives

The Business of Medicine Additional Specialized Services – Practice start-ups – On-going practice management – Accounts receivable management – Coding and documentation review – EMR strategic planning and implementation

The Business of Medicine Additional Specialized Services – There are organizations that can help you with compliance plan development. – Separate certificates are also available

The Business of Medicine Additional Specialized Services – HIPAA – privacy and security risk assessment – Fee reimbursement and utilization assessment – OSHA internal control plan development and training – Business/malpractice insurance evaluation – Personnel and human resource management – Employee benefit costs – Recruiting assistance

The Business of Medicine Additional Specialized Services – Individual financial planning and wealth management – Risk management consulting – business and individual insurance analysis

The Business of Medicine Additional Specialized Services – Retirement plan design and implementation

The Business of Medicine Additional Specialized Services – Audit and assurance services – Technology advising

Kolb+Co.’s Health Care Niche Development of the Health Care Industry Niche – Development of industry expertise and reputation – “Back office” for many practices

Keys to Success Look for ways to add value –Go beyond the numbers Look for opportunities that can be replicated in other practices –Compliance plan Make your health care niche known –LinkedIn, Twitter, Facebook page etc. –Form an advisory group of professionals for your area – quarterly meetings

Health Care Today & Tomorrow Health Care Industry today – Obstacles – Opportunities Health Care Industry in the Future – Obstacles – Opportunities

Organizations to Join HCAA (National CPA Health Care Advisors Association) PVN (Physician’s Viewpoint Network) MGMA (Medical Group Management Association) State MGMA associations HIMSS (Health Information and Management Systems Society) Compliance Resources

Questions Thank you! Keith Kamperschroer, CPA, CHCC Robert Denkert, CPA