Utilizing Client Level Financial Data

1
Utilizing Client Level Financial Data

• Jana D. Collins, Financial Manager
• Bluegrass Care Clinic
• Ryan White Title II III
• Ryan White Grantee Conference
• August 30, 2006

2
Presentation Outline

• Introduction to Bluegrass Care Clinic
• Reasons for Client Level Financial Data
  Management
• Financial Process
• Financial Management Systems

3
Introduction to the Bluegrass Care Clinic
4
Mission/Goals

• University based HIV primary care clinic
  (University of Kentucky) caring for PLWHA since
  1990.
• Mission To provide a continuum of high quality,
  state-of-the-art, multi-disciplinary HIV primary
  care in a compassionate, culturally sensitive
  manner.
• Goal To achieve 100 access to HIV primary care
  with 0 socioeconomic disparity in health
  outcomes.

5
History

• Established as a Ryan White Title III clinic in
  fall 2001.
• Established as a Ryan White Title II provider in
  summer 2006.
• Client population has increased nearly 40 since
  2002.
• In 2005 new patients enrolling into care
  increased by 52 (86 in 2004 to 113 in 2005)
• In 2006, 77 new patients have enrolled into care
  at the BCC to date.

6
Staff

• Direct Patient Care
• Medical Director
• Patient Services Coord.
• Infectious Disease MD (5)
• Infectious Disease Fellows (2)
• Primary Care MD (2)
• Clinic Pharmacist
• Mental Health Counselor (LCSW)
• Care Coordinators (6)

• Administration
• Project Director
• Program Coordinator (Title III)/Financial Manager
• Program Coordinator (Title II)/ Social Work
  Supervisor
• Data Manager
• Project Assistant

7
Services

• Ryan White Title III
• Direct Services
• Infectious Dis. Specialty
• Primary Care
• Psychiatry
• Mental health Counseling
• Pharm. Counseling
• Medical Case Mgmt.
• Prevention Counseling
• By Referral
• Nutrition counseling
• Specialty care (GI, ENT, etc.)
• Dental and Ophthalmology
• Diagnostic, Radiology, Laboratory Testing
• Family counseling

• Ryan White Title II
• Social/Medical Case Mgmt.
• Facilitate Medicare, Medicaid, Social Security
  Applications
• Specialty Care and co-pay assistance
• Referral to Mental Health and Substance Abuse
  Counseling
• Emergency Medicine Assist.
• Transportation Assistance
• Food (referrals)
• Nutrition assistance
• Referral to Legal Services

8
Demographics

• Gender ()
• Male 500 (80)
• Female 120 (19)
• Transgender 5 (1)
• Race/Ethnicity ()
• White 478 (76)
• Black 109 (17)
• Hispanic 32 (5)
• Unreported 5 (1)
• HIV/AIDS ()
• HIV, not AIDS 317 (51)
• CDC, AIDS 308 (49)

• Poverty Line ()
• 101-200 - 82 (13)
• 201-300 - 53 (8)
• 300 - 91 (15)
• Unreported 158 (25)
• Insurance Status ()
• Private 210 (34)
• Medicare 153 (24)
• Medicaid 100 (16)
• No Insurance 156 (25)
• Unreported 6 (1)

9
Demographics

• Age ()
• 2-12 yrs 1 (0)
• 13-24 yrs 16 (3)
• 25-44 yrs 381 (61)
• 45-64 yrs 217 (35)
• 65 yrs 10 (2)

• Risk Factor ()
• MSM 343 (55)
• Heterosexual 178 (28)
• IDU 33 (5)
• MSM IDU 17 (3)
• Unreported 16 (3)
• Blood Transfusion 15 (2)
• Hemophilia 7 (1)
• Perinatal 2 (0)

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Reasons to Collect Client Level Financial Data
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2
3
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5
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Previous System in Place

• NO SYSTEM
• Budget was made based solely on previous years
  spending no adjustments based on population
  increased
• Individual patient bills were received, signed
  off on, but not tracked

12
Previous System in Place

• NO SYSTEM
• Billing agency had tendency to hold bills for 6
  months
• Couldnt address patient questions because bills
  were not tracked internally.
• No accountability for authorized expenditures

13
Previous System in Place

• NO SYSTEM PROBLEMS
• Bills were paid as long as money was available
• Patient caps were not tracked/adhered to.
• No quarterly trends or forecasts were made to
  ensure that money was used to offer the most
  services possible
• End of grant year we would have a 20,000
  surplus, or a stack of 300 bills that we werent
  expecting/couldnt pay for

