Sample Board Resolution for Director Appointment

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Sample Board Resolution for Director Appointment Powered By Docstoc
					                  Tools for Evaluating Your Health Center’s
                               Financial Health

                                                                Michael Holton
                                   National Association of Community Health Centers, Inc.
                                                         Telephone: 919-571-3266
                                                    Email: MHolton@NACHC.Com




                                                                                            1
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                                              Overview

      Topics to be addressed:

      •   First Order of Business = Maximizing Reimbursement
      •   Must Understand and Document the Revenue Cycle
      •   Financial and Operational Influences on Reimbursement
      •   Reporting Tools and Analysis
      •   Strategies to Position the Health Center to Maximize Revenue




                                                                                   2
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                 Steps for the Board and Executive Management to
                 Ensure the Health Center is Maximizing Revenue

  •     Establishing a culture of Revenue Maximization
  •     Setting the Health Center up for Success – operationally
  •     Regular Reports and Monitoring
  •     Intervening When Necessary




                                                                                   3
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                       Impact of Executive Management and Board

       While the day to day processes of the revenue cycle are performed by
       dedicated health center staff, executive management and the Board play a
       large role in determining the success of the process by:
               – Establishing the proper culture of billing and collection: health centers
                    that have a clear mandate from the board through management to bill
                    correctly and maximize reimbursement as an organization priority do a
                    better job of billing and collection than those who do not. This mandate
                    plays out in management and staff goals
               – Maintaining a balance of financial, operational and regulatory
                 requirements
               – Maintaining the overall financial health of the health center and its
                 revenue streams
               – Developing and monitoring processes; intervening where appropriate


                                                                                               4
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                  Revenue Cycle Infrastructure




                                                                                   5
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                                   The Revenue Cycle

  Patient Enters                                                                                              Provider
                                                                          Patient Seen By
  Facility/greeted at                Patient Registers                                                        Completes
                                                                          Provider
  reception                                                                                                   Encounter Form




 Claims sent to                                                                                               Patient Released
 payor (non-                          Claim Report                        Encounter Form
                                                                          Processed                           at Front Desk
 capitation)                          Prepared




 Remittance                   Billing
                                                             Denials                        Resubmission of              Month Ending
 Received with                Department
                                                             Investigated and               Denied Claims                Journal Entries
 Payment                      Reconciles and
                                                             Corrected                                                   Posted
                              Posts




                                                                                                                                       6
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                 Objectives when Reviewing Billing/Revenue Cycle



           •       Strong internal control procedures/compliance with policies
           •       Collection of proper billing information
           •       Proper recording of revenue
           •       Maintenance of subsidiary accounts receivable
           •       Collection of information for management reporting
           •       Satisfy Federal reporting requirements




                                                                                   7
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                Establishing Policies and Procedures

 •        Set of expectations
 •        Many health centers are strong in policies and weak in procedures
 •           Steps for revising policies & procedures:
         –      Board and management affirm commitment to process
         –      Identify goals and implementation date
         –      Develop internal committee
         –      Develop appropriate policies and procedures
         –      Board of Directors approves policies
         –      Implement; distribute written policies and procedures
         –      Reinforce that compliance with policies and procedures is central to health
                center mission
         –      Reinforce through regular education and training
         –      Monitor & take action against violators

                                                                                       8
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                             Billing Cycle Procedures



          The billing cycle should include procedures at:
          •      Front desk
          •      Registration
          •      Exam room (by provider)
          •      Cashier/Appointment scheduling/Check-out
          •      Billing
          •      Patient accounts




                                                                                   9
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
              Ensuring Compliance with Policies and Procedures –
                            Compliance Review
 • Good Policies and Procedures without follow up are worthless
     • “Even the best laid plans of mice and men oft go awry.” – Robert Burns

 • Review all Policies and Procedures

 • Having a well-established compliance plan can reduce risk of fraud and abuse,
 as well as potential penalties

 • Compliance plan also goes beyond Policies and Procedures by:
         • Defining appropriate behavior and helping improve employee behavior
         • Promoting self-evaluation, problem detection and resolution
         • Promoting open communication



                                                                                   10
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
         Financial, Operational & Regulatory Influences
                       on Reimbursement




                                                                                   11
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                                  Financial Influences
  Rate setting system
         • Cost Reporting
         • Wrap-Around
         • Marketplace Factors

 • Billable services/payment rules
         •   What is a billable visit?
         •   Visits vs. Encounters
         •   Rules differences among payors (e.g., Medicaid, Medicare, Private Insurance)
         •   Scope of FQHC rate
         •   Capitation vs. Fee-For-Service

