Superbill Template by qbe69028

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									                                             CySolutions
                                              Presents

              Functional enhancments for
                                         Centricity Practice Solutions™

Designed specifically for FQHC’S, RHC’s and
           Public Health Agencies
 CySolutions CHC Enhancements Training
 Thursday, August 18, 2011
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
   Thursday, August 18, 2011
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
   Thursday, August 18, 2011
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)


    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
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%)


    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
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



   CySolutions CHC Enhancements Training
   Thursday, August 18, 2011
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

   CySolutions CHC Enhancements Training
   Thursday, August 18, 2011
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


    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
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



    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
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


    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
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


    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
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
    Thursday, August 18, 2011
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
    Thursday, August 18, 2011
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)

    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
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
   Thursday, August 18, 2011
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
   Thursday, August 18, 2011
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

   CySolutions CHC Enhancements Training
   Thursday, August 18, 2011
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
   Thursday, August 18, 2011
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
   Thursday, August 18, 2011
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



    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
 Community Health Enhancements




CySolutions CHC Enhancements Training
Thursday, August 18, 2011
Patient Registration – Complete CHC Demographics




   CySolutions CHC Enhancements Training
   Thursday, August 18, 2011
Patient Registration – Single Form Navigation




   CySolutions CHC Enhancements Training
   Thursday, August 18, 2011
Patient Registration – Single Form Navigation




   CySolutions CHC Enhancements Training
   Thursday, August 18, 2011
Patient Registration – Single Form Navigation




    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
Patient Registration – Single Form Navigation




    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
Patient Registration – Single Form Navigation




    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
Patient Registration – There’s More!




  CySolutions CHC Enhancements Training
  Thursday, August 18, 2011
Patient Registration – Expanded Contacts




  CySolutions CHC Enhancements Training
  Thursday, August 18, 2011
Patient Registration – User Defined




  CySolutions CHC Enhancements Training
  Thursday, August 18, 2011
Patient Registration – User Defined




 CySolutions CHC Enhancements Training
 Thursday, August 18, 2011
Complete Alias Tracking and Demographic
                 History




 CySolutions CHC Enhancements Training
 Thursday, August 18, 2011
Dashboard Schedule Managment




 CySolutions CHC Enhancements Training
 Thursday, August 18, 2011
Referrals and Authorizations




 CySolutions CHC Enhancements Training
 Thursday, August 18, 2011
Referrals and Authorizations - History




   CySolutions CHC Enhancements Training
   Thursday, August 18, 2011
Referrals and Authorizations - Detail




  CySolutions CHC Enhancements Training
  Thursday, August 18, 2011
Immunizations – Includes Registry Export




  CySolutions CHC Enhancements Training
  Thursday, August 18, 2011
Immunizations – Includes Registry Export




  CySolutions CHC Enhancements Training
  Thursday, August 18, 2011
Immunizations – Includes Clinical Details




  CySolutions CHC Enhancements Training
  Thursday, August 18, 2011
Immunizations – Includes Clinical Details




   CySolutions CHC Enhancements Training
   Thursday, August 18, 2011
Immunizations – Track All IZ’s or Import!




    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
Immunizations – Track All IZ’s or Import!




   CySolutions CHC Enhancements Training
   Thursday, August 18, 2011
Immunizations – Immunizations Logs




  CySolutions CHC Enhancements Training
  Thursday, August 18, 2011
Complete Dental Billing and Scheduling




   CySolutions CHC Enhancements Training
   Thursday, August 18, 2011
Complete Dental Billing and Documentation




   CySolutions CHC Enhancements Training
   Thursday, August 18, 2011
Complete Dental Billing and Documentation




   CySolutions CHC Enhancements Training
   Thursday, August 18, 2011
Complete Dental Billing




 CySolutions CHC Enhancements Training
 Thursday, August 18, 2011
ADA Paper and Electronic 837D




 CySolutions CHC Enhancements Training
 Thursday, August 18, 2011
Track Incomplete Registration Information!




    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
Track Incomplete Registration Information!




    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
Show All Tracked Information – User Configurable




    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
Expanded Document Management




 CySolutions CHC Enhancements Training
 Thursday, August 18, 2011
      Single Click Document Retrieval




CySolutions CHC Enhancements Training
Thursday, August 18, 2011
            Perinatal Case Management




CySolutions CHC Enhancements Training
Thursday, August 18, 2011
UDS Table 7 Required Information and More!




  CySolutions CHC Enhancements Training
  Thursday, August 18, 2011
UDS Table 7 Required Information and More!




   CySolutions CHC Enhancements Training
   Thursday, August 18, 2011
            Title X Reporting and Tracking




CySolutions CHC Enhancements Training
Thursday, August 18, 2011
Global Management of Title X, Immunizations, Perinatal, Referrals




     CySolutions CHC Enhancements Training
     Thursday, August 18, 2011
Complete Sliding Fee Functionality




 CySolutions CHC Enhancements Training
 Thursday, August 18, 2011
Patient Portion Automatically Computed from Schedules




  CySolutions CHC Enhancements Training
  Thursday, August 18, 2011
Medicaid and Medicare FQHC Visits Automatically Processed




    CySolutions CHC Enhancements Training
    Thursday, August 18, 2011
Unparalleled UDS, Title X and Grant Reporting




   CySolutions CHC Enhancements Training
   Thursday, August 18, 2011
Including Perinatal Table 7 and Tables 9(c) & 9(d)




CySolutions CHC Enhancements Training
Thursday, August 18, 2011
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
Thursday, August 18, 2011
                                        Contact information

                                         CySolutions Support

                                         (866) 883-9299 x234

                             7:00am – 7:00pm Central Time
                             Weekends & Evenings on call



CySolutions CHC Enhancements Training
Thursday, August 18, 2011

								
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