Karen Zupko in 2024

Friday, April 5, 2024 | 1:15 p.m. – 4:45 p.m.
Omni PGA Frisco Resort
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Karen Zupko’s three-hour presentation at TOA’s 2023 Annual Conference was one of the most popular presentations at TOA’s conferences. Back by popular demand, Karen will present an all-new three-hour session – “What Every Orthopaedic Surgeon Needs to Know About Their Business Office” – at TOA’s 2024 Leadership Conference.

How people, process and technology drive profitability.

You Can’t Manage What You Don’t Measure
Why do you need these reports? How to use the data to make better decisions and capture more revenue.

Participants will be encouraged to run data reports during the seminar.

Does Your Fee Schedule Need a Fix?

Coding Improvement Drives Revenue

Making the Out-of-Network Decision: Carefully!

Avoiding Clawbacks

Attendees will receive a 66-page workbook when the seminar begins.

The workshop is interactive, and it will help surgeons and practice administrators learn what is (or what is not) happening in the business office. Consider bringing the following items to enhance your experience:

1.  Accounts receivable (AR) run different ways.  Please bring only the summary sheet at the end.  Run all reports out to 180 days.   

2.  Run one version of the AR by date of service DOS versus DOE, which is date of entry. 

3. Ask for AR to have only patient owed balances versus monies owed by carriers.

4.  Run AR by insurance companies.  

5.  Ask for a credit balance report.  

6. Year end 2023 CPT frequency report. Separate all E/M codes and run these together.  

7. Surgery codes and see if they can run a report with and without modifiers. 

8. Ask for your denial report. You want the version that shows the number of times a denial was used and the dollar value. 

1. Accounts Receivable (AR)

An AR report can be run several different ways for different diagnostic reasons.  Ask for your report to be run both by Date of Service (DOS) and by Date of Entry (DOE) for the same time range.  Furthermore, run the report out to 180 days—not the usual 120+.  Only the last page is needed—it should have the total dollars and calculate the percentage. (No patient names please! )

Next, run AR by responsible party, which means differentiating patient owed balances from money billed and owed by insurance plans. Again, you only need the last pages for each.  Age the totals out to 180 days.

Running the AR by insurance plan is useful if you are thinking about dropping participation in some plans.  We will, for example, be discussing dropping some Medicare Advantage plans.  So, it would be useful to bring AR by plans.

The credit balance report is important to run, as well as unapplied credits because both impact the AR.

2. Denial Reports

Run a detailed denial report for an individual MD/DO.  Ideally, it will have the CARC codes, as well as the frequency and the dollars associated with each denial.  

Run a denial report for a Medicare Advantage plan you participate in.

Remember, someone on the team owns every denial code.  Denial reports provide useful information about exactly where the revenue leak is occurring and what you need to fix.   

3. Coding-Related Reports

Review of CPT frequency reports are often required by a good compliance plan.  For the meeting, run a report with only the new, established, consultation and hospital visit codes for 2023. The report will show you how many times each code was billed.   We strongly encourage you to print two versions of the report, one without the modifier 25 and another report with a 25 modifier.   We will discuss the multiple uses that this report has. We find value in running a report that shows the top 5 to 7 CPT codes both in the insurance and patient AR over 90 days old.

4. Charges, Payments & Adjustments

Drilling down to the provider level and to the plan level on this report is valuable.  We’ll illustrate why.

5. Bring a List of Payers and the Adjustment Types or Codes Used in Your Practice

Adjustment types include contractual adjustments, non-contractual and other adjustments (charity care, surgical assist not covered). 

Come prepared to see how these reports complement one’s full understanding of what is or is not going on in the business office.