LTPAC CFOs in the 21^st century have to be concerned about many things. But in reality, much of what CFOs do revolves around getting paid on time in the amounts anticipated. Perhaps paying attention to the not-so-obvious factors influencing payment may be worth investigating.

Does this CFO job description for a Life Plan Community (LPC) sound familiar?

• Ensures corporate financial processes and systems, including overall financial controls
• Oversees accounting and financial reporting, financial planning & analysis, and budgeting
• Establishes financial systems and investment accounting and reporting
• Assures all financial operations function efficiently and effectively in compliance with all applicable policies and procedures and statutory/regulatory guidelines (Italics added)
• Strong participation in strategic planning and initiatives, project management

To accomplish this, the essential duties involved include:

• Providing proactive and sound guidance regarding management of assets, investments, and financial trends
• Overseeing a system of responsible accounting including budget and internal controls
• Developing and leading the finance team to maximum productivity and responsiveness (Italics added)
• Ensuring that monthly financial statements are provided on a timely basis
• Acting as a trusted counselor regarding development of new sources of revenue

Although each of these are specific to this LPC, they are for the most part what CFOs are responsible for no matter how many locations the company operates. They have one thing in common – responsible oversight of all income, expenses, and investments. For the purposes of this blog, let’s focus on three ways to shorten the revenue cycle by “developing and leading the finance team to maximum productivity and responsiveness” – specifically by addressing A/R team job satisfaction, claims processing costs, and secondary claims payments.

1. A/R Team Job Satisfaction

In previous blogs, we have addressed such job-satisfaction drivers as empowering the AR team through participation in the admissions process, direct involvement in helping residents apply for Medicaid, sharpening the blade of job skills through recurring education and best-practice updates, employing successful billing habits, making sure the census is correct, checking eligibility regularly, participation in regularly-held billing triple checks, familiarity with key aspects of payer contracts, and getting back to the billing basics. Competence, education, and good, old-fashioned appreciation and positive feedback contribute significantly to reduced turnover and job satisfaction. A happy team is a productive team and a productive team collects money owed.

2. Claims Processing Costs

Does it matter how much it costs to process claims? Yes. Let’s just take a simple example. An operator of 40 facilities in the western US used to process claims at the facility level. But with the advent of all-in-one claims clearinghouses, centralizing the billing function in the corporate office became doable and resulted in cost-saving efficiencies. Much of the claims preparation, submission, corrections as needed, follow-up, and payment receipts could be performed on line and for the most part automatically. Fewer billers were needed, resulting in a reduction in labor costs. Just as importantly, they collected money more quickly.

3. Medicare Secondary Payer (MSP) Claims

In the case cited in the previous paragraph, the provider in question was able to automate the processing of MSP claims resulting in an accelerated payment cycle with a reduction of 30 days between secondary claims filing and payment receipts. 

Is your company getting paid on time in the amount anticipated at lower costs? We suggest that with your AR manager(s) you take a hard look at these three productivity contributors and determine what initiatives need your support. Because, really, it all makes good cents.

You can’t go wrong with Business Intelligence (BI). But if you are new to the game, knowing which Key Performance Indicators (KPIs) are more useful to seasoned LTPAC BI Pros, those who were early adopters, may be useful. From start-ups to well-established providers, executives and managers have selected what they consider to be the most important KPIs for their operations. Let’s look.

Frontline Management’s Dean Kiklis, CFO, knows the importance of BI to multi-facility operations. In the beginning, the management team skipped the step of manually creating reports and moved right to BI to meet its aggressive information and scalability requirements for this rapidly growing company. Kiklis says, “By doing it right the first time, we won’t have to face a disruptive economic and operational challenge later on.” Focusing on census, labor and Days Sales Outstanding every Monday with daily updates throughout the week, Frontline Management is able to observe quickly the daily status of these key areas of its operation. For example, since employing primeVIEW, Days Sales Outstanding have dropped by 10 days.