 • Patient service revenue as a driver of bottom line/cash flow
         • Collection percentage
         • Expected revenue net of allowances, write-offs, etc.
         • Timing of billing and payments
                                                                                            12
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                    Relationship Between Billing and
                                       Health Center Operations
• Billing timing (Finance)
        – Proper and timely completion of encounter forms
• Billing accuracy (Front Desk/Registration)
        – Proper patient demographics
• Coding and Documentation (Clinical)
        – Using all applicable and appropriate codes and documenting patient visits
          thoroughly
• Reimbursement vs. Quality/Clinical Protocols (Clinical)
        – Billing multiple visits in one day
        – Group visits
• Cash (Management) – ultimately, success in billing & collection will have a large impact
on management’s ability to position the health center to meet the community’s current &
future needs
                                                                                     13
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                                    Report Package




                                                                                   14
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                              Reporting on Patient Services Revenue
                                     and Patient Receivables

•On a regular basis, the finance department should produce basic reports to:
            –      Properly Monitor the Accounts Receivable
            –      Evaluate Collection Efforts
            –      Monitor Billing Efforts
            –      Maximize Collections
            –      Evaluate if the process is working


•Different levels of reporting are required based on the users:
            –      Board of Directors
            –      Finance Committee
            –      Management


                                                                                   15
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                        Cascading Down the Analysis
  High level results may be indicative of problems in the revenue
    cycle:

  •     Is the Health Center making or losing money?
  •     Is there a negative net worth?
  •     How is working capital doing?
  •     Are there reserves?




                                                                                   16
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                Example of Troubled Health Center

                                                                 Current            Prior Year      Change
                         Balance Sheet                           Period                End        FAV/(UNFAV)    %




           Current Ratio                                                0.82                1.1         (0.28)   -25%

           Working Capital                                       ($107,975)            $104,907     ($212,882)   -103%

           Days Cash on Hand                                                5                25           (20)   -80%

           Days in Patient A/R                                           109                 66           (43)   -65%

           Days in A/P                                                     64                57            (7)   -12%



What are revenue cycle trends and how might they be affecting these numbers?



                                                                                                                         17
 Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                                  Timing of Analysis
  • The Health Center must constantly analyze its position before
    it’s in trouble.
  • If the Health Center is making money or has a comfortable
    cash position, is that enough?
     – NO! That does not mean that it is maximizing revenue.
        How can we help the help center thrive, not just survive?

  The billing cycle must be constantly analyzed through a standard
    set of clear, understandable reports.



                                                                                   18
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                              Reporting on Patient Services Revenue
                                     and Patient Receivables
                                              Board of Directors:
  •       Commonly review monthly reports “in total”
            –    Days in Accounts Receivable, Net
            –    Bad Debt as a Percentage of Net Patient Services Revenue
            –    Visit Payor Mix Analysis
            –    Visits by Provider
            –    Revenue Per Visit

  •       Measures commonly compared against:
            –    Prior periods – year over year
            –    Budget
            –    Industry norms – collection percentage, days in A/R, Payor Mix
            –    Strategic or Annual Operating Plan


                                                                                   19
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                    Sample Board of Directors Reports on Revenue

                                                                                                                     Industry
                                                                                                                      Norms
     Revenue Maximization Accounts                 Current         Prior                                Strategic     (where
          Receivable Metrics                       Period         Period           % Change   Budget      Plan      available)

  Days in Patient A/R                                     89             76            -17%       60           50     70 -105


  Bad Debt (as % of Net Pt. Revenue)                   9.0%         10.2%               12%     9.5%         8.0%        6.2%


  Per Visit

        Total Revenue                               $155.32       $154.90                0%   $157.00     $160.00

        Patient Services Revenue                    $110.02       $101.26                9%   $107.00     $115.00

  Total Billable Visits                              17,000         18,000               3%    18,500      19,000

  Provider FTE                                              5              5             8%        5            5

  Visits Per Provider FTE                              3,400         3,600              -4%     3,700       3,800       3,800



                                                                                                                          20
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                    Sample Board of Directors Reports on Revenue
     Revenue Maximization                Current                                                                        Industry
  Accounts Receivable Metrics            Period         Prior Period      % Change         Budget      Strategic Plan    Norms

Revenue Payor Mix
       Medicaid FFS                           54.1%             54.8%               -1%       54.3%            56.0%         38%
       Medicaid Managed Care                  14.7%             14.0%                5%       14.5%            12.0%         21%
       Medicare                                6.1%              6.2%              -1.6%       6.3%            10.0%         12%
       Commercial/Other                        4.9%              5.1%              -3.9%       5.2%             5.0%         14%
       Self-Pay                               20.2%             19.9%                2%       19.7%            17.0%         15%

