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CHC Financial Check Up Karen J. Kuhn Revenue Cycle Management Consultant
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How to know if your CHC financials are healthy or in need of resuscitation.
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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 trending data Talking to others in your organization about the data
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Define “Healthy” Every CHC or practice will define healthy in a different way. The indicators presented in this session are a start and will help define healthy for your organization.
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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!
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Other Possible Indicators % of checks deposited EFT % of remits posted electronically Time lapse between patient visit and data entry Time lapse between data entry and billing claim
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Claim Status What is the status of most of your claims? Reports/CHC Reports/Billing Status Analysis
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Unapplied Funds Do you have unapplied funds? Transaction management, unapplied “yes” Fix whatever is causing your unapplied funds Front Desk Staff – Pmt posting training Billing Staff – Pmt posting training, conveyance training Electronic Remits – training, set up, clean up Unapplied funds are a sign of weakness in the organization’s internal controls.
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Unapplied Funds
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AR = Accounts Receivable Balance Global AR 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: Medicare FQHCMedicaid FQHCCommercial
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Write Offs Many CHCs see write offs as a “project”, in any practice there will be some write offs, they should be done consistently Reports/Financial/Adjustments Pull combinations that make sense for your CHC – GL accts from the CFO Monitor these for a few months, what are your averages?
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Credits & Money on Deposit Are you refunding your patients and payors timely? Consistency again. Reports/AR/Credit Balance Are deposits/conveyances being handled in the system? If these activities are not happening routinely, you probably have some messes to clean up
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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
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Closing Soft Close - Closing Batches daily Hard Close Monthly Batch Closing in Admin Hard closing date
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Communicating to Others Culture of communication – formal or informal Paper, Electronic, Courier or E-Mail Billing Staff & Mgr, CFO, Coding, Operations
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Very Important Reminder! Please remember the difference between Trending & Reporting Use Finance Class reports for trending ONLY! Never use Finance Class for reporting, especially in an FQHC. Never.
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Possible Reports
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VisAnalytics
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Working Claim Statuses Pull Billing Criteria Start with largest dollar, 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!
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About Paid Status Tickets with a balance should NEVER be in Paid Status. Often, far too often, tickets are manually changes to Paid status and they are not…actually paid. Review this status. There may be money to mine here.
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Digging into Statuses - Rejected Pull a billing screen of one concerning status, one recent month
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Rejected Tickets Continued Visit Owner set by denial type Are they being worked consistently? Billing department organization o Alpha last name of patient o Payer o Site o Line of Business Scrutinize every process Cross train every task possible
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Digging into Statuses – File Succeeded Again, one month of data Ran in June 2014 for April DOS
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File Succeeded Status Continued Are they really successful or should they be in Rejected? 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!!
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A Word About SFS Tickets that are SFS should NEVER be in Approved status. Identify SFS issues early, fix always. If your SFS aren’t working, seek help from Vis help desk, customer service. If fee schedules aren’t fixed, it will haunt you forever and create many phone calls from patients. Identify Early, Fix Always.
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Major Funds on Deposit, Conveyances Active reports o Small balance write off o Conveyances within ticket o Conveyances within a date range Get help with these reports from Vis Support BEFORE you run them! Keep them cleaned up Identify processes that are creating conveyances
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Ongoing Write Offs Outside collection agencies, be consistent Non-credentialed clinician, write off the loss Beyond timely, write them off Ongoing charity or zero pay programs, make these someone's primary responsibility Monitor write offs, there is probably a monthly goal
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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
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Other Thoughts What to do when you hit “Normal” or “Healthy” Keeping the equilibrium What to do if you cannot reach “Healthy” Practice Pulse with Angela Jarrett Visualutions has Revenue Cycle Management services: o Projects o Part of the billing process o Complete billing services
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Download all conference presentations at visualutions.com/ug15conference Join our newsletter and stay up to date! visualutions.com/newsletters Thank you.
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