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P006: Office of Facilities Management (FY18 Parent)

P006: Percent of eligible third-party revenue collected at all agency facilities

Current Value

92.0%

FY 2017

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 to provide an enhanced level of care to our consumers.
  • The state's revenue fluctuates each year, and as a result the amount of General Fund appropriated to New Mexico Department of Health is directly affected.  The New Mexico Department of Health must strive to collect on other eligible revenue.
  • The eligible third-party collection rate for Fiscal Year 2018-Quarter 3 is 93.1%.  The target of 93% was met.  Facilities maintained focus on revenue collection through regular meetings with Managed Care Organizations to address billing/payment issues.  Monthly actual and projected revenue reports for each facility/program were reviewed by the Administrative Services Division and discussions were had with each Finance Director to assist with resolving collection issues. 
  • There are challenges with collecting revenue timely and efficiently at each facility, which may include Managed Care Organization contractual issues related to service types, billing/collection staff turnover and various problems that arise with claims processing. As progress is being demonstrated, actions in place will continue.

Partners

  • Facility and Community Program Finance Directors and billing/collection staff
  • Managed Care Organizations
  • Commercial insurance providers
  • New Mexico Department of Health Human Resources Bureau
  • New Mexico Department of Health Administrative Services Division
  • Human Services Department

What Works

  • Regular communication with the facilities and Managed Care Organizations to resolve claims issues and outstanding payments.
  • Periodic communication between New Mexico Department of Health and the Human Services Division to resolve payment issues that occur with the Managed Care Organization 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 Managed Care Organizations and third-party payers on unresolved claims.
  • Work with Human Services Division to address payment issues that occur with Managed Care Organizations.
  • 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: Administrative Services Division will review monthly revenue actual and projected collections reports prepared by facilities for collection rate.  Administrative Services Division will have discussions with each Facility Finance Director and Administrator regarding resolutions when rates fall below the target. Ongoing.
  • Q4: Facilities and Administrative Services Division will review collection efforts of aging medical claims prior to writing off revenue.

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