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Reasons to Collect Client Level Data

• Track Spending per Patient
• Gives realistic picture of spending based on
  client needs
• Useful for forecasting based on disease
  status/insurance status
• Allows for patient cap adherence

15
Reasons to Collect Client Level Data

• Insurance status
• Verify that billing agency has patient insurance
  information
• Verify that insurance (if applicable) was charged
  first
• Identify if charge was denied by insurance to
  determine if it was a coding issue

16
Reasons to Collect Client Level Data

• Title II coverage (Lexington vs. Cumberland
  Valley)
• Identify Patients by Care Coordinator District
• Direct Billing to Correct District

17
Reasons to Collect Client Level Data

• Sliding Fee Scale Billing
• Key to ensuring that tight dollars are spread
  across patient population
• Verify Correct Patient Level
• Ensure correct billing assignment (Grant vs.
  Patient Responsibility)

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Reasons to Collect Client Level Data

• Address Patient Questions
• Have resource to address patient billing
  questions.
• Can address patient questions as to why bill was
  received, what their responsibility is, etc.

19
Financial Process
20
Billing Sources

• Physician Visits Kentucky Medical Services
  Foundation (90)
• Physician Visits, Outside providers (10)
• Laboratory, Diagnostic, Radiology Testing UK
  Patient Accounts (100)
• Pharmaceuticals, KY Clinic Pharmacy (75)
• Pharmaceuticals, Outside Pharmacies (25)

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Rate Negotiating

• Federally mandated to negotiate the lowest rate
  possible
• Negotiate with major billing agencies as early as
  possible, at time of award
• Negotiate specialty referrals, as needed, by MOA

22
Financial Tools/Processes

• Ryan White Title III
• Patient Enrollment Form
• Sliding Fee Scale Level/Cap Chart
• Patient Spreadsheet
• Lab Tracker
• Patient Bills Database (Grant Responsibility)
• Patient Bills Database (Patient Responsibility)

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Financial Tools Process Ryan White III
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Financial Enrollment Process

• Patient meets with financial counselor at intake
  and annually thereafter to enroll in grant program

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Financial Enrollment Process

• Utilize in- house financial counselors if
  possible
• There are financial incentives for billing
  agencies to screen patients to ensure they are
  enrolled in all available programs

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Bluegrass Care Clinic, Patient Levels

• Patient Level is determined by provided
  information, utilizing patient level and cap
  determination chart.

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Bluegrass Care Clinic, Sliding Fee Scale

• Sliding Fee Scale Level Chart

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Bluegrass Care Clinic, Patient Cap Chart

• Patient Cap Determination Chart

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BCC, Financial Tools/Processes

• Sliding Fee Scale Level/Cap Chart
• Patients are provided this information annually
  at enrollment/recertification.
• Determined annually based on federal poverty
  level. This information can be found on the US
  Department of Health Human Services site
  (http//aspe.hhs.gov/poverty/06poverty.shtml)
• Determined by patient proof of income two
  consecutive pay stubs, disability award letter,
  previous year tax form, etc.
• Can be adjusted based on patient change of income

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Bluegrass Care Clinic, Patient Spreadsheet

• Ryan White III Patient Certification Spreadsheet

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Bluegrass Care Clinic, Patient Spreadsheet

• Ryan White Patient Certification Spreadsheet
• Key to Success
• One person is responsible for maintaining and
  updating information
• Information is provide to billing agency/ and
  grant program only
• Spreadsheet update weekly

32
Bluegrass Care Clinic, Patient Spreadsheet

• Ryan White Patient Certification Spreadsheet
• Patients meet with a financial counselor at
  their intake appointment, at their annual
  screening, and as needed
• Spreadsheet is update weekly/bi-weekly, depending
  on patient enrollment, by financial counselor
• Spreadsheet is sent to university billing
  agencies (UK Hospital/Kentucky Medical Services
  Foundation) as well as Title III staff
• Used as guide to determine patients level, or
  progress in enrolling/recertifying for grant, as
  well as other financial programs available

33
Bluegrass Care Clinic, Patient Spreadsheet

• Ryan White Patient Certification Spreadsheet
• The day before each patient appointment project
  assistant scans each patient on spreadsheet to
  ensure that their enrollment is up-to-date
• Inserts one of three cards in patients chart to
  ensure that financial counselor is notified if
  needed

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Bluegrass Care Clinic, Patient Spreadsheet

• Ryan White Patient Certification Spreadsheet
• It patient is enrolled and up-to-date the
  following card is placed in the patients chart.

