in a challenging healthcare environment

Transcription

1 Welcome to our Seminar Sponsored by: in a challenging healthcare environment

2 Helping Independent Physicians Thrive AGENDA 5:45 p.m. 6:15 p.m. Cocktails and hors d oeuvres 6:15 p.m. 6:40 p.m. Introductory remarks from Congressman Jason Altmire 6:40 p.m. 8:00 p.m Presentations How connected healthcare systems drive efficiencies Use technology to eliminate the leaks in your practice revenues How you can get a piece of the Federal Economic Stimulus Package 7:30 p.m. 8:00 p.m Dessert / Coffee / Tea Panel Discussion (Q&A) Prize Drawings (ipad & Buhl Mansion Package)

3 Introductory Remarks on Healthcare Congressman Jason Altmire is serving his second term in the U.S. House of Representatives, where he represents all or parts of six counties in western Pennsylvania. He has quickly established himself as one of Congress' leading voices on health care, small business and veterans issues.

4 How Connected Healthcare Systems Drive Efficiencies Mike Baillie Mike is VP, Channel Development at Ingenix CareTracker Mike is responsible for building a nationwide network of channel partners who help independent physicians nationwide implement their integrated PM/EHR solution. Version 7 Ingenix CareTracker version 7, is a CCHIT Certified 2011 Ambulatory EHR.

5 Menu Ingenix CareTracker CCHIT 2011 Mike Baillie Vice President, Channel Development Agenda Items: The Bigger Picture What Makes CareTracker Different Our Partnership with HST

6 Current Environment Adoption of EHR has historically been low below 10% among independent small practice physicians, most without CPOE/results or decision support Why? Rational decision making large upfront capital outlay difficult to implement disruptive to workflow expensive to maintain clearly negative ROI

7 The Push for EHR Government stimulus program (ARRA) provides $18.7 billion for adoption of EHR Medicare and Medicaid physicians Medicare physicians receive up to $44,000 over 4 years Must demonstrate Meaningful Use to receive payments Government definition Payments begin 1/1/11 Penalties start 2015 Physicians are starting to adopt even in very small practices

8 The Bigger Picture HIE Technology

9 Why Ingenix & Channel Partner: The Big and Local Approach Why Ingenix and Channel Partner Big and Local Approach Ingenix Guarantee Meaningful Use Big, Stable 2 Billion in Rev ,300 Worldwide Employees 2,500 Diverse Healthcare Clients Tremendous Assets built into CareTracker Healthcare Support Technologies Local Resource with Years Experience Practice Mgmt., RCM, Clinical Expertise They care about your RCM Implementation Experience & Flexibility We are passionate advocates for the use of health information to save lives, improve care, and solve fundamental problems in health care. We measure our success through the success of our partners Ingenix, Inc. 9

10 CareTracker Why it is different Why Ingenix and Channel Partner Big and Local Approach CareTracker: Why it is Different CareTracker is a true Web Solution Access through browser 3 Major Releases in calendar year Dashboard presentation Creates smart work list ClaimsManager scrubbing engine Dramatically increase client pay at first pass rates with best-in-class pre-submission claim editing tools - Auto PQRI prompting and reporting Easy, automated tools to help clients capture the Medicare 2% bonus - E-prescribing refill/new - Capture the 2% e-prescribing bonus in 2009 with easy online script writing capability. Simple enrollment. Ingenix Provider 360 Ingenix, Inc. 10

11 CareTracker Why it is different Why Ingenix and Channel Partner Big and Local Approach CareTracker: Why it is Different The effort to build, maintain and update all files is done. All content is imbedded into the product on day-one, is certified and continuously maintained CPT & ICD-9 Every referring US provider with NPI and UPIN # s 40,000+ pharmacies All known US based health insurance companies Every US city, state and zip All payer claims rules known and learned Hundreds of standard letters Connectivity is provided and maintained: Claims clearing is either direct or best of breed (2,300+ plans) Claims status clearing (1,600+ plans) Eligibility clearing (1,300+ plans) Electronic Remits (2,300+ plans) National lab connectivity Quest, LabCorp, Caris (simple enrollment) SureScripts (simple enrollment) Televox (simple enrollment) Ingenix, Inc. 11

12 CareTracker Why it is different Why Ingenix and Channel Partner Big and Local Approach Integration & Connectivity: Bigger than Just PM and EMR Transcription CareTracker Patient Portal CareTracker Referral Network Portal CareTracker Document Mgmt. CareTracker Messaging CareTracker Inter operability CareTracker PM & EMR CareTracker Faxing Ingenix Provider 360 CareTracker Intelligence CareTracker Suite Complete Integration Ingenix Claims Manager Across All Modules

13 Best of Breed vs. Integrated PM & EMR Best Totally of integrated Breed dominated PM and the CCHIT mid and Certified late 90 s. EMR Keep Powerful, your PM intuitive, and find and the cost-effective best EMR (per-module, for your practice. pay-as-you-use All you have to fee do structure), is Seamless our interfaces clinical EMR between allows your two clients products. to work their way to a paperless office at their own pace Scheduling Interfaces Integration Expensive Decrease TCO Unreliable Reliable Disrupt Improve Workflow Follow-up Scheduling & Billing Billing PM Eligibility Clinical EMR Workflow Clinical Ingenix, Inc. 13

14 Our Solution Fully integrated, web-based Practice Management & Electronic Health Record (EHR) suite Time. Simplicity. Value.

