CHC Financial Check Up

Karen J. Kuhn

Revenue Cycle Management Consultant

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 trending data• Talking to others in your organization

about the data

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.

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!

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

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”• 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.

Unapplied Funds

AR = Accounts Receivable Balance

• Global AR balance• Drill down – who owes you money?• Reports/AR/Aging by Financial ClassGlobal from totals of the report – deposits and total AR from Patient and Insurance

Snips showing totals by some FC:

Medicare FQHC Medicaid FQHCCommercial

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?

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

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 E-Mail• Billing Staff & Mgr, CFO, Coding,

Operations

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.

Possible Reports

VisAnalytics

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!

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.

Digging into Statuses - Rejected

• Pull a billing screen of one concerning status, one recent month

Rejected Tickets Continued

• Visit Owner set by denial type • Are they being worked consistently?• Billing department organization

o Alpha last name of patiento Payero Siteo Line of Business

• Scrutinize every process• Cross train every task possible

Digging into Statuses – File Succeeded

• Again, one month of data• Ran in June 2014 for April DOS

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!!

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.

Major Funds on Deposit, Conveyances

• Active reportso Small balance write offo Conveyances within ticketo 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

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

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”• Practice Pulse with Angela Jarrett• Visualutions has Revenue Cycle

Management services:o Projectso Part of the billing processo Complete billing services

Download all conference presentations at

visualutions.com/ug15conference

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Thank you.