Finance Staff Guide

Overview

As Finance staff, you manage the financial aspects of Medicaid billing including invoicing, receivables, payments, cost reporting, and revenue reconciliation.

---

Your Responsibilities

Area	What You Manage
Revenue	Track billed visits and expected reimbursements
Invoices	Generate and manage district invoices
Receivables	Track payments and outstanding balances
Credit Memos	Process adjustments and credits
Cost Reports	Generate Medicaid cost reports
Settlements	Reconcile settlement payments

---

Understanding the Revenue Cycle

Visit Documented → Billed to TMHP → Paid/Denied → Revenue Recorded → Invoice Generated

Key Milestones

Stage	What Happens
Billed	Visit claim sent to TMHP
Paid	TMHP approved and paid the claim
Denied	TMHP rejected the claim
Invoiced	District billed for services
Received	Payment received from district

---

Core Tasks

Task 1: Review Revenue Dashboard

Goal: Monitor billing and payment activity

Steps:

1. Go to Finance → Revenue
2. Select district (or view all)
3. Select date range
4. Review:
   • Total visits billed
   • Total revenue (paid claims)
   • Denial rate
   • Pending payments

Key Metrics:

• Billed Amount - What was submitted to Medicaid
• Paid Amount - What Medicaid actually paid
• Denial Rate - Percentage of claims denied (target: <5%)

---

Task 2: Generate District Invoice

Goal: Bill a district for services rendered

Steps:

1. Go to Finance → Invoices
2. Click Create Invoice
3. Select the district
4. Select the billing period
5. System calculates:
   • Paid visits in period
   • Revenue amounts
   • Fee calculation (based on contract)
6. Review line items
7. Add any adjustments
8. Generate Invoice
9. Send to district (email or download PDF)

Invoice Components:

• Paid visits by service type
• Revenue by campus
• Contract fee (percentage or flat)
• Any credits applied
• Net amount due

---

Task 3: Record Payment

Goal: Enter payment received from district

Steps:

1. Go to Finance → Receivables
2. Find the outstanding invoice
3. Click Record Payment
4. Enter:
   • Payment date
   • Payment amount
   • Payment method (check, ACH, etc.)
   • Reference number
5. Apply to invoice(s)
6. Save

Partial Payments:

• System tracks remaining balance
• Multiple payments can apply to one invoice

---

Task 4: Create Credit Memo

Goal: Issue credit for billing adjustments

Steps:

1. Go to Finance → Credit Memos
2. Click Create Credit Memo
3. Select district
4. Enter:
   • Credit reason
   • Amount
   • Description
   • Related invoice (if applicable)
5. Save
6. Apply credit to future invoice or refund

Common Credit Reasons:

• Billing error correction
• Contract adjustment
• Denied visit reversal
• Overpayment refund

---

Task 5: Run Revenue Reports

Goal: Analyze financial performance

Key Reports:

Report	Purpose	Navigation
Revenue by District	Revenue breakdown by district	Finance → Reports → Revenue by District
Revenue by Campus	Campus-level revenue	Finance → Reports → Revenue by Campus
Revenue by Service	Revenue by service type	Finance → Reports → Revenue by Service
Aging Report	Outstanding receivables	Finance → Reports → Aging
Payment History	Payments received	Finance → Reports → Payments
Denial Analysis	Denied claims breakdown	Finance → Reports → Denials

Steps:

1. Go to Finance → Finance Reports
2. Select report type
3. Set filters (date range, district, etc.)
4. Run report
5. Export to Excel/PDF as needed

---

Task 6: Process Cost Report

Goal: Generate Medicaid cost report for settlements

Steps:

1. Go to Finance → Cost Report
2. Select the reporting period (typically annual)
3. Select district(s)
4. System compiles:
   • Total allowable costs
   • Medicaid-eligible costs
   • Interim payments received
   • Settlement calculation
5. Review report data
6. Export for submission

Cost Report Components:

• Direct service costs
• Administrative costs
• Transportation costs
• Interim payment reconciliation

---

Task 7: Reconcile TMHP Remittance Files

Goal: Match TMHP payments to billed visits

Steps:

1. Go to Finance → RS Files (Remittance & Status)
2. Import the TMHP remittance file
3. System matches:
   • Paid claims to visits
   • Denied claims with reasons
   • Adjustments
4. Review unmatched items
5. Resolve discrepancies
6. Update visit statuses

---

Task 8: Monitor Receivables Aging

Goal: Track outstanding balances

Steps:

1. Go to Finance → Receivables
2. View aging buckets:
   • Current (0-30 days)
   • 31-60 days
   • 61-90 days
   • 90+ days
3. For aged items:
   • Contact district
   • Send payment reminder
   • Document collection efforts

---

Financial Workflows

Monthly Close Process

1. Week 1: Review all visits billed in prior month
2. Week 2: Process TMHP remittance files
3. Week 3: Generate and send invoices
4. Week 4: Record payments, follow up on outstanding

Quarterly Review

1. Run revenue comparison (quarter vs. prior quarter)
2. Analyze denial trends
3. Review receivables aging
4. Prepare management reports

Annual Tasks

1. Generate cost reports
2. Reconcile annual settlements
3. Archive prior year records
4. Update fee schedules (if contract changes)

---

Understanding Payment Calculations

Revenue Calculation

Paid Visits × Reimbursement Rate = Gross Revenue
Gross Revenue × Fee Percentage = District Fee
Gross Revenue - District Fee = Net to District

Example

Component	Amount
Paid Visits	500
Avg Reimbursement	$45
Gross Revenue	$22,500
Fee (15%)	$3,375
Net to District	$19,125

---

Common Issues & Resolutions

Payment Discrepancy

Problem: TMHP paid different amount than expected

Resolution:

1. Check the remittance file for adjustments
2. Compare billed procedure code vs. paid
3. Review for partial payments
4. Update records to match TMHP

Missing Payment

Problem: District claims payment was sent

Resolution:

1. Request payment proof (check image, ACH confirmation)
2. Check if applied to different invoice
3. Verify payment wasn’t returned
4. Record and reconcile

Invoice Dispute

Problem: District disputes invoice amount

Resolution:

1. Pull supporting visit detail
2. Review calculation methodology
3. Provide documentation
4. Issue credit memo if warranted

---

Reports Quick Reference

Need	Report	Filters
How much did we bill?	Revenue Summary	Date range, District
What’s outstanding?	Receivables Aging	District, Age bucket
Why were claims denied?	Denial Analysis	Date range, Reason
District performance?	Revenue by District	Date range
Campus breakdown?	Revenue by Campus	District, Date range
Payment history?	Payment Report	District, Date range

---

Navigation Quick Reference

Task	Navigation Path
Revenue Dashboard	Finance → Revenue
Create Invoice	Finance → Invoices → Create
View Invoices	Finance → Invoices
Record Payment	Finance → Receivables → Record Payment
Credit Memos	Finance → Credit Memos
Cost Reports	Finance → Cost Report
RS File Import	Finance → RS Files
Finance Reports	Finance → Finance Reports
Audit Viewer	Finance → Finance Audit Viewer