15 Use Technology to Eliminate Leaks and Make Your Practice Thrive Geoff Lusty Geoff is VP, Sales and Marketing at Healthcare Support Technologies. HST is an Ingenix CareTracker channel partner and offers medical billing services that are fully integrated with the Web-based Ingenix CareTracker EHR solution delivering a complete Revenue Cycle Management Solution to independent physicians.

16 Our Background Over 18 years in business We help our clients implement a proactive approach to maximizing reimbursements Technology drives our services Offer Integrated Billing, Practice Management & EHR Solution

17 EHR is Here EHR incentives are here (up to $44k) Must show meaningful use of a certified EHR Many EHR vendors to choose from The challenge is to choose the right fit, and follow the right implementation plan to achieve success

18 Implementing an EHR The Wrong Approach Paper driven scheduling, encounters, billing and charting Disparate client-server software systems (scheduling, billing, clinical) Failure to integrate front office and billing Duplication of Efforts (patient demographics, etc)

19 Implementing an EHR The Right Approach Implement electronic and integrated scheduling, encounter capture, billing and THEN charting Choose technology that drives a proactive approach to medical billing, accelerating payments Choose technology that guarantees stimulus incentives Web-based vs. client server

20 How to get to your $44k? Practice Management is the first step. Now more than ever your hard earned revenues are at risk. Workloads have increased by 19%; yet income by only 12% 21% Medicare reimbursement cuts looming E&M code reimbursement has dropped by over $29/service since 2004 Patient payment delinquencies have increased by 25% since 2008 EHR mandates are on the horizon

21 Identify the Leaks in Your Revenue Cycle Up to 17% of your revenue can be lost from leaks Revenue Leaks include: Incorrect Insurance Information Incorrect Patient Data Missing Appointments Missing Encounters Lack of Follow up Lack of Collections at time of service Timely Filing Issues Employee Theft

22 Choose/Use the Right Technology and Billing Process to Eliminate Leaks Automated Eligibility Verification Claims Scrubbers Encounter Reconciliation Proactive (vs. Reactive) Rules-based Follow-up Automated Appointment Reminders Practice Dashboards Employee Accountability

23 Automated Insurance Verification: The Challenge Deductibles, co-insurance and co-pays are rising Accurate insurance information must be captured and verified at the time of service Can risk reimbursement for visit if eligibility is not verified up front

24 Insurance Verification: Old Way Manual insurance verification process Send claim (w/ no ins. Verification) Wait days for denial Resubmit corrected claim and wait up to another 30 days Follow-up after 60 days Timely filing issues are more likely Result is: ~ 3% of charges are uncollectable

25 Insurance Verification: New Way Automated, technology-driven process < 1% are uncollectable Insurance verified prior to visit System proactively notifies front office of any issues Issues are resolved at the time of service Clean claims sent successfully, resulting in payments Result is < 1% of charges are uncollectable

26 Claim Scrubbing: Old Way Most claim scrubbers review combination of CPT/ICD-9 to verify accuracy Most scrubbers are out-dated and do not look at multiple services per claim Results: ~ 75% of claims accepted on first pass, delayed payment cycle due to denials

27 Claim Scrubbing: New Way Good PM software will have a sophisticated scrubbing engine built in Should be able to add payor specific rules Results: ~ 92% of claims accepted on first pass

28 Missing Encounters: Old Way Patient is seen, encounter form left with front office Front office needs additional info from Dr., encounter form given back Encounter form misplaced, never billed Result: up to 5% of encounters never get submitted

29 Missing Encounters: Technology-driven Process Electronic scheduler is used All patients on schedule are required to have an electronic encounter captured Dashboard provides check and balance and proactively reminds staff of missing encounters. Result: Leak eliminated

30 A/R Follow-up: Old (Manual) Way Following up with patient balances and Accounts Receivable was historically a very manual process Send claim Wait 60 days Print follow-up report Call to resolve issues Follow-up activities are typically low in priority Timely filing issues can arise due to inactivity

31 A/R Follow-up: New Way Rules-based follow-up technology reduces days in receivables Send claim Technology tracks progress of claim Progress is based on individual payer rules Follow-up occurs proactively Results: Payment cycles can be reduced from 45 to 29 days on the average

32 Technology-driven Practice Management Success Insurance A/R over 90 days: less than 10% Claims accepted on first pass: 90% and above 15-day reduction in payment cycle: 45 to 29 days Total Collections increased up to 17% by eliminating leaks Reduction in overall billing costs: up to 50%

33 Technology-driven Practice Management Success Integrated Front Office (scheduling), Billing, Reporting and then EHR A Web based cloud solution Automated Appointment Reminder Calls Integrated Messaging Patient Portal PQRI Report capabilities Interface Support (HL7, etc) (to 3 rd party solutions/hospitals)

34 Thank You! Geoff Lusty (724) x23

35 How Your Practice Can Get a Piece of the Federal Economic Stimulus Package Ken Eisner Ken Eisner has over 25 years experience in business law, health law, estate planning, and alternative dispute resolution. Ken sees every dispute as a potential deal and prides himself on utilizing his transaction experience to resolve disputes, prior to litigation, often resulting in substantial savings to clients.

