Itentive's Evaluating Your Practice's Financial Health€¦ · Evaluating Your Practice’s...
Transcript of Itentive's Evaluating Your Practice's Financial Health€¦ · Evaluating Your Practice’s...
Evaluating Your Practice’s Financial Health
DisclaimerThis 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 LogueDirector,
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 AnalysisRun 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 NameIns 1 AmtIns 2 AmtIns 3 AmtPat AmtAccount BalanceUnapplied Amt
Account ID• Filter 2
Pat Amt “Not Equals” $0.00Acct Bal “Equals” $0.00
Report #2• Reports > Accounts Receivable >
Collections > Account Summary• On the Columns tab, select the
following headers:Guar NameIns 1 AmtIns 2 AmtIns 3 AmtPat AmtAccount BalanceUnapplied Amt
Account ID• Filter 2
Ins 1 Amt “Not Equals” $0.00Pat Amt “Equals” to $0.00Acct 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 EncountersWith 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
AdvisorDo 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 out 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 organize 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 LogueDirector, Managing Consultants [email protected] 224-220-5571
• Keith JustusDirector, Business Development [email protected] 224-220-5551
Thank you