1. Introduction to Financial Management in Family Planning Settings
Introduction to the Financial Management Change Package
Facilitator Notes
Welcome to today’s meeting, where we will discuss financial management. In this session, we’ll introduce the Financial Management Change Package, which was developed by the Family Planning National Training Center. We will review best practice recommendations for financial management, and we’ll start to brainstorm ideas for improving financial management in your setting. (Note to facilitators: See related discussion guides for more information.)
Activity
Conduct participant and facilitator introductions.
Note to Facilitators
We recognize that Title X grantees have networks of sub-recipients and service sites, and how they’re described can be confusing. For the purposes of this training, we have used agency and site throughout (and interchangeably). We encourage you to refer to your network in the terms you’re most comfortable with/accustomed to using.

2. Meeting Objectives By the end of today, you should be able to:
Define the best practice recommendations for financial management to increase revenue as outlined in the Financial Management Change Package
Describe one tool available to document and measure financial performance indicators
Describe one financial performance indicator that will impact revenue
Describe three strategies for improving performance on the financial management performance indicators
Facilitator Notes
There are 4 objectives for today. By the end of today’s meeting you should be able to:
Define the best practice recommendations for financial management to increase revenue as outlined in the Financial Management Change Package
Describe one tool available to document and measure financial performance indicators
Describe one financial performance indicator that will impact revenue
Describe three strategies for improving performance on the financial management performance indicators

3. Why is Financial Management Important?
Financial Management: planning, directing, monitoring, organizing and controlling an agency’s monetary resources
Monitoring financial data informs you of your agency’s financial health
Achieve financial goals to accomplish clinical and business objectives
Facilitator Notes
Before we jump into the Financial Management Change Package, let’s take a step back and talk about why we should focus on financial management and why it is important to your family planning setting. Let’s start with defining financial management. When we say financial management, we define this as planning, directing, monitoring, organizing, and controlling an agency’s monetary resources and for clinics, this is service revenue.
When we focus on financial data, we can assess the financial health of our individual family planning agencies. Ultimately, when we focus on our financial health as an organization, it can enable us to serve more women and men in need of family planning. Looking at your agency’s financial health as an organization can impact the ability to expand the number of clinics/sites, remaining viable in this market, adding hours, and adding services. It all takes money and planning.

4. Clinic Team’s Role in Financial Management
Day-to-day activities of all clinic staff directly affect revenue. For example:
Number of clients seen
Front desk registration process—gathering accurate information
Measure, monitor, and manage financial performance indicators
Allows for specific issue identification
Allows for focused, targeted improvement plans
Facilitator Notes
Financial management, as it pertains to clinic staff and managers, mostly refers to optimizing revenue and monitoring of related financial objectives.
Clinic revenue is impacted by all clinic staff. Their day-to-day activities and processes directly affect revenue.
Simply put, more clients equal more revenue. Scheduling more clients (a function of front desk staff) and seeing more clients (a function of clinicians) increases charges, and if receivables are managed well, will increase revenue too.
Ensuring accurate capture of third party payer information at the front desk will affect payer mix, and increase revenue, as third-party payer reimbursement is almost always more than an uninsured/self-pay client. If mistakes are made, insurance coverage isn’t captured and as a result, revenue is decreased.
It is recommended that clinic staff measure and monitor financial indicators using a monthly key indicator report, or financial dashboard. By reviewing data that measure the financial results of a given activity or process (or activities/processes), a team can identify areas in which the clinic is performing well, along with areas in which performance can be improved.
Measuring and managing financial indicator data enables clinic staff to make focused, targeted improvements to areas that can improve revenue stream. Sharing these data with all clinic staff is important for buy-in to identify and/or implement targeted improvements.
The revenue cycle management process consists of many steps and moving parts. When we focus on one step, we can measure those particular processes, workflows, and/or data in order to make improvements and then manage financial data.

5. Overview of the Financial Management Change Package
Goal: Support improvement of financial management practices and the factors that impact organizational financial health to improve revenue
Facilitator Notes
The Financial Management Change Package was developed by the Family Planning National Training Center. It is a compendium of financial management recommendations to support Title X grantees and their networks of sub-recipient and service sites in improving revenue. This package can be used by sites to:
Increase awareness of best practice strategies
Select high-impact strategies to implement
Identify key financial indicators with the largest impact
Assess the impact of implemented changes

6. Best Practice Recommendations
Bill the correct payer and optimal amount
Monitor and manage client fee collections
Monitor and manage payments from third-party payers (TPPs)
Facilitator Notes
This change package outlines three best practice recommendations for increasing revenue. They are:
Bill the correct payer and optimal amount. This best practice includes ensuring the correct slide or discount for clients, assuring accurate gathering of third party payer (TPP) information.
Monitor and manage patient fee collections. This best practice includes collecting fees from uninsured clients at the time of visit as well as assuring correct slide and collection of insured clients’ copays, deductibles, and coinsurances.
Monitor and manage payments from TPPs. This best practices focuses on assuring account receivables (A/R) and denials are efficiently managed.
This change package also includes a rationale for each recommendation, as well as specific strategies related to each recommendation. We’ll take a closer look at these strategies now. (Note to facilitators: For more discussion on these topics, see related discussion guides for each best practice.)

