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HCET Home > On-line Training > Money Matters > Module III: How Do We Collect More?

Money Matters Module III: How Do We Collect More? Charges, billing and collections

Contents of Module III

1. Introduction (below)
2. Developing Fee Scales
3. Schedule of Discounts
4. Charges
5. Alternative Sources of Payment: 3rd Party Reimbursement
6. Billing
7. Collections
8. References
9. Post-test
10. Evaluation

1. Introduction

How Do We Charge Fairly?

The first module of this three-part series included an introduction to the cost center report, as well as instruction in:

1. completing a time study
2. collecting fiscal data; and
3. completing allocation spreadsheets

The second module addressed using this information to establish appropriate clinic fee structures. In conclusion, module three is focused on charges, billing and collections.

Objectives

By the end of this third module of a three-unit program, participants will be able to:

1. Determine fees based on the cost analysis
2. Interpret charges that will be recognized and paid by third parties
3. Identify billing practices that increase the revenue stream for the agency
4. Distinguish successful collection practices

Review of Module II Key Concepts

1. Understanding the relative value methodology for doing cost analysis
2. Reviewing forms 1 – 4 on the cost analysis
3. Comparing current fees to actual cost of providing service

Determine the relative values of services/procedures: A relative value is a number that relates one service to all other services based on the amount of time, materials, and level of skill of the personnel who are involved in a particular service. Each relative value is important only in how it compares to other relative values.

• physician work
• practice expense (net of malpractice expenses); and
• the cost of malpractice insurance

Form 1: Medical Cost Center

• The relative value for each of the CPT codes is inserted automatically from the “procedures” spreadsheet onto the form
• The next step is to insert utilization numbers for each of the CPT codes for the time frame under analysis
• You need to compare your current fee with what it cost you to provide the service for the last year
• You should use the COLA/Margin cell to estimate costs for the next year

• The counseling must be documented in the chart and is recorded in fifteen-minute intervals
• This is preventive counseling around a specific area designed to change behavior and/or reduce risk
• If programs do not track counseling, it must be included in the medical cost center

• Where relative values are available through the Clinical Diagnostic Laboratory Fee Schedule, the “National Limit” value is used
• If no “National Limit” or “Mid Point” values are available, the payment for the specific state (i.e.; WI) is used

• Relative values for pharmacy are based on the cost, or average cost, of the pharmacy supplies
• The “supplies” spreadsheet is used to develop the average cost

• Wisconsin providers, since January 2003, have had performance-based contracts that require the counting of patients receiving services with the use of CPT and ICD-9 codes.
• Wisconsin's Medicaid Family Planning Waiver also facilitates reimbursement with this coding and classification system.
   

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URL: http://www.hcet.org/training/Mmatters/ModIII/1MMIII.htm
 Last update: 04/22/08