10/15/2014 1 experience momentum // CPAs & ADVISORS Tennessee Primary Care Association: 2014 Annual Leadership Conference October 23, 2014 SETTING YOUR ORGANIZATION UP FOR SUCCESS: UNDERSTANDING THE COMPLEXITIES OF THE FQHC REVENUE CYCLE The following information was used as visual aid during a presentation/training session led by a BKD, LLP advisor. This content was not designed to be utilized without the verbal portion of the presentation. Accordingly, information included on these slides, in some cases, are only partial lists of requirements, recommendations, etc. and should not be considered comprehensive. These materials are being issued with the understanding they must not be considered legal advice. 2 //
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PowerPoint Presentation · 10/15/2014 4 BILLING & COLLECTIONS Health Center programs must: •Maintain adequate cash flow to support operations •Maximize revenue from non-Federal
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10/15/2014
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experience momentum //
CPAs & ADVISORS
Tennessee Primary Care Association: 2014 Annual Leadership Conference
October 23, 2014
SETTING YOUR ORGANIZATION UP FOR SUCCESS: UNDERSTANDING THE COMPLEXITIES OF THE FQHC REVENUE CYCLE
The following information was used as visual aid during a presentation/training session led by a BKD, LLP advisor. This content was not designed to be utilized without the verbal portion of the presentation. Accordingly, information included on these slides, in some cases, are only
partial lists of requirements, recommendations, etc. and should not be considered comprehensive. These materials are being issued with the
understanding they must not be considered legal advice.
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CONTAINING COSTS
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THE REVENUE CYCLE
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BILLING & COLLECTIONS
Health Center programs must:
• Maintain adequate cash flow to support operations
• Maximize revenue from non-Federal sources
• Have systems in place to maximize collections & reimbursement for its costs in providing health services, including written billing, credit & collection policies & procedures. (Section 330(k)(3)(F) & (G) of the PHS Act)
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BILLING & COLLECTIONS, CONT.
Revenue maximization requires • An adequate & competitive fee schedule
• A corresponding schedule of discounts
• Prompt & accurate billing of third-party payers
• Billing of patients in accordance with the schedule of discounts
• Timely follow-up on all uncollected amounts
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BILLING & COLLECTIONS, CONT.
Process necessary to ensure that federal grant resources address true financial access barriers to the maximum degree possible
Health Centers are expected to utilize information to monitor performance compared to internal & external benchmarks, as well as for tracking trends
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THE REVENUE CYCLE
Charge structure
Patient scheduling
Patient registration
Pre-appointment activities
Patient flow
Charge capture & entry
Third-party billing
Denial management
Patient collections
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DO ALL OF THE PIECES FIT?
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KEY AREAS FOR FRONT DESK SUCCESS
1. Recruitment & retention
2. Training
3. Customer service
4. Telephone
5. Patient scheduling
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KEY AREAS FOR FRONT DESK SUCCESS, CONT.
6. Patient registration
7. Time of Service (TOS) collections
8. Patient checkout
9. Management
10. Communication
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PATIENT COLLECTIONS IN A COMMUNITY HEALTH CENTER
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TIME OF SERVICE (TOS) COLLECTIONS
Best opportunity to collect
Educate patients regarding payment for services
• Financial policy
Co-pay
Self-pay
Past due accounts
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PATIENT COLLECTIONS
Set the tone
• Expectations consistently communicated by all health center personnel
Information contained in this presentation is informational only & is not intended to instruct hospitals & physicians on how to use, or bill for health care procedures. Providers should consult with their respective insurers, including Medicare fiscal intermediaries & carriers, for specific information on proper coding & billing for health care procedures. Additional information may be available from physician specialty societies & hospital associations. Information contained in this presentation is not intended to cover all situations or all payers' rules & policies. Reimbursement laws, regulations, rules & policies are subject to change.