Evaluating Your Practice’s Financial Health
Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some state laws. This should not be used as legal advice. Itentive recognizes that there is not a “one size fits all” solution for the ideas expressed in this webinar; we invite you to follow up directly with us for more personalized information as it pertains to your specific practice and issues. Thank you, and enjoy the webinar.
Introductions Jeannie Logue Director, Managing Consultants
2013 and 2014 were very busy times with EHR implementations; upgrades and meaningful use; Have you checked the financial health of your practice lately?
Financial Health • How do I know? • What do I look for? • What do I change?
How do I Know? NextGen contains many basic reports that can help you get a quick pulse of your overall financial health; we will focus on a just a few of them
Get a Quick Pulse… Then Dig Deeper • Calculate Days in AR and Percentages • Payer Mix • Net Collections • Unapplied • Balance Control • Statements/Statement Counter
Days In AR Calculate Days in AR • (Net AR Balance/Monthly Charges) * Days In the Month
Days In AR • • Multispecialty Surgical • • Primary Care Non-Surgical * Stats Per MGMA
Insurance Aging Analysis Run your IAA report; Reports>Accounts Receivable>Collections> Ins Aging Analysis • Filter by Date of Service for true AR data • Calculate percentages for each aging bucket
Percentages of AR • Total Percentage of AR in 0-30 days. National average is 55%. • Total Percentage of AR greater than 90 days. National average is 23%. • Based on Multispecialty
Payer Mix Payer Mix is a report that gives you an overview of your payers • Understand your payer percentages by charges, payments and adjustments Reports> Monthly > Transactions > By Line Item > Summary • Columns tab, select Fin Class, Payer Name, Chg Count, Chg Amt, Adj Count, Adj Amt, Pay Count, Pay Amt, Ref Count, Ref Amt. • Filter 1 tab, select the Chg Create Date and the Tran Post Date option for last 90 days(or other specified time frame) • Sorting tab, sort by Fin Class. • Create you report with Totals Only
Net Collections Practice Net Collection Report • AR Reports > Receivable Analysis > By Month • Filter Aging Dates by Process Date • Include all charge status for historical data • This is a charge based report
Unapplied • Practice Unapplied Report AR Reports > Unapplied Amounts • Account versus Encounter Don’t filter out your dates Keep this cleaned up • Unapplied payments will impact your financial reports • Patients will also receive statements if a paid copay is still in unapplied Unapplied transactions are on many financial reports, unless you exclude them
Balance Control • Review accounts that have an account balance equal to zero, but you have a credit and debit in your buckets that need to be offset. • There are few reports that you can use, but best practice tends to be to look at the account level versus the encounter level.
Balance Control Report #1 Report #2 • • Reports > Accounts Receivable > Reports > Accounts Receivable > Collections > Account Summary Collections > Account Summary • • On the Columns tab, select the On the Columns tab, select the following headers: following headers: Guar Name Guar Name Ins 1 Amt Ins 1 Amt Ins 2 Amt Ins 2 Amt Ins 3 Amt Ins 3 Amt Pat Amt Pat Amt Account Balance Account Balance Unapplied Amt Unapplied Amt Account ID Account ID • • Filter 2 Filter 2 Pat Amt “Not Equals” $0.00 Ins 1 Amt “Not Equals” $ 0.00 Acct Bal “Equals” $0.00 Pat Amt “Equals” to $0.00 Acct Bal “Equals” $0.00
Balance Control Report 1 Report 2
Statements/Patient Collections Run a statement report • Reports>Accounts Receivable>Collections>Account Summary • Sort and Group by Statement Counter to determine how many statements you have with a statement counter > 3 • Totals; Count by Act ID and Sum Account Balance There are 41 guarantor accounts that have received 7 statements. These accounts have a sum total of $2804.26
Statements/Patient Collections • Statement Counter • Practice Preference set up to determine when this is reset • How many times are you sending out statements to a patient with a balance under $50? • Utilize Filter 2 • Send Statements Daily
