MCV PHYSICIANS ANNUAL MEETING

1. MCV PHYSICIANSANNUAL MEETING OCTOBER 25, 2007 Part 2

2. MCV PHYSICIANSANNUAL MEETING OCTOBER 25, 2007 Revenue Cycle and Billing Systems Greg V. Strickland, MHA, CMPE Director of Revenue Cycle Services

3. Topics • Annual Performance Update • P4P: Impact on MCVP • Health Professional Shortage Area (HPSA) • National Provider Identification Program • Things That Keep Me Awake at Night

4. I. Performance

5. Accomplishments (Since May 2007 Semi-Annual Meeting) • Investigated and implemented HPSA payment program. • Reviewed (with Orthopaedics) and began negotiations for additional compensation for Worker’s Compensation. • Reallocated Bad Debt Placements with Collection agencies to maximize collections (Increase “Seasonal Program”). • Investigated and implemented PQRI program with Compliance and Clinical Departments. • Realigned payor reporting for consistency with MCVP and MCVH (pending HPA).

6. Accomplishments (Continued) • Investigated and planned implementation of automated eligibility product (will reduce FTEs and improve verification process to less than 10 seconds). • IMaCs update – implemented in July 2006. • Identified $459k in underpayments. • Received $230k in additional payments. • Also found $100k in “false positives”. • Obtained approval to begin e-statements for patients (Cost = current statements). • Realigned Referral Management activities to transition focus on pre-authorizations as referral requirements decrease.

7. Accomplishments (Continued) • Developing Teams to address HPA impact on MCVH and MCVP. • Reduced billing cost as a percent of collections. • Savings passed to Departments monthly.

8. II. MCVP Billing Expenses(As a % of Net Collections)

9. III. Pay for PerformanceImpact on MCVP Billing • P4P for physicians is still in it’s infancy. • Anthem • Limited programs (Cardiology, Primary Care) • < $50,000 for MCVP • Other payors (United, Cigna, etc) have “gold star” programs but data are flawed. e.g., Limited number of MCVP providers since payor claims many MCVP providers are not Board Certified.

10. P4P- PQRI • Medicare PQRI program began July 1, 2007 • CMS refers to PQRI as “Value Based Purchasing” • Data are submitted via the billing process using CPT II and G-codes with appropriate diagnosis • Hospital data submitted retrospectively; Physician data submitted concurrently • Submitted with $0.00 charge • (Required GE-IDX BAR programming)

11. P4P-PQRI Example- Melanoma • CPT: 99203 (Outpatient; New) • ICD-9: 172.0 • CPTII: 2029F

12. P4P - PQRI And if that was not complicated enough… In order to receive the bonus, each provider who participates must: • Pick at least 3 Quality Measures. • Report on at least 80% of the Medicare patients that meet the criteria of the 3 Quality Measures.

13. P4P- PQRI Risks • “No good deed goes unpunished” • CMS has indicated that it WILL Audit providers who participate in PQRI. • CMS reserves the right to not only review the PQRI measure, but the service that was provided.

14. P4P-PQRI Risks Providers have asked: • If they are more likely to be audited if they don’t meet the 80% threshold? (to be determined) • If CMS finds issues with the documentation, will other audits follow? (most likely)

15. P4P-PQRIMCVP’s Approach • A “slow and deliberate approach”. • Not prepared to manage a P4P approach. • This is a “quality” initiative more than a “revenue” initiative. • Estimated Revenue for MCVP – less than $80,000. • The costs to fully implement would most likely be greater than the incentive. • Developed Methodology

16. P4P-PQRIMCVP’s Approach • Prior to starting PQRI: • Must select only 3 Quality Measures • Must review documentation with Compliance • Must pilot process and pass review from Compliance on encounter and PQRI (e.g., PQRI, attestation, etc.) • If Compliance cannot validate documentation, no PQRI data are submitted to CMS. • Once PQRI data are submitted, Compliance will continue periodic review and PQRI will discontinue if validation is not met.

17. P4P – PQRISummary of MCVP’s approach MCVP… • has implemented a slow and deliberate approach to PQRI. • will gain limited experience in PQRI (i.e., P4P) on a larger scale. • will need to determine a response to P4P if this trend continues.

18. IV. Health Professional Shortage Area (HPSA) • CMS provides additional compensation to providers who work in HPSAs. • CMS utilizes 3 different “tests” to determine HPSAs. • One test is reviewing the ZIP codes of the patients that are served. • The main VCUHS Campus was identified as a HPSA based on the ZIP code test.

19. HPSAs Too good to be true? • Received notification in Spring 2007. • Reviewed Regulations for HPSA. • Obtained Clarification from Trailblazers (CMS Medicare Carrier) in writing. • Requires a modifier to be added to claims. • Business Office adds programming logic to add modifiers . • The payment calculation is an additional 10% above what Medicare pays (not allows).

20. HPSAs • Not paid with claim but a separate quarterly payment • Impact for MCVP- > $1 million/year for FY 2008 • Received ~$165,000 to date • (received ~ ½ of quarterly payment due to timing)

21. V. Things That Keep Me Awake at Night • National Provider Identifier (NPIs) • CMS gave original deadline of May 23,2007. • On May 15, 2007 delayed final deadline to May 23, 2008. • CMS gave providers option to begin May 23, 2007 but no later than May 23, 2008. • MCVP began using NPIs May 23, 2007. • CMS was not ready. • Result: 2 weeks of claims (~$1.2 million delayed).

22. NPIs Impact of NPIs • Delayed billing in 2007. • Potential delayed billing in 2008. • NPIs required also for referring physicians for consultative services (e.g., Consults, Radiology, Pathology, etc). • MCVP sent ~3,500 letters to referring providers to obtain their NPIs. • Down from 3,500 to < 200 providers. • Will need help from Departments to obtain 100%.

23. NPIs Impact of NPIs (Continued) • Impact for Individual Providers. • You now have one NPI that will follow for the rest of your career. • Treat it as your DEA number. • Changing information on your NPI may have a negative impact in MCVP’s ability to bill for your service. • Please coordinate with Medical Staff Services.

24. Things That Keep Me Awake at Night(continued) • HPA (New Hospital Billing System) MCVH will use GE-IDX. • “Joined up to the hip”. • MCVH’s success will be MCVP’s success. • Process changes are all ready starting. • When the HPA conversion occurs, MCVP Billing may be “down” for 2-3 days. Current staff are “rising to the occasion” • Need to maintain the momentum. • Retaining and Rewarding Staff While Simultaneously Reducing Costs.