Collection Rate by Payor
       Medicaid FFS                           98.7%             98.5%                0%       99.0%            99.0%         94%
       Medicaid Managed Care                  86.0%             87.0%              -1.1%      87.0%            90.0%         96%
       Medicare                               88.5%             84.9%                4%       98.0%            99.0%         89%
       Commercial/Other                       61.9%             68.0%              -9.1%      68.0%            75.0%         88%
       Self-Pay                               52.0%             50.0%                4%       50.0%            55.0%         77%
Net Revenue (Total Revenue -
Bad Debt)                                  $334,816          $324,651                3%     $362,420        $412,787


                                                                                                                             21
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                  Sample Board of Directors Report on Activity
                                                         Budget         Actual         Over(Under)     Budget         Actual         Over(Under)
  Billiable Patient Visits
  Site/Provider #1
      Medicare                                                     50             35            (15)         600            650               50
      Medicaid                                                    150            134            (16)       1,800          1,820               20
      Private Insurance                                            30             33              3          360            350              (10)
     Self-Pay Patients                                            110            125             15        1,320          1,400               80
     Other                                                         10             14              4          120            110              (10)
          Total for Site/Provider #1                              350            341             (9)       4,200          4,330              130
  Site/Provider #2
      Medicare                                                     55             50             (5)         660            625              (35)
      Medicaid                                                    165            160             (5)       1,980          2,080              100
      Private Insurance                                            35             40              5          420            450               30
     Self-Pay Patients                                            105            110              5        1,260          1,330               70
     Other                                                         10             11              1          120             95              (25)
          Total for Site/Provider #2                              370            371              1        4,440          4,580              140
  Total for All Sites/Providers
      Medicare                                                  530           540               10         6,360          6,400                40
      Medicaid                                                1,550         1,675              125        18,600         17,900              (700)
      Private Insurance                                         400           410               10         4,800          4,650              (150)
     Self-Pay Patients                                        1,350         1,440               90        16,200         17,500             1,300
     Other                                                      200           190              (10)        2,400          2,150              (250)
          Total for All Providers                             4,030         4,255              225        48,360         48,600               240

  Walk-ins                                                        20%            25%            5%              20%            26%            6%
  No Show s                                                       30%            40%           10%              30%            42%           12%
  New Patients
    Medicare                                                       6              3              (3)             72             61            (11)
    Medicaid                                                      45             38              (7)            540            490            (50)
    Private Insurance                                              3              1              (2)             36             30             (6)
    Self-Pay Patients                                             25             30               5             300            360             60
    Other                                                          1              0              (1)             12             13              1
        Total New Patients                                        80             72              (8)            960            954             (6)




                                                                                                                                             22
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                              Reporting on Patient Services Revenue
                                     and Patient Receivables

  Finance Committee:

  • Commonly review similar measures/ratios as Board of Directors, both in
    total as well as by individual payor.

  • Patient Receivable Agings, both in total and by payor

  • If significant Medicaid managed care activity:
          – Change in member mix and capitation revenue by actuarial class
          – Managed care member utilization analysis




                                                                                   23
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                       Analyzing Patient Receivables


              Revenue Maximization Accounts                   Current           Prior       Change
                   Receivable Metrics                         Period           Period     FAV/(UNFAV)    %




           Weighted Total Days in Patient A/R                        79.2          66.4        (12.79)       -19%

                Medicaid Fee For Service                             72.3          66.4         (5.90)       -9%

                Medicaid Capitation                                  54.6          53.7         (0.90)       -2%

                Medicare                                             72.1          78.4           6.30        8%

                Commercial/Other                                     72.1          65.7         (6.40)       -10%

                Self-Pay                                           119.4           82.4        (37.00)       -45%




                                                                                                                    24
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                       Analyzing Patient Receivables




   Revenue Maximization
          Accounts
       Receivable Aging                 Current             31-60 days             61-90 days    91-120 days    120+ days



                       Total           $          %           $         %           $      %      $      %       $      %



  Current Period        79,500       19,000       24%      10,000      13%         9,000   11%   9,500   12%   32,000   40%



  Prior Period          70,500       20,000       28%       9,000      13%         9,500   13%   4,750   7%    27,250   39%




                                                                                                                            25
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                      Analyzing Accounts Receivable



  • Analyze trends in days in accounts receivable by payor:
          – Is days in A/R less than 100?
          – Are certain payors not paying on a timely basis?
          – Are you appropriately recording contractual allowances?

