FORGET TODAY! WHAT DO WE DO TOMORROW? 2009

1. FORGET TODAY! WHAT DO WE DO TOMORROW?2009 A Management overview of the year ahead This session will review all the topics to be covered for the year and discuss performance metrics, setting Lead and Lag measures, preparing your culture for change and many other core elements to get you ready for the year ahead. February 26 May 14 June 11 March 12 April 9 • Proactive Billing & Collections: • Billing Frequency • Discrepant Payments • Claims scrubbing • Collections • Operational Refinements I: • Daily Check List • Culture Migration • Suggestive Selling • Staffing: • Teamwork • Customer Service • Training • Stop revenue loss: • Co-pays/Deductibles • No Shows/Fee schedules • Ancillary Services • Quality Care Standards Attendees: Managers, Staff Optional Attendees: Managers, Staff Optional Attendees: Managers, Financial Attendees: Managers, Staff optional July 9 August 13 September 10 October 8 • Operational Refinements II: • Firing Patients • Physician Relations • Collaboration Management • Harvesting the Cash : • Staff Incentives • Suggestive Selling • Extended Visits • Auditing • Technology: • EMR • E-Prescribe • Patient Portals • A Look Ahead: • Budgeting • Strategic Planning • The Current Climate Attendees: Managers, Financial, Providers Attendees: Managers, Providers Attendees: Managers, Staff Optional Attendees: Managers, Financial November 12 The year ahead: This year end session is designed to discuss what went well in 2009, consider outsourcing options and discuss the Four Principles of Execution to ensure 2010 has less bumps in the road. Attendees: Managers, Providers Facilitator: Herbert L. Drayton III

2. Office Management 2009 Series Forget Today!! What Do We Do Tomorrow?? February 26 Office Managers Kickoff Meeting : A Management overview of the year ahead

3. The Management Series Ground Rules • The facilitator does not know everything • Neither does the audience • We are all Leaders • We are all Managers • We are open minded • We do not have a scarcity mentality • We do have an abundance mentality • We always hire talent better than our best talent • We develop our best talent • No more than five power point slides per session

4. 8 Stages of ChangeExcerpt from: “Leading Change” by John P. Kotter • Establishing a sense of urgency • Creating a guiding coalition • Developing a Vision and Strategy • Communicating the Change Vision • Empowering Employees for Broad-Based Action • Generating Short-Term Wins • Consolidating Gains and Producing More Change • Anchoring New Approaches in the Culture

5. "When you can measure what you are speaking about and express it in numbers; you know something about it, but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meager and unsatisfactory kind." --Lord Kelvin

6. Lead and Lag Measures The lag measures are metrics that are obtained after the event is over- the destination, whereas the Lead measures are things that have to happen, things you have to measure or the drivers that help reach the destination Lag Measure: Revenue, money in the door, all receipts for a given month Examples of Lead Measures Visits Charges Charge per patient No shows Cancellations High volume services Weekly Receipts Daily Receipts Accounts Receivables Collection Activity

8. Office Management 2009 Series Forget Today!! What Do We Do Tomorrow?? March 12 Stop Revenue Loss

9. Forget Today!! What Do We Do Tomorrow?? The Lag measures are metrics that are obtained after the event is over- the destination, whereas the Lead measures are things that have to happen, things you have to measure or the drivers that help reach the destination Lag Measure: Revenue, money in the door, all receipts for a given month Typical Lead Measures

10. Forget Today!! What Do We Do Tomorrow?? Co-Pay • A co-pay is an agreement between the insured and the insurer • A co-pay is a mechanism used to minimize abuse • A co-pay must be paid at the time of service by the insured Deductibles • A deductible is an agreement between the insured and the insurer • A deductible is a mechanism used to minimize abuse • A deductible can be used to manage the cost of premiums • A deductible must be satisfied prior to insurer liability activation

11. No Shows Charge a no show fee Utilize staff to call patients and offer to write off no show fee if patient reschedules Utilize an appointment reminder system 25 patients daily with a 15% no show rate (3.75 patients/day) x (260 work days) = 975 visits (975 visits) x ($50) = $48,750 25 patients daily utilizing an appointment reminder system (25 patients) x (260 work days) = 6,500 annual visits 6,500 x .21 (cost of reminder service)= $1,365 Forget Today!! What Do We Do Tomorrow?? • Fee Schedule • Request a fee increase annually in writing • Be careful with links to Medicare • Run an analysis to identify high utilization codes • Always use catch- all language at the end of the request

