End of The Fiscal Year Push!
Every organization associated with Health Information Coding has felt the pressure to catch everything up at the end of the Fiscal Year. It helps to understand what is at stake and how you can help.
Fiscal Years (FY) vary depending on the organization. Some correspond to the calendar year, while others start/end at times established for taxing and accounting purposes (The Balance, 2019). Annual Financial reports are generated during this time to show the success or failure of the organization to meet its goals and expectations. Banks and Financial Institutions look at these reports to evaluate their investment and decide whether to raise or lower the rates they charge based on the perceived risk. Administration will use the data to plan for future expansion or contraction. Finance can identify weaknesses in the Revenue Cycle and negotiate contracts with Third-Party Payers. Raises and bonuses rely heavily on positive results. The positive and negative consequences are dependent on collections, cash reserves, and bad debt – all items influenced by timely and accurate coding.
DNFB (discharged, not final billed) is the accumulation of charges for accounts that have not been coded or cleared the Billing edits. This number can get out-of-hand with unnecessary delays that cripple the cash flow and rob the organization of interest it could earn from cash reserves. If bad enough, the organization will have to pay interest on money borrowed to cover expenses that should have been covered by reserves. Rejected/denied accounts can further erode the financial well-being of the organization: billing/appeal deadlines missed, underinsured may pay the first accounts submitted and have nothing left for the late bills, old accounts may be lost and never processed, etc. Community goodwill may also suffer if patients are billed for items or services that should have been covered by Third-Party Payers.
An expensive remedy for delays from coding backlog is to use overtime. Forcing employees to work weekends and evenings may be helpful to their pocketbooks, but can exhaust them, resulting in errors, lower productivity, and disruption of personal plans. The extra cost will also have to be covered in the budget somehow.
Rejected/denied accounts can result in long payment delays from the Payers. To avoid this, it may be better to suffer a short delay by scrubbing the account clean before billing. Edits for missing charges, incorrect dates, wrong physicians, and coding errors can be corrected upfront. However, if these delays are not followed up and fixed in a timely fashion, it can result in other losses: billing deadlines missed, funds may dry up when the patient is underinsured, and old accounts may never get attention.
After the crunch of “dropping everything” is over at the end of the FY, it is an opportune time to look at fixes for these problems. An ounce of prevention is worth a pound of cure. Setting productivity standards and monitoring coding quality will ameliorate some of the mad rush next year. Preventative measures to decrease and monitor holds is another step in an effective, efficient Revenue Cycle program.