President Trump is providing support to healthcare providers fighting the COVID-19 pandemic. On March 27, 2020, the President signed the bipartisan CARES Act that provides $100 billion in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response. This funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get testing and treatment for COVID-19.

Immediate infusion of $30 billion into healthcare system

Recognizing the importance of delivering funds in a fast and transparent manner, $30 billion is being distributed immediately – with payments arriving via direct deposit beginning April 10, 2020 – to eligible providers throughout the American healthcare system. These are payments, not loans, to healthcare providers, and will not need to be repaid.

Who is eligible for initial $30 billion

• All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution.
• Payments to practices that are part of larger medical groups will be sent to the group’s central billing office.
  • All relief payments are made to the billing organization according to its Taxpayer Identification Number (TIN).
• As a condition to receiving these funds, providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.
• This quick dispersal of funds will provide relief to both providers in areas heavily impacted by the COVID-19 pandemic and those providers who are struggling to keep their doors open due to healthy patients delaying care and cancelled elective services.
• If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.

How are payment distributions determined

• Providers will be distributed a portion of the initial $30 billion based on their share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019.
• A provider can estimate their payment by dividing their 2019 Medicare FFS (not including Medicare Advantage) payments they received by $484,000,000,000, and multiply that ratio by $30,000,000,000. Providers can obtain their 2019 Medicare FFS billings from their organization’s revenue management system.
• As an example: A community hospital billed Medicare FFS $121 million in 2019. To determine how much they would receive, use this equation:
  • $121,000,000/$484,000,000,000 x $30,000,000,000 = $7,500,000

What to do if you are an eligible provider

• HHS has partnered with UnitedHealth Group (UHG) to provide rapid payment to providers eligible for the distribution of the initial $30 billion in funds.
• Providers will be paid via Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS).
  • The automatic payments will come to providers via Optum Bank with “HHSPAYMENT” as the payment description.
  • Providers who normally receive a paper check for reimbursement from CMS, will receive a paper check in the mail for this payment as well, within the next few weeks.
• Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for signing the attestation will be open the week of April 13, 2020, and will be linked on this page.
• HHS’ payment of this initial tranche of funds is conditioned on the healthcare provider’s acceptance of the Terms and Conditions – PDF, which acceptance must occur within 30 days of receipt of payment. Not returning the payment within 30 days of receipt will be viewed as acceptance of the Terms and Conditions. If a provider receives payment and does not wish to comply with these Terms and Conditions, the provider must do the following: contact HHS within 30 days of receipt of payment and then remit the full payment to HHS as instructed.  Appropriate contact information will be provided soon.

Is this different than the CMS Accelerated and Advance Payment Program?

Yes. The CMS Accelerated and Advance Payment Program has delivered billions of dollars to healthcare providers to help ensure providers and suppliers have the resources needed to combat the pandemic. The CMS accelerated and advance payments are a loan that providers must pay back. Read more information from CMS.

How this applies to different types of providers

All relief payments are being made to providers and according to their tax identification number (TIN). For example:

• Large Organizations and Health Systems: Large Organizations will receive relief payments for each of their billing TINs that bill Medicare. Each organization should look to the part of their organization that bills Medicare to identify details on Medicare payments for 2019 or to identify the accounts where they should expect relief payments.
• Employed Physicians: Employed physicians should not expect to receive an individual payment directly. The employer organization will receive the relief payment as the billing organization.
• Physicians in a Group Practice: Individual physicians and providers in a group practice are unlikely to receive individual payments directly, as the group practice will receive the relief fund payment as the billing organization. Providers should look to the part of their organization that bills Medicare to identify details on Medicare payments for 2019 or to identify the accounts where they should expect relief payments.
• Solo Practitioners: Solo practitioners who bill Medicare will receive a payment under the TIN used to bill Medicare.

Priorities for the remaining $70 billion

The Administration is working rapidly on targeted distributions that will focus on providers in areas particularly impacted by the COVID-19 outbreak, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans.

Ensuring Americans are not surprised by bills for COVID-19 medical expenses

The Trump Administration is committed to ensuring that Americans are protected against financial obstacles that might prevent them from getting the testing and treatment they need from COVID-19.