12. Forget Today!! What Do We Do Tomorrow?? Ancillary Services Evaluation • What ancillary services are currently ordered by the physician group from "outside" providers and can we identify "new" ancillary services to order? • What are the costs of the ancillary equipment and other "hard" assets? • What support will be needed for the ancillary service? • Does the ancillary service require third-party approval? • Collect utilization and payer source data for the ancillary service. • Compare the entire cost of providing the ancillary service in-house to the anticipated reimbursement. • Identify any contractual impediments to providing the ancillary service. • Evaluate the proposal under the Stark Law. • Evaluate the proposal under the Anti-Kickback Statute. • Evaluate the proposal under the Medicare Rules.

13. Staff uncover PRACTICE MANAGER secret

14. Office Management 2009 Series Forget Today!! What Do We Do Tomorrow?? April 9 Operational Refinements I

15. 8 Stages of ChangeExcerpt from: “Leading Change” by John P. Kotter • Establishing a sense of urgency • Creating a guiding coalition • Developing a Vision and Strategy • Communicating the Change Vision • Empowering Employees for Broad-Based Action • Generating Short-Term Wins • Consolidating Gains and Producing More Change • Anchoring New Approaches in the Culture

16. Finding Complacency and false urgency • Are critical issues delegated to consultants or task forces with little involvement of key people? • Do people have trouble scheduling meetings on important initiatives (“Because, well, my agenda is so full”)? • Is candor lacking in confronting the bureaucracy and politics that are slowing down important initiatives? • Do meetings on key issues end with no decisions about what must happen immediately (except the scheduling of another meeting)? • Are discussions very inwardly focused and not about markets, emerging technology, competitors, and the like? • Do people spend long hours developing Power-Point presentations on almost anything? • Do people run from meeting to meeting, exhausting themselves and rarely if ever focusing on the most critical hazards or opportunities? • Are highly selective facts used to shoot down data that suggests there is a big hazard or opportunity? • Do people regularly blame others for any significant problems instead of taking responsibility and changing? • Does passive aggression exist around big issues (“Oh, was that due today? I wasn’t told”)? • Are failures in the past discussed not to learn but to stop or stall new initiatives? • Do people say “We must act now!” and then don’t act? • Do cynical jokes undermine important discussions? • Are specific assignments around critical issues regularly not completed on time or with sufficient quality?

17. Medicare Providers Staff Our World then and Now

18. Some of the activities associated with filling a script What is it costing the practice?

19. Office Management 2009 Series Forget Today!! What Do We Do Tomorrow?? May 14, 2009 PROACTIVE BILLING

20. Initial patient contact (usually by telephone, when this information should be updated and any outstanding balance communicated) Eligibility confirmed prior to appointment Patient registration completed or updated Co-payment, Deductible, Outstanding balance collected Services documented by ancillary staff as per protocol Services documented by provider Encounter form reviewed, additional payment collected if applicable Billing system updated Insurance claim filed within 24 hours Acknowledgement reports reviewed and claims corrected Payment received from insurance carrier Inquiry letter received from insurance carrier Denial received from insurance carrier Patient billed Patient pays the bill Review accounts receivable Collection efforts Account closed 18 Steps to Billing

21. MEDICAL PRACTICE BILLING SEVEN DEADLY S INS SEVEN DEADLY S INS No Co-pay No Deductible OHI Collections Secondary claim Accident Forms Under-coding SEVEN DEADLY SINS