Southeast-based American Healthcare, LLC operates multiple SNFS in Virginia. To remain competitive in a rapidly-evolving, quality-driven reimbursement environment, Robbie Dalton, CFO, reports that controlling costs are critical. Because labor consumes over 65%-75% of total spend, having a firm hand on labor is mission critical. In primeVIEW, the current daily census and labor are automatically tied, affording management a precise view each day of staffing to budget and actual census. This insight gives AHC’s management team opportunities to train Administrators and DONS to more effectively oversee staffing during each shift. Routinely, management uses PCT’s primeVIEW BI dashboard during its weekly census calls and goal setting.

Revenue is also important to AHC and BI has helped its facilities to increase the average daily census of skilled patients by 7% and private pay by 9% over a 12-month period, resulting in revenue increases of $2.6 million and $980,000 respectively.

Jackson, Mississippi-based Health Care Management, Inc. (HCM), reports Greg Seeger, COO, is able to track what is going on at each of its facilities. “We train our team to use primeVIEW as their go-to KPI information source to track census, labor, 5-star, length of stay, clinical quality, receivables, cash flow, and more. It’s a tremendous resource.” Utilizing the dashboard enables the team to identify discharge types and forecast trends. In addition, decision makers from the facility to the corporate office can access the current census levels by total as well as by payer type which enables the facility to forecast their labor and cash projections with ease.

Health Services Management’s Ray Tyler, COO, reports, “One of the biggest advantages to primeVIEW is our ability to view labor from a consolidated corporate, as well as a facility and even department and employee level…not only today, but we can trend and report on past performance as well.” Take overtime for example. PrimeVIEW’s facility, regional, and corporate reporting enables administrators and their department heads to view not only their performance, but they can also observe how they are doing compared to the other facilities within the company. Information in the dashboard helped HSM facilities reduce OT by an average of three percentage points in the nursing department alone.

Because BI generates current and relevant views of critical LTPAC-related and configurable KPIs, executives and managers are able to monitor and effectively manage those KPIs which are critical to achieving strategic goals. Take it from the pros, they literally know what they are doing and the impact their decisions can have on facility performance.

“To know is to grow.” Yes, as I pondered this week’s blog topic, this quote came to mind – probably not original, but it is apropos and kind of catchy. As the manager of an accounts receivable team at the corporate, region, or facility level, your job is to help your team members grow in knowledge, skill sets, and ultimately productivity. For over ten years, Prime Care Technologies has asserted that knowledge is the power to succeed and to grow. The seed of knowledge is data converted to useful information and transformed into knowledge. Let’s explore five ways you can help your team’s productivity and success through knowledge.

1. Become a part of the admissions team – Know who is to be admitted when, who is to pay, and be able to collect permissable deposits. Office managers have the obligation to remind admissions decision makers that the temptation to admit “warm bodies” just to fill empty beds will certainly drive up direct care costs, but may not contribute to a healthy bottom line. Further, company policy can insist that the administrator/executive director sign off on all write-offs. Bad debt sitting passively on the books is one thing, but a write-off is concrete confirmation that the facility is not going to collect and can serve as a real deterrent to the practice of “heads in beds,” as a veteran AR consultant once stated to me.

On an even more proactive note – become part of the admissions team. We have observed that the more responsible facilities, which happen to have a better bottom line track record, require that each member of the admissions team (comprised at least of the administrator, director of nursing, rehab services, and the business office) must sign off on each pending admission. By doing so, the team members insure that the essential bases are covered.

2. Help the family with the Medicaid application – Figuratively speaking, hold their hands. Once you know that the resident may qualify for Medicaid, at the least, either prior to or on admission have a copy of the Medicaid application ready for the responsible party. Highlight the applicable sections to be filled out. Even include a cover list with simple instructions about how to fill out the form. In some facilities, the business office actually sits down with the responsible party to walk through the form and to complete the form right there and then. The facility makes a copy of the completed application for the responsible party and then mails the original.

3. Collect resident liability up front – For Medicaid-covered residents, some states allow you to collect the resident liability on admission. Check with your state’s Medicaid program to confirm and to determine what the collectible pro-rated amount should be.