7. Best Practice 1. Bill the correct payer and optimal amount
Strategies
Develop and/or update policies and procedures
Conduct cost analysis, utilize data to adjust fee schedule and to make other business decisions
Implement front-end procedures that assure accurate gathering of TPP and family size and income information
Provide training on documentation and coding
Facilitator Notes
Best Practice 1 is to bill the correct payer and optimal amount. This means making sure that your agency is billing the right payer for each client and when you do this, that you are billing the optimal amount for the services provided. The strategies for this best practice were developed for the grantee level, but you can also implement them in your setting.
The first strategy is to develop and/or update policies and procedures to ensure they are accurate and efficient. Once you have developed or updated policies and procedures, you may need to provide training to your staff to ensure they are followed. For example, you may want to assess your front-end procedures—including scheduling, collection/electronic verification of insurance information, and family size and income information.
It is recommended that sites complete an annual cost analysis. It is important to compare the costs of your services to your current fee schedule and TPP contractual rates. Data can also be used to assess the need to modify expenses or services.
Capturing client data at the front end assures that, when appropriate, a TPP can be billed, as you can capture more revenue from a TPP than from an uninsured client. Secondly, when family size and income information is accurately gathered at the front desk, this ensures that the correct discount can be applied for all clients.
Last but not least, provide training on complete and correct documentation of clinical care and processes to ensure that all corresponding charges/codes are captured.
Discuss
When thinking about your site (or agency), what are some reasons or day-to-day operations that impact your ability to bill the correct payer and optimal amount successfully?

8. Best Practice 2. Monitor and manage client fee collections
Strategies
Establish and/or update and implement policies on client payment and collection processes
Manage discounted fee collections at time of visit for uninsured clients
Accurately discount and bill for TPP client fees (copays, deductibles, coinsurances)
Facilitator Notes
Best Practice 2 is to monitor and manage client fee collections. This is accomplished by managing fee collections at the time of visit for clients without health insurance who pay from your sliding fee scale as well as for insured clients who may have copayment or coinsurance fee(s). The strategies for this best practice were developed for the grantee level, but you can also implement them in your setting.
Strategies for implementing this best practice recommendation include:
Establish and/or update and implement policies on client payment and collection processes.
The second strategy to consider is to manage discounted fee collections at time of visit for uninsured clients. This is an important function of front desk staff. Additional strategies are can be found in the Financial Management Change Package.
Accurately discount and bill insured (TPP) client fees. These include copayments, deductibles, and coinsurances.
Discuss
Thinking about your site (or agency), what are some barriers to managing client fee collections?

9. Best Practice 3. Monitor and manage payments from third-party payers (TPPs)
Strategies
Develop/implement detailed written policies
Analyze accounts receivable (A/R) on a monthly basis
Analyze denial rates and trends on a monthly basis
Implement strategies to manage TPP contract terms and relationships
Facilitator Notes
Best practice 3 is to monitor and manage payments from third-party payers (TPP).
Strategies related to this recommendation include:
Develop detailed written policies such as claim submission process/time frames, payment posting, A/R follow-up, and denials management
Analyze A/R on a monthly basis to identify issues that need to be addressed
Analyze denial rates and trends on a monthly basis, by payer, and by denial type
Implement strategies to manage contract terms and relationships with TPPs
Discuss
Thinking about payments from TPPs, what issues prevent your site (or agency) from receiving monies owed to you for services provided (and submitted claims for)?

10. Financial Management Performance Indicators
Indicators that impact revenue
Payer Mix : % amount by visit and by revenue of different payer sources
Monthly Charges: amount billed for services rendered, gross and net charges
Claims Denial Rate: % of claims denied by TPP
A/R Aging: length of time an account balance has been outstanding
Net Collection: retrospective analysis, amount of money collected vs. amount expected
Facilitator Notes
When looking at improving revenue in your family planning setting, there are many variables that impact revenue. We have identified five possible performance indicators that impact revenue that you could focus improvements on.
The first indicator is payer mix. When you focus on this measure, you can calculate the percentage amount by visit as well as by revenue for different payer sources—such as Medicaid, private insurance, and self-pay/uninsured clients—in your family planning setting.
The second indicator is monthly charges. By looking at this measure, you can measure charges by different revenue sources—such as Medicaid, private insurance, and uninsured/self-pay clients—in your setting. You can use this measure to identify the average charge per client by each revenue source, as well as by total charge per client across all revenue sources. Additionally, you can assess discounts given to uninsured clients, including the percentage of clients in each of your discounted categories.
The third indicator, claims denial rate, reflects the percentage of claims denied by TPPs, comprised of private insurance and Medicaid, during a given time period.
A/R aging is another indicator that impacts revenue. Aging refers to the length of time an account balance has been outstanding and is used as an indicator of the ability to collect receivables in different time “buckets.” A/R aging can be analyzed by a variety of comparisons—such as by payer and by clinician.
Last, we have identified net collection as an indicator that impacts revenue. This measure is typically a retrospective analysis to assure collection efforts are completed on client services for a particular time period. Similar to A/R aging, net collection can by analyzed using a variety of comparisons—such as by each specific TPP.
When a Title X agency or site thinks about implementing a quality improvement (QI) initiative around financial management, it is important to collect baseline data on the five indicators mentioned, and apply that data to identify which best practice to work on.