• As announced in early April, a portion of the $100 billion Provider Relief Fund will be used to reimburse healthcare providers, at Medicare rates, for COVID-19 related treatment of the uninsured.
  • As a condition, providers are obligated to abstain from “balance billing” any patient for COVID-related treatment.
• The Families First Coronavirus Response Act requires private insurers to cover an insurance plan member’s cost-sharing payments for COVID-19 testing.
• President Trump has also secured commitments from private insurers, including Humana, Cigna, UnitedHealth Group, and the Blue Cross Blue Shield system to waive cost-sharing payments for treatment related to COVID-19 for plan members.

SOURCE: https://www.hhs.gov/provider-relief/index.html; Content created by Assistant Secretary for Public Affairs (ASPA); Content last reviewed on April 13, 2020

The kids are back to school and life is a little slower now. It’s a good time to look at your year-to-date federal and Colorado withholdings to make sure that you won’t have either a large balance due at year-end or a large overpayment on April 15, 2018.

Did you get a large refund with your 2016 return?  Are your work and tax circumstances about the same for 2017?  If so, perhaps you should reduce your withholding for the remainder of 2017. The ideal payroll withholding situation is to have just enough tax withheld to (1) avoid underpayment of estimated tax penalties and (2) avoid a large balance due on your 2017 tax returns.

Just stop by your payroll office and submit a new Form W-4 to change your withholding.

If you receive income that is not subject to withholding, you may need to either increase your withholding for 2017 or make estimated tax payments. If you make estimated tax payments, now is a good time to reassess your third and fourth quarter estimated tax payments or determine if you need to make additional estimated tax payments. This will allow you to avoid underpayment of estimated tax payments or to make sure that you don’t overpay your taxes for 2017.

You tax advisor can help you determine the amount of required withholding and/or estimated tax payments for 2017.

We’ve previously published several articles in our blog, Practice Elevations, related to the need for adequate internal controls to prevent theft in medical and dental practices.  Because of evidence that theft is increasingly common in small businesses, including professional practices, with the amount of losses also on the rise, we are returning to this subject again this month.

The 2016 report of the Association of Certified Fraud Examiners (ACPE) share reveals some sobering statistics:

• The survey results show that most businesses lose 5% of revenues each year as a result of theft, and much of that loss of revenues is to employees. Lost revenues have a particularly significant impact on the economic success of small businesses, including dental and medical practices.
• The median loss for all cases in the 2016 ACFE report was $150,000, up from $145,000 in the 2014 report. The median loss incurred by small businesses was the same as for largest businesses.
• The most frequent forms of theft involved billing and check tampering schemes.

Medical and dental practices are particularly susceptible to fraud and theft. It is estimated that fraud and theft account for three to 10 percent of total health care costs in the United States.  Why are medical and dental practices particularly susceptible?  In many cases, the practice, due to limited staffing resources and the existence of long-term employees and centralized accounting functions, has not implemented or deemed internal controls to be necessary in the past.

What practice and business circumstances lead most frequently to employee theft?  Here are three elements that are usually present when employees commit theft:

• Pressure – work related pressures or personal finance pressures
• Opportunity – lack of basic accounting and internal controls; prior lack of disciplinary action; misplaced trust of the employer
• Rationalization – the employee believes that the employer owes money to the employee or that the employee is just “borrowing” the money

What are some financial red flags that could indicate possible fraud or theft in your medical or dental practice?

• Increase in accounts receivable
• Decrease in collection ratio
• Increase in accounts payable
• Increase in over-time, but work output remains behind or not current
• Poor accounting records
• Large increase in supply expenses over prior periods
• Patient and payer complaints about recording of payments

What basic internal controls are a must for every medical and dental practice?

• Segregation of job duties
• Mandatory vacations
• Institute employee fidelity bonding, a form of insurance protection

Where are the potential weak spots in your practice that need internal controls and extra attention from practice management?

• Front desk
• Billing and collections
• Accounts payable
• Payroll

Below are basic internal controls for each of the areas that need controls and extra attention from management:

Front desk internal controls:

• Make sure that every patient encounter on the daily schedule has a charge and a payment.
• All payments received must be accounted for in the reconciliation at the end of the day.

