Behind the Scenes: Finance

6/19/2019  By HealthNews

06.19.2019

We sat down with KVH Senior Finance Analyst Jason Adler and Accounts Payable Specialist Deborah Connors, to try to get a handle on the mystery that is healthcare finance.

How is the work divided between the team in your department?

Jason: Accounting is a part of finance, and finance is also the whole revenue cycle. They all partner together.

Deborah: And you do a lot of budgeting.

Jason: I do the budget and it rolls into accounting to compare the budget or financial plan to the actual accountings.

Deborah: I have a very small part of the whole accounting department. Pretty much just paying the bills.

Jason: Well, I think she has a really big part. How much money did you spend last year?

Deborah: You know, I don't remember, but I did hear Kelli [Goodian Delys, Finance Director] say that I wrote over 10,000 checks. One night I was here until 7:30 doing checks and someone's like, wow, you're here late. I’m like, I'm just trying to keep the lights on.

Jason: Literally.

If you were to give a really high level of what your teammates do, what are the different roles? Kelly Winters does payroll.

Deborah: Kelly does payroll. I pay the bills. Vicky Sterkel pays the bills. She enters employee deductions and things like that. She also sorts the mail that comes in and helps do a lot of data entry in Cerner for matching invoices to purchase orders.

And Sharoll Cummins?

Deborah: Sharoll does just about everything else.

Jason: She puts in journal entries to account for things like bills we haven't paid yet, like when a company bills us about a month behind, but we need to expense it at the time of service to ensure we have the money for it.

Deborah: Sharoll also keeps track of all the fixed assets, whether it's a new computer system or a building.

What program do you use for all of this work?

Jason: We probably use Excel the most. Multiview is our general ledger software. So that's where everything comes together in our general ledger, which is like the book of truth, I guess you would say.

What’s different about working in finance in healthcare?

Deborah: I had to learn a lot of terminology. My first six months I googled a lot of things, many of which I wish I'd never looked up. But, accounting is accounting. The basic principles are the same. It's just the terminology that is a little bit different.

I just know from my perspective in marketing, but marketing in a healthcare environment has that layer of ‘it's for a greater good.’

Deborah: That is actually part of what drew me to wanting to come to work here. You know, being part of an organization that does good things for people.

Jason: I guess one of the biggest differences with healthcare is learning how we actually get paid, and what we can charge for. Every payer pays us differently.

Deborah: Incredibly complicated.

Jason: Yeah. And contracts with insurance companies will conflict. You might have a contract with one insurance company where a service is allowed and paid for and another company that is complete opposite.

Deborah: There are a lot of things that are very negotiable.

How do you keep all of it straight?

Jason: It takes the whole team. There's little things like with Medicare and Medicaid where location is really important on how you get paid. We can do the exact same service in two different areas and what we get paid for the services can be significantly different.

Deborah: And even things like the utility bill. Engineering absorbs most of the utility bills into their department, but not all. The ones for the Rural Health Clinics get charged to the clinics, so they can be included on the Medicare Cost Report reimbursements.

I think that's the single biggest thing that I learned since coming here, is how complex the entire finance system is.

Jason: We do the cost report, so we're paid on cost from Medicare and Medicaid, which is about 60 percent of our business, but pays about 33% of our costs by the time we factor out all non-allowable expense. It's just accuracy with the most basic things such as square footage of my office compared to a patient room. Just the square footage makes a huge difference on payment for services.

Speaking of having numbers right, how often do audits come into play?

Deborah: Two a year.

Jason: The state audit, and the independent audit.

Deborah: It's my understanding that government agencies whose revenue exceeds a certain dollar amount are required by law to have independent audits done on an annual basis.

Jason: It’s required that the board choose a firm for the independent audit. Our firm is DZA and they just did the report out at the last board meeting. We have a state audit every fall.

Deborah: We don’t just go, "Hey, it'd be a great idea to get audited." It's required by law.

Jason: We’ll have payers do audits, too. We hire a third party audit to audit patient accounts. Just at random, to check that we're doing a good job.

Deborah: And that's a big part of the audits. It's not just "What are you doing wrong?" It's like, "This is the way we've been doing things. Can we do it better?"

What are the challenges of finance?

Deborah: I have a huge volume of work that comes through. It never stops.

Jason: Yeah, the volume’s a big one. I've just learned that even though I'll have some periods with tighter deadlines, I do what I can, and at the end of the day I go home, because it’s never really done.

Rewards of working in finance?

Deborah: I like solving puzzles. Accounting's a big puzzle. Sometimes you don't know what it's supposed to look like, and I like that part of it.

Jason: Being part of a community hospital and community health care. I know that I need health care, my family needs health care, and it's great to be a big part of this and then know the numbers, the behind-the-scenes of why we do everything.

We try to keep it improving continuously for the small community. It feels like I’m actually helping friends and neighbors, unlike a big city where it's thousand people I don't know. I see patients I know every day. It’s really rewarding.

What would you tell a new teammate to bring with them for a successful day on the job?

Deborah: I'd say patience and a sense of humor.

Jason: Ditto. Especially patience.

For many of us, being in a hurry with our work can create more problems than we’re solving.

Deborah: Yeah, that's true. I usually find when I've made mistakes, it's because I've got rushed through something.

Jason: I like to try to have a second set of eyes on things.

Any misconceptions that folks tend to have about finance that you would like to dispel here or anything that people might find interesting about your work?

Deborah: Well, I don't think accounting is boring, but a lot of people do.

Jason: Yeah, I don’t think a lot of people are going to find accounting interesting.

Well, but they're seeing it from the outside, right? Getting directly involved in it might make it interesting.

Deborah: I think people might be surprised to learn that just because you work in accounting doesn't mean you don't have to be able to relate to people really well, because a lot of what we do is talking with people. Even if most of it's in emails and spreadsheets, you still need to be able to communicate really well to do accounting.

How does your department’s work support the KVH mission of quality care?

Jason: Well, there's access and financial sustainability too, right?

Oh yes. Our core values. If you couldn't afford to have the doors open. You said something before about the lights being on.

Jason: Well, timely bills keep supplies coming in and the lights on.

Deborah: And monitoring those expenses in addition to the revenue, just to make sure that we're not paying more than we need to, that we're not getting taken advantage of.

You also are making it so that there's a future here. We have, like, rainy day funds and we have operating costs and, I mean, all that stuff is all, you know. (Because clearly, I don't know.)

Deborah: And in that way it's not a lot different than your household budget. You always have to put a little money aside because you never know when that money coming in might slow down.

Just on a much larger scale here.

Jason: Exactly.

It’s pretty important work you all do. I still don’t understand a lot of it, but I’m really glad you’re here to take care of it all.