1. MiPCT Financial Reporting Templates
Carla A. Galligan
Consultant

2. Why Financial Reporting
Financial reporting will ensure accountability for the funds received.
Reporting will reconcile revenue collected and expenses.

3. Reporting Templates There are 4 reporting templates:
Revenue and Membership
Care Coordination
Practice Transformation
Incentive

4. Basic components of all templates
Revenue (cash collected)
Membership ( corresponds to cash collected)
Expense

5. Payers included in reporting
Blue Cross Blue Shield of Michigan
Blue Care Network
Medicare
Medicaid Managed Care

6. Reporting Deadlines
Reports submitted on a quarterly basis for Care Coordination and Practice Transformation .
Incentive reporting is for a 6 month period.
PO/PHO’s will be given 30 days after the quarter end to submit reports .
Due dates:
May 1, 2012
July 31, 2012
October 31, 2012
January 31, 2013
Data will be submitted electronically. Details on electronic transmission will be finalized by Jan 1, 2012 and will be communicated to PO/PHO’s.

7. Summary of Payer Membermonths and Revenue
This worksheet purpose is to summarize all payer revenues.
Care Coordination payments are made directly to PO’s for Medicare and Medicaid Managed Care.
Care Coordination payments are made to Practices for BCBSM and BCN.
Practice Transformation payments are made to practices for all payers.

8. Summary of Payer Membermonths and Revenue
Care Coordination
PMPM
Membermonths
Revenue
Payer
BCBSM
$3.00
1,698,018
$5,094,054.00
BCN
885,216
$2,655,648.00
Medicare
$4.50
540,747
$2,433,361.50
Medicaid Managed Care
600,675
$1,802,025.00
Total
3,724,656
11,985,088.50
Practice Transformation
$1.50
$2,547,027.00
$1,327,824.00
$2.00
$1,081,494.00
$901,012.50
$5,857,357.50

9. Care Coordination Template
The care coordination template will present all revenue and expenses as outlined in Implementation Plan C.

10. Care Coordination Reporting Template
Revenue
$11,985,088.50
CARE COORDINATION EXPENSES
COMPENSATION
$6,500,000.00
OVERTIME
$750,000.00
BENEFITS
$2,145,000.00
TRAINING
$150,000.00
EDUCATION
$375.00
CERTIFICATION
$25,000.00
TRAVEL
MEETING COST
$6,000.00
OTHER:EXPLAIN
$0.00
TOTAL CARE COORDINATION EXPENSE
$9,601,375.00
NET INCOME (LOSS) CARE COORDINATION
$2,383,713.50

11. Care Coordination Expenses
Care Coordination expenses are amounts spent during the reporting period.
Expenses and FTE’s will be cross referenced to Implementation Plan C.
Descriptions of Expenses:
Compensation, Overtime, Benefits, Training,
Education, Certification, Travel, Meeting Costs and Other (explain).

12. Care Coordination Expense Documentation Requirements
The PO’s/PHO’s must complete the FTE spreadsheet as support for Care Coordination Expenses.
The FTE spreadsheet purpose is to reconcile compensation and benefit expense as reported .
PO’s/PHO’s will include Implementation C plan FTE data as a data element.

13. Care Coordination support for FTE’s and Benefits
Care Coordination FTE Detail
Practice
Hire
Total Hours
Total
Total Employee
Implementation Plan
Practice Location
Name
Employee Name
Position
Date
Hourly Rate
worked
Compensation
Benefit Expense
C FTE
Detroit
Detroit Physician Group
Susan Scott
MCM
1/1/2012
$40.00
160
$6,400.00
$2,000.00
1.00

14. Practice Transformation Template
The Practice Transformation template will present revenue and expenses as outlined in Practice Plan Phase 1.

