MiPCT Financial Reporting Templates

Carla A. GalliganConsultant

Why Financial Reporting

• Financial reporting will ensure accountability for the funds received.

• Reporting will reconcile revenue collected and expenses.

Reporting Templates

• There are 4 reporting templates: Revenue and Membership Care Coordination Practice Transformation Incentive

Basic components of all templates

• Revenue (cash collected)• Membership ( corresponds to cash collected)• Expense

Payers included in reporting

• Blue Cross Blue Shield of Michigan• Blue Care Network• Medicare• Medicaid Managed Care

Reporting Deadlines• Reports submitted on a quarterly basis for Care Coordination and

Practice Transformation .• Incentive reporting is for a 6 month period.• PO/PHO’s will be given 30 days after the quarter end to submit reports .• Due dates:• May 1, 2012• July 31, 2012• October 31, 2012• January 31, 2013• Data will be submitted electronically. Details on electronic transmission

will be finalized by Jan 1, 2012 and will be communicated to PO/PHO’s.

Summary of Payer Membermonths and Revenue

• This worksheet purpose is to summarize all payer revenues.

• Care Coordination payments are made directly to PO’s for Medicare and Medicaid Managed Care.

• Care Coordination payments are made to Practices for BCBSM and BCN.

• Practice Transformation payments are made to practices for all payers.

Summary of Payer Membermonths and Revenue

Care Coordination PMPM Membermonths Revenue

Payer

BCBSM $3.00 1,698,018 $5,094,054.00

BCN $3.00 885,216 $2,655,648.00

Medicare $4.50 540,747 $2,433,361.50

Medicaid Managed Care $3.00 600,675 $1,802,025.00

Total 3,724,656 11,985,088.50

Practice Transformation

BCBSM $1.50 1,698,018 $2,547,027.00

BCN $1.50 885,216 $1,327,824.00

Medicare $2.00 540,747 $1,081,494.00

Medicaid Managed Care $1.50 600,675 $901,012.50

Total 3,724,656 $5,857,357.50

Care Coordination Template

• The care coordination template will present all revenue and expenses as outlined in Implementation Plan C.

Care Coordination Reporting TemplateRevenue $11,985,088.50

CARE COORDINATION EXPENSES

COMPENSATION $6,500,000.00

OVERTIME $750,000.00

BENEFITS $2,145,000.00

TRAINING $150,000.00

EDUCATION $375.00

CERTIFICATION $25,000.00

TRAVEL $25,000.00

MEETING COST $6,000.00

OTHER:EXPLAIN $0.00

TOTAL CARE COORDINATION EXPENSE $9,601,375.00 NET INCOME (LOSS) CARE COORDINATION $2,383,713.50

Care Coordination Expenses

• Care Coordination expenses are amounts spent during the reporting period.

• Expenses and FTE’s will be cross referenced to Implementation Plan C.

• Descriptions of Expenses: Compensation, Overtime, Benefits, Training, Education, Certification, Travel, Meeting Costs

and Other (explain).

Care Coordination Expense Documentation Requirements

• The PO’s/PHO’s must complete the FTE spreadsheet as support for Care Coordination Expenses.

• The FTE spreadsheet purpose is to reconcile compensation and benefit expense as reported .

• PO’s/PHO’s will include Implementation C plan FTE data as a data element.

Care Coordination support for FTE’s and Benefits

Care Coordination FTE Detail

Practice Hire Total Hours Total Total Employee Implementation PlanPractice Location Name Employee Name Position Date Hourly Rate worked Compensation Benefit Expense C FTE

Detroit Detroit Physician Group Susan Scott MCM 1/1/2012 $40.00 160 $6,400.00 $2,000.00 1.00

Practice Transformation Template

• The Practice Transformation template will present revenue and expenses as outlined in Practice Plan Phase 1.

Practice Transformation Reporting Template

Revenue $5,857,357.50

PRACTICE TRANSFORMATION EXPENSES

COMPENSATION $2,000,000.00 OVERTIME $200,000.00 TRAINING $50,000.00 EDUCATION $7,500.00 CERTIFICATION $8,000.00 CARE MANAGEMENT SOFTWARE $10,000.00 COMPUTER $15,000.00 FAX $50.00 INTERFACE REGISTRY $16,000.00 MINOR EQUIPMENT $500.00 MEETING COST $125.00 PATIENT SURVEY COST $750.00 PRACTICE COACHING $50.00 POSTAGE $150.00 REFERENCE MATERIAL $650.00 RENT/SPACE $900.00 STAFF TRAINING $200.00 SUPPLIES $50.00 TELEPHONE $150.00 TRAVEL $36.00 OTHER $500.00 OTHER $1,000.00 OTHER $2,000.00 OTHER $3,000.00

Total Practice Transformation Cost $2,316,611.00

NET INCOME (LOSS) PRACTICE TRANSFORMATION $3,540,746.50

Practice Transformation Expenses• Practice Transformation expenses are amounts spent during the reporting

period.• Expenditures will be cross referenced to Practice Plan Phase 1 item C.