  • Total A/R:
          – Has A/R been cleaned up to recognize bad debt?
          – Has self pay been cleaned up?
          – Has General Ledger been reconciled to the practice management system?




                                                                                    26
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                              Reporting on Patient Services Revenue
                                     and Patient Receivables

                                                  Executive Management:
              • Revenue report (charges, adjustments, payments)
              • Adjustments by payor source and type of adjustment
              • Aged accounts receivable reports:
                          – In total
                          – By payor source (and carrier/plan)
                          – In detail
              • Special reports to monitor activity of billing staff
              • Denial report
              • CFO should be monitoring at least bi-weekly


                                                                                   27
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                Reporting on Patient Services Revenue
                                       and Patient Receivables

                                                        Less:
                                                     Contractual
                                                    Allowance and                                       Net Revenue
                                                     Sliding Fee               Net            Less:      Less Bad
             Payor               Charges              Discounts              Revenue         Bad Debt       Debt
         Medicaid
         Fee For
         Service            $ 1,130,559             $        248,050        $ 882,510    $     79,426   $    803,084
         Medicaid
         Capitation         $    765,982            $         441,324       $ 324,658    $     29,219   $    295,439
         Medicare           $    534,083            $         280,444       $ 253,639    $     22,827   $    230,811
         Commercial/
         Other              $    952,558            $         548,820       $ 403,738    $    36,336    $    367,401
         Self-Pay           $ 1,686,866             $      1,358,059        $ 328,807    $    29,593    $    299,215
         Total              $ 5,070,047             $      2,876,696        $2,193,351   $ 197,402      $   1,995,949


 From this report can also calculate per visit figures, collection percentages, and bad debt
 Percentages.
                                                                                                                        28
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                        Analyzing Trends in Revenue


          Reasons why revenue decreases while visits increase:

            • Retroactive settlement in prior period
            • Poor collections in current year
            • Shift in Payor Mix – Medicare and Medicaid pay substantially more
            than any other payor
            • Large bad debt write-off in the current period pertaining to old
            receivables currently on the books
            • Rate Revisions
            • Improper Coding
                                                                                   29
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                     Analyzing Shifts in Payor Mix


                                               Effects of Changes in Payor Mix


                                Current Period                                          Prior Year




                                    Payor        Revenue         Total                        Payor        Revenue      Total
                      Visits         Mix         per Visit      Revenue            Visits      Mix         per Visit   Revenue

  Medicaid              6,256          53%             $96        $597,812          6,500            65%       $100     $650,000

  Self - Pay            5,554          47%             $22        $122,188          3,500            35%        $20      $70,000

  Total                11,810         100%            $61         $720,000         10,000       100%            $72     $720,000




                                                                                                                              30
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                                      Analyzing Users

  • Current users:
          –    Is payor mix shifting?
          –    Are you losing users to your competitors? How might this be known?
          –    What is the visit utilization of your users?
          –    Are managed care users retaining the health center as their PCP?
          –    Is wrap-around being settled on time?

  • New users:
          – What is the source of new users? Outreach?
          – Does the payor mix of new users differ from that of current users? Are other
            demographics different?




                                                                                           31
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                 Analyzing Managed Care Members


    • Member Utilization:
              – Does utilization vary by MCO?

    • Managed Care Revenue Per Visit:
              – Are you billing for all fee-for-service procedures?
              – Are you collecting copays?

    • Capitated Revenue Per Member Per Month:
              – Is patient mix changing?
              – Is wrap-around being paid timely?




                                                                                   32
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                             When does the Board need to intervene
                                with Executive Management?

  • Trends to watch for
          – Overall financial instability (e.g., losing money, negative fund balance)
          – Abnormally high bad debt percentage – or a trend of increasing bad debt
          – Medicaid or other payor audit results in large recoupment of payments,
            resulting from inaccurate coding and documentation
          – Days in self-pay receivables > 365
          – Days in Medicaid receivables > 100
          – Large shift in total volume, up or down
          – Big swings in payor mix




                                                                                        33
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                   When does Management need to intervene in the
                       Finance Department and Operations?
  • Trends to watch for:
          –    Shifts in net revenue per visit
          –    High denial rates
          –    Milestones/benchmarks in the billing cycle aren’t being met
          –    Days in Medicaid receivables are higher than target
          –    Inaccurate or incomplete coding and documentation




                                                                                   34
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                  Strategies to Position the Health Center for
                                    Success




                                                                                   35
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                       Billing and Revenue Strategies

     Billing and revenue strategies are intended to improve the billing and
     collections process in the Health Center and encourage the effective use of
     staff who perform these functions.

