CySolutions
Download
1 / 65

- PowerPoint PPT Presentation


  • 308 Views
  • Uploaded on

CySolutions Presents Functional enhancments for Centricity Practice Solutions ™ Designed specifically for FQHC’S, RHC’s and Public Health Agencies. What is an FQHC, RHC, Look-Alike ?. Rural Health Clinics created by Congress in 1977

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about '' - arabella


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Slide1 l.jpg

CySolutions

Presents

Functional enhancments for

Centricity Practice Solutions™

Designed specifically for FQHC’S, RHC’s and Public Health Agencies


Slide2 l.jpg

What is an FQHC, RHC, Look-Alike ?

  • Rural Health Clinics created by Congress in 1977

    • Created cost-based reimbursement system for clinics located in underserved rural areas

    • Encouraged the use of mid-level practitioners in rural areas as reimbursement formula paid same amount for services whether done by provider or mid-level

    • Reimbursements processed through the Medicare/Medicaid systems

    • Services provided are generally primary care


Slide3 l.jpg

What is an FQHC, RHC, Look-Alike ?

  • Federally Qualified Health Centerscreated by Congress in 1989 (Section 330 of Public Health Services Act)

    • Includes:

      • Federally Qualified Health Centers (FQHC)

      • Community Health Centers (CHC)

      • Migrant Health Centers (MHC)

      • Healthcare for the Homeless Centers (HCH)

      • Public Housing Primary Care Centers (PHPC)

      • FQHC Look-Alikes (FQHCLA) – Same as FQHC without the “330” Grant

      • Outpatient Health Programs operated by tribal organizations under the Indian Healthcare Improvement Act


Slide4 l.jpg

What is an FQHC, RHC, Look-Alike ?

  • Administered by Bureau of Public Health (BPHC) (http://bphc.hrsa.gov)

  • Congress created the FQHC program to allow special Medicare and Medicaid payments for CHCs and MHCs thereby ensuring that grant dollars intended for the uninsured were available for that purpose.

  • Approximately 1,500 FQHC’s nationwide

  • Approximately 3,500 RHC’s nationwide

  • FQHC’s are non-profit by definition – governed by a Board of Directors of which 51% of directors must be non-employees of the health center

  • RHC’s can be for-profit clinics

  • Annual Grants are administered by BPHC. Prospective Payment System (PPS) reimbursements administered by state Medicaid system.

  • FQHC’s and FQHCLA’s must file annual reports with BPHC (Uniform Data System (UDS) Reports)


Slide5 l.jpg

Payor Sources for CHC’s

  • Section 330 Grants – FQHC, Homeless (330h), Migrant (330g) – Administered in connection with Sliding Fee Discounts provided to patients (users) under 200% of Federal Poverty Guidelines – Typically 50% of encounters

  • Prospective Payment through Medicare (5%) & Medicaid (35%)

  • Title X grants – Family Planning Services

  • Ryan White – HIV Grant Program

  • State and Local Programs varies by state (examples)

    • BCCCP – Breast Cancer & Cervical Cancer Prevention Program

    • Family Pact – California Family Planning Services Program

    • EAPC – California Early Access to Primary Care

    • CHDP, KidCare, CHIPS – Pediatric Immunization Programs for Children

    • Participation in Chronic Disease Collaboratives including Diabetes, Cardiac Care, Depression, Cancer.

  • Private Grant Funding

  • Commercial Insurance – (10%)


Slide6 l.jpg

Objectives of a CHC Implementation

  • Priorities for CHC’s in selecting a new system

    • Reporting capabilities

      • Compliance – UDS, Title X, CADR (Ryan White), Grants

      • Financial –

        • Accrual accounting reconciliation to cash accounting

        • Production/incentive compensation reporting

    • Reimbursement

      • Sliding Fee

      • FQHC Medicare and Medicaid

      • Managed Care – Both Capitation and Fee for Service

      • Grants and Special Programs (Indigent, Disease Management)

    • Automation

      • Table Automation

      • Custom Billing Preparation – Corporate billing

      • Automated Alert Notes – Recalls, Missing information

      • Managing non-billable resources


Slide7 l.jpg

CHC Implementation Visit - Checklist

  • Initial Customer Visit includes meeting with:

    • Financial Department Representative

    • Clinical Services Manager

    • Billing Manager

    • Chief Operating Officer (optional)

  • We ask for the following information:

    • Copy or list of all compliance reports filed (UDS, CADR,Title X)

    • Sample of each type of claim (primary AND secondary) filed Medicare A, Medicare B, Each Medicaid program, Grant payers, Dental, Special Plans.

    • Customer is furnished plugins for Medicare A (UGS), Medicare B, Medicaid (all programs), BCBS/Anthem, Dental


Slide8 l.jpg

CHC Implementation Visit – Checklist (more)

  • Custom Forms including:

    • Superbills

    • Patient Profile and Consents (bi-lingual)

    • Encounter Reports

    • Custom HCFA/UB-92/State Medicaid

    • Eligibility Applications

  • FQHC Requirements for Prospective Payment Reimbursement

  • Managed Care filing rules – wraparound rules

  • Uninsured programs

    • Sliding Fee programs (Standard, Title X, Ryan White, Homeless)

    • State/County Indigent or Homeless Programs


Slide9 l.jpg

CHC Implementation Visit – Checklist (more)

  • Discussion of Services Delivered

    • Primary medical care (including labs, pharmacy)

    • Immunizations – funded/unfunded, in-clinic/out-clinic

    • Hospital/Skilled Nursing Facilities

    • OB/Prenatal (Table 7 UDS, CPSP)

    • Pediatric care

    • Behavioral Health

    • Substance Abuse

    • Case Management – Social Services

    • Dental

    • School based health


Slide10 l.jpg

CHC Implementation Visit – Checklist (more)

  • Workflow discussion

    • Patient Registration – New/Established

      • Documentation required – Missing information/Required Fields/Mini-Reg

      • Financial Interviewers used?

      • Alias Tracking

      • Custom Demographics

    • Family Billing

    • Scheduling – Clinic Based, Resource Based

      • Open Access

      • Forward Scheduling

      • Time Study Requirements

      • Resource Based/Non-Billing Resource Appointments


Slide11 l.jpg

CHC Implementation Visit – Checklist (more)

  • Workflow discussion (continued)

    • Patient Registration – New/Established

      • Documentation required – Missing information/Required Fields/Mini-Reg

      • Financial Interviewers used?

      • Alias Tracking

      • Custom Demographics

    • Family Billing

    • Scheduling – Clinic Based, Resource Based

      • Open Access

      • Forward Scheduling

      • Time Study Requirements

      • Resource Based/Non-Billing Resource Appointments


Slide12 l.jpg

CHC Implementation Visit – Checklist (more)

  • Workflow discussion (continued)

    • Billing

      • Uninsured Patient Processing

      • Check-in and Checkout process

        • Re-registration

          • Insurance Eligibility

          • Pending Medicaid vs. Presumptive Eligibility

        • Copay collection

        • Front desk Checkout vs. completion by Billing Department

      • Organize transition to direct filing of claims for Medicare, Medicaid, Blues, Dental. Obtain submitter numbers

      • OB Case management, Dental Case Management

      • Medicare A/Medicare B split visit

      • Title X – Confidential visits

      • Patient Liability – Billing, Statements, Collections


Slide13 l.jpg

CHC Implementation Visit – Checklist (more)

  • Workflow discussion (continued)

    • Reporting

      • Daily Close process

      • Monthly Close process – Financial reconciliation and outcome/production reporting

      • Year-end financial audit process

      • Compliance reporting – UDS, OSHPD, Title X, Homeless, CADR, etc.

    • Data Conversion

      • System in use

      • Discuss items to be converted including:

        • Demographics, Patient, Guarantor

        • Extended Demographics (Ethnicity, Language, Family Size, Income, multiple chart numbers including tie back to existing system

        • Balance Forward – Usually Patient only at beginning. Insurance worked off in old system and balances remaining after 90-120 days transferred to Centrcity

        • Mid-Year implementations convert visit information for current year (for compliance reports)


Slide14 l.jpg

CHC Implementation Visit – Checklist (more)

  • Workflow discussion (continued)

    • Data Conversion (continued)

      • Timing for first pass conversion – prior to admin training if possible, enables building of master tables out of converted data.

      • Determine desire to convert future appointments

    • Training matrix and timelines

      • Number of users by classification, number of locations

      • Training classes limited to 8 users per class per trainer

      • General guidelines for training per class of 8:

        • 2-3 Days Admin

        • 1.5 Days Scheduling, Registration, Front Desk Checkout

        • 1.5 Days Billing (prior to go-live)

        • 2 Days Billing, Claim Submission (Primary/Secondary), Payment Posting, Reports Training (post go-live)


Slide15 l.jpg

CHC Implementation

  • Review of Training

    • Admin

      • Master table creation, Company, Facility, Doctor, OP, Resource

      • Setup of Payer information

        • Insurance Carriers

        • Fee Schedules

        • Sliding Fee Functionality

          • Allocation Sets

          • Sliding Fee Schedules

          • Custom Allocation Sets

        • FQHC claims setup, primary, wraparound, quarterly settle up

        • FQHC Approval Plugin setup

        • Non-traditional payment sources – Managed care carve-outs, capitation, grants, insurance carrier/corporate billing

        • Insurance Policy Type vs. Financial Class discussion


Slide16 l.jpg

CHC Implementation

  • Review of Training (continued)

    • Admin (continued)

      • CHC List Editor settings

        • Sliding Fee Schedules, Custom Allocation Sets

        • Automated processing, Sliding Fee Notification

        • Required fields, Missing information

      • Schedule Admin – Appointment types, Appointment Statuses, Schedule Templates

      • Resource setup – Determine non-billable resources and visit processing for them

      • Review of custom forms and/or reports for processing (superbills, profiles, chart check out slips, appointment reports, daily productivity)

      • Security Setup

      • All Setup done in Live Database

      • As much setup as possible is done through scripting, active reports and through data conversion


Slide17 l.jpg

CHC Implementation

  • Review of Training (continued)

    • Super-user/End User Training

      • Patient Registration

        • Selection of CHC Screen

        • Mini-Reg vs. Full Registration

        • Family Registration

        • Custom Fields

        • Missing Information

        • Sliding Fee and Homeless History – Auto Update Allocation Set

        • Confidential Visits

        • Document Management

      • Integration of Alias Tracking

      • Wait Status Screen

      • Setup of Short-Cuts on Schedule

      • Processing of Profiles – Bi-lingual

      • Custom reports – Labels, forms


Slide18 l.jpg

CHC Implementation

  • Review of Training (continued)

    • Super-user/End User Training

      • Superbill, route slip, checkout form printing in accordance with workflow established in implementation or admin training.

      • Checkout process

        • Payment Posting

        • Charge entry and Patient Determination including Visit Approval process

        • Receipt printing

        • Payment on account

        • On-demand statement printing

      • Front desk administration

        • Appointment reports

        • End of day batch closing reports

      • Activity Log and Appointment Activiity List Review


Slide19 l.jpg

CHC Implementation

  • Review of Training (continued)

    • Billing Training

      • Charge Entry

        • Medicare FQHC Primary Split to Medicare B

        • Medicaid FQHC/Non-FQHC

        • Family Planning Visit special processing

          • Confidential Visits

          • EPSDT

        • Multiple Encounter processing (if applicable)

        • Managed Care processing

        • Medicaid Pending (Including Reports)

        • Dental Billing - Cases

        • OB Case Management

        • Third Party billing interfaces (Lab Billing)

        • Visit Approval Process, Auto Adjustment


Slide20 l.jpg

CHC Implementation

  • Review of Training (continued)

    • Billing Training (continued)

      • Claims Submission – Electronic, Paper

      • Payment Posting

      • Secondary Processing – Paper/Electronic

        • FQHC Wraparound Processing

        • Custom HCFA/UB-92 requirements

      • Case Management Encounter Billing (if applicable)

      • Group Visit Billing (if applicable)

      • Insurance Carrier/Corporate Billing (if applicable)

      • Additional Visit Information, Immunizations, Dental

    • Reports

      • End of Day

      • Billing Audit Reports – Billing Status Analysis

      • Periodic Financial Reports – CHC

      • Electronic Statement Processing – FQHC

      • Collections & Bad Debt Processing

      • Month end processing

      • Year end reports – year end accrual computations

      • Productivity Reporting

      • Disease Management, Collaborative, Grant reporting













































What else do you get with all of this l.jpg

What else do you get with all of this? Referrals

Premium support

Peace of mind – Over 70 satisfied FQHC’s use our products in 32 states

Smooth transition – We convert data from your existing system(s)

We are experts in the FQHC compliance arena

All products are maintained with updates no less than semi-annually

At GE Healthcare, our FQHC experts provide regular forums and user group meetings to enable customers to realize the maximum from their investment


Contact information l.jpg

Contact information Referrals

CySolutions Support

(866) 883-9299 x234

7:00am – 7:00pm Central Time

Weekends & Evenings on call


ad