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One-Page Financial ReportMonthly - must be done regularly in order to spot trends and make appropriate corrections.

Statistic Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec1 Total Charges $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

Avg Daily Charges (ADC) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

Total Charges Physician #1Total Charges Physician #2

Total Charges Physician #3Total Charges Other2 Total Payments (or Receipts)3 Total Refunds4 % Copayments Collected5 Total Accounts Receivable (A/R)

Total over 90 days% over 90

6 Gross collection ratio7 Net Receipts - Budget

Net Receipts - Actual8 Operating Expenses - Budget

Operating Expenses - Actual9 Net Income10 Total encounters11 Total new patient visits

% new patient visits12 Full-time equivalent (FTE) staff

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Yr to Date$0

$0

$0

$0

$0$0

$0

$0

0.00%

$0$0

$0

$0

$0

$0

$0

0

0

0.00

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Annual Report

Instructions:

Statistic Yr 1 Yr 2 Yr 3 Yr 4 Yr 5 Util ization

1 Total encounters 02 Encounters/day3 Total proc/tests/etc.4 Total bed days5 Avg length of stay (ALOS)

ALOS Provider # 1

ALOS Provider # 2

6 Total RVUsRVUs Provider #1

RVUs Provider #2

Financial

7 Total Charges $0Charges Site #1

Charges Site #2Charges Site #3

8 Total Receipts $09 Total Gross Income $010 Ancillary & Other Receipts11 % anc & other receipts12 Physician compensation13 Total operating expense14 Tot op exp by site

Site #1

Site #2

15 Overhead percentSite #1

Site #2

16 Capitation Payments17 Gross Collection Ratio

The formulas in the first column (Yr 1) automatically draw data from the year-to-date column in the Monthly Sheet.Once the first year is complete, start over with year two and so on. You may also do this semi-annually, but you willneed to adjust the formulas accordingly, or enter appropriate numbers rather than drawing from the monthly sheet.For future years (Yr 2 and onward), you will need to copy the formulas used for Yr 1, but use the spreadsheet forthe corresponding year.

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Purpose:

Instructions:

CPT Code

Frequency

(Volume) RVU Total RVU

Marginal

Cost/CPT

Total

Cost/CPT

99211 0.56 0.0099212 1.24 0.0099213 2.09 0.0099214 3.08 0.0099215 4.15 0.0099201 1.25 0.0099202 2.16 0.0099203 3.13 0.00

99204 4.80 0.0099205 5.95 0.0099385 3.19 0.0099386 3.71 0.0099387 4.10 0.0099395 2.81 0.0099396 3.07 0.0099397 3.46 0.00G0402 4.74 0.00G0403 0.15 0.00

G0404 0.26 0.00G0405 0.25 0.00G0438 4.74 0.00

G0439 3.16 0.0099221 2.86 0.0099222 3.89 0.0099223 5.71 0.0099231 1.13 0.0099232 2.04 0.0099233 2.93 0.0099238 2.03 0.0099239 2.98 0.00

99252 2.14 0.0099253 3.26 0.0099254 4.70 0.00

0.000.000.000.000.000.00

0.000.000.000.000.000.00

Tracks productivity based on relative value units (RVU). Can be used to calculate physician pincome distribution, to negotiate payor contracts, to evaluate relative resource use within yourfees, or to conduct cost benefit analyses.

RVU Report

Select the most commonly billed codes for your practice, including E&M codes as well as anyimportant procedures, lab tests, or other ancillary codes, so that at least 85-90% of your totalrepresented (more is better). As appropriate, delete any low volume CPTs from the list below

lines as needed, being careful to adjust the formula in the total row if necessary.

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0.000.000.000.000.000.000.00

Total 0.00 0.00Total units chged

% of total 0.00%

Total operating cost/RVU

Total cost/RVU

Note 1:

Note 2:

For both of the above operating cost figures, you should adjust the total based on what perce

practice revenue is covered by the high volume CPT codes you have selected to use. For exincluded CPT codes represent 91% of your total revenue, then you may wish to reduce the totexpenses to equal the same percentage.

To obtain updated RVUs, go to the CMS web site at the following web address and enter theof codes) you are interested in. (Select Relative Value Units, then Global. The columns to adFacility Work" + "Non-Facility PE" (practice expense) + "MP" (malpractice) for services providsetting. For inpatient services, the use the "facility" columns.)

Total operating expenses

Total expenses (including MD)

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roductivity forpractice, to set

financiallyolume isor add as many

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t of total

mple, if theal practice

odes (or ranged are is "Non-d in the office

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Evaluating Payors

Financial considerations:Does (will) this payor cover my costs? (Steps 1 and 2 below)Will this payor pay me sufficiently? (Step 1 below)

Utilization considerations:

How important is (will be) this payor to my practice, both in percent of total revenue andshare of my patient base?

What type of patients does (will) this payor bring me?

Intangibles:How do the "hassle factors" compare to other plans?Is this payor important to my referring physicians or the hospital where I practice?Are there any patient/public relations issues?Is there an out-of-network option that would allow my patients to continue seeing me(albeit at a higher copay) if I withdraw from the plan?

