Office Operations: Using today’s technology to improve your practice’s billing effectiveness

1. Office Operations:Using today’s technology to improve your practice’s billing effectiveness presented by: Alta Partners, LLC Stan Kasmarcak, CPA Principal

2. Agenda • Introduction to Alta Partners • Using Today’s Technologies in Billing Software to improve you billing effectiveness • IS tools for • Front Office Scheduling • Patient Check Out • Charge Entry • Using your billing system to provide a system of internal controls in your office • Use of Claims Scrubbers to improve % of “clean” claims sent • Conclusions and Q&A

3. Alta Partners Comprehensive Billing and Practice Management Experience • Billing • Managed $54 million in charges for 120 physicians in 2000 as part of the Fairview Medical Group • Managed $35 million in charges for 80 physicians in 2001 and 2002 • Estimated charges of $45 million for 101 physicians in 2003 • Estimated charges of $66 million in 2004 • Utilize Misys Vision/Optimum software since 1997 • Practice Management • Experienced practice managers for groups ranging in size from start-ups to 100 physicians • Experienced in building, managing & divesting practices • Experienced with both private practice & system owned groups • Healthcare Consulting • Fair Market Valuations on physician practices • Practice Operational Assessments, Billing Office Assessments, Financial Assessments • Practice Development / Divestiture strategies & implementation • Physician Compensation Plan Design • Healthcare Litigation Support

4. Dermatology Emergency Medicine Family Practice Family Practice Residency Hematology & Oncology Internal Medicine Internal Medicine Residency Neonatology Nephrology Neurology Obstetrics & Gynecology Occupational Medicine Orthopedics Pain Management Pediatrics Perinatology Physical Medicine & Rehabilitation Radiology Psychiatry Psychology Radiation Therapy Radiology Surgery, General Surgery, Plastic Urgent Care Alta PartnersBreadth in Physician Billing Expertise

5. Front Office Scheduling Tools • User customization • Custom physician templates • Encounter forms printed by batch or demand • Alert notes notify staff when special patient needs or financial status is of concern • Multiple view formats on screen • Label print features for charts and mailings • Physician time management • Distribution of appointments on screen to help manage physician efficiency and productivity • wait lists for patients who can show up with little notice to fill holes due to cancellations or no-shows • patient recall features integral to the product • Schedule follow-up appointments at check out

6. Front Office Scheduling Tools • Strong internal control features make sure all scheduled appointments are accounted for • Missing Appointment / Cancelled Appointment Reports ensure all office charges are captured • Schedule surgeries and due dates (for deliveries) to avoid missing charges • Schedule hospital and nursing home rounds to avoid missing charges (no time slots needed plus the nursing home rosters won’t change often)

7. Front Office Scheduling Tools • Maximize the information obtained during the “check in” process: • Verify patient identity • Privacy notice • Billing information • Copy of insurance card • Identify responsible party and obtain signature each visit • Advance discussion of any non-covered services -obtain ABN form • Verify receipt of referrals, pre-certifications, & pre-authorizations • Attach any forms and labels required for the day’s services • Ask patients if a work/school excuse is required or any other paperwork that may need to be completed

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13. Front Office Procedures Patient Registration - (behind the scenes) • Security • Limit screen views by log-in • Viewing patient data can be limited to activities specific to practice • Customization of data fields • Required fields by practice - ensures accuracy • ex. IM practice requires SS#, Pediatric practice does not • Default fields by user- saves time • ex. Sex defaults to female for an OB/GYN practice • Complete and easy insurance registration • Co-pay, PCP, effective dates, and insurance verification can all be entered at time of registration • All edits stay with patient permanently - great internal control!

