Evaluating Your Practices Financial Health Disclaimer This webinar - - PowerPoint PPT Presentation

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
• Primary Care
• Surgical
• 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

• Total Percentage of AR

in 0-30 days. National average is 55%.

• Total Percentage of AR

greater than 90 days. National average is 23%.

Percentages of AR

• Based on Multispecialty

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

Payer Mix

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

Net Collections

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

• 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

• Reports > Accounts Receivable >

Collections > Account Summary

• On the Columns tab, select the

following headers: Guar Name Ins 1 Amt Ins 2 Amt Ins 3 Amt Pat Amt

Account Balance Unapplied Amt

Account ID

• Filter 2

Pat Amt “Not Equals” $0.00 Acct Bal “Equals” $0.00 Report #2

• Reports > Accounts Receivable >

Collections > Account Summary

• On the Columns tab, select the

following headers: Guar Name Ins 1 Amt Ins 2 Amt Ins 3 Amt Pat Amt

Account Balance Unapplied Amt

Account ID

• Filter 2

Ins 1 Amt “Not Equals” $0.00 Pat Amt “Equals” to $0.00 Acct Bal “Equals” $0.00

Balance Control

Report 1 Report 2

Balance Control

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

Statements/Patient Collections

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

• Run Audit Reports
• Keep an Eye on your Advisor
• How do I Close the gaps
• Understand the life cycle of a

encounter

What Else Do I Look For?

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

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

Audit Reports

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? Monitor your unbilled claims quickly, then run reports Quick glance days in AR System Index Issues can effect your financial Reports

• Bill all visits or close encounters

that are unbillable; don’t lose

• ut on missing revenue
• Billing and Claims
• Follow Up on Denials
• Insurance Verification

Close The Gaps

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

Encounters

• Encounter Billing/Claims
• Look Up Limits (user

preference)

• Pending Claims
• Dirty Claims

Billing/Claims Processing

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

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

Insurance Verification

• 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

The Life Cycle of an Encounter

What Do I Change

• Review Processes
• Work Smarter; Not Harder
• Maximize Automation
• Review Set-Up

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

Review Processes

• 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

Maximize Automation

• Claim Edits
• Reason Code Library
• Reason Code Subgroups to help
• rganize denials

Review Set-Up

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

Claim Edits

Reason Code Library

• Auto Adjustments on ERA posting
• Who and How do you want to work

denials?

Reason Code Library

Reason Code Subgroups help organize denials

• Utilize subgroups for reporting
• Utilize subgroups for tasking
• Non Covered
• Timely Filing
• Eligibility
• COB
• Bundled

Reason Code Subgroups

• 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

Summary

It’s Not Too Late! Take Your Financial Pulse Today and Get Your Financial Health Back On Track!!

Keep the financial health of your practice as healthy as you keep your patients.

Questions

• Jeannie Logue
• Director, Managing Consultants
• JLogue@Itentive.com
• 224-220-5571
• Keith Justus
• Director, Business Development
• kjustus@itentive.com
• 224-220-5551

Thank you