Physician Practices

Non-clinical aspects of medical practice are undergoing radical change. Physicians and practice groups are facing unprecedented demands to negotiate managed care contracts, see more patients, get pre-certifications and pre-authorizations, track utilization, deal with practice guidelines, contain costs, market their practices, acquire new computer capabilities, measure outcomes, develop affiliations with other physicians, and more. Doctors need to respond to the needs of a transitioning health care system where cost containment and managed care dominate, institutional integration is the norm, and practice consolidations are becoming increasingly necessary and commonplace.

Physicians and groups look to Weiser to negotiate managed care contracts and relationships, structure alliances, organize and simplify administrative requirements, and assist with strategic planning. Our clients rely on us to guide them through the intricacies of insurer/payer systems and referral sources, clarify the considerations and options in partnering with hospitals and other physicians, and set up systems to meet the administrative requirements necessary to continue the practice of medicine.

Weiser has a strong track record in performing health care audits and financial reviews, conducting valuations and structuring mergers and acquisitions, analyzing payer rate setting and implementation issues, developing management information systems, and establishing mechanisms to respond efficiently to the array of medical business demands that now need to be satisfied.

We are called upon regularly to assist in educating physician board members, owners, practice managers and staffs as to the transformation of the health care system and its impact on providers in terms of challenges and opportunities. This ability has allowed us to offer formidable guidance to clients seeking to strategically and tactically position themselves to survive and prosper in the changing healthcare marketplace.

Our physician practice management consultants specialize in devising growth strategies. We help you establish relationships with selected insurers and other providers, access capital, build your geographic base, and establish organizational governing structures.

We provide guidance to keep you focused on the future of your practice. This helps you to better direct resources and create the framework for growth and flexibility. We are especially involved in the provision of expanding practice capabilities and the implementation of changes in support mechanisms identified as vital to your success.

Managing Your Accounts Receivable

The competence of your billing and collection activity are important to the viability of your practice. Most practices have well established routines to monitor and collect accounts receivable. Even so, over time the collection of payments due from problem accounts can become a significant issue requiring the employment of innovative methods to collect. Practices sometimes need to learn new ways to take control of these receivables and improve processes for billing and collection.

Weiser professionals can evaluate the efficiency and effectiveness of your staff and review the billing and collection procedures that are being used for your practice. Once the staff has been evaluated and procedures have been documented and analyzed, we will make recommendations to improve the billing and collection procedures that could make a significant difference in your practice cash flow.

Areas that Weiser focuses on include:

• Charge make-ready and billing procedures
• Coding expertise
• Internal controls over receivables
• Credit and collection policies
• Accounts receivable standards and ratios
• Enhancements to existing computerized billing
• Alternative electronic billing methods
• Ways to maximize your fee schedule
• Managed care pre-authorizations and co-pay collections procedures

Practice Assessment and Operations Review

Particularly in a larger practice setting, there are times when you may need to consider the overall effectiveness and efficiency of your medical practice operations in an in-depth way. Practice managers wear many hats and are often overextended which can set the stage for items to “slip through the cracks.” From human resources and accounts receivable to billing issues and bottom-line reporting, our professionals perform comprehensive, independent reviews and evaluations of your practice that help you prioritize agendas and improve work flow efficienty between staff and physicians.

A partial list of practice assessment issues that Weiser will address includes:

• Organizational structure and strategic practice goals
• Human resources: practice policy manuals, employee evaluations, salary and benefit administration, training programs, and management review
• Managed care contracting policies
• Accounts receivable, computer systems, and billing operations review
• Financial management and accountability, including reporting standards, internal controls, and tax planning
• Asset management, including depreciation, amortization, and negotiation
• Patient relations and practice development

The Practice Financial Check-Up

Have you considered the profitability of your medical practice? Are your costs too high? Are your physicians producing at the appropriate levels? If you are unsure of the answers to these questions, Weiser can help. Our financial check-up service involves a review of your financial statements and trend analysis of your current balance sheet and income statements across the past several years. Operating expense ratios will be compared to your peers for your specialty. Your final financial check-up report is presented in an easy-to-read graphic and numerical format.

A sampling of key financial indicators Weiser will review includes:

• Operating expenses as a percentage of cash collections and on an FTE physician basis
• Operating expenses as a percentage of revenue compared to industry standards
• Gross collections and adjusted collection percentages
• Physician compensation and fringe benefits
• Days in accounts receivable
• Production by physician
• Payer mix

Practice Auditing and Accounting

You want the business end of your practice to run as proficiently as possible. You want to monitor the pulse of the practice’s financial situation, identify inadequacies and correct them, and highlight future opportunities. The cornerstone of good practice business is a foundation of solid professional accounting and auditing. Weiser professionals bring decades of individual and collective time-tested expertise to every medical practice assignment.

Our medical practice audit and accounting services include:

• Audits of financial statements
• Audits of specific areas
• Reviews and compilations of financial statements
• Internal control evaluations
• Cash flow projections
• Profit planning and budgeting
• Preparation of information to comply with regulatory agencies
• Assistance with loan negotiations
• Coordination of personal and practice financial affairs
• Year-end planning

Financial Operations

Weiser physician practice experts can help you focus on re-orienting the business end of your fee-for service or managed care practice to increase your “bottom line.”