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Bluegrass Care Clinic, Patient Spreadsheet

• Ryan White Patient Certification Spreadsheet
• Front Desk/Registration staff enters patient
  level in at appt. registration to ensure that
  patients are billed appropriately

36
Bluegrass Care Clinic, Financial Databases

• Patient financial information is entered into
  LabTracker for reporting and research purposes

37
Bluegrass Care Clinic, Patient Bills

• Patient bill and cover page are received by
  billing agencies for level assignment/ payment

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Bluegrass Care Clinic, Financial Databases

• Program Manager utilizes in-house Access Database
  to designate grant Payment

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Bluegrass Care Clinic, Financial Databases

• Bills are entered in upon receipt
• Tracks patient expenditures to all sources
• Tracks paid bills
• Tracks outstanding bills

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Bluegrass Care Clinic, Financial Databases

• Program Manager utilizes in-house Access Database
  to designate patient responsibility

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Bluegrass Care Clinic, Financial Databases

• Patient Responsibility
• Tracks patient charges based on assigned level
• Tracks patient progress towards cap

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Bluegrass Care Clinic, Financial Databases

• Patient Responsibility
• When patient meets cap balance is zeroed out
  and patient is dropped to a Level 1

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Financial Tools/Processes

• Ryan White Title II
• Client Financial Spreadsheet
• Care Ware

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Financial Tools Process Ryan White II
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Bluegrass Care Clinic, Patient Spreadsheet

• Patient Level is determined by provided
  information, utilizing patient level and cap
  determination chart.

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Bluegrass Care Clinic, Patient Spreadsheet

• Sliding Fee Scale Level Chart

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Financial Tools/Processes

• Sliding Fee Scale Level/Cap Chart
• Patients are provided this information annually
  at enrollment/recertification.
• Determined annually based on federal poverty
  level. This information can be found on the US
  Department of Health Human Services site
  (http//aspe.hhs.gov/poverty/06poverty.shtml)
• Determined by patient proof of income two
  consecutive pay stubs, disability award letter,
  previous year tax form, etc.

48
Bluegrass Care Clinic, Client Spreadsheet

• Ryan White Title II Client Spreadsheet

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Bluegrass Care Clinic, Client Spreadsheet

• Ryan White Client Spreadsheet
• Key to Success
• One person is responsible for maintaining and
  updating information
• Information is provide to pharmacy and grant
  program only
• Spreadsheet update weekly or as needed

50
Bluegrass Care Clinic, Client Spreadsheet

• Spreadsheet is provided to pharmacy where patient
  levels and responsibility are entered into their
  billing database.
• Care Coordinators provide financial assistance
  based on a percentage which is figured by the
  patient level.

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Bluegrass Care Clinic, Financial Databases

• Client Financial Information is entered into Care
  Ware for reporting purposes

52
Bluegrass Care Clinic, Financial Databases

• Client Financial Information is entered into Care
  Ware for reporting purposes

53
Bluegrass Care Clinic, Client Spreadsheet

• Ryan White Title II Financial Assistance based on
  Sliding Fee Scale
• Example 1 Billing system that can accommodate
  percentage payments. Program helps Level 4
  patient pay for Bactroban (42.24) Patient pays
  15.84, grant pays 26.40
• Example 2 Program helps Level 3 patient
  (Patient has 40 responsibility) pay for medicine
  co-pays at 30 per month. Pharmacy is unable to
  charge based on percentage. The Care Coordinator
  program pays two months and patients pays for the
  third month, etc.

54
Bluegrass Care Clinic, Patient Bills

• Patient bill received by financial manager for
  level assignment/ payment

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Bluegrass Care Clinic, Financial Databases

• Billing information/authorization is entered into
  Care Ware

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Bluegrass Care Clinic, Financial Databases

• Through Customizable fields CARE WARE tracks
  authorized action and payment number (check
  number to verify payment).

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Evaluation of Client Level Financial Tracking

• Reporting allows you to track expenditures by
  grant, doctor, specialty, etc. (as specific as
  you want to be)
• Determine if funds are being used effectively per
  specialty, consider alternate referrals/programs,
  grants to apply for to help with costs???

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Evaluation of Client Level Financial Tracking

• Consider negotiating cheaper rates if possible
  for multiple referrals to one specialty
• Determine costs per quarter to forecast
  expenditures, to ensure grant funds are being
  used effectively