4. Ask if the responsible party would like the facility to manage the resident income – The resident trust fund can be a real benefit to responsible parties and families members. Because it is federally insured direct-deposit account that collects interest, the facility business office can pay resident-specific bills. The family does not need to worry about bringing in deposits or paying bills. It can contribute to peace of mind and can strengthen the responsible party/facility relationship.

5. Thank your staff. Regularly let them know how much you appreciate your team. They work hard and in a frequently frantic environment. A “thank you” goes a long way by letting them know you appreciate them and are aware of their successes.

Knowledge about admissions, that the Medicaid application has been filed, that deposits are collected, the resident bills are going to be paid, and that good work is recognized goes a long way to foster success. What other things do you do to fuel your AR team’s pursuit of excellence? Please share it with us. It makes cents.

What makes billers effective? Habitual attention to specific details and consistent execution of routine, yet critical tasks. I’d like to share with you what our team considers to be nine habits of highly effective long term care billers. Caution the resultant success can be addictive. That's a good thing. 

1. Make sure your census is correct. We can’t stress this enough. Work closely with the Director of Nursing to make sure the night shift nurses are indeed taking a midnight census. Here is an example of what could happen if they don’t. Let’s say Mrs. Brown is discharged to the hospital, but the discharge is not correctly noted. Because she is still considered in the census, you may bill for the entire month incorrectly. Daily stand-up meetings are great opportunities to confirm the census count and to review the previous 24 hours’ admissions, discharges, and bed holds. Whatever procedures are in place to track the census, relentlessly encourage accuracy and timeliness.
2. Check eligibility regularly. Do this at least monthly. For example, residents can change from the traditional Medicare model to a Medicare HMO plan at any time. It’s impossible to bill for Part A days when the resident has already exhausted the days available in the Benefit Period.
3. Triple check during the month-end close. We’ve mentioned month-end triple checks before. If your facility or facilities a significant volume of Part A and Part B claims each month, you may be willing to check a random sampling of bills during this meeting. But what should you cover during the triple check?

• Consistency of nursing and therapy documentation – Make sure that the nursing documentation supports the therapy documentation and vise-versa. If the resident needs therapy to learn to ambulate, nursing and therapy documentation needs to support that.
• Verify that the medical record supports the intervention performed – This is, of course, dependent upon the supervising clinician’s judgment. Make sure the team addresses this issue.
• Verify therapy minutes – Confirm that the minutes to be billed are consistent with the RUG level’s requirements.
• Charting – Especially for skilled Part A services, clinicians need to chart as required. Make sure clinical documentation has progress notes, noting that the resident needs skilled intervention.
• Benefit days availability - Communicate available Part A days.
• MDS assessment reference dates - Verify the MDS-assessment reference dates are accurate for the 5 day, 14 day, 30 day, etc.
• Physician orders - Make sure that physician orders have been received and have been implemented.
• Physician certification/re-certification – Make sure the attending physician has certified or recertified the need for skilled services and that the record includes reliable documentation.

4. Know your payer contracts – As we discussed in the last blog, review your payer contracts regularly.
5. Make sure the business office staff is continually learning – Dr. Covey referred to it as sharpening the saw. If you are an AR manager, this is important. The world of claims processing and billing requirements change constantly. Challenge yourself and your staff to learn something new every day. Also, acknowledge that turnover among billing staff exists which means in some cases, you must start over again. Take advantage of the webinars provided by the MACs when available.  They’re free!
6. Get organized and know where to find and plan what needs to be done by when. Remember today’s technology can be your best friend with digital calendaring, automatic reminders and alerts, software-based task lists, and more.
7. Don't be an island to yourself - Be transparent in your billing practices and routines. Just as back-up and failover procedures are critical to IT, so is “cloning” yourself extremely important. Billing must be on time. Train others to pick up where you may have to leave off, just in case.
8. Foster positive working relationships among staff members – An atmosphere of open dialogue and trust contributes to a smooth-running operation. Have a go-to person in each department. Those “insiders” can give you the information you need quickly and accurately.
9. Be the go-to person yourself – Let trust and dependability begin with you.

Okay, I am sure you can add to the list, but we suggest you keep it short and do what matters most in your role as a biller. It just makes good cents.