What Else Do I Look For? • Run Audit Reports • Keep an Eye on your Advisor • How do I Close the gaps • Understand the life cycle of a encounter
Run Audit Reports • Unbilled Encounters With charges and without charges • EHR Pending Charges • On Hold Report Encounter can be placed on hold for further review, before sending out the claim
Audit Reports Unbilled Encounters – Don’t Filter your dates • Reports > Accounts Receivable > Unbilled Encounters Kept Apt No Charges • Scheduling > Kept Apts w/no Charges
Audit Reports On Hold Report • Reports > Accounts Receivable > Unbilled Encounters > Filter 1 > Hold date greater than today EHR Pending Charges • Reports > General > EHR Manual Charge Processing Pending
Advisor • Days in AR • Varies based on how you have this set up to age in Practice Preferences • Unbilled Encounters • Claims Pending • Electronic and Paper • System Support
Advisor Do you have claims you are not processing? Are all my statements processing? System Index Issues can effect your financial Reports Monitor your unbilled claims quickly, then run reports Quick glance days in AR
Close The Gaps • Bill all visits or close encounters that are unbillable; don’t lose out on missing revenue • Billing and Claims • Follow Up on Denials • Insurance Verification
Encounters Keep your Unbilled Encounter Report Up to Date • Bill all visits or close encounters that are unbillable; don’t lose out on missing revenue • Create SIM codes to move encounters into history status; for example: Patient left without being seen Duplicate Encounter
Billing/Claims Processing • Encounter Billing/Claims • Look Up Limits (user preference) • Pending Claims • Dirty Claims
Billing/Claims Processing • MT – Media Type; Verify you don’t have paper claims that have never been printed • Cond – Dirty Claims will never be created in your EDI file
Denials • Review Denials closely to eliminate root cause; should review within 24 hours • Utilize Reason Code Subgroups to trend and analyze your denials • Get denials to the right team quickly with tasking • Per MGMA - Each denial costs a practice approximately $25 to rework
Denial Reports • Reports>Daily>by Line Item>Reason Codes>Adjustments • Reports>Daily>by Line Item>Reason Codes>Payments Utilize your subgroups for trending/analysis
Insurance Verification Whether you are utilizing NextGen RTS or another resource, verifying patients coverage is very important • Patient’s insurance can change from visit to visit • This is one of the top rejections on claims • Establish a workflow to guarantee insurance is verified before or during the patients visit
The Life Cycle of an Encounter • Encounter Date • First Bill Date • Last Bill Date * • Encounter Status • Statement Counter • Patient Responsibility Date * This will not age until all line items are out to patient • Historical Reports; remember to mark history charge status
What Do I Change • Review Processes • Work Smarter; Not Harder • Maximize Automation • Review Set-Up
Review Processes Do a walkthrough of all processes. • Scheduling • Check In/Check Out • Eligibility Check • Copayments/Payments on Account • Charge Entry • Claim Edit Review/Claim Processing • Payment Posting • Denial Management
Maximize Automation • Autoflow Check In/Check Out • Payment Posting ERA/Manual • Maximize use of the BBP • RTS Insurance Verification • Clearinghouse Auto Upload/Auto Download • Tasking EPM Worklog
Review Set-Up • Claim Edits • Reason Code Library • Reason Code Subgroups to help organize denials
Claim Edits Claim Edits • Review rejections from Clearinghouse. Can you turn on a new claim edit? • Tasking from Claim Edits Turn on Enterprise Preference Task to appropriate work group for clean up
Reason Code Library Reason Code Library • Auto Adjustments on ERA posting • Who and How do you want to work denials?
Reason Code Subgroups Reason Code Subgroups help organize denials • Utilize subgroups for reporting • Utilize subgroups for tasking Non Covered Timely Filing Eligibility COB Bundled
Summary • Run a few key indicator reports to get a quick pulse • Audit regularly • Close gaps • Review processes • Review your set up • Maximize automation for efficiency
It’s Not Too Late! Take Your Financial Pulse Today and Get Your Financial Health Back On Track!!
Recommend
More recommend