Note: These considerations do NOT take into account specifics included in the contract itself, suchas termination clauses, prompt payment clauses, definitions of clean claim, etc.

Steps to Evaluate Payors:

1 Complete the Payor Profitability worksheet to determine profitability, either overall or byCPT code

2 Complete the Collection Monitoring report

3 If both of the prior steps spell trouble, consider the intangibles.

4 If the signs all point to terminating the contract, then do so according to contract terms.If the financial analysis is borderline or indicates a problem, perhaps renegotiating theterms is an option.

There are several considerations in evaluating the viability, both financial and otherwise, of a particularpayor. For existing contracts, use actual data whenever available. For new contracts, make assumptions

according to experience with similar payors or overall practice data.

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Purpose: Using the same concept as the RVU report, you can evaluateeach payor, either to negotiate a fee schedule or assess overall profitability.

Instructions:

CPT

Code

Frequency

(Volume) RVU Total RVU

Operating

Cost/CPT

Total

Cost/CPT Fee

99211 0.56 0.0099212 1.24 0.0099213 2.09 0.0099214 3.08 0.0099215 4.15 0.0099201 1.25 0.00

99202 2.16 0.0099203 3.13 0.00

99204 4.80 0.0099205 5.95 0.0099385 3.19 0.0099386 3.71 0.0099387 4.10 0.0099395 2.81 0.0099396 3.07 0.0099397 3.46 0.00G0402 4.74 0.00G0403 0.15 0.00

G0404 0.26 0.00G0405 0.25 0.00G0438 4.74 0.00G0439 3.16 0.00

99221 2.86 0.0099222 3.89 0.0099223 5.71 0.00

99231 1.13 0.0099232 2.04 0.0099233 2.93 0.0099238 2.03 0.0099239 2.98 0.0099252 2.14 0.0099253 3.26 0.0099254 4.70 0.00

0.000.000.000.000.000.000.000.000.000.00

Payor Profitability

Select the codes most commonly billed to the payor you are evaluating or with whom you areincluding E&M codes as well as procedures, lab tests, or other ancillary codes, so that at leasthe volume is represented. Delete any low volume CPTs from the list and add as many linesbeing careful to adjust the formula in the total row if necessary. This evaluation works best if

expenses are included.

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0.000.000.000.000.000.000.000.000.00

0.000.00

Total 0.00 0.00 0.00 0.00Total Profit(Loss)

Operating Profit(Loss)

$0.00

$0.00

Note 1:

http://www.cms.hhs.gov/apps/pfslookup/

To obtain updated RVUs, go to the CMS web site at the following web address and enter therange of codes) you are interested in. (Select Relative Value Units, then Global. The column"Non-Facility Work" + "Non-Facility PE" (practice expense) + "MP" (malpractice) for servicesoffice setting. For inpatient services, the use the "facility" columns.)

Total operating cost/RVUTotal operating expenses

Total expenses (including MD)

Total cost/RVU

http://www.cms.hhs.gov/apps/pfslookup/http://www.cms.hhs.gov/apps/pfslookup/

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Receipts

0.000.000.000.000.000.00

0.000.00

0.000.000.000.000.000.000.000.000.000.00

0.000.000.000.00

0.000.000.00

0.000.000.000.000.000.000.000.00

0.000.000.000.000.000.000.000.000.000.00

negotiating,t 85-90% ofas needed,physician

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0.000.000.000.000.000.000.000.000.00

0.000.000.00

0.00

0.00

codes (ors to add are isrovided in the

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Purpose: To measure how well each payor is doing compared to other payors and overall. This information can

be used in making decisions about renegotiating or terminating contracts. The report should be

prepared at least semi-annually, if not quarterly.

Instructions: Run Accounts Receivable, charges and payments reports by payor. Time period is month end or

year-to-date. For more detailed information and control, this report should be broken down by contract.

There should be a separate line for each individual payor, so insert rows where applicable and copy theformulas into the cells.

Payor Mix-Charges

Total % Total % Total % Total % TotalMedicareMedicaidCommercialManaged Care exc. CapManaged Care Cap. OnlyOtherSelf Pay

Total $0 $0 $0 $0 $0

Payor Mix-Payments

(or Receipts) Total % Total % Total % Total % TotalMedicareMedicaidCommercialManaged Care exc. CapManaged Care Cap. OnlyOtherSelf Pay

Total $0 $0 $0 $0 $0

Perio

Period 1 Period 2 Period 3 Period 4

Collection Monitoring Report

Period 1 Period 2 Period 3 Period 4

Perio

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Payor Collection Ratio

MedicareMedicaidCommercialManaged Care exc. CapManaged Care Cap. OnlyOtherSelf Pay

Total

Accounts Receivable

by Payor Total DAR Total DAR Total DAR Total DAR TotalMedicareMedicaidCommercialManaged Care exc. CapManaged Care Cap. OnlyOtherSelf Pay

Total $0 $0 $0 $0 $0

Period 1 Period 2 Period 3 Period 4 Perio

Period 1 Period 2 Period 3 Period 4 Perio

TotTotalTotal TotalTotal

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%

%

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DAR

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Purpose:

Instructions:

CPT Code Description Practice Fee Cost/CPT Medicare Payor 1 Payor 2 Payor 3

99211 Est pat, min99212 Est pat, focused

99213 Est pat, moderate

99214 Est pat, expanded99215 Est pat, complex

99201 New pat, min

99202 New pat, focused99203 New pat, moderate

99204 New pat, expanded99205 New pat, complex

99385 Prev, new, 18-39

99386 Prev, new, 40-6499387 Prev, new, 65+

99395 Prev, est, 18-39

99396 Prev, est, 40-64

99397 Prev, est, 65+99221 Inpat, initial, low

99222 Inpat, initial, mod99223 Inpat, initial, high

99231 Inpat, subsequent, low

99232 Inpat, subsequent, mod99233 Inpat, subsequent, high

Fee Schedules by Payor

MM/YY UpdatedContract Renewal Date

For the billing staff to make sure each payment is what it should be. For negotiating contracts, this report can provide a quick look at

how a proposed contract compares to existing contracts and whether, upon renewal, certain fees need to be addressed.

Fees may be based on the actual contract, fees obtained from payors' provider relations departments, EOB's, or however else you ca

find fees by CPT code. You can easily add rows for other commonly billed codes and columns showing that payor as a percent of

Medicare if appropriate.

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Adding a New Service -- Cost vs. Benefit Analysis

Purpose: To determine whether a new or existing service is profitable.

Instructions:

Step 1 -

Step 2 -

Step 3 -

Step 4 -

Step 5 -

Revenue Scenario 1 Scenario 2 Scenario 3Volume expected (/day, /wk, /mo, /yr)

Charge x gross collection percentageor

Reimbursement average or actual basedon payor fees/reimbursement

TOTAL REVENUE $0.00 $0.00 $0.00

ExpensesFixed cost

Equipment costsLease or purchase amortization

MaintenanceOther fixed equipment costs

Total equipment costs $0.00 $0.00 $0.00

Other direct costsTrainingLicensure

Total direct costs $0.00 $0.00 $0.00

Rent + utilities

Indirect staff (e.g., a portion of manager,billing, front desk, scheduler time)

Other indirect allocated expenses

Marketing expense (to let your patientsknow about the new service)

Total indirect fixed costs $0.00 $0.00 $0.00

Total Fixed Costs $0.00 $0.00 $0.00

Variable Costs Scenario 1 Scenario 2 Scenario 3Supplies

Direct staff and MD time (% of salary +benefits)

QA testingTotal variable costs $0.00 $0.00 $0.00

TOTAL EXPENSES $0.00 $0.00 $0.00

PROFIT (LOSS) $0.00 $0.00 $0.00

Indirect (allocated) fixed costs

Figure out what CPT codes you will use to charge the new service. Determine reimbursement ratesby Medicare and commercial payors.

Estimate how much time it will take to perform the service and what office resources will be required.

For example, the test takes 10 minutes for a nurse or a tech to administer the test, which will beapproximately x% of her total time, and the doctor can read the results in 2 minutes, or 3% of his time.

That % times the person's salary plus benefits equals the personnel costs of producing the service.Assess other factors, such as patient satisfaction and retention, convenience, quality and continuity ofcare, technology advancement, etc.Estimate how many tests will be performed. For example, for a bone density test, assumex women

in your practice, of whom x% are post-menopausal, multiplied by the number of actual testsconducted, or recommended frequency of the test, etc.

Try different scenarios, such as for different volumes, different expenses, or different reimbursementrates.

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Source Reports (if available)(from Practice Management System, except as noted)

Report

Recommended

Frequency

1) Accounts Receivable Aging Schedule Monthly1a) By payor Monthly1b) By provider Semi- or Annually1c) By location Semi- or Annually

2) Month-end Balance Sheet, Income Statement, and Budget Report from accountantsoffice or accounting software Monthly

3) Patient visit report (lists patients seen by date of service and by doctor/location) Monthly

4) Report by CPT, or Procedures Report Monthly

4a) CPT report by doctor and location Semi- or Annually

5) Admission and days report (if available from hospitals) Monthly

6) Charges by payor report Semi- or Annually

7)Charges by provider report Monthly

8) Payments by payor report Semi- or Annually

9) RVU report (by doctor/location) Semi- or Annually

10) Patient origin report (by zip code) Semi- or Annually

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Suggested Reading

From Advisory Publications (www.AdvisoryPublications.com)Medical Office Financial Management ($99)Financial Oversight for Doctors Who Hate It ($44)Building a Medical Practice Budget ($44)Improving Financial Reports and Controls ($44)

From Medical Group Management Association (www.mgma.com)Financial Management for Medical Groups ($82 members/$123 non-members)Medical Practice Reimbursement Manual ($60/$93.60)Looking for the Cash Cow: Actions Steps to Improve Cash Flow ($40/$63)

RVUs: Applications for Medical Practice Success ($63/$94)

From Aspen Publishing

"Medical Practice Management Handbook: Complete Guide to Managed Care,Accounting, Tax Issues, and Daily Operations" by Reed Tinsley ($144)