Why Outsourcing Your SNF