Billing and collections internal controls:

• Segregate duties and cross train employees
• Consider a lockbox
• The total receipts in the general ledger (posted from the deposit slip) just agree to the total receipts posted in the billing system daily. If receipts are received at month end, before explanation of benefits, reconcile deferred revenue on a monthly basis so that cash collections in the financials agrees to cash collections in the practice management system.
• Randomly conduct spot checks every few days and routinely review adjustments to ensure there was a valid reason for making them. No charges can be written off without written consent by the manager. Often, just the knowledge that someone may be looking over their shoulder is enough to keep would-be fraudsters in line.
• Determine if the practice management system can block a 100% write-off.
• Monitor contractual adjustments
• Monitor bad debt write-offs

Accounts payable internal controls:

• Throw away all signature stamps!
• Ensure there is a regular check signer in the practice
• Develop a list of approved vendors
• There should be an invoice, stamped “paid” with each check so that the invoice cannot be paid a second time – either accidentally or deliberately, attached to each check. Signer should review each invoice for reasonableness
• Set bank account controls so that transfers can be made only between specified accounts at the same bank and only by authorized individuals
• Bank statements should be opened by an owner or by a manager who has no check writing/signing responsibilities. Review cancelled check payees
• Bank reconciliation should be prepared by someone who has no check writing or billing/collection/deposit responsibilities
• Regular and frequent review of general ledger detail
• Regular and frequent review of practice overhead

Payroll internal controls

• Managers approve payroll hours before submitted for payment
• All overtime must be approved by a manager in advance
• Periodically review year-to-date gross wages for individual employees to ensure that compensation is reasonable

Stockman Kast Ryan + CO can help you take fraud prevention a step further by conducting an external review of internal controls. In addition, an operational audit may be commissioned to help ensure that the practice is enjoying efficient operations while minimizing the risk of fraud loss.

 

Contact our office today to learn more. 

Collections are the lifeblood of any medical or dental practice. But do you really know if you’re doing a good job of collecting receivables? Find out for sure by monitoring these three collections performance indicators:

1. Days in Accounts Receivable

To find out how long it takes to collect a day's worth of gross charges, add up the charges posted for a specific period of time and divide by the total number of days in that period. Then divide the total accounts receivable by the average daily charges. 

For instance, if you have charged $640,000 in the past 12 months, or 365 days, your average daily revenue is $1,753. Then, if your total accounts receivable today are $80,000, the days in accounts receivable is 45.6. That means it is taking an average of 45.6 days to collect your payments. Note that if this number is consistently high — or you notice a jump in the number of days outstanding from one month to the next — it could be sign of problems caused by anything from coding errors and incomplete documentation to claims rejections caused by patient registration errors. 

Recommendation: We recommend that you use a rolling average of 12 months of charges for this computation. The results will vary by specialty and payer mix, but a typical goal for days in accounts receivable is 35 to 40 days.  

Action: Determine how your practice’s days in accounts receivable compares with other practices using a source such as the Medical Group Management Association (MGMA) annual Cost Survey Report or Performance and Practices of Successful Medical Groups Report. 

2. Accounts over 90 days

The practice’s aging report, based on date of entry and NOT ”re-aged,” should be reviewed monthly. Obviously, the longer an account remains unpaid the higher the risk of it becoming uncollectable. So, it’s critical to measure the percent of your accounts receivable in each “aging bucket.” 

Recommendation: We recommend that you review a separate aging report for both insurance and patient receivables monthly, paying particular attention to outlier payers in the insurance aging report to spot any developing trends. Credit balances in accounts receivable should be investigated and manually added back to each aging “bucket” to get a clear picture of accounts receivable aging. An acceptable performance indicator would be to have no more than 15 to 20 percent total accounts receivable in the greater than 90 days category. Yet, the MGMA reports that better-performing practices show much lower percentages, typically in the range of 5 percent to 8 percent, depending on the specialty. 

Action: Consider establishing a target AR range for your practice. For example, you might shoot for having 60 percent of receivables fall into the 0-30 days bucket, 20 percent in 31-60 days, 5 percent each at 61-90 days and 91-120 days, and 10 percent falling over 120 days. 

3. Net Collection Percentage

This is the bottom-line number that reveals how successful you were in collecting the money you are entitled to collect. Add up your total collections and divide by adjusted charges (charges less contractual adjustments) to determine how much you have actually collected. For example, if your practice only collected $50 on a procedure contracted for $75, your net collection rate would be 67 percent (50 divided by 100 minus 25). 

Recommendation: We recommend that you use a rolling average of 12 months of net charges and receipts for this calculation. In general, a net collection percentage of 97 percent or higher will help ensure a healthy bottom line for the practice.