22. "South Carolina Health Care Financial Recovery and Protection Act" http://www.scstatehouse.gov/CODE/t38c059.htm SECTION 38-59-220. Requesting fee schedule from insurer; confidentiality. (A) Within six months of the effective date of this article, each insurer, upon written request from a physician who is also a participating provider will provide, by CD-ROM, or electronically at the insurer's option, the fee schedule that is contracted with that physician for up to 100 CPT(r) Codes customarily and routinely used by the specialty type of such physician. Each physician may request from an insurer an updated fee schedule no more than two times annually. (B) A physician requesting a fee schedule pursuant to subsection (A) may elect to receive a hard copy of the fee schedule in lieu of the foregoing; however, the insurer may charge the physician a reasonable fee to cover the increased administrative costs of providing the hard copy. (C) The physician shall keep all fee schedule information provided pursuant to this section confidential. The physician shall disclose fee schedule information only to those employees of the physician who have a reasonable need to access this information in order to perform their duties for the physician and who have been placed under an obligation to keep this information confidential. Any failure of a physician's office to abide by this subsection shall result in the physician's forfeiture of the right to receive fee schedules pursuant to this section and at the option of the insurer may constitute a breach of contract by the physician. (D) Nothing in this section prohibits an insurer from basing actual compensation to the physician on the insurer's maximum allowable amount or other contract adjustments, including those stated in the patient's plan of benefits, or both. SECTION 38-59-230. Time frame for payment of clean claims; acknowledging receipt of claim; processing of electronic claims by billing service. (A) An insurer shall direct the issuance of a check or an electronic funds transfer in payment for a clean claim that is submitted via paper within forty business days following the later of the insurer's receipt of the claim or the date on which the insurer is in receipt of all information needed and in a format required for the claim to constitute a clean claim and is in receipt of all documentation which may be requested by an insurer which is reasonably needed by the insurer: (1) to determine that such claim does not contain any material defect, error, or impropriety; or (2) to make a payment determination. (B) An insurer shall direct the issuance of a check or an electronic funds transfer in payment for a clean claim that is submitted electronically within twenty business days following the later of the insurer's receipt of the claim or the date on which the insurer is in receipt of all information needed and in a format required for the claim to constitute a clean claim and is in receipt of all documentation which may be requested by an insurer which is reasonably needed by the insurer: (1) to determine that such claim does not contain any material defect, error, or impropriety; or (2) to make a payment determination. (C) An insurer shall affix to or on paper claims, or otherwise maintain a system for determining, the date claims are received by the insurer. An insurer shall send an electronic acknowledgement of claims submitted electronically either to the provider or the provider's designated vendor for the exchange of electronic health care transactions. The acknowledgement must identify the date claims are received by the insurer. If an insurer determines that there is any defect, error, or impropriety in a claim that prevents the claim from entering the insurer's adjudication system, the insurer shall provide notice of the defect or error either to the provider or the provider's designated vendor for the exchange of electronic health care transactions within twenty business days of the submission of the claim if it was submitted electronically or within forty business days of the claim if it was submitted via paper. Nothing contained in this section is intended or may be construed to alter an insurer's ability to request clinical information reasonably necessary for the proper adjudication of the claim or for the purpose of investigating fraudulent or abusive billing practices. (D) A clearinghouse, billing service, or any other vendor that contracts with a provider to deliver health care claims to an insurer on the provider's behalf is prohibited from converting electronic claims received from the provider into paper claims for submission to the insurer. A violation of this subsection constitutes an unfair trade practice under Chapter 5, Title 39, and individual providers and insurers injured by violations of this subsection have an action for damages as set forth in Section 39-5-140.

23. Lucky Seven • Forms • Carrier Mix • Coding Matrix • Billing Frequency • Carrier Compliance • Claims Scrubbing • Collections

24. Scheduler, Receptionist, Clinical Staff, Physicians (Extenders), Discharge, Insurance Biller, Collector

25. Office Management 2009 Series Forget Today!! What Do We Do Tomorrow?? June 11, 2009 Customer Service Teamwork Training

28. Hey, I was out last week- why did she say we have to sit on these things again?

29. Teamwork, Customer Service & Training Glossary of Terms Simple Scenarios Do’s and Don’ts Telephone etiquette

31. Office Management 2009 Series Forget Today!! What Do We Do Tomorrow?? July 9, 2009 HARVESTING THE CASH Staff Incentives Suggestive Selling Extended Visits Auditing

32. Success is harder to live through than failure To make a difference in our world you have to learn to do it different

33. Incentive: Something, such as the fear of punishment or the expectation of reward, that induces action or motivates effort.