Expenditure deviations from the submitted plan are permitted.• Support for FTE’S and Expenses > $5000.00 (single transaction) are required.• Expenses other than Salary and Benefit cost can be assigned on a direct cost or

allocation methodology.• The allocation methodology can be used for expenses such as postage, office

supplies, telephone etc..• A column has been added to the templates for designation D – Direct, and A-

Allocation.• Support for FTE expenses will be the same as required for Care Coordination.• PO/PHO’s must complete a supplemental report for single disbursements >

$5000.00 .

Practice Transformation support for FTE’s and Benefits

Practice Transformation FTE Support

Practice Hire Total Hours Total Total EmployeeImplementation Plan

Practice Location Name Name Position Date Hourly Rate worked Compensation Benefit Expense C FTE

Ann ArborAnn Arbor Physicians Joan Right Receptionist 1/1/2012 $40.00 160 $6,400.00 $2,000.00 1.00

Practice Transformation Support for Single Transaction Expense> $5000.00

MIPCT Support for Practice Transformation costs Single Transaction >$1000.00Reporting Entity:Date:

Prepared by:

Expense Amount included in Location Practice Name Category Vendor Description of Item Amount Date Practice Plan

Excess Medicaid Managed Care Funds

• PO/PHO’s will be allowed to roll forward no more than 20% of Medicaid Managed Care excess of revenue over expense for each reporting module (Care Coordination and Practice Transformation).

• An allocation methodology will be used to determine expense by payer using membermonths as the basis for the allocation of expense.

• The 20% roll forward will be allowed only if supported by documentation as to why the funds were not expended in the year.

• Amounts > 20% will be offset beginning February 2013.

Care Coordination Cost Methodology

Description Total Expenses BCBSM BCN CMSMedicaid Managed

Care Total

Care Coordination PMPM $3.00 $3.00 $4.50 $3.00

Member months 1698018 885216 540747 600675 3724656

Revenue $5,094,054.00 $2,655,648.00 $2,433,361.50 $1,802,025.00 $11,985,088.50

CARE COORDINATION EXPENSESCOMPENSATION $6,500,000.00 $2,963,258.08 $1,544,814.88 $943,672.52 $1,048,254.52 6,500,000 OVERTIME $750,000.00 $341,914.39 $178,247.87 $108,885.29 $120,952.45 750,000 BENEFITS $2,145,000.00 $977,875.17 $509,788.91 $311,411.93 $345,923.99 2,145,000 TRAINING $150,000.00 $68,382.88 $35,649.57 $21,777.06 $24,190.49 150,000 EDUCATION $375.00 $170.96 $89.12 $54.44 $60.48 375 CERTIFICATION $25,000.00 $11,397.15 $5,941.60 $3,629.51 $4,031.75 25,000 TRAVEL $25,000.00 $11,397.15 $5,941.60 $3,629.51 $4,031.75 25,000 MEETING COST $6,000.00 $2,735.32 $1,425.98 $871.08 $967.62 6,000 OTHER:EXPLAIN $0.00 $0.00 $0.00 $0.00 $0.00 0

TOTAL CARE COORDINATION EXPENSE $9,601,375.00 $4,377,131.09 $2,281,899.53 $1,393,931.34 $1,548,413.04 $9,601,375.00

NET INCOME (LOSS) CARE COORDINATION 716,922.91 373,748.47 1,039,430.16 253,611.96 2,383,713.50

Practice Transformation Cost Methodology

Practice Transformation PMPM $1.50 $1.50 $2.00 $1.50

Member months 1,698,018 885,216 540,747 600,675.00 3,724,656

Revenue $5,857,357.50 $2,547,027.00 $1,327,824.00 $1,081,494.00 $901,012.50 $5,857,357.50