15. Practice Transformation Reporting Template
Revenue
$5,857,357.50
PRACTICE TRANSFORMATION EXPENSES
COMPENSATION
$2,000,000.00
OVERTIME
$200,000.00
TRAINING
$50,000.00
EDUCATION
$7,500.00
CERTIFICATION
$8,000.00
CARE MANAGEMENT SOFTWARE
$10,000.00
COMPUTER
$15,000.00
FAX
$50.00
INTERFACE REGISTRY
$16,000.00
MINOR EQUIPMENT
$500.00
MEETING COST
$125.00
PATIENT SURVEY COST
$750.00
PRACTICE COACHING
POSTAGE
$150.00
REFERENCE MATERIAL
$650.00
RENT/SPACE
$900.00
STAFF TRAINING
$200.00
SUPPLIES
TELEPHONE
TRAVEL
$36.00
OTHER
$1,000.00
$2,000.00
$3,000.00
Total Practice Transformation Cost
$2,316,611.00
NET INCOME (LOSS) PRACTICE TRANSFORMATION
$3,540,746.50

16. Practice Transformation Expenses
Practice Transformation expenses are amounts spent during the reporting period.
Expenditures will be cross referenced to Practice Plan Phase 1 item C. Expenditure deviations from the submitted plan are permitted.
Support for FTE’S and Expenses > $ (single transaction) are required.
Expenses other than Salary and Benefit cost can be assigned on a direct cost or allocation methodology.
The allocation methodology can be used for expenses such as postage, office supplies, telephone etc..
A column has been added to the templates for designation D – Direct, and A- Allocation.
Support for FTE expenses will be the same as required for Care Coordination.
PO/PHO’s must complete a supplemental report for single disbursements > $

17. Practice Transformation support for FTE’s and Benefits
Practice Transformation FTE Support
Practice
Hire
Total Hours
Total
Total Employee
Implementation Plan
Practice Location
Name
Position
Date
Hourly Rate
worked
Compensation
Benefit Expense
C FTE
Ann Arbor
Ann Arbor Physicians
Joan Right
Receptionist
1/1/2012
$40.00
160
$6,400.00
$2,000.00
1.00

18. Practice Transformation Support for Single Transaction Expense> $5000.00
MIPCT Support for Practice Transformation costs
Single Transaction >$
Reporting Entity:
Date:
Prepared by:
Expense
Amount included in
Location
Practice Name
Category
Vendor
Description of Item
Amount
Date
Practice Plan

19. Excess Medicaid Managed Care Funds
PO/PHO’s will be allowed to roll forward no more than 20% of Medicaid Managed Care excess of revenue over expense for each reporting module (Care Coordination and Practice Transformation).
An allocation methodology will be used to determine expense by payer using membermonths as the basis for the allocation of expense.
The 20% roll forward will be allowed only if supported by documentation as to why the funds were not expended in the year.
Amounts > 20% will be offset beginning February 2013.

20. Care Coordination Cost Methodology
Description
Total Expenses
BCBSM
BCN
CMS
Medicaid Managed Care
Total
Care Coordination PMPM
$3.00
$4.50
Member months
885216
540747
600675
Revenue
$5,094,054.00
$2,655,648.00
$2,433,361.50
$1,802,025.00
$11,985,088.50
CARE COORDINATION EXPENSES
COMPENSATION
$6,500,000.00
$2,963,258.08
$1,544,814.88
$943,672.52
$1,048,254.52
6,500,000
OVERTIME
$750,000.00
$341,914.39
$178,247.87
$108,885.29
$120,952.45
750,000
BENEFITS
$2,145,000.00
$977,875.17
$509,788.91
$311,411.93
$345,923.99
2,145,000
TRAINING
$150,000.00
$68,382.88
$35,649.57
$21,777.06
$24,190.49
150,000
EDUCATION
$375.00
$170.96
$89.12
$54.44
$60.48
375
CERTIFICATION
$25,000.00
$11,397.15
$5,941.60
$3,629.51
$4,031.75
25,000
TRAVEL
MEETING COST
$6,000.00
$2,735.32
$1,425.98
$871.08
$967.62
6,000
OTHER:EXPLAIN
$0.00
TOTAL CARE COORDINATION EXPENSE
$9,601,375.00
$4,377,131.09
$2,281,899.53
$1,393,931.34
$1,548,413.04
NET INCOME (LOSS) CARE COORDINATION
716,922.91
373,748.47
1,039,430.16
253,611.96
2,383,713.50