14. Patient Checkout Tools • Prepare staff to ask for co-pays; offer MC/Visa; print demand statement with return envelope • Explain payment policy (also include in practice brochure & explain to all new patients on 1st visit) • Encourage patient to schedule follow-up appointments • Verify referrals/authorizations for the next visit or for a specialist • Review physician orders, lab tests, answer questions • Provide patient with what to expect: how to prepare information sheet, fee schedule, hospital procedures

15. Front Office Procedures Charge Entry • Entry of patient, physician, facility, referring physician, group number, all insurance information, co-pay amount and responsible party information is automatically completed by the scheduling module • CPT and ICD-9 coding completed by physician based on chart documentation • Charge entry and co-pays can be either batch entered at end of day or real time

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17. Internal Control Management-Let your billing system protect your office assets • Warning Signs • Overly dedicated employee • Cancelled checks that are not posted on accounts • Frequent use of whiteout • Copies of ledgers, reports, encounter forms - no originals found • Missing documentation • NSF checks missing from month-end reports • Segregate Job Duties & Authorization • Opening mail • Posting payments and contractual adjustments • Creating deposits • Master file access • Write-offs (mandatory written physician consent) • Customer Service calls should be rotated among staff

18. Internal Control Management-Let your billing system protect your office assets • Deadlines for Completing Billing Activities • Charge Entry • Payment Posting • Daily close: manual and systematic • Statement mailings • Claim filing • Deposits • Bank reconciliation against your ledger as well as your computer system • Appointment reconciliation against charges • Firm, clearly written policies for safeguarding assets: • Petty cash and the change drawer should never be one and the same and should be audited regularly • Confidential system logins or passwords may not be shared • If an employee is given a key or access to a given area, this should not be shared with other employees

19. Internal Control Management-Let your billing system protect your office assets • Create financial codes in your system to monitor financial activities • Never use miscellaneous • Create contractual adjustments by insurance company • NSF checks (is this a payment or an adjustment?) • Interest • Unidentified • Assure you see everything clearly on reports and that no information is being withheld • Familiarize yourself with practice systems • Monitor for “dummy” accounts - patients as well as insurance • Do not allow use of white out. Corrections should consist of a single thin diagonal line through the corrupt data, the addition of the correct data, and initialed by the person who made the correction

20. Claim Submission-IT to ensure claims are “clean” the first time • Claims are submitted daily and are scrutinized through three levels of claim editing: • Misys’s internal claim scrubber, customized by carrier, reviews claim for completeness before transmission • Claim sent to Misys clearinghouse for a second review, first set of FastNotes is electronically received and posted • Claim forwarded to carrier scrubbers for last review, second set of FastNotes is received such as these examples: • Bad policy / group numbers • Insurance claim reference number - (proof of timely filing) • Incomplete or sub-divided diagnosis code • Pending / requested information needed • Notification on pending payment of claim • FastNotes is a proprietary Misys product detailing claim errors identified that is electronically attached to the patient financial history and retained for follow-up and customer service questions.

21. Other Technology EnhancementsUse it to speed up your collections • Electronic Payment Posting • Increases speed and efficiency • Electronic payment file can be utilized for secondary claim submissions by producing the primary EOB on demand or by file. • Electronic Statements • Save time and $$ • Patients statements can be outsourced • Issued by alpha grouping to keeping call flow constant and not OVERWHELM staff

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25. Results after using “Fast Notes” for follow-up COMPARISON OF BILLING STATISTICS - For the years ending 2000 through 2002

26. TechnologyUse it to speed up your collections • Use the Internet to follow-up on accounts • Ohio Department of Insurance(http://www.ins.state.oh.us/) • Ohio BWC medical providers (http://www.ohiobwc.com/provider/default.asp) • Palmetto - Medicare - Provider Information Page (http://www.palmettogba.com) • Anthem (http://www.anthem.com) • Aetna - medial services and tools (http://www.aetna.com/provider/medical_providers.html) • United Healthcare Online Self Service (http://www.unitedhealthcare.com) • Medical Mutual ProviderLink gateway page (http://providerlink.mmoh.com/)

27. Alta Partners, LLCyour partner for practice profitability • For more information, or to schedule an on-site demonstration, please call or visit our website: • Website: www.altapartnersllc.com • Principals: • Dan Kasinec 440-808-3648 • Stan Kasmarcak 440-808-3647 902 Westpoint Parkway Suite 320 Westlake Ohio 44145