C-TACFINANCIAL OPERATIONS

PRACTICES, POLICIES AND PROCEDURES

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

Questions to ask yourselfAre you ready?

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 ctac@ccsi.org Continue to visit CTAC website Upcoming Financial Planning Webinars

› Benchmarking Tool› Sensitivity Tool