Success Stories

United Hospital District: Reimbursement

Developing a long-term plan for improvements.

physician-integration issues

Situation

United Hospital District (UHD) is a critical access hospital that owns three off-site clinics, which were being operated as separate entities. Leadership recognized the benefits of integrating clinic operations and decided to implement a new work-relative-value-based physician compensation plan. In addition, UHD completed a provider-based clinic (PBC) financial analysis. This analysis reported that an additional reimbursement of $227,000 was available if the clinics were converted to PBCs.

Strategy

Wipfli brought project management and technical expertise to supplement UHD’s excellent staff.  The teams worked together to complete system redesign, system testing, attestations, and implementation of the program. A key component of the process was the redesign of the revenue cycle, from scheduling through the account resolution process.

The requirements to complete the CMS attestation provided the framework for addressing many of the physician-integration issues.  UHD also used this process as an opportunity to switch to Method II billing. This election allowed them to bill both the professional and technical portions of the provider-based billing. This election also increased the outpatient portion of clinic billing, which resulted in an additional 15% reimbursement.

Benefits

As a result of the combined efforts of the board and staff in supporting the compensation plan and the PBC program, UHD was able to complete the desired physician integration, improve reimbursement resulting from the PBC program, and receive the 15% reimbursement increase associated with Medicare Method II billing.

During the process, UHD staff worked together as a team and developed a long-term plan for system improvements. This plan will streamline the revenue system within the requirements of the PBC program.