This is the time of year to open the windows, air out the house, deep clean long neglected spaces, and tidy up. For AR managers, it’s also a good time to “spring clean” the revenue cycle in a few key ways.

1. Update and refresh your payers’ contracts “wiki”. Likely, payer requirements have changed. Know the nuances. Reviewing the contracts and the summary sheet you’ve created for each to make sure your knowledge is current. Make sure your billing practices are consistent with payer expectations. You may think, “But my billing software should be up to date with all changes.” Not necessarily. You will discover that it’s always a good idea to check and to communicate disparities with your vendor. Some areas to focus on: 
   • Levels of care by RUG scores or service levels
   • The level of ICD-10 code specificity required
   • How many days are considered co-pay days
   • Which ancillaries are covered in the base rate and which may be billed separately or not at all
   • If a pre-authorization and re-authorizations for a stay are needed

2. Check the aging. Ask yourself, “Are our payers paying correctly?” Are they paying the contracted rates for ancillary services? The billing software may have it right, but does the payer? Reconcile what you are billing with the actual payments. If you don’t the ripple effect could be significant. A credit on your aging may not really be an overpayment. It may mean you are not tracking payments carefully. This involves more than just answering the question, “Did we get paid?” Instead, you should ask, “Did we get paid correctly and are you recording the payments correctly?

3. Revisit your pre-admission screening procedures. Confirm that the pre-admissions screening procedures cover all the financial bases before admission. This may sound overly simplified, but it is so essential because of the numerous moving parts.

4. Make sure the census is correct. This seems so obvious, but it is so critical. Make sure the census is up to date and entered correctly in the billing software.

5. Stay on top of your Days Sales Outstanding (DSO). Discuss DSO with your team. Evaluate your progress towards reducing it to an acceptable level – ideally around 30 days. Realistically identify what is in your control. For example, Medicaid in some states pay much later than others. Consider DSO carefully, set goals thoughtfully, collect aggressively, and review regularly.

6. Conduct a thorough claims triple check. This should be a multi-disciplinary review of all claims prior to submission. While it may not be practicable to review all claims, identify what could be a reasonable random sampling. You may want to target claims forwarded to a certain payer with which you have had problems in the recent past.

7. Engage the right clearinghouse. Reassess your clearinghouse. You need to be sure that:
   • It knows your business and post-acute payers
   • You see cash flow improvements quarter over quarter
   • Its application is robust with simplified, intuitive workflows
   • It generates accurate and actionable reports
   • That the application is truly enterprise class with single sign-on for ease of access to multiple facilities, especially for designated region and corporate staff
   • The clearinghouse support team listens and promptly responds to your concerns and requests

It’s time to open those windows and let the fresh air in.  Spring clean your revenue cycle. It just makes cents.

Bonus: Discover 5 tips for maintaining your revenue stream in 2016

Ah, yes, it’s that time of year – time to make those New Year’s resolutions. Exercise, diet, vacations, revisit the old “bucket list”, maybe even finances. Finances? Now a financially-focused resolution or two should resonate with any AR Manager. Maybe we can help you kick off 2016 right with some helpful resolution hints. They may not be earth-shaking taken independently, but together, they can certainly have a positive impact for you and your team.

Resolution #1 - Make sure that pre-admissions screening covers all the financial bases before the admission. This may sound overly simplified, but it is so essential with numerous moving parts. It is a time not only to be informed, but to inform not just once, but regularly after the admission.

• To be informed – All members of the admissions team must know who the payer is and the proper billing procedure - how much, how long, and for what services. Not only immediately after admission, but should the length of stay outlast such coverage as Medicare or private insurance, the team, the family, and resident must know who will pay. You might say that you want to make sure all your “bucks” are in a row.
• To inform – This is something that some providers forget to proactively pay attention to and communicate. Communicate to whom? The rest of the team, the party (private or third party) who will be paying the bill, and the family. Providers need to keep in mind that placing a loved one in a facility is traumatic and unavoidably new. Prior to and on admission, family members/responsible parties encounter so much information. Your team needs to compassionately and frequently remind them of expectations and their loved one’s status. Changing from one payer to another should never be a surprise. Fostering a positive relationship with responsible parties throughout each resident’s stay will pay big dividends in the long run.

Resolution #2 - Make sure the census is correct, up to date, and entered correctly in the billing software. Whether your facility or facilities are still laboring under a manual census tracking and recording process or you are enjoying the benefits of electronic charting, knowing who is in what bed each midnight is critical. Even electronic charting still requires the personal touch, that is, someone has to make the rounds to confirm the beds are occupied, on hold, or vacant.  

Resolution #3 - Make sure to conduct a triple check before submitting any bills or claims. We are not going to elaborate on the triple check process at this time, but stay tuned for helpful tips in future blogs.

Resolution #4 – Stay informed by attending seminars and webinars. Medicare, Medicaid, Bundled Payments, ACOs, VA, etc. are changing and unless you and your team are informed about what has changed or is about to change, you may be a day late and a dollar short. State and Federal agencies, your state and national trade associations, industry media publishers, and others conduct education sessions throughout the year to help you effectively manage the revenue cycle. Plan on attending as many of these as possible.

Resolution #5 - ICD10 training and updates. Although you and your team are usually not the initial coders, you still have to be ICD10 savvy. The key here is specificity – the highest level of specificity. You have our permission to review those codes and if you are uncertain about the codes specificity, push back on admission and during the triple check. At primeCLAIMS, we have seen many claims rejections since the ICD10 implementation due to a lack of specificity.

Resolution #6 – Stay on top of your Days Sales Outstanding (DSO). Discuss DSO with your team and set goals to reduce it to an acceptable level – ideally around 30 days. However, realistically identify what is in your control. For example, Medicaid in some states pay much later than others. Consider that carefully, set goals thoughtfully, and collect aggressively.

Making and successfully achieving resolutions specific to your department’s and business’s needs can make 2016 truly a Happy New Year at least financially.

It just make cents.

“I believe people are like boats.” With that I’ve started many a seminar and webcast. After a brief pause, I relieve the tension by saying, “They toot the loudest when they’re in a fog.” Ambiguity, tardy information, and just plain situational ignorance can keep many a decision-maker in a fog. However, because of the critical need to know how much and when cash will be flowing into and out of the bank, CFOs need crystal clear visibility. And business Intelligence dispels the haze and sharpens the perception of what is happening. From cash collections and revenue projections to labor and non-labor spend management, operations and finance executives alike can know almost up to the minute how much cash is flowing in and how much is flowing out.

Business Intelligence makes it happen

As we have discussed in previous blogs, Business Intelligence (BI) has become the go-to tool to help managers keep their fingers on their business’s multiple pulses all in one convenient easy-to-view location. For LTPAC providers, this amounts to such Key Performance Indicators (KPIs) as census, cash, accounts receivable, labor and non-labor spend, clinical, and other information. Roll up. Drill down. It doesn’t matter. CFOs can glimpse a consolidated view of KPIs important to them and then drill down as deep as they need to track, trend, and act. It’s real time and it’s highly effective. How? BI makes information visible at all levels within the organization simultaneously. And visibility drives accountability

But let’s limit this conversation to cash flow

Turning revenue into cash in the bank

Let’s explore a day-in-the-life-of one of a CFO who uses BI to monitor and hold accountable those responsible for keeping the cash flow steady and predictable. It’s mid-month and after logging into the BI tool (in our customers’ case, primeVIEW), the CFO, we’ll call him, “Craig”, reviews the tiles he’s configured for his home page displaying what to him are the critical KPIs. From there he clicks on the Cash/AR tab to view such information as:

• The current month collections-to-goals performance with 12-month trending
• What’s been collected and deposited each day by payer type for the current month, recent quarter, and year-to-date (Remember. He can view a corporate summary or drill down to a region or facility level.)
• How each facility or region ranks compared to their company peers by payer type
• The status of each facilities aging with payer type drilldown capabilities
• The Days Sales Outstanding (DSO) over a specified period of time
• How revenue is trending by payer typ

Craig notices that the South region is falling short of its MTD collections through the 15^th of the month. He calls Melissa, one of his veteran regional managers, and invites her to open up primeVIEW to discuss these outliers and what her staff can do today to right the regional ship and get it back on course by the next collection benchmark which is the 20^th. Melissa reports that she and her staff have been working with Facilities A and D since noticing the slowdown in collections on the 10^th. She assures Craig that her team is confident that these facilities will reach the month-end harbor very close to their goals

Financial performance

After concluding the call, Craig clicks on the financial tab to check on current revenues generated compared to budgeted projections by region as well as by facility by payer type. He further reviews revenue by occupancy by day, by payer, and by service. Convinced that the company is on track to meet goals and, in a couple of facilities, to exceed goals, Craig then turns his attention to the bad debt allowance status by facility as well as month-to-month trending. He makes a note to himself to address this issue in the next meeting with his corporate AR manager

Conclusion – Visibility is more than just clarity of sight

Because of BI, cash flow visibility is current, communication is specific, and required action is timely. Visibility encourages accountability and fosters real results.