Weiser is especially active in assisting in the following areas:

• Revenue modeling/analysis
• Charge structure assessment
• Pricing strategy guidance
• Fee schedule development
• Revenue enhancement
• Accounts receivable reduction for improved cash flow
• Cost containment
• Coding for diagnoses and procedures
• Regulatory compliance
• Medicare, Medicaid, and other insurance issues, including: 
       - Profile analysis
       - Reimbursement
       - Participation and/or acceptance
       - Payer mix
       - Contracting
       - Compliance and regulatory matters
• Workers’ compensation and no-fault requirements
• Related educational programs and training for management, clinical, and business office personnel

Improving Systems for Financial Reporting

The success of any business is measured in dollars. Often profitability is dependent upon a group’s financial management computer system. An accounting system is more than just a means of gathering historical information about something that has happened; it should lso be designed to manage by exception. The need for relevant, timely, and reliable financial reporting is essential. The proper selection and implementation of an efficient financial management system is the pre-requisite. Weiser analyzes each practice’s needs and recommends steps that will result in a strong accounting solution.

We can assist in the following:

• Development of a financial reporting system that will account for costs by doctor, department or location, activity, or any other relevant criteria, with emphasis on the income allocation formula
• Easy-to-read financial statements keying in on critical indicators
• Assistance with developing an equitable income allocation worksheet
• Budget preparation and reporting system
• In-house payroll system
• Integrated general ledger system

Fee Analysis and Revenue Enhancement

Revenue enhancement is a concept that involves increasing a practice’s income without increasing the energy required by the doctor(s) to generate that income. Weiser’s professional staff will address the production, quality, and collectability of revenue, all of which impact cash flow. We approach each practice environment with the awareness of reimbursement pressures and continued reporting requirements. Our team of professionals will ask insightful questions, form objective evaluations, and make recommendations, accordingly.

Among the issues that Weiser will address in our evaluation are:

• Payer mix – determination of revenue sources for the practice
• Fees – are they at appropriate levels to ensure maximum reimbursement from major third-party payers?
• Cost accounting – determination of cost and profitability of frequently performed procedures
• Quality control – CPT4 and ICD9 coding compliance and skill levels
• Returned claims processing – how are these effectively resolved?
• Statement evaluation – are statements easily understood by patients?
• Review of payment, adjustment, and collection policies – are payments made in a timely fashion, accounts adjusted routinely, and follow-up procedures used effectively?

Tax Planning and Compliance

There’s an old saying that there are only two things certain in life. As a doctor, you try to prevent the first. As accountants, we try to minimize the second. Weiser tax experts maintain a constant vigilance on the changes in federal, state, and local tax laws and regulations. We keep doctors informed of changing tax laws and court decisions that impact medical practice. We identify potential opportunities for achieving significant tax advantages and savings throughout the year.

Examples of the issues Weiser tax professionals help solve are:

• Selection of form of business – PC, subchapter S or C, limited liability company or partnership
• Real estate studies – cash flow analyses, fair market value, taxation, financing, purchase, and sale
• Allocation of income and losses
• Life cycle planning – college education, retirement, wills
• Creation and administration of estates and trusts
• Fiduciary accounting
• Assessing taxable income
• Determination of economic viability
• Securities transactions and implementation of regulations

Managed Care Contracting

Are you overwhelmed with the barrage of HMOs, PPOs, IPAs, MSOs, and other managed care contracts you are asked to join? Not only can every contract arrangement be time-consuming to review and difficult to understand, they can often be dangerous to your financial well-being. Our medical practice advisors at Weiser will help your practice better understand these contracts before committing to them. We will point out the advantages and disadvantages of belonging to any managed care program.

A sampling of the process and services Weiser offers in the managed care contracting area include:

• Review and summary of the contract into easy-to-understand language
• Providing a background sketch of the managed care company
• Evaluation of the pros and cons of joining and the offering of recommendations
• Assistance in working with your practice in dealing with claim denials
• Providing an analysis of the financial impact to your practice
• Devising strategy to get a better deal on a renewal contract
• Negotiating on your behalf

Practice Merger and Acquisition

Integration and consolidation are two of the most tangible characteristics of the sweeping changes occurring in healthcare. As more physicians and groups are either brought into large, emerging, integrated delivery systems, or find themselves moving in the direction of combining with other doctors to build multi-specialty, multi-site, risk-bearing groups in varied forms, practice mergers, joint ventures, and acquisitions are as important a strategic consideration for physicians as they are for Fortune 500 companies.

Weiser is uniquely qualified to advise physicians on merger and acquisition transactions from initial exploration through final implementation. Contacts and experience enable us to identify and confirm good partners, assist in identifying and gaining access to capital resources, and structure agreements to best meet client needs. Further, the firm possesses the industry background and knowledge necessary for an effective assessment of the regulatory and competitive managed care environmental considerations that increasingly impact these transactions.

Weiser’s practice merger and acquisitions approach includes the initial assessment of your needs, the thorough identification and evaluation of potential buyers, sellers, and partners, practice valuation, careful assessment of the long-term viability of the prospective change, the negotiation of the terms and structure of the agreement, due diligence, and collaboration with attorneys in the review of legal documents and orchestration of the final closing.

Beyond the transaction, we help clients smooth the transition when necessary, providing operational guidance and assistance in optimizing both the clinical and non-clinical operations of the resulting practice. The Weiser approach is to assure that long-term outcome of the arrangement equals or exceeds the expectations of the client.

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