Issues

Product issues pertain to one contract and one effective date rather than billing procedures for the whole clinic. For example, if a product is missing a fee schedule for an HMO contract, a contract analyst enters a product issue and links it to one of the following:

• The Contract Document–a master document, which covers multiple products and can have multiple effective dates and apply to more than one clinic
• The Contract Terms–The TAC document, which can be shared across clinics and have multiple Contract Effective Date entries
• The Contract Effective Date Table–one contract with one effective date

In group clinics, if you are reviewing product issues, it is best to select the group when you log on so that you can review all products issues for all clinics at the same time.

Facility issues are those that affect a facility or group. Typically, these issues pertain to how the facility or group defines a service type or how the service type is identified on a claim.

For example, a contract analyst at FinThrive sees that the top ten contracts at Lone Star Hospital distinguish between live and cadaver transplants, but it is not clear how the facility defines the two service types, so the analyst creates a facility-level issue to determine how these service types are defined at the facility.

In group facilities, if you are reviewing facility issues, it is best to select the group rather than a facility when you log on, so that you can review issues for one facility or the whole group.

FinThrive applies a category to an issue during certain stages and statuses of the implementation. Categories help FinThrive to track the reasons for any contract profile rejections, either by the customer or FinThrive. Specifically, a FinThrive analyst in charge of the contract must apply a category to an issue whenever the contract status is “rejected” in one of the following stages:

• FinThrive Audit
• Client Audit (customer audit)

For more information about implementation stages, refer to Implementation Stages.

The following table explains Product Issue categories.

Category	Description
Billing Practices	The facility bills a service type differently than indicated in the profile
Contract Interpretation	There is a difference of opinion about the interpretation of contract wording
Incorrect Attributes	The service type has incorrect attributes, such as the wrong DRG, revenue code or days expression
Incorrect Calculation	The calculation method appears to be incorrectly loaded
Incorrect Fee Schedules	The wrong fee schedule (for example, ICD, DRG or CPT schedule) is associated with the contract
Incorrect Terms	The rate loaded in the system is something other than what is in the contract
Invalid Rates Loaded	The rates are defined incorrectly in the system according to the contract; for example, the contract rate should be loaded as 60%, not 75%
Missing/Extra Svc Types	There are missing or extra service types in the Contract Profile
Missing/Outdated Fee Sch.	A fee schedule is missing or there is an outdated fee schedule in the system
Missing/Outdated Fee Terms	One or more fee terms are missing or outdated
Research/Clarification	A calculation or system definition needs clarification
Not Categorized	This is not selected as a category, but is the default if no category is assigned

The following table explains Facility Level Issue categories.

Category	Description
Adjustment File	The issue involves the adjustment files received from FinThrive
CBO Errors	The issue involves the CBO system
Contract Implementation	The issue is implementation-related
Data	The issue involves the data in the system
Data Acquisition	The issue involves acquiring the data used in the system
Import Job	The issue involves an import job
Internet	The issue is Internet-related
Medicare	The issue involves Medicare or other government payors
Queries	The issue involves queries
Reports	The issue involves reports
Reprice Error	The issue involves one or more reprice errors
Reprice Job	The issue involves a particular reprice batch or job
Request Enhancements	The issue suggests an enhancement to the system
Contract Modeling	The issue involves Contract Modeling or Contract Loading
Not Categorized	This is not selected as a category but is the default if no category is assigned

The issue status indicates whether the issue is open, closed or on hold, as follows:

• Open is unresolved.
• Closed is resolved.
• On Hold means either the issue is unresolved and cannot be addressed in the near future, or it means that FinThrive and the customer have agreed to put the issue aside for now.

In Contract Manager Professional, comments are added to issues to explain them and to coordinate their resolution. Both FinThrive personnel and customers enter comments each time an issue is addressed, so that anyone monitoring the issue can see how the resolution is progressing. Comments are added when:

• The issue is opened.
• The issue is addressed by a customer or an FinThrive employee.
• The issue is resolved.