     Common goals and objectives achieved through billing and revenue
     strategies:
            •    Increased patient revenue.
            •    Improved collections rates.
            •    Reduced medical coding errors.
            •    Cost savings of doing it right the first time.




                                                                                   36
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                   Ensuring Proper Coding – High-Level Overview

 •Collect data on provider visits (E&M Codes)
         – By individual Provider
         – In the aggregate for the health center


 •Prepare graphs to show frequency of codes used
         – Show increasing intensity of visit from left to right


 •Overlay Health Center providers and aggregate data on national averages
         – Include payor-source specific graphs




                                                                                   37
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                       UNDERCODER HEALTH CENTER

                                   70%

                                   60%

                                   50%

                                   40%

                                   30%

                                   20%

                                   10%

                                    0%
                                            99211       99212      99213       99214       99215

                                                         National Average*         Undercoder

                               *Source: Ingenix, 2001

                                                    Established Patient Visits
                                                  National Average*        Undercoder Health Center
                                 E&M Codes            % of Total            # Visits     % of Total
                                   99211                         2.7%             2,300        23.0%
                                   99212                       20.6%              3,500        35.0%
                                   99213                       63.5%              3,800        38.0%
                                   99214                       11.3%                400         4.0%
                                   99215                         2.0%                -          0.0%
                                                                                                       38
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                        How Can You Recognize Improper Coding?
          When we add payor-based coding information, the differences
                         may become even clearer:

   60%
                                                                                            Medicaid

   50%
                                                                                            Medicare
   40%

   30%
                                                                                            Commercial
                                                                                            Insurance
   20%
                                                                                            Self Pay
   10%

     0%                                                                                     National
                  99211              99212              99213               99214   99215   Average




                                                                                                       39
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                  Tracking Productivity and Performance based on
                            Relative Value Units (RVUs)
 •Each procedure code has an associated value – an RVU
 •The RVU compares services against one another
     – The more intense the service, the higher its RVU
 •Three components to the RVU
     – Work RVU which measures effort of the provider
     – Practice Expense RVU which measures support staff and overhead costs
         associated with providing the care
     – Malpractice RVU which translates the cost of average malpractice coverage
         attributable to the code
 •Work RVU is the important component for provider productivity




                                                                                   40
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                     Billing and Revenue Strategies –
                                         Understanding Contracts
            •    Eligibility/preauthorization
            •    Claims timeliness
            •    Complete information
            •    Accurate information
            •    On appropriate forms
            •    In compliance with managed care contract/from provider manual




                                                                                   41
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                              Billing and Revenue Strategies:
                          Centralized Billing and Related Functions

     • Definition: Consolidating billing functions that may reside within
       individual sites.
     • Benefits: Health Centers can facilitate communication, standardize
       work processes, obtain economies of scale, and enhance quality
       control.
     • Select implementation tasks:
            – Review current billing functions organization-or network-wide.
            – Analyze current productivity standards.
            – Conduct cost-benefit analysis based on changes from decentralized to
              centralized billing functions including changes in “personal service” and
              “other than personal service” costs and savings.
            – Develop new policies and procedures.


                                                                                          42
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                              Billing Cycle Milestones

     Two kinds of claims:

     • “Clean” Claim
            –Perfectly coded, all services within scope of payor agreement
     •“Unclean” Claim
            •Results in a denial or “pending status” from payor




                                                                                   43
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                            Strategies to avoid denials


        Select Implementation Tasks:
           – Incorporate standards and policies that guide personnel.
           – Establish analysis for denials
           – Coordinate training of clinical staff and billing personnel.
           – Develop a standard feedback mechanism for professional
              employees.
           – Institute regular chart/billing reviews to assess compliance and to
              identify issues requiring further education.
        Measure performance at the front desk
           – Select standard measurements for accuracy of data collection
           – Establish minimum thresholds for staff to meet

                                                                                   44
Presented by Michael Holton, Director for Financial Management Assistance, NACHC
                                                     Session Summary


     Health center managers need to understand and utilize a number of
      reports and financial tools to aid management and the Board of
      Directors in decision-making. Key components to achieving this
                                   goal are:
      • Preparing and monitoring departmental and organizational budgets
      • Analyzing both expense and revenue drivers at the health center
      • Keeping the Board of Directors and senior management informed
      • Updating fiscal information throughout the year




                                                                                   45
Presented by Michael Holton, Director for Financial Management Assistance, NACHC

				
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Description: Sample Board Resolution for Director Appointment document sample