Action: If your net collection rate is lower than this, drill down and calculate the net collection rate by each of your payers to determine if the problem is coming from a particular source. If net collection percentage is consistently down across all of your payers, you’ll know that the problem is internal (e.g. your front-end billing process is resulting in rejected claims). 
 

Contact our office today for help in monitoring your practice’s collection performance.

Stay on top of filing and reporting deadlines with our tax calendar! Our tax calendar includes dates categorized by employers, individuals, partnerships, corporations and more to keep you on track. 

 

The statistics are sobering: You’re much more likely to become disabled than to die during your practice years. The cost of disability insurance can be daunting — anywhere from two percent to four percent of the income you are trying to replace. Still, few physicians are prepared to rely solely on their personal savings during an extended period of disability. With that in mind, consider these steps for ensuring you have a source of income should you become disabled:

Step #1: Know Your Options 

Most employers provide some form of group disability coverage, and a basic employer-sponsored plan certainly helps when you are starting out in practice. Coverage under a basic employer-sponsored plan usually is limited and policies are not portable if you change employers. Well-informed medical and dental professionals treat this type of coverage as supplemental to a more comprehensive personal policy.

Personal policy premiums are higher than group plans, but the coverage and flexibility are superior. Coverage is customizable and provides substantially more control. Individual polices follow you throughout your career and can be designed around your particular practice specialty and lifestyle needs. Unlike group policies, individually owned plans are generally non-cancellable, non-taxable and benefits cannot be reduced.

Step #2: Ask Plenty of Questions When Shopping for a Personal Disability Policy

• What is the cost/benefit value of the policy?

• Is the policy guaranteed for renewal? Is it non-cancellable?

• Is the definition of disability in the policy for a “true and pure” occupation, modified occupation or regular occupation?

• What is the definition of income in the policy? Is only base pay (not incentive pay) considered?

• Is the policy specialty-specific?

• What restrictions or exclusions are included in the policy?

• Does the policy include provisions that would reduce the benefit under certain circumstances?

• Does the policy include partial benefits?

• Does the policy include recovery benefits?

• Is the company writing the disability contract financially sound?

Step #3: Get Sufficient Coverage

Consider beefing up coverage with policy riders to ensure that you obtain benefits specific to your needs and for as long as possible. A rider for Own-Occupation protects you if you are unable to perform the duties of "your own medical specialty" and continues to pay benefits if you are forced to practice a new specialty or even a new occupation because of disability. A Future Purchase Option gives you the right to purchase a pre-determined amount of coverage in the future. In particular, it allows residents and early-career physicians to increase coverage as their income grows without having to go through additional medical underwriting.

If you are working in a solo or small medical group practice, consider overhead continuation insurance for you and your partners. This insurance is relatively affordable and is designed to help pay a professional’s share of office expenses for a period of disability without the need to dip into personal or family savings, or take on more debt.

Step #4: Work with a Pro

Work with an agent who specializes in disability insurance for medical and dental professionals. Consider working with an independent agent who can shop your coverage with several disability insurance companies. Each company will look at your location, gender and medical specialty a little differently, so it’s critical to request a variety of quotes. 

Step #5: Act Now

There really is no time like the present. Because an insurer’s underwriting decisions are based on your age, current health status and accident/illness history, the best time to purchase disability coverage is when you are young and healthy. 

Ultimately, the best disability policy is one that is tailored to your specific income replacement needs and specialty. If you choose your options wisely, you may have a reliable source of income even if an illness or injury forces you to stop practicing.

As you consider disability insurance options, you can turn to our firm for guidance on determining the right amount of coverage and options. 

Did you know that you face a much higher probability of becoming disabled than of dying during your working years?

Considering that the average long-term disability absence lasts 2.5 years, your family’s finances — and your practice — could take a hit if you are disabled and have not prepared.

What Brings Docs Down

The Council for Disability Awareness’ most recent Long-Term Disability Claims Review shows that the following conditions are the leading causes of new disability claims:

1. Musculoskeletal/connective tissue disorders (arthritis, back pain, spine/joint disorders)
2. Cancer
3. Injuries and poisoning (fractures, sprains, burns, allergic reactions)
4. Cardiovascular/circulatory disorders (hypertension, heart attack, stroke)
5. Disorders of the nervous system (Parkinson’s, ALS, Multiple Sclerosis, Alzheimer’s Disease)

You can use the calculator developed by the Council for Disability Awareness to calculate your own “disability quotient.” Access the calculator here.

