P006: Office of Facilities Management
P006: Percent of eligible third-party revenue collected at all agency facilities
Current Value
92.0%
Definition
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Story Behind the Curve
- The Affordable Care Act increased the number of insured nationally. This increase puts more emphasis on third-party billing and collections.
- Collection of revenue is important to maintain services across the state. Greater revenue collection allows the New Mexico Department of Health (NMDOH) to provide an enhanced level of care to our consumers.
- Our third-party collection rate for FY18-Q2 is 85.0%.
- There are challenges with collecting revenue timely and efficiently at each facility, which include managed care organization (MCO) contractual issues from service type reimbursements and claims processing.
- Facilities continue to focus on revenue collection through weekly meetings with billing agents and MCOs to address any issues that occur and to make sure they file and collect on claims in a timely manner.
Partners
- Facility and community program financial managers and billing/collection staff
- MCOs
- Commercial insurance providers
- NMDOH Human Resources Bureau
- NMDOH Administrative Services Division (ASD)
- Human Services Department (HSD)
What Works
- Regular communication with the facilities and MCOs to resolve claims issues and outstanding payments.
- Periodic communication between NMDOH and the HSD to resolve payment issues that occur with the MCO contracts, and to ensure regulatory and contract requirements are being met.
- Sharing best practices and frequent collaboration among the facilities.
- Dedicated staff focused on outstanding claims, questioning discrepancies, and following-up on payments consistently and timely.
- Monthly reconciliation of revenue to identify unpaid claims and address issues preventing payment.
Strategy
- Communicate at least monthly, and in some cases weekly, with MCOs and third-party payers on unresolved claims.
- Work with HSD to address payment issues that occur with MCOs.
- Assess personnel resources for maximum efficiency in medical coding, billing, and revenue collection efforts.
- Perform monthly reconciliation of revenue for consistent monitoring of earned income and revenue collection.
Action Plan
- Q1-Q4: Facilities will record revenue on a monthly basis following the new draft policy “Recording Patient Revenue and Accounts Receivable." Ongoing.
- Q1-Q4: ASD will review monthly revenue actual and projected collections reports prepared by facilities for collection rate. ASD will have discussions with each Facility Finance Director and Administrator regarding resolutions when rates fall below the target. Ongoing.
- Q4: Facilities and ASD will review collection efforts of aging medical claims prior to writing off revenue.
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