21. Practice Transformation Cost Methodology
Practice Transformation PMPM
$1.50
$2.00
Member months
1,698,018
885,216
540,747
600,675.00
3,724,656
Revenue
$5,857,357.50
$2,547,027.00
$1,327,824.00
$1,081,494.00
$901,012.50
PRACTICE TRANSFORMATION EXPENSES
COMPENSATION
$2,000,000.00
$869,684.67
$453,386.70
$369,277.10
$307,651.53
OVERTIME
$200,000.00
$86,968.47
$45,338.67
$36,927.71
$30,765.15
TRAINING
$50,000.00
$21,742.12
$11,334.67
$9,231.93
$7,691.29
EDUCATION
$7,500.00
$3,261.32
$1,700.20
$1,384.79
$1,153.69
CERTIFICATION
$8,000.00
$3,478.74
$1,813.55
$1,477.11
$1,230.61
CARE MANAGEMENT SOFTWARE
$10,000.00
$4,348.42
$2,266.93
$1,846.39
$1,538.26
COMPUTER
$15,000.00
$6,522.63
$3,400.40
$2,769.58
$2,307.39
FAX
$50.00
$21.74
$11.33
$9.23
$7.69
INTERFACE REGISTRY
$16,000.00
$6,957.48
$3,627.09
$2,954.22
$2,461.21
MINOR EQUIPMENT
$500.00
$217.42
$113.35
$92.32
$76.91
MEETING COST
$125.00
$54.36
$28.34
$23.08
$19.23
PATIENT SURVEY COST
$750.00
$326.13
$170.02
$138.48
$115.37
PRACTICE COACHING
POSTAGE
$150.00
$65.23
$34.00
$27.70
$23.07
REFERENCE MATERIAL
$650.00
$282.65
$147.35
$120.02
$99.99
RENT/SPACE
$900.00
$391.36
$204.02
$166.17
$138.44
STAFF TRAINING
$200.00
$86.97
$45.34
$36.93
$30.77
SUPPLIES
TELEPHONE
TRAVEL
$36.00
$15.65
$8.16
$6.65
$5.54
OTHER
$1,000.00
$434.84
$226.69
$184.64
$153.83
$2,000.00
$869.68
$453.39
$369.28
$307.65
$3,000.00
$1,304.53
$680.08
$553.92
$461.48
TOTALPRACTICE IMPLEMENTATION COST
$2,316,611.00
$1,007,360.53
$525,160.31
$427,735.70
$356,354.46
NET INCOME (LOSS) CARE COORDINATION
$3,540,746.50
$1,539,666.47
$802,663.69
$653,758.30
$544,658.04

22. Calculation of Medicaid Managed Care Excess Funds
Care Transformation
Total Excess Funds
$253,611.96
Total Revenue
$1,802,025.00
20% roll forward cap
$360,405.00
Excess funds % to revenue
14.07%
Provide explanation of how roll forward expenses will be used:

23. Practice Incentive Reporting
Practice Incentive reporting is defined as all payments received by the PO’s/PHO’s for Medicare and Medicaid Managed Care only.
PO/PHO’s will report funds disbursed to practices.
Reporting requirements are by payer and include: Practice name, Location, Amount, Date.
PO’s/PHO’s are subject to a maximum retention of 20% of the total Incentive dollars received.
The retention of the PO/PHO Incentive dollars >20% may require documentation supporting the dollars retained.

24. Draft Incentive Reporting Module
Medicare
Medicaid Managed Care
Total Incentive Funds Received by PO/PHO
$1,000,000.00
$500,000.00
Incentives Paid to Practices:
Name of Practice
Location
Date
Robert Smith M.D.
Detroit
7/1/2012
$500.00
$675.00
Total Incentives Paid
Net Retention of Incentives withheld by PO
$999,500.00
$499,325.00
% of retention withheld by PO
99.95%
99.87%

25. Questions
Questions on MiPCT Financial Reporting can be submitted to contact us.

26. Narrative status update
Clare Tanner and Carol Callaghan
Narrative status update

27. Overview Narrative Status Update Detail will vary by quarter
6 and 12 month report require practice level detail
3 and 9 months, brief PO- level overview
Avoids duplication of SRD and Quarterly PGIP Progress reports

28. Narrative Status Update
Content: based on year 1 requirements and priorities
Care Manager hiring progress and barriers
Infrastructure implementation progress across practices
Electronic registry functionality
Care Management documentation
Transition notifications
Opportunity to communicate barriers and successes

29. Care Management Activity Reporting
Minimum core data: 
Number of encounters per care manager, by payer
Will be required beginning third quarter 2012
Necessary for reporting to participating payers and MDCH
Need to understand PO/practice reporting capacity to minimize burden 

30. Submission Due dates for quarterly reporting
May 1, 2012
July 31, 2012
October 31, 2012
January 31, 2013
Submission: to