1. Functional enhancments for Centricity Practice Solutions™
CySolutions
Presents
Functional enhancments for
Centricity Practice Solutions™
Designed specifically for FQHC’S, RHC’s and Public Health Agencies

2. 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

3. 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

4. What is an FQHC, RHC, Look-Alike ?
Administered by Bureau of Public Health (BPHC) (
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)

5. 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%)

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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 days transferred to Centrcity
Mid-Year implementations convert visit information for current year (for compliance reports)

14. 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)

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. Community Health Enhancements

22. Patient Registration – Complete CHC Demographics

23. Patient Registration – Single Form Navigation

24. Patient Registration – Single Form Navigation

25. Patient Registration – Single Form Navigation

26. Patient Registration – Single Form Navigation

27. Patient Registration – Single Form Navigation

28. Patient Registration – There’s More!

29. Patient Registration – Expanded Contacts

30. Patient Registration – User Defined

31. Patient Registration – User Defined

32. Complete Alias Tracking and Demographic History

33. Dashboard Schedule Managment

34. Referrals and Authorizations

35. Referrals and Authorizations - History

36. Referrals and Authorizations - Detail

37. Immunizations – Includes Registry Export

38. Immunizations – Includes Registry Export

39. Immunizations – Includes Clinical Details

40. Immunizations – Includes Clinical Details

41. Immunizations – Track All IZ’s or Import!

42. Immunizations – Track All IZ’s or Import!

43. Immunizations – Immunizations Logs

44. Complete Dental Billing and Scheduling

45. Complete Dental Billing and Documentation

46. Complete Dental Billing and Documentation

47. Complete Dental Billing

48. ADA Paper and Electronic 837D

49. Track Incomplete Registration Information!

50. Track Incomplete Registration Information!

51. Show All Tracked Information – User Configurable

52. Expanded Document Management

53. Single Click Document Retrieval

54. Perinatal Case Management

55. UDS Table 7 Required Information and More!

56. UDS Table 7 Required Information and More!

57. Electronic Lab Import and Lab History

58. Electronic Lab Import and Lab History

59. Abnormals Highlighted

60. Ability to annotate lab findings

61. Flowsheet Display Available

62. Flowsheet Display Available

63. Flowsheet Graph Also Available

64. Flowsheet Graph Also Available

65. Title X Reporting and Tracking

66. Global Management of Title X, Immunizations, Perinatal, Referrals

67. Complete Sliding Fee Functionality

68. Patient Portion Automatically Computed from Schedules

69. Medicaid and Medicare FQHC Visits Automatically Processed

70. Unparalleled UDS, Title X and Grant Reporting

71. Including Perinatal Table 7 and Tables 9(c) & 9(d)

72. 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

73. Weekends & Evenings on call
Contact information
CySolutions Support
(866) x234
7:00am – 7:00pm Central Time
Weekends & Evenings on call