Profits Are Not The Motive… They Are The Reward!

1. Profits Are Not The Motive… They Are The Reward! Surgically Correcting all of the Challenges John V. Guiliana, DPM. MS

2. “I feel like I’m working harder and harder for less and less”

3. What’s Costing You? • Reduced Reimbursements? • Rising Expenses? • Ridiculous Regulatory Issues? Mi$$ed Opportunities!

4. Thinking “Surgically” and Keeping Your Fingers on the Pulse of Things…

5. Our Theoretical Practice

6. Total Visits

7. Total vs New Target should be greater than 10.0%. Lower than benchmark might mean that the practice is not offsetting the typical attrition rate of a medical practice.

8. New Patient Coding

9. Established Patient Coding

10. New vs Established Weighted Average Coding 2.10 1.85 A weighted average compares coding level to it’s utilization. For example, equal numbers of level 2 codes to level 3 codes = 2.5

11. Accounts Receivables - Percentages Target is to have less than 15% of total A/R in buckets greater than 90 days. This looks excellent

12. Total Visits vs Services Industry 3.0 1.5 22.0 4.0 3.0 1.5

13. Our Priorities and Action Plan

14. Priority 1. Aged Claims ??? 2. Marketing ??? Coding ??? 3. 4. Services ???

15. Action Plan • Assign most qualified staff member the duty of investigating the details of claims over 60 days old. • Re-file • Appeal • Write Off Remember the Who, What, When Rule!

16. Action Plan • Assign most qualified staff member the duty of initiating a Marketing Plan • Budget • Design • Execute Outsource?

17. Action Plan • Attend Coding Seminars and institute a Coding Compliance and Auditing Policy

18. Action Plan • Develop and Adhere to EB Clinical Protocols Assign Protocol Compliance Officer

19. Protocol Adherence and Measurement

20. Rationale for protocols Uniquely similar Consistent quality outcomes Perceptual credibility Anticipatory staff Streamlined processes Cost reduction Improved revenues

22. Measuring an Effect of Clinical Protocol Adherence The Per Visit Value (PVV)

23. Measuring The Effect of Clinical Protocols Foot Care Associates Per Visit Value PVV = Total collections / Total Patient Visits

24. Action Plan For Foot Care Associates (if clinical protocols are being complied with) • Payer Reimbursements ? • Billing and Collection Protocol ? ? ?

26. Action Plan For Foot Care Associates (if clinical protocols are being complied with) • Payer Reimbursements ? • Billing and Collection Protocol ? • Volume and Physician Extenders ? ?

27. A look at our practice’s payroll • The Payroll Ratio ( payroll / collections ) x 100

28. Foot Care Associates Payroll Ratio Payroll Ratio = (Total Payroll / Collections) X 100

29. Cross Referencing Data to Improve the Puzzle

30. Foot Care Associates Heel Pain versus Orthotics

32. Summary of Reports • Monthly A/R Report P/L Statement CPT Analysis ICD Analysis Total Charges Total Adjustments • Quarterly Random fee schedule cross reference (10-15 claims per top 5 carriers) • Annual Per Visit Value

33. jguiliana@aappm.org