C-TAC FINANCIAL OPERATIONS

1. C-TACFINANCIAL OPERATIONS PRACTICES, POLICIES AND PROCEDURES

2. Fiscal Management and Controls

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Fiscal Management and Controls • Common Fiscal Mistakes • Inaccurate budgeting • Staffing issues • Productivity • CPT/ APG Projection errors • Unlinked NPI numbers

10. 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

11. 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

12. Next Steps • Checklist – Things you should be thinking about • Questions & Answers • Upcoming Webinars • Benchmarking Tool • Sensitivity Tool

13. Questions to ask yourself Are you ready?

14. Organizational Structure Do 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?

15. Technology Can 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.

16. 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.

17. 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?

18. 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

19. 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)?

20. 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

21. 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?

22. 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