CHC Financial Check Up How to know if your CHC financials are healthy or in need of resuscitation.

Objectives Define “Healthy” Discuss possible indicators to track Learn what reports to run to get to your indicators Assess what that data is telling you Mechanisms for reporting and tracking trends Talking to others in your organization about the data

Possible Indicators Claim Statuses Unapplied funds AR Balances Closing dates Write Offs Remember when choosing indicators, these are personal, unique to your clinic system – one size does not fit all!

Claim Status What is the status of most of your claims? Reports/CHC Reports/Billing Status Analysis

Unapplied Funds Do you have unapplied funds? Transaction management, unapplied “yes” Why? Fix them, FIX what caused them! Front Desk Staff – Pmt posting training Billing Staff – Pmt posting training, conveyances Electronic Remits – training, set up, Unapplied funds are a sign of weakness in the organization’s internal controls

Unapplied Funds

A/R = Accounts Receivable Balance Global A/R balance Drill down – who owes you money? Reports/AR/Aging by Financial Class Global from totals of the report – deposits and total AR from Patient and Insurance ______________________________________ Snips showing totals by some FC:

Write Offs Many CHCs see write offs as a “project”, in fact they are a way of life for CHCs and should be done consistently Reports/Financial/Adjustments Pull combinations that make sense for your CHC – perhaps Bad Debt & Collections & Charity or Ins Bad Debt & Past Timely Monitor these for a few months, what are your averages?

Credits & Money on Deposit Are you refunding your patients and payors timely? Who do you owe money to? Reports/AR/Credit Balance Are deposits/conveyances being handled in the system?

Deposits & Credits Deposits from the Aging by FC Report Credits on patient accts from Credit Balance Report Credits owed to insurance companies Pull a billing screen, status of Overpaid, all insurances except Sliding/Self Pay

Closing Soft Close - Closing Batches daily Hard Close Monthly Batch Closing in Admin Hard closing date

Communicating to Others Culture of communication – formal or informal Paper, Electronic, Courier or Billing Staff & Mgr, CFO, Coding, Operations

Possible Reports

VisAnalytics

Now that you know where the claims are, how do you work them? Pull Billing Criteria Start with largest number, oldest claims If you have lots of old claims, prioritize by DOS Realize and inform leadership, there may be losses due to timely filing Know that as you work rejections, file succeeded will increase – moving targets The goal is “Paid” but how you get there matters!

Digging into Statuses - Rejected Pull a billing screen of one concerning status, one recent month

Rejected Tickets Continued Are you using Visit Owner? Have Visit Owners been set up by Denial Type or named for a person? Are they being worked? Consistently? Some of this is dependent on how your billing dept is organized – by alpha in last name, by payor, by site, by line of business, etc Scrutinize everything – where is the process failing?

Digging into Statuses – File Succeeded Again, one month of data – this was pulled in late June 2014

File Succeeded Status Continued So…they went to the payor…and…what now? Know how long it takes your major payors to pay If claims are not paid in expected time – inquire online, call, follow up. Refile without knowledge as a LAST resort!!

You have major funds on deposit, not enough hands to do conveyances There are active reports that can be run to help with writing off small balances including small credits, conveying balances to the same ticket or within a date range of tickets Get help with these reports from Support BEFORE you run them! Keep them cleaned up! Use Task Management

Ongoing Write Offs If you send patients to outside collections, perhaps due to return mail, work the process consistently If you have a clinician that isn’t credentialed, take care of those tickets when you are sure they are a loss If you have tickets beyond timely, write them off If you have ongoing charity or zero pay programs, keep up with the write offs Someone in the CHC probably has an idea of what should be written off annually or monthly (CFO), find that number and make it the write off goal – monitor it and work toward it

Possible Stumbling Blocks Write offs increase dramatically Frustrated staff on many levels Starting to right the ship and not completing the job Expect ups & downs “Blips” in reporting Change takes time

Other Thoughts What to do when you hit “Normal” or “Healthy” Keeping the equilibrium What to do if you cannot reach “Healthy” Visualutions has Revenue Cycle Management services; for projects, partial billing or to perform complete billing services from charge entry to paid status.