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Post on 22-Dec-2015
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Fiscal Management and Controls
Clinic Director
Assistant Director
Front Desk Staff
Admission/ Discharge
Scheduling
Ongoing Entitlement Verification
Insurance Copays/ Fee Collection
Clerical Functions
M.D.s
Therapists
Fiscal Management and Controls
Overview of Finance Department› Financial operations include:
Establishment of annual budget Monthly reporting considerations Manage billing and collection function Reporting on uncollected and other accounts
receivable CFR Accounting Methodology
Fiscal Management and Controls
Revenue Modeling› Clinic Services offered› Services by CPT/APG codes› Payor mix and its impact on revenue› Medicaid/Medicare Crossovers› Uncompensated Care and Uncollectable amounts› Complicated billing issues such as:
Add-ons Two/three services in one day No shows
› Future Webinars will Review OMH Projection tools Fiscally Viable Fiscally Optimal
Fiscal Management and Controls
Developing and Measuring Productivity Standards› Calculating the fiscal, entitlements and
other staff needed beyond the front desk› Therapist’s productivity calculations› Psychiatrists’ productivity› Medical doctor’s (PNP) productivity› Onsite/offsite› Employee Retention
Fiscal Management and Controls
Software and the Impact on Clinics› Software Interoperability – that moves from
Clinician to Front Desk to Billing and General Ledger
› Centralized Scheduling› E-Prescribing› Eligibility Checking› Efficiency
Speed of billing/ payment process› Accuracy› Remote note writing and billing procedures
Fiscal Management and Controls
Contracts beyond Medicaid, panel enrollment, and billing for other coverages:› Other Managed Care and Commercial
Insurance contracts› Individual Provider NPI panel enrollment› Managed Care Companies paying the full
Medicaid Rate
Fiscal Management and Controls
Reports and Analyses› Monthly Clinic Profit and Loss Statement› Weekly Productivity Reports
Upcoming Presentation of Tools› Weekly/ Monthly Service Projections› CPT/APG Reports as compared to Budget
Fiscal Management and Controls
Common Fiscal Mistakes› Inaccurate budgeting› Staffing issues› Productivity› CPT/ APG Projection errors› Unlinked NPI numbers
Fiscal Analysis for a Productive and Fiscally Viable clinic
Weekly productivity measurements Weekly billing reports Monthly financial statements with
productivity measured. Problem recognition and developing
corrective fiscal plans. The gold standard of fiscal practices
Gold Standard of Fiscal Practices
Bi-Monthly Review at the Highest Levels
Ongoing Reviews scheduled with both Finance Department & Clinic Management
Ongoing Loop– Numbers Tell a Story› Clinics provide the story behind the
numbers
Next Steps
Checklist – Things you should be thinking about
Questions & Answers Upcoming Webinars
› Benchmarking Tool› Sensitivity Tool
Organizational StructureDo your clinics have clearly defined lines of
authority to support accountability?Is your organizational structure clearly
articulated and understood by staff?Do program and finance staff work closely
together in an efficient and productive manner?
Is staff aware of their roles and are their performance expectations clear, documented and reviewed on a routine basis?
TechnologyCan your accounting system and finance staff: Isolate clinics as a separate cost center. If you have multiple sites can you isolate
costs and revenues by location. Can your staff assure that shared costs are
properly allocated based upon CFR methodology
Can your staff assure all services/expenses/revenues are accurately recorded prior to month end close to promote accurate monthly financial reporting.
Can your billing systems provide the following information?
No show and cancellation rates by staff and client.
Activity by CPT code by staff/client/payer. Group size by staff. Units of service and revenue by payer type. Difference between Insurance
co-pay/deductibles from sliding fee payments. Services that are second service same day. Services that are subject to a modifier. Amount of time spent providing crisis services
and bill and report accordingly.
Scheduling System Do you have a centralized electronic
scheduling system? Do you have a clear definition for No
Shows and Cancellation? Do you capture No Shows and
Cancellations by Staff and by Client? Is your scheduling system efficient and
does it reduce the amount of unused clinical capacity?
Electronic Medical Record Have you implemented an EMR
solution for your agency If not, do you have a plan for
purchasing and implementing an EMR
Fiscal Modeling and Benchmarking Performance
Have you modeled your programs performance using the OMH projection tools?
Have you benchmarked your productivity standards to assure fiscal viability?
Have you analyzed your payer mix and have you set benchmarks to assure fiscal viability?
Have you analyzed your service mix and have you set benchmarks to assure appropriate clinical practice and fiscal viability?
Have you modeled minimum group sizes for breakeven based upon staff time allowed for each group?
Can you download transactional data into a format that can be easily analyzed (ex. Excel)?
Reporting and Analysis
Can you produce the following reports?• Staff performance (including consultants) showing actual
activity and a % of standard.• Staff No show and cancellation rates and the % of standard.• A comparative analysis of Program and site expense
(including accurate allocation of A&OH) to expectations using the accrual basis of accounting.
• A comparative analysis of Program and site revenues to expectations using the accrual basis of accounting.
• Payer mix (% of units and Revenue by payer source by location).
• YTD average reimbursement rates by payer by CPT code. • CPT code distribution by staff• Units of service/revenue per hour paid for consultants and/or
per diem employees
Assuming you can produce the reports above:
Do you have a regular process for reviewing actual results against your baselines and budgets?
Are you able to make changes to your operation that may be necessary to meet your baselines and budgets?
Next Steps
Questions & Answers› Today’s slides and a list of Q&A will be
posted on CTAC website. www.ctacny.com› Feel free to email questions or suggestions
for future webinars at [email protected] Continue to visit CTAC website Upcoming Financial Planning Webinars
› Benchmarking Tool› Sensitivity Tool