Health Is Wealth

You may have heard this before: Your health is your wealth. Your most important asset, as a medical or dental professional, is your intellectual capital and your ability to work. Even with basic disability insurance, you will probably be able to replace only 50 to 60 percent of current income, and monthly benefits will probably be capped.

To mitigate the risk of that loss, consider how a disability of any duration would impact your finances — and what you can do to prepare. 

1. Review your current income and monthly expenses.

Start with an honest appraisal of your lifestyle. If your income stream was disrupted, would you be able to maintain financial commitments such as private schools for the kids, philanthropic undertakings and planning for a comfortable retirement? What about any lingering educational debt? Then, factor in the normal costs of living (mortgages, healthcare, etc.) and ask yourself if your assets and income will cover expenses. 

Action: Determine how expenses could be adjusted to eliminate unnecessary spending in the event of disability. Review potential sources of income to replace your current paycheck and help weather the disability crisis.

2. Consider the long-term impact of a disability.

A disability can potentially rob you of the ability to earn a living. In the case of a permanent disability, the potential loss of income can run into the millions of dollars for a physician or dentist whose career spans 20-30 years. At the same time your earning potential dries up, medical and other bills related to the disability only increase. For example, there may be costs for specialized transportation, ongoing care and alterations to accommodate your disability.  

Action: Determine the income you would need to replace and the potential expenses that would need to be covered in the event of your disability. Then figure out if you have the personal savings, investments or other financial resources to cover them. 

3. Consider the impact on your practice.

What about the income of the practice? For example, if you are a sole practitioner and a disability keeps you from generating revenue for any length of time, you might not have a practice to return to. 

Action: Think through what would happen if you needed to use personal assets to keep the practice open. Last-resort options might include using credit cards to pay expenses, obtaining a second mortgage, using a home-equity line of credit or withdrawing money from a retirement plan.

4. Salt away some savings.

Long-term disability insurance typically kicks in only after 90 or 180 days, so it is important to be able to cover expenses until the elimination period has been completed and benefits start flowing.

Action: If you haven’t already, make sure you have access to enough liquid funds to cover anywhere from three to nine months of living expenses. This could be CDs, Treasury Bills or even a line of credit.

After you’ve reviewed the impact of disability and your current disability coverage, determine what additional disability coverage and overhead continuation insurance you might need.

The threat of disability is real. Let our experienced accounting professionals help you run the numbers to see if you are prepared to weather a disruption in income.

Stay on top of filing and reporting deadlines with our tax calendar! Our tax calendar includes dates categorized by employers, individuals, partnerships, corporations and more to keep you on track. 

 

Stay on top of filing and reporting deadlines with our tax calendar! Our tax calendar includes dates categorized by employers, individuals, partnerships, corporations and more to keep you on track. 

 

WASHINGTON – The Internal Revenue Service, state tax agencies and the tax industry on Jan. 25 renewed their warning about an email scam that uses a corporate officer’s name to request employee Forms W-2 from company payroll or human resources departments.

This week, the IRS already has received new notifications that the email scam is making its way across the nation for a second time. The IRS urges company payroll officials to double check any executive-level or unusual requests for lists of Forms W-2 or Social Security number.

The W-2 scam first appeared last year. Cybercriminals tricked payroll and human resource officials into disclosing employee names, SSNs and income information. The thieves then attempted to file fraudulent tax returns for tax refunds.

This phishing variation is known as a “spoofing” e-mail. It will contain, for example, the actual name of the company chief executive officer. In this variation, the “CEO” sends an email to a company payroll office or human resource employee and requests a list of employees and information including SSNs.

The following are some of the details that may be contained in the emails:

• Kindly send me the individual 2016 W-2 (PDF) and earnings summary of all W-2s of our company staff for a quick review.
• Can you send me the updated list of employees with full details (Name, Social Security Number, Date of Birth, Home Address, Salary).
• I want you to send me the list of W-2 copy of employees' wage and tax statement for 2016, I need them in PDF file type, you can send it as an attachment. Kindly prepare the lists and email them to me asap.

Working together in the Security Summit, the IRS, states and tax industry have made progress in their fight against tax-related identity theft, but cybercriminals are using more sophisticated tactics to try to steal even more data that will allow them to impersonate taxpayers.The Security Summit supports a national taxpayer awareness campaign called “Taxes. Security. Together.” This campaign offers simple tips that can help make data more secure.