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172x Filetype XLSX File size 0.15 MB Source: www.nahc.org
Sheet 1: Instructions
| Relief Funding Revenue and Cost Tracking Tool |
| General Instructions |
| All blue tabs represent tabs for which data should be entered by user |
| All red tabs are populated with formulas that will populate once data is entered onto blue tabs |
| All red tabs have been locked to avoid disruption of formulas, but can be unlocked with the password "NAHC" under Review > Unprotect Sheet |
| The green tabs include roll-up figures for revenue, costs, and key performance indicators (KPIs) |
| Revenue |
| 1) Enter revenue, census, and visit information onto HH Rev Data Input and HO Rev Data Input tabs. Note that in order to demonstrate revenue loss most accurately the accrual accounting method should be used to record revenue |
| 2) The headers for each input section will explain the recommended calculation method for the section's requested data. |
| 3) Medicare refers to traditional Medicare and does not include Medicare Advantage |
| 4) Non-Medicare (PDGM) refers to Medicare Advantage plans that reimburse using PPS/PDGM methodology |
| 5) Non-Medicare (FFS) refers to Medicare Advantage, Medicaid Managed Care, traditional Medicaid, Commercial, private pay and any other payors that reimburse fee-for-service or other non-PPS/PDGM methodology |
| 6) The subsequent HH Rev tabs (all red revenue tabs) will provide the cumulative revenue loss for each service line/payor category that is experienced during the crisis |
| 7) The HH Medicare Rev, HH Non-Medicare (PDGM), and HO Medicare tabs are designed to account for the suspension of sequestration for dates of service 5/1 and after. It is understood that the April calculation for home health Medicare/non-Medicare PDGM claims is complicated as only periods extending into May will benefit from this, but the template removes sequestration from all April revenue on these tabs in order to simplify this analysis. |
| 8) Key Performance Indicator (KPI) data will also be entered in the revenue tabs. These indicators are meant to support any revenue changes (ie census/admission decreases supporting a reduction in revenue) |
| Cost |
| 1) Enter all cost information onto the Cost Data Input tab, this should represent all COVID related costs incurred after January 27, 2020 which is the effective date of the public health emergency |
| 2) The information entered on the Cost Data Input tab should represent all costs incurred that are directly related to the COVID-19 crisis. This does not represent the incremental change in costs due to the crisis. For example, assume supply costs increased from monthly average of $25,000 to $60,000 in April, and $40,000 was spent on supplies related to the crisis. The cost entered on this template would be $40,000, not the incremental increase of $35,000. |
| 3) The following columns will require information entered on the Cost Data Input tab in order for information to flow onto the Cost Summary tabs: |
| Service Line: select whether costs was incurred by home health or hospice |
| Cost Category: the selection in this column will determine which Cost Subcategories are available for section in the next column. The Appendix A tab will detail all Cost Subcategories under each Cost Category. |
| Cost Subcategory: selections available in this column will be determined by the selection in the Cost Category column. Each Cost Subcategory will be summarized into a different line item in the HH Cost Summary and HO Cost Summary tabs. The Cost Definitions tab provides definitions for each Cost Subcategory included in the template. |
| Expense: this repesents the total dollars spent on the selected Cost Subcategory |
| Month: this represents the month in which the cost was incurred |
| 4) All other columns in the Cost Data Input tab can be used to track detail for all costs, but will not flow onto the Cost Summary tabs |
| 5) All information in the drop-down lists in the Cost Data Input tab is pulled from the Appendix A tab. This tab has been locked, but can be unlocked and updated by the user if additional options are desired. |
| Data Input Sheet (Home Health) | ||||||||||||
| Total Revenue (PPS/PDGM) | Total earned revenue for the month (PPS/PDGM reimbursement methodology only) | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare (Traditional) | ||||||||||||
| Non-Medicare (PDGM/PPS) | ||||||||||||
| Total Revenue (FFS) | Total non-Medicare revenue for the month (fee-for-service). | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Non-Medicare (FFS) | ||||||||||||
| PDGM Case Mix | Calculated case mix for PDGM periods only (admissions and recertifications starting on or after 1/1/2020). | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare (PDGM) | ||||||||||||
| LUPA% | LUPA periods/episodes divided by total PDGM/PPS periods/episodes. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare (PDGM/PPS) | ||||||||||||
| Outlier% | Outlier periods/episodes divided by total PDGM/PPS periods/episodes. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare (PDGM/PPS) | ||||||||||||
| Average Daily Census (ADC) | Average volume of patients on service per day over a one month period. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare (PDGM/PPS) | ||||||||||||
| Non-Medicare (FFS) | ||||||||||||
| Referrals | Total volume of referrals received by primary payor category over a one month period. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare (PDGM/PPS) | ||||||||||||
| Non-Medicare (FFS) | ||||||||||||
| Admissions | Total volume of patients admitted by primary payor category over a one month period. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare (PDGM/PPS) | ||||||||||||
| Non-Medicare (FFS) | ||||||||||||
| Recertifications | Total volume of patient recertifications by primary payor category over a one month period. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare (PDGM/PPS) | ||||||||||||
| Non-Medicare (FFS) | ||||||||||||
| Total Visits | Total visit volume for all disciplines over a one month period. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare (PDGM/PPS) | ||||||||||||
| Non-Medicare (FFS) | ||||||||||||
| Total Therapy Visits | Total visit volume for all therapy disciplines (PT, OT, ST) over a one month period. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare (PDGM/PPS) | ||||||||||||
| Non-Medicare (FFS) | ||||||||||||
| Average Length of Stay (LOS) | Average number of days from admission to discharge for all patients that received services within the month. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare (PDGM/PPS) | ||||||||||||
| Non-Medicare (FFS) | ||||||||||||