34. EXTENDED OFFICE VISITS and SUGGESTIVE SELLING Level 4 Office Visits

35. AUDITING • Charges • Surgeries/Procedures • DME • Financials • Carrier AR • Carrier Compliance • Patient AR • EOBs • Scheduled Ancillary Services • Global periods • “Incident to” Billing

36. The Paradoxical Commandmentsexcerpt from “The 8th Commandment” by Stephen Covey • People are illogical, unreasonable, and self centered. Love them anyway • If you do good, people will accuse you of selfish ulterior motives. Do good anyway • If you are successful, you will win false friends and true enemies. Succeed anyway. • The good you do today will be forgotten tomorrow. Do good anyway. • Honesty and frankness make you vulnerable. Be honest and frank anyway. • The biggest men and women with the biggest ideas can be shot down by the smallest men and women with the smallest mind. Think big anyway. • People favor underdogs but follow only top dogs. Fight for a few underdogs anyway. • What you spend years building may be destroyed overnight. Build anyway. • People really need help but may attack you if you do help them. Help people anyway. • Give the world the best you have and you’ll get kicked in the teeth. Give the world the best you have anyway KENT KEITH

37. Office Management 2009 Series Forget Today!! What Do We Do Tomorrow?? August 13, 2009 Technology EMR E-Prescribe Patient Portals

39. Do not Implement electronic prescribing or Electronic Medical Records for the following reasons • Safe • Secure • Formulary Discipline • Generic Utilization • Provider Efficiency • Drug-Drug Interaction • Allergy Interaction • Pharmacy Call backs • Patient Calls • Handwriting Errors • Multiple MDs Share data • Less Paper work • Faster Access to Data • Prevent Medication Errors • Reduced Insurance Premiums • Improved Reimbursement Rates • Increase Patient Satisfaction • Clinical Trials Revenue • Increased Patient Safety • Repurpose Storage Space • Reduce Supply Expenses • Reduce Patient Callbacks • Faster A/R Cycle • MEDICARE/STIMULUS INCENTIVE

40. South Carolina Facts Year End 2008 • % of Patient Visits w. a Prescription Benefit Request 2.59% National Rank: 47 • % of Total Prescriptions Routed Electronically • 1.25% National Rank: 48 • % of Physicians Routing E-Prescriptions at Year End • 6.71% National Rank: 43 • % of Patients with Available Rx Benefit Information 61.13% National Rank: 31 • % of Total Community Pharmacies E-Prescribing • 78.80% National Rank: 21

41. Some of the activities associated with filling a script What is it costing the practice?

42. Leaders and managers either: stand out or out in front

43. Office Management 2009 Series Forget Today!! What Do We Do Tomorrow?? September 10, 2009 Operational Refinements Firing Patients Physician Relations Collaboration Management

44. Bullying surgeons. Power-pimping attending. Boorish residents. Firing Patients

45. "Collaboration Management Framework“ Its central concept is the "conversation" which consists of a series of business documents/information exchanged under common subjects among practices. The framework defines how to define, manage, and implement conversations. The framework enables integrating B-to-B (external) processes as well as in B (internal) processes being executed in multiple systems, and the building up a complete picture of a business model that can help track, enhance and analyze the system behavior.

46. Leadership Necessities • Positioning and Repositioning: Finding a central idea for business that meets customer demands and that makes money • Pinpointing External Change: Detecting patterns in a complex world to put the business on the offensive • Leading the Social System: Getting the right people together with the right behaviors and the right information to make better, faster decisions and achieve business results • Judging People: Calibrating people based on their actions, decisions, and behaviors and matching them to the non-negotiable elements of the job • Molding a Team: Getting highly competent, high-ego leaders to coordinate seamlessly • Setting Goals: Determining the set of goals that balances what the business can become with what it can realistically achieve • Setting Laser-Sharp Priorities: Defining the path and aligning resources, actions, and energy to accomplish the goals • Dealing with Forces Beyond the Market: Anticipating and responding to societal pressures you don’t control but that can affect your business

47. Ambition Drive and Tenacity Self Confidence Psychological Openness Realism Appetite for Learning

48. Cognitive Traits that improve the Know-Hows A Wide Range of Altitude- to transition from the conceptual to the specific A Broad Cognitive Bandwidth- to take in a broad range of input and see the big picture Ability to Reframe- to see things from different perspectives or simply as they are

49. Office Management 2009 Series Forget Today!! What Do We Do Tomorrow?? October 7 Office Managers Kickoff Meeting : A Management overview of the year ahead