36 February 17, 2009-American Recovery and $787 billion spending bill: Tax Cuts Reinvestment Act of 2009 Unemployment benefits Social Welfare Domestic spending on education, energy, and HEALTHCARE.

37 HITECH ACT Health Information Technology for Economic and Clinical Health Act

38 HITECH ACT ELIGIBLE PROFESSIONALS that establish MEANINGFUL USE of ELECTRONIC HEALTH RECORDS ( EHR ) technology are entitled to incentive payments. GOAL-EHR for 90% of physicians and 70% of hospitals by 2015.

39 Medicare Eligible Professionals Doctors of medicine Doctors of osteopathy Doctors of dental surgery Doctors of dental medicine Doctors of podiatric medicine Doctors of optometry Chiropractors

40 Medicare Eligible Professionals Professionals must be: Physicians Dentists Certified Nurse Midwifes Physician Assistants Practicing in federally qualified health centers or rural health centers.

41 Medicare Incentive Physicians seeing Medicare patients can receive up to $44,000 over 5 years. Payments are based on 75% of submitted allowable charges. (Clinic that charges $100,000 in year 1 will receive $18,000 the following year. Clinic that charges $16,000 in year 1 will receive $12,000 the following year).

42 Medicare Incentive Additional 10% if operating in a designated Health Professional Shortage Area. Per Doctor, not per practice, payable to Doctor. Incentive, not reimbursement.

43 Physician Medicare Payment Incentives TOTAL Paid 2011 $18,000 $12,000 $8,000 $4,000 $2,000 $0 $44, $18,000 $12,000 $8,000 $4,000 $2,000 $44, $15,000 $12,000 $8,000 $4,000 $39, $12,000 $8,000 $4,000 $24, Penalties start for non-adopters 1% in 2015, 2% in 2016, 3% in 2017 and up to 5% starting in 2019 Note: Physicians reimbursed by Medicaid can receive up to approximately $65,000 starting in 2011 based on state-defined guidelines.

44 Medicaid Incentive Eligible Provider: Non hospital based professional with at least 30% of his/her patient volume coming from Medicaid patients. Non hospital based pediatrician with at least 20% of his/her patient volume coming from Medicaid patients.

45 Medicaid Incentive (cont.) Children s hospitals or acute care hospitals with at least 10% patient volume coming from Medicaid patients. Provide up to $63,750, limited to 85% of allowable EHR costs. Professionals who practice predominantly in federally qualified health center or federal health clinic with at least 30% of the professional s patient volume coming from Medicaid patients.

46 2015 and beyond Physicians not demonstrating meaningful use of EHR technology will have their Medicare fee schedule reduced: 2015: -1% 2016: -2% 2017: -3% Beyond: 3-5%

47 Choices, Choices Physicians must choose either Medicaid or Medicare Incentive. No double dipping. Hospitals do not have to choose.

48 Summary Medicare: up to $44k per doctor Medicaid: up to $63,750 per doctor Money is per doctor; not per practice Money goes directly to the doctor

49 Hospitals get to play too! Hospitals: Based upon number of discharges and percent of Medicare (not including charity care).

50 Example: Hospital with 10,000 Annual Discharges and 30% Medicare Volume TOTAL Paid 2011 $1,256, 733 $942, $1,256, 733 $628,36 7 $942, $1,256, 733 $314,18 3 $628,36 7 $942, $942,55 0 $0 $0 $3,141,883 $314,18 3 $628,36 7 $628, $628,36 7 $0 $3,141,883 $314,18 3 $314,18 3 $314,18 3 $3,141,883 $1,885,100 $942,550 Maximum Medicare and Medicaid payments estimated at $11 million

51 Hospital Physicians Lose Professionals that are hospital based are not eligible for payments. Examples: pathologists, anesthesiologists, ER physicians.

52 Meaningful Use Focus is on electronically capturing health information in a coded format using that information to track key clinical conditions, communicating that information for care coordination purposes and initiating the reporting of clinical quality measures and public health information. A meaningful user is an eligible professional who demonstrates: Use of electronic prescribing functionality. Their EHR is connected in a manner that provides for the electronic exchange of health information to improve the quality of healthcare. Submits information on clinical quality measures. Allows patients to access their health records in a timely manner. All HIPAA or state privacy or security violations must be resolved.

53 Panelists include representatives from: Panel Discussion

54 Prizes! Win an Apple ipad! ($499 value) Win a Castle Escape Package to Buhl Mansion ($350 value) Prizes sponsored by:

55 Thank You! OUR EVENT WAS SPONSORED BY: Version 7 Special thanks to: