Transcript Slide 1

CySolutions
Presents
Functional enhancments for
Centricity Practice Solutions™
Designed specifically for FQHC’S, RHC’s and
Public Health Agencies
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
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
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
What is an FQHC, RHC, Look-Alike ?
• Federally Qualified Health Centers created 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
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
What is an FQHC, RHC, Look-Alike ?
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Administered by Bureau of Public Health (BPHC)
(http://bphc.hrsa.gov)
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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.
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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)
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CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Payor Sources for CHC’s
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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%)
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
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
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Sliding Fee
FQHC Medicare and Medicaid
Managed Care – Both Capitation and Fee for Service
Grants and Special Programs (Indigent, Disease Management)
– Automation
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Table Automation
Custom Billing Preparation – Corporate billing
Automated Alert Notes – Recalls, Missing information
Managing non-billable resources
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
CHC Implementation Visit - Checklist
• Initial Customer Visit includes meeting with:
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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
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
CHC Implementation Visit – Checklist (more)
• Custom Forms including:
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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
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
CHC Implementation Visit – Checklist (more)
• Discussion of Services Delivered
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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
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
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
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Open Access
Forward Scheduling
Time Study Requirements
Resource Based/Non-Billing Resource Appointments
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
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
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Open Access
Forward Scheduling
Time Study Requirements
Resource Based/Non-Billing Resource Appointments
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
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
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
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)
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
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:
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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)
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
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
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
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
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
CHC Implementation
• Review of Training (continued)
– Super-user/End User Training
• Patient Registration
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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
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
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
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
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
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
CHC Implementation
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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
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Case Management Encounter Billing (if applicable)
Group Visit Billing (if applicable)
Insurance Carrier/Corporate Billing (if applicable)
Additional Visit Information, Immunizations, Dental
– Reports
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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
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Community Health Enhancements
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Patient Registration – Complete CHC Demographics
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Patient Registration – Single Form Navigation
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Patient Registration – Single Form Navigation
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Patient Registration – Single Form Navigation
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Patient Registration – Single Form Navigation
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Patient Registration – Single Form Navigation
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Patient Registration – There’s More!
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Patient Registration – Expanded Contacts
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Patient Registration – User Defined
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Patient Registration – User Defined
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Complete Alias Tracking and Demographic
History
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Dashboard Schedule Managment
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Referrals and Authorizations
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Referrals and Authorizations - History
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Referrals and Authorizations - Detail
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Immunizations – Includes Registry Export
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Immunizations – Includes Registry Export
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Immunizations – Includes Clinical Details
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Immunizations – Includes Clinical Details
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Immunizations – Track All IZ’s or Import!
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Immunizations – Track All IZ’s or Import!
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Immunizations – Immunizations Logs
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Complete Dental Billing and Scheduling
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Complete Dental Billing and Documentation
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Complete Dental Billing and Documentation
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Complete Dental Billing
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
ADA Paper and Electronic 837D
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Track Incomplete Registration Information!
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Track Incomplete Registration Information!
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Show All Tracked Information – User Configurable
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Expanded Document Management
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Single Click Document Retrieval
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Perinatal Case Management
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
UDS Table 7 Required Information and More!
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
UDS Table 7 Required Information and More!
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Title X Reporting and Tracking
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Global Management of Title X, Immunizations, Perinatal, Referrals
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Complete Sliding Fee Functionality
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Patient Portion Automatically Computed from Schedules
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Medicaid and Medicare FQHC Visits Automatically Processed
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Unparalleled UDS, Title X and Grant Reporting
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Including Perinatal Table 7 and Tables 9(c) & 9(d)
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
What else do you get with all of this?
 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
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015
Contact information
CySolutions Support
(866) 883-9299 x234
7:00am – 7:00pm Central Time
Weekends & Evenings on call
CySolutions CHC Enhancements Training
Tuesday, July 07, 2015