PRACTICE TRANSFORMATION EXPENSES

COMPENSATION $2,000,000.00 $869,684.67 $453,386.70 $369,277.10 $307,651.53 $2,000,000.00 OVERTIME $200,000.00 $86,968.47 $45,338.67 $36,927.71 $30,765.15 $200,000.00 TRAINING $50,000.00 $21,742.12 $11,334.67 $9,231.93 $7,691.29 $50,000.00 EDUCATION $7,500.00 $3,261.32 $1,700.20 $1,384.79 $1,153.69 $7,500.00 CERTIFICATION $8,000.00 $3,478.74 $1,813.55 $1,477.11 $1,230.61 $8,000.00 CARE MANAGEMENT SOFTWARE $10,000.00 $4,348.42 $2,266.93 $1,846.39 $1,538.26 $10,000.00 COMPUTER $15,000.00 $6,522.63 $3,400.40 $2,769.58 $2,307.39 $15,000.00 FAX $50.00 $21.74 $11.33 $9.23 $7.69 $50.00 INTERFACE REGISTRY $16,000.00 $6,957.48 $3,627.09 $2,954.22 $2,461.21 $16,000.00 MINOR EQUIPMENT $500.00 $217.42 $113.35 $92.32 $76.91 $500.00 MEETING COST $125.00 $54.36 $28.34 $23.08 $19.23 $125.00 PATIENT SURVEY COST $750.00 $326.13 $170.02 $138.48 $115.37 $750.00 PRACTICE COACHING $50.00 $21.74 $11.33 $9.23 $7.69 $50.00 POSTAGE $150.00 $65.23 $34.00 $27.70 $23.07 $150.00 REFERENCE MATERIAL $650.00 $282.65 $147.35 $120.02 $99.99 $650.00 RENT/SPACE $900.00 $391.36 $204.02 $166.17 $138.44 $900.00 STAFF TRAINING $200.00 $86.97 $45.34 $36.93 $30.77 $200.00 SUPPLIES $50.00 $21.74 $11.33 $9.23 $7.69 $50.00 TELEPHONE $150.00 $65.23 $34.00 $27.70 $23.07 $150.00 TRAVEL $36.00 $15.65 $8.16 $6.65 $5.54 $36.00 OTHER $500.00 $217.42 $113.35 $92.32 $76.91 $500.00 OTHER $1,000.00 $434.84 $226.69 $184.64 $153.83 $1,000.00 OTHER $2,000.00 $869.68 $453.39 $369.28 $307.65 $2,000.00 OTHER $3,000.00 $1,304.53 $680.08 $553.92 $461.48 $3,000.00

TOTALPRACTICE IMPLEMENTATION COST $2,316,611.00 $1,007,360.53 $525,160.31 $427,735.70 $356,354.46 $2,316,611.00

NET INCOME (LOSS) CARE COORDINATION $3,540,746.50 $1,539,666.47 $802,663.69 $653,758.30 $544,658.04 $2,316,611.00

Calculation of Medicaid Managed Care Excess Funds

Care Transformation

Total Excess Funds $253,611.96

Total Revenue $1,802,025.00

20% roll forward cap $360,405.00

Excess funds % to revenue 14.07%

Provide explanation of how roll forward expenses will be used:

Practice Incentive Reporting

• Practice Incentive reporting is defined as all payments received by the PO’s/PHO’s for Medicare and Medicaid Managed Care only.

• PO/PHO’s will report funds disbursed to practices.• Reporting requirements are by payer and include:

Practice name, Location, Amount, Date. • PO’s/PHO’s are subject to a maximum retention of 20%

of the total Incentive dollars received. • The retention of the PO/PHO Incentive dollars >20% may

require documentation supporting the dollars retained.

Draft Incentive Reporting Module

Medicare Medicaid Managed Care

Total Incentive Funds Received by PO/PHO $1,000,000.00 $500,000.00

Incentives Paid to Practices:

Name of Practice Location Date

Robert Smith M.D. Detroit 7/1/2012 $500.00 $675.00

Total Incentives Paid $500.00 $675.00

Net Retention of Incentives withheld by PO $999,500.00 $499,325.00

% of retention withheld by PO 99.95% 99.87%

Questions

Questions on MiPCT Financial Reporting can be submitted to WWW.MIPCT.ORG contact us.

NARRATIVE STATUS UPDATEClare Tanner and Carol Callaghan

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Overview

• Narrative Status Update– Detail will vary by quarter

• 6 and 12 month report require practice level detail• 3 and 9 months, brief PO- level overview

– Avoids duplication of SRD and Quarterly PGIP Progress reports

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Narrative Status Update

• Content: based on year 1 requirements and priorities– Care Manager hiring progress and barriers– Infrastructure implementation progress across

practices• Electronic registry functionality• Care Management documentation• Transition notifications

– Opportunity to communicate barriers and successes

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Care Management Activity Reporting

• Minimum core data: – Number of encounters per care manager, by payer

• Will be required beginning third quarter 2012• Necessary for reporting to participating payers

and MDCH• Need to understand PO/practice reporting

capacity to minimize burden

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Submission

• Due dates for quarterly reporting– May 1, 2012– July 31, 2012– October 31, 2012– January 31, 2013

• Submission: email to mipctdemo@michigan.gov

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