“If you build it, they will come.” For those of you who are Field of Dream fans, like me, yes, I admit this is a misquote. (It should read, “If you build it, he will come.”) But for the purposes of this blog, we can take some liberties and Hollywood should forgive us.  Let’s assume you and other members of the management team are persuaded that business intelligence (BI) is THE way to go to improve performance through data mining and KPI reporting automation. You’ve determined that outsourcing BI makes the most sense and you’ve purchased and are ready to implement the best, most cost-effective, and easy to implement solution available. You’re ready to go, but what about those further down the decision chain? Just because you’ve made the decision, doesn’t mean they will follow. Are they ready? Will they use it? How can you be sure?

Not surprisingly, we have noticed that unless leaders take certain steps, they will be frustrated by implementation’s fitful nature. They spend more time trying to get manager buy-off than solving the problems and seizing the opportunities BI reveals. So what’s required? Leadership. Leadership of change. (I give credit to my mentor, Dr. D. Tyler Nelson, PhD, who over twelve years ago introduced this to me and I now share its highlights with you.)

Change is only the beginning

First of all, change is only the start; it’s a beginning. It’s situational. Over your career how many times have you seen new initiatives introduced with a big announcement, training programs, perhaps a new policy and procedure manual, only to see them at best take longer to be implemented than desired or at worst die of inertia? Why? Lack of effective transition management. A successful transition is essential if the change is to work as planned. In this case, helping people transition from the old reporting habits to enthusiastically embracing BI.

“Faced with the choice between changing one’s mind and proving that there is no need to do so, almost everybody gets busy on the proof.” - John Kenneth Galbraith

Transition starts with and ending and ends with a beginning

To be brief, while change is simply situational, transition, on the other hand, is psychological.  It’s guiding people through the process of:

• Realizing an ending to the old ways,
• Acknowledging and dealing with the sense of loss associated with the ending,
• Letting go of the old ways,
• Seeing the vision of the new when the new isn’t fully operational, and
• Embracing and making a new beginning.

Change management is to understand the desired outcome and how to get there; transition management is to convince people to leave “home”.

As the BI champion, you’ll succeed when you acknowledge that transition starts with an ending (of the old) and finishes with a beginning (of the new).  It starts with the ending your BI users will have to make to leave behind the old ways of reporting.  Within the bullet points above are the keys to what you must do to help your users move through transition to:

• Significantly reduce the negative effects change can have on productivity
• Shorten the length of time from the inception of BI implementation to the achievement of the final desired performance targets. i.e. the use of BI to achieve your organization’s goals
• Minimize the decline in productivity that naturally follows before full implementation is realized

How’s it done?

In short, our successful clients have made BI part of their management culture. It starts at the top; all decisions are referenced and based on the KPIs viewable in the BI dashboard and reports. One COO refers to the primeVIEW dashboard, PCT’s BI product, during the monthly facility financial review. His regional staff and facility leaders must be just as conversant with the KPIs displayed as he is. Not only do they look at the prior month’s financials, but also at the present situation revealed in primeVIEW. It’s the expectation he has established that. “I am using it; so should you.”

In another company, management accepts only reports viewable and generated by primeVIEW. No other reports are accepted.

At the beginning of its primeVIEW implementation, another customer clearly stated to its management team what is going away, that primeVIEW is replacing it, and clearly described how it will make their lives easier. Because managers no longer have to manually prepare reports, they can more productively spend their time making decisions.

Conclusion

One last point, not everyone transitions at the same pace. Each person is different and that’s where leadership comes in to play. As the BI champion you have to acknowledge where your team members are in the transition process and help them to:

• Leave the past behind,
• Get through the wilderness of reporting uncertainty, profiting from it, and
• Embrace new attitudes, behaviors, and identity (as decision makers, not data gatherers)

While BI tools, like primeVIEW, can be easy to learn and use, each organization’s leaders must ensure that transition is skillfully managed and sound leadership principles applied. It’s putting people and processes together to achieve a certain end – full BI implementation.

Change + Human Beings = Transition