| Additional KPIs (optional) | ||||||||||||
| Visit Mix | Percentage of discipline visits performed by an RN, PT, or OT. Example: if 60% of visits were performed by and RN, and 40% were performed by an LPN, enter 60% for the month. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| RN/LPN | ||||||||||||
| PT/PTA | ||||||||||||
| OT/OTA | ||||||||||||
| Productivity | Average number of visits performed per day by clinician (agency weighted visit structure can be applied). | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| RN/LPN | ||||||||||||
| PT/PTA | ||||||||||||
| OT/OTA | ||||||||||||
| ST | ||||||||||||
| HHA | ||||||||||||
| MSW | ||||||||||||
| Direct Cost per Visit (CPV) | Average cost of wages + benefits + supplies + mileage per visit by discipline. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| SN | ||||||||||||
| PT/PTA | ||||||||||||
| OT/OTA | ||||||||||||
| ST | ||||||||||||
| HHA | ||||||||||||
| MSW | ||||||||||||
| Total | ||||||||||||
| % Contracted Labor | Percentage of discpline visits performed by contracted employees during the month. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| RN/LPN | ||||||||||||
| PT/PTA | ||||||||||||
| OT/OTA | ||||||||||||
| ST | ||||||||||||
| HHA | ||||||||||||
| MSW | ||||||||||||
| Charity Care | Total earned revenue designated to Charity Care for the month. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Total Charity Care | ||||||||||||
| Days Sales Outstanding (DSO) | Total Accounts Receivable (AR) divided by average daily revenue over the past three months. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare (PDGM/PPS) | ||||||||||||
| Non-Medicare (FFS) | ||||||||||||
| Total DSO | ||||||||||||
| Bad Debt Write-offs | Total balance written off as uncollectible in the month. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare (PDGM/PPS) | ||||||||||||
| Non-Medicare (FFS) | ||||||||||||
| Unbilled Claim Amount | Total balance at the end of the month of unbilled claims that are held due to unsigned plan of care/verbal orders, incomplete face-to-face encounter, and any other requirements preventing claims from being billed. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare (PDGM/PPS) | ||||||||||||
| Non-Medicare (FFS) | ||||||||||||
| Additional Costs | Total cost designated to listed field divided by total earned revenue for the month. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| % Marketing Cost/Net Revenue | ||||||||||||
| % Orientation Cost/Net Revenue | ||||||||||||
| Data Input Sheet (Hospice) | ||||||||||||
| Total Revenue | Total earned revenue for the month. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare | ||||||||||||
| Total SIA Visits | Total visit volume for all qualifying Service Intensity Add-on (SIA) visits, defined as SN and MSW visits that occur within seven (7) days of a patient's date of death. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Total SIA Revenue | Total revenue earned from SIA visits, calculated based on SIA reimbursement rates multiplied by volume of SIA visits. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Average Daily Census (ADC) | Average volume of patients on service with agency over a one month period, broken down by primary payor. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare | ||||||||||||
| Referrals | Total volume of referrals received by primary payor over a one month period. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare | ||||||||||||
| Admissions | Total volume of patients admitted by primary payor over a one month period. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare | ||||||||||||
| Total Patients | Total number of patients on service over a one month period. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare | ||||||||||||
| Average Length of Stay (LOS) | Average number of days from admission to discharge for all patients that received services within the month. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare | ||||||||||||
| Hospice House Occupancy | Average daily volume of patients in hospice house (in percentage format). If agency does not have a hospice house, leave this section blank. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare | ||||||||||||
| Additional KPIs (optional) | ||||||||||||
| Total Medicare Days | Total days on service in the month for all Medicare patients in monthly census. Continuous Care should be represented in hours not days. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Routine | ||||||||||||
| Continuous Care | ||||||||||||
| Respite | ||||||||||||
| General Inpatient | ||||||||||||
| Total Non-Medicare Days | Total days on service in the month for all Non-Medicare patients in monthly census. Continuous Care should be represented in hours not days. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Routine | ||||||||||||
| Continuous Care | ||||||||||||
| Respite | ||||||||||||
| General Inpatient | ||||||||||||
| Room & Board | ||||||||||||
| Productivity | Average number of visits performed per day by clinician (agency weighted visit structure can be applied). | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| RN/LPN | ||||||||||||
| HHA | ||||||||||||
| MSW | ||||||||||||
| Direct Cost per Visit (CPV) | Average cost of wages + benefits + supplies + mileage per visit by discipline. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| SN | ||||||||||||
| HHA | ||||||||||||
| MSW | ||||||||||||
| Chaplain | ||||||||||||
| Total | ||||||||||||
| Charity Care | Total earned revenue designated to Charity Care for the month. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Total Charity Care | ||||||||||||
| Days Sales Outstanding (DSO) | Total Accounts Receivable (AR) divided by average daily revenue over the past three months. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare | ||||||||||||
| Total DSO | ||||||||||||
| Bad Debt Write-offs | Total balance written off as uncollectible in the month | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare | ||||||||||||
| Unbilled Claim Amount | Total balance at the end of the month of unbilled claims that are held due to unsigned CTIs or any other requirements preventing claims from being billed. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| Medicare | ||||||||||||
| Non-Medicare | ||||||||||||
| Additional Costs | Total cost designated to listed field divided by total earned revenue for the month. | |||||||||||
| January | February | March | April | May | June | July | August | September | October | November | December | |
| % Marketing Cost/Net Revenue | ||||||||||||
| % Orientation Cost/Net Revenue | ||||||||||||
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