1. IMPLEMENTING A MEDICAL BILLING MODEL: STUDENT HEALTH CENTER REVENUE POTENTIAL Donna Hash & Merry Lawrence

2. Presentation Overview Background Getting Started Terms & Definitions Fee Schedule Planning Process Operational Changes Key Considerations Implementing the Process Evaluation Monitoring & Reporting Lessons Learned Next Steps

3. Background: Motivating Factors Our Previous Approach Financial Considerations University Administrative Charges Student Fees Organizational Aims Improve Services to Students Recruit & Retain Quality Clinicians Data In 2008, ~90% of students surveyed were insured* *Based on spring 2010 NCHA data (1,632 student respondents)

4. Getting Started: Exploring New Opportunities Health Services Fee Ongoing cost increases and budget/resources decreases Medical Billing Model (old vs. new) Provide cost-effective services & generate revenue Consistent with industry billing standards Establish a Fee Schedule What to charge? How much? Conversion factor

6. Getting Started: Learning the Lingo

7. In-house Billing vs. Billing Service EMR/EHR Establishing a Fee Schedule Conversion factor CPT, E&M Codes RBRVS Operational Changes: Preliminary Decisions

8. CodeDescription Work Value Non Fac PE FAC PEMalpractice Non Fac Total Fac Total Global Gap 15952Excision, trochanteric pressure ulcer, w/ skin flap closure; 12.3112.03 2.6326.97 090 15953with ostectomy13.5713.29 2.6729.53 090 15956Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; 16.7914.05 3.4234.26 090 15958with ostectomy16.7514.83 3.3934.97 090 16000Initial treatment, first degree burn, when no more than local treatment is required.891.01.34.122.021.35000 16020Dressings and/or debridement of partial- thickness burns, initial or subsequent; small (less than 5% total body surface area).711.56.770.102.371.58000 16025Medium (eg, whole face or whole extremity or 5% to 10% total body surface area) 1.742.271.260.294.303.29000 16030Large (eg, more than 1 extremity., or greater than 10% total body surface area) 2.082.861.450.375.313.90000 16035Escharotomy; initial incision3.741.53 0.635.90 000 16036Each additional incision (list separately in addition to code for primary procedure) 1.500.69 0.272.46 zzz 17000Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), first lesion 0.651.650.920.082.381.65010

9. CodeDescription Work Value Non Fac PE FAC PEMalpractice Non Fac Total Fac Total Global Gap 17110 Deconstruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other thank skin tags or cutaneous vasular proliferative lesions; up to 14 lesions 0.702.481.270.083.262.05010 Fee for Service Example: Non FAC Total (code value) = 3.26 Sample Conversion Factor = $50.00 Code Value x Conversion Factor 3.26 x 50 = $163.00

10. Contracting with insurance plans Top 3 Clearinghouses Electronic medical claim submission (ERA) Staffing Billing Manager Payment processing Check ICD/CPT codes Create billable claim forms Submit claims (electronically) Correct/re-bill claims Post payments Manage accounts receivables Patient responsibility charges to patient accounts Operational Changes: Key Considerations

11. Utilize Practice Management Software/EMR Document patient information (e.g., store ID cards) Use reporting tools 3 Primary Reports: Accounts Receivable Aging Report Payer Mix Analysis Summary of Charges Analyze by transaction code Operational Changes: Insurance Aging A/R

12. A/R Report: Patient charges detailed by plan Aging “buckets” Focus on oldest claims Analysis of aging conducted by the Billing Manager Evaluation: Monitoring & Reporting

13. Evaluation: Payer Mix Analysis

14. Evaluation: Summary of Charges

15. Provider Cooperation & Coordination Clinical staff buy-in Management support Billing Office Staff Professional development Reporting Process Payment codes, adjustment codes, charting system, missed charges etc. Monitor reimbursements for errors Annual Technology Upgrades Plan for changes & train staff Lessons Learned

16. Next Steps Adapt to ACA Contract with additional insurers Adjust fee schedule Consider the value of an in-house patient advocate Student advisory board Financial assistance plan Prepare for ICD 10 October 1, 2015 expected implementation Continue to support the health & well-being of students

17. Contacts & Resources Contacts at WSU: Donna Hash, Administrative Manager Health & Wellness Services 509.335.6759 donna.hash@wsu.edu Merry Lawrence, Billing Office Manager Health & Wellness Services 509.335.5293 mklawrence@wsu.edu Online Resources: Resource-Based Relative Value Scale www.ama-assn.org//ama/pub/physician-resources/solutions- managing-your-practice/coding-billing-insurance/medicare/the- resource-based-relative-value-scale.page Medical Group Management Association www.mgma.com American Medical Association www.ama-assn.org/ama/pub/physicians/physicians.page Credentialing & Contracting Article www.articlesbase.com/business-articles/improve-your- practice039s-financial-health-focus-on-the-four-ps-in-a-pod- patients-payers-payments-and-productivity-2003088.html