January 27, 2017

Every business concept has brilliant ideas or elements in them. Unfortunately, great ideas are not enough to produce a great business. I have seen hundreds of great ideas, but few of those great ideas end up creating a new business because so many ‘would-be’ business owners lack either the experience or the expertise to successfully manage their great concepts into cash-rich businesses.

Go ahead and develop your business concept. Identify and consult all the professionals essential to the project [accountants, lawyers, engineers, designers, architects, builders, and trades ]. Now you will have a clear understanding of what is involved in completing the implementation of your project.

You have sourced competitive quotations on the costs each profession needs to charge for their professional work, the input of the various trades and the materials for each task and stage of the complete job. So eventually, you have brought all this information together with the scheduling plan of your project manager. Now you can place every task, stage and the corresponding cost into a timeline format.

So, the draw-down schedule brings together each task, the cost of that task or stage, and the time in which the work is to be completed. These are the 3 elements of a draw-down schedule.

When all this is completed you may now quantify the draw-down schedule, where you need to pay each contractor or professional as they complete their stages of your project.

How to do this? Create a timeline with markers at regular intervals, indicate each month of the project implementation phase. [Tip: Number the first month of project implementation as Month 1 etc. Therefore, if there are delays in starting, you don’t have to re-write the spreadsheet.]

Now locate each component of your project on that timeline, show when each piece of the task needs to begin, and when it should be ended. You may find that this is quite complex. If you’re doing this on paper it may take a few tries to finalise. This will depend upon the complexity of the project implementation.

If you’re recording the timeline on a computer you may need to re-sort the information a few times to get it all ordered. Now plot on this timeline axis a place for the expenditure for each component of the work. When this is done for every piece of the project you shall have a $$$ value for the amount of capital needed to pay for all the work. Make sure that you include the costs of accessing the investment funding, any commissions payable etc.

When you identify the amount of capital you and your fellow shareholders have in hand at the start, you shall be able to identify the point in time when you shall need to have access to an investor’s funds to continue the development program.

Now your ‘draw-down schedule’ is complete. This is a vital piece of information you need to bring to us, as we prepare your winning business plan. Your detailed work demonstrates to …

Importance of Using Proper Modifiers:

1. The physician performed multiple procedures

2. The procedure performed was bilateral

3. The E/M service was done on the same day of the procedure

4. The procedure was increased or decreased

5. The procedure has both professional and technical component

6. The procedure was performed by other provider (Anesthesiologist, Surgeon Physical Therapist, Speech Pathologists etc.)

7. Procedure on either one side of the body was performed

8. The E/M service was provided within the postoperative period

9. The E/M service resulted to Decision of Surgery

10. Unusual Circumstance

Maximize your reimbursement for bilateral procedures by using the correct modifier.

Bilateral Modifier (-50)

Depending upon the insurance payer, processing claims with bilateral procedure should be paid 150%

Medicare Part B requires one single line of bilateral procedure code with Modifier 50. They normally process the claim with 150% reimbursement. But again, you have to check on this in your state and in your region.

Some commercial insurance would prefer Two Lines of the same code, once with 50, second without 50. Then second modifier on the 1st line is RT or LT, modifier RT or LT on second line, with 1 unit of service each code. Must be reimbursed at 150%

Some commercial insurance would prefer two lines of the same code with modifier LT or RT on each line with 1 unit of service each code. Must be reimbursed at 150%

Always check on your Physician’s Fee Schedule if the procedure code is billable as bilateral J.

Using LT & RT modifier is used to specify which side of the body the procedure was done by the physician. Medicare Part B based on my experience requires specific modifier, either LT or RT. Example you may report procedure 64626 done on the Right C4-C7 Facet Joint Nerve Ablation as 64626-RT.

Modifier -26. Professional Component.

Example: Report procedure code 77003 – Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid,, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint) including neurolytic agent destruction) with modifier -26 to indicate the physicians Professional Component only reimbursement and not technical component. If the provider’s office owns the fluoroscopic equipment, do not append -26 modifier.

Modifier -25. Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service.

Example: Report E/M code 99213 (Office or other outpatient visit for the evaluation and management of an established patient) with Modifier -25 for procedure code 20610 Knee Joint Injection done on the same day of the procedure. Modifier -25 indicates significance and separate identifiable E/M service outside the procedure done on the patient. DO NOT use modifier -25 to report E/M service that resulted for initial decision for surgery.

Instead use modifier -57 for Decision for Surgery

Modifier -24. Unrelated Evaluation and Management Service by the Same Physician During Postoperative Period

Example: Report E/M code 99213 with Modifier …