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Note that each of these categories can also be structured as a stand alone project as well.
Revenue Identification
In calculating profit margins, dialysis facilities should not use cash collections as their basis for stating revenues. They should use "expected net revenues" or ENR. ENR is calculated from the "bottom up", on each month's treatment and ancillary pharmacy utilization. Payor mix and payment rates by payor are included in this calculation. The result is ENR per treatment for a given time period which can then be compared to the costs necessary to provide the SAME TREATMENTS. In addition, the ENR provides a benchmark from which to measure actual "dollars collected". In other words, are you collecting every dollar that you should be?
HDS brings an expected net revenue calculation tool that is based upon years of research and development to accomplish the goal of calculating an accurate ENR on an ongoing basis. These ENR data are then trended and summarized by quarter, semi-annually, and annually.
Dialysis Billing
In our extensive experience with dialysis facility management, we have found that the most effective process for maximizing net revenues and minimizing days of outstanding AR is to have a well trained dialysis biller located at a location NEAR THE PATIENTS, preferably at the facility. This allows for ongoing monitoring of coverage issues, and for efficient follow up with the local and regional payors. The key is to have a well trained person in the role of your dialysis biller.
HDS can help you in several ways:
- HDS can not only train your biller to carry out the billing function, but to be your REVENUE CHAMPION. The revenue stream is the lifeline of your business, and if AR gets out of control, life can get difficult in today's operating environment.
- HDS can provide a cost effective alternative to purchasing an expensive dialysis billing system. HDS can add a data set to it's dialysis billing system to accommodate your facilities. A "front end" is installed at your facility for ongoing use by your biller. The front end is connected to the HDS billing system via internet connection, where electronic, HIPAA compliant claims are submitted monthly, and a special collection module is accessed. The data set is purchased by HDS on behalf of the client and the expense is passed through at cost. The data storage and ongoing use of the system is billed on a per treatment basis.
- HDS can provide a comprehensive billing policy and procedure manual tailored to your individual situation.
- HDS can provide ongoing support to your revenue champion in the form of updates to charge master and the latest changes in reimbursement rules and requirements.
Financial Management Oversight
To support this process, HDS works with the Governing Body to establish cost profiles and productivity measures for the outpatient dialysis facility. HDS will provide the following:
- Compare the performance of the dialysis unit to industry standards (obtained from a database of over 2800 freestanding outpatient dialysis facilities).
- Set financial targets by line item Prepare quarterly and annual Cost Per Treatment (CPT) Analyses for each renal service unit (hemodialysis and peritoneal)
- Prepare and distribute a comparison of the dialysis program's CPT Analysis to industry standards annually.
- Prepare and submit annual budget for each renal service unit
- Prepare and distribute monthly, quarterly, and annual Budget Variation Report - Comparison of Actual to Budgeted Costs
Filing of Medicare Cost Report
HDS will file the annual Medicare Cost report, including bad debt reporting, prospective exception request eligibility and renal reimbursement mechanisms.
Payor Relations
- Define negotiation strategies for managed care contracts
- Provide contract management support
- Determine profitability under a proposed at-risk contract
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