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CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
CySolutionsPresents
Functional enhancments for
Centricity Practice Solutions™
Designed specifically for FQHC’S, RHC’s and Public Health Agencies
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
What is an FQHC, RHC, Look-Alike ?
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
What is an FQHC, RHC, Look-Alike ?
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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)
What is an FQHC, RHC, Look-Alike ?
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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%)
Payor Sources for CHC’s
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
Objectives of a CHC Implementation
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
CHC Implementation Visit - Checklist
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
CHC Implementation Visit – Checklist (more)
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
CHC Implementation Visit – Checklist (more)
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
CHC Implementation Visit – Checklist (more)
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
CHC Implementation Visit – Checklist (more)
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
CHC Implementation Visit – Checklist (more)
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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)
CHC Implementation Visit – Checklist (more)
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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)
CHC Implementation Visit – Checklist (more)
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
CHC Implementation
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
CHC Implementation
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
CHC Implementation
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
CHC Implementation
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
CHC Implementation
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
• 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
CHC Implementation
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Community Health Enhancements
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Patient Registration – Complete CHC Demographics
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Patient Registration – Single Form Navigation
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Patient Registration – Single Form Navigation
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Patient Registration – Single Form Navigation
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Patient Registration – Single Form Navigation
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Patient Registration – Single Form Navigation
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Patient Registration – There’s More!
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Patient Registration – Expanded Contacts
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Patient Registration – User Defined
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Patient Registration – User Defined
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Complete Alias Tracking and Demographic History
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Dashboard Schedule Managment
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Referrals and Authorizations
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Referrals and Authorizations - History
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Referrals and Authorizations - Detail
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Immunizations – Includes Registry Export
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Immunizations – Includes Registry Export
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Immunizations – Includes Clinical Details
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Immunizations – Includes Clinical Details
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Immunizations – Track All IZ’s or Import!
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Immunizations – Track All IZ’s or Import!
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Immunizations – Immunizations Logs
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Complete Dental Billing and Scheduling
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Complete Dental Billing and Documentation
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Complete Dental Billing and Documentation
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Complete Dental Billing
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
ADA Paper and Electronic 837D
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Track Incomplete Registration Information!
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Track Incomplete Registration Information!
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Show All Tracked Information – User Configurable
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Expanded Document Management
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Single Click Document Retrieval
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Perinatal Case Management
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
UDS Table 7 Required Information and More!
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
UDS Table 7 Required Information and More!
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Title X Reporting and Tracking
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Global Management of Title X, Immunizations, Perinatal, Referrals
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Complete Sliding Fee Functionality
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Patient Portion Automatically Computed from Schedules
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Medicaid and Medicare FQHC Visits Automatically Processed
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Unparalleled UDS, Title X and Grant Reporting
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
Including Perinatal Table 7 and Tables 9(c) & 9(d)
CySolutions CHC Enhancements TrainingTuesday, April 11, 2023
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 TrainingTuesday, April 11, 2023
Contact information
CySolutions Support
(866) 883-9299 x234
7:00am – 7:00pm Central Time
Weekends & Evenings on call