11. Other Indicators Why use other/additional indicators?
Data collection challenges
Staff position
Solutions/process changes may involve multiple steps “sub-indicators” to achieve improvement
Indicator: Increase Medicaid in Payer Mix
Sub-indicators: number of Medicaid waiver applications completed or number of Medicaid waiver applications approved
Facilitator Notes
In addition to the performance indicators mentioned, sometimes you may need to look at other indicators. First, looking at other indicators may be helpful if your agency experiences any data collection challenges.
Secondly, other indicators may be helpful based on your agency’s staff and their position and responsibilities. It is important to ensure the indicator is meaningful to the staff involved in the solution. For example, front desk staff may not find meaning or significance in A/R aging buckets, but these amounts will decrease if front desk staff assures no claims are “pending” or are awaiting submission due to missing or inaccurate data, at the end of the week. A performance indicator to track as a sub-indicator of A/R aging could be the number of claims pending.
Third, solutions and/or process changes may involve multiple steps (or sub-indicators) to achieve improvement in the overall performance indicator. For example, if we have a goal to increase the percentage of Medicaid in our payer mix (payer mix being the performance indicator), a sub-indicator may be the number of Medicaid waiver applications completed. There are many tasks that may be aligned with increasing this number, such as training front desk staff on how to complete the enrollment process most efficiently, scripts for them to use when talking with clients, and so on. Another sub-indicator may be the number of Medicaid waiver applications approved. This sub-indicator may follow once an agency has determined there is a denial issue with applications. Homing in on the reasons for errors and improving this sub-indicator will improve the performance indicator (Increase Medicaid in Payer Mix).

12. Analyzing Financial Data
Questions to ask
Are the data accurate?
Data collection challenges
What questions result from data analysis?
What other data would be helpful to review?
Approaches to analyzing data
Compare/analyze trends
Compare sites, identify best practices
Compare to benchmarks
Facilitator Notes
As is always the case with data, it is important for us to ask some questions and employ certain strategies when looking at financial data. For example, start by asking if the data are accurate. Are you accurately extracting the data from your system? Can the data (or report) be replicated? Asking questions about the accuracy of data can lead to identifying data collection challenges such as staff time, practice management or electronic health record system limitations, or user limitations (knowledge of systems).
Something else to think about: what questions does reviewing the data raise?
Last but not least, it is good to think about what other data would be helpful to review. For example, if you run a claims denial report and it shows a denial rate of 20%, it might be helpful to have a report by denial type to further home in on the issue and solution.
There are multiple approaches to analyzing financial data. These include:
Looking at trends. Is the trend going in a positive or negative direction? Does this trend make sense or can you identify why a trend may be occurring? For example, if you notice an increase in denials since a front desk staff person resigned, perhaps a training issue regarding accuracy of insurance information gathering would be helpful for new staff.
If you as a sub-recipient manage more than one site, it may be helpful to compare performance across the sites you manage. Another way to compare to your peers is to ask the grantee to help put your data into perspective as compared to other sub-recipient sites.
Lastly, another approach is to compare your data to national benchmarks, to Title X averages, or benchmarks set by you or your leadership.

13. Financial Management Performance Indicator Report
Facilitator Notes
The Family Planning National Training Center has developed a performance report to help sites track financial data. The tab shown here is the summary tab where you can enter data on a monthly basis for revenue and the five performance measures. Each measure has its own subsequent tab where you can track your progress. Remember that several of these performance indicators can be tracked/analyzed in a variety of ways.

14. Financial Management Baseline Data
Facilitator Notes
First, let’s look at where you are starting. What is your site’s current performance on these five measures? Remember, if you are unable to calculate your site’s performance on any of these measures, that is important to identify.
Activity/Discuss
Ask site(s) to discuss financial management baseline data. (Note: Facilitators can have data on their screen or instruct sites to bring copies of their data to the training. It is recommended that the facilitator reviews data for all sites prior to this session.)
What data jump out at you? Is there an indicator that seems low?
Were there any indicators you were unable to extract/pull from your practice management/electronic health record system?
After reviewing your performance indicator data, develop a performance goal or plan on how you will improve in that particular indicator. (Note: Depending on time, facilitators should encourage at least two to three sites to share their sample performance goals. Make sure that sites mention their baseline data, as well as their performance goals.)

15. Financial Management Performance Indicator Report
Revenue and Payer Mix
Facilitator Notes
The revenue and payer mix indicator tab enables you to document revenue on a monthly basis. You can document payer mix by visit and by revenue for different payer sources (uninsured/self-pay clients, Medicaid, and private insurance).

16. Financial Management Performance Indicator Report
Monthly Charges
Facilitator Notes
The monthly charges tab in the performance report and improvement plan Excel spreadsheet enables you to document monthly charges—by payer source (uninsured/self-pay clients, Medicaid, and private insurance) as well as by total monthly charges and estimate charge per client.

17. Financial Management Performance Indicator Report
Claims Denial Rate
Facilitator Notes
The claims denial rate tab enables you to document the number (and percentage) of denied claims. You can insert the different payers such, as Medicaid (including different Medicaid managed care organizations and different private insurance payers). Additionally, you can document denial reasons to identify the percentage of denied claims by common denial reasons. The tab lists a few common denial reasons, but you can add more.

18. Financial Management Performance Indicator Report
A/R Aging
Facilitator Notes
The A/R aging tab in the performance report and improvement plan enables you to document the dollar amount and percentage of claims in different time buckets (0-30, 31-60, 61-90, , and over 121 days). The tab lists by site, but you can also use this to compare across different payers. A national benchmark for each time bucket is listed.

19. Financial Management Performance Indicator Report
Net Collection Rate
Facilitator Notes
Net collection rate is typically a retrospective analysis. You can look at collections for clients in different payer categories (uninsured/self-pay, private insurance, and Medicaid) as well as at total collections.

20. Setting Performance Indicator Goals
Approaches
Industry benchmark
For example: 5% is an industry benchmark for claims denial rate
A best practice among your sites
Determined based on historical experience, state information, or peer data/experiences
Can be reset, incrementally adjusted as improvements are made
Facilitator Notes
There are several ways to set goals for these performance indicators. Some of them, such as denial rate, have clear industry benchmarks.
Another approach is to look at best practices in your network of sites. For example, you could identify which site has the lowest denial rate percentage and use that percentage as your goal for the other sites in your network. If you have one site, you could look at denial rates by providers instead.
Third, you can set goals based on historical experience such as when there is a change in staff or a new PM or EHR system; state information such as state percentages of Medicaid managed care enrollments; or peer data, such as denial rates for a specific payer across a Title X network.
Lastly, it is important to note that, regardless of the approach you take in setting performance indicator goals, these goals can be reset or incrementally adjusted as improvements are made.

21. Quality Improvement (QI) Team
QI team may include representatives from:
Administrative
Clinical
Billing/finance
Front desk/registration
Members may vary depending on the financial management QI initiative
Who is on your QI team already?
Facilitator Notes
We hope you are feeling excited about possible improvements you can make at your site. QI is a team effort. In order to approach systems changes, you will need a team that represents all aspects of the system.
A good QI team is diverse—and should include representation of staff from clinical, administrative/clinic management, billing and finance, front desk, etc.
Members of your QI team may vary depending on the specific financial management QI initiative.
Think about who is on your QI team and who else you want or must have on the team. Make sure to get the necessary team involved as early as you can in your QI initiative.

22. Next Steps Involve additional staff on the QI team, if needed
Designate regular meeting time for QI team
Designate staff member to collect and report data on a regular basis (e.g., monthly)
Designate meeting time for Develop a Site- Level Improvement Plan
Facilitator Notes
Next steps should include:
Designate regular meeting time for QI team
Identify when future sessions will take place and who needs to be there
Designate staff member to provide data on a regular basis (e.g., monthly)
Designate meeting time for developing a site-level improvement plan. (Note to facilitators: The discussion guide, Develop a Site-level Improvement Plan, was designed to follow this session.)
Discuss
What are other next steps you will take in addition to what is listed here?
When will your QI team meet next?

23. What other questions do you have
What other questions do you have? What other issues would you like to discuss?
Discuss (if time allows)
What other questions do you have for each other before we end? Are there other issues or challenges that we haven’t discussed yet?
Before we leave, what is one thing you will take away from today’s discussion? (Note to facilitators: Consider round robin sharing or ask a couple of participants to share.)

24. Contact: fpntc@jsi.com
Thank you!
Contact:
Facilitator Notes
Thank you for participating in today’s discussion!
If applicable, you can contact me at:_________
You can also always contact the Family Planning National Training Center with questions/comments.