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, conveyancesElectronic 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 MonthlyBatch 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

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.