July-August 2020

Revenue Cycle Management: Consistent Financial Processes Key to Multilocation Health Care Practices
By Shannon Crowley, CPA, MSA
For The Record
Vol. 32 No. 4 P. 5

As a health care practice grows and expands into multioffice locations, so too, does the importance—and challenges—of maintaining consistent financial processes. Accurate and timely financial information, visibility to all locations, proper controls, and effective communication are essential to a flourishing health care practice.

In order to effectively manage financial performance, all locations should be using the same general ledger system and chart of accounts. Profit and loss and balance sheets should be run at the practice level and by each location and doctor/health care provider. Some multioffice practices make the mistake of utilizing silos—systems that are unable to operate with other systems—resulting in a lack of real-time reporting.

If each location is running on separate systems, overall financial tracking and outlook cannot be achieved. Silos create an environment of individual and disparate systems within an organization, opening the entire practice’s financials up to delays in reporting, additional employee attention, and the potential for increased error.

Additionally, management should evaluate the current processes being handled at the individual locations vs at the finance office level in order to ensure consistent processes and reduce redundancy. A general lack of control and interruption in workflow is the end result in the absence of consistent financial processes within a practice. While a certain amount of autonomy can be a healthy element in individual office locations, patient service revenue, cash management and banking, purchases and accounts payable, payroll and human services, and financial statement closings and reporting should be under one roof.

Cultivating Tech Savvy
Operations can be further simplified with technology, specifically cloud-based storage. In brief, cloud computing refers to any service that allows a company the ability to store, access, and edit data in a remote and virtual environment, as opposed to an office location. Cloud integration offers multilocation practices the ability to collaborate through use of the internet and intranet in or out of the office setting, enabling office personnel to share, edit, and publish documents in a unified system. Communication is improved, marketing abilities are increased, and, in general, day-to-day business processes are enhanced as a result.

A strong cybersecurity protocol should also be a mandate for health care practices. Beyond the immediate damage to a compromised network, the financial repercussions are many when sensitive patient information is breached, opening the door to widespread identity theft. Fiscal liability can do significant damage to a practice as the result of a cyberattack, but steps can be taken to protect against inherent vulnerabilities, including updated patches on all servers and PCs and updated antivirus software. Additionally, the importance of staff knowing their role in securing sensitive patient information cannot be overstated, as there is a high rise in phishing and spear-phishing attacks—personalized e-mail approaches whereby a hacker creates a message that appears to come from a trusted coworker or known business entity—with the ultimate goal of stealing sensitive information. Train employees to “trust but verify” e-mail.

Technology may be the key to managing the financials of multilocation health care practices, but without communication, problems will arise; if neglected, the entire organization may be at risk.

Methods of communication can be established through full team weekly staff meetings. Regular in-person meetings may be out of the question for practices with out-of-state or otherwise inconvenient locations, but teleconferencing can take care of that issue. Face-to-face time not only builds camaraderie but also cements a consistent culture. Practices might also consider having offices take turns hosting each other yearly to allow staff members on all levels to get to know each other better. If feasible, a practice’s CEO, COO, or management members should take the initiative and personally visit each location on a scheduled basis.

Having a consistent financial processes plan in place is central to the success of a multioffice health care practice, but the importance of establishing a collective organizational culture must be underscored. Certainly, providing the highest quality medical care is a practice’s goal and its patients’ expectation, but that level of care should begin the moment patients enter the door right through to when they make their next appointment … at each and every location.

— Shannon Crowley, CPA, MSA, is a principal at blumshapiro, the largest regional business advisory firm in New England, with offices in Connecticut, Massachusetts, Rhode Island, and Virginia. The firm, with a team of more than 500, offers a diversity of services, which include auditing, accounting, tax, and business advisory services. Crowley can be reached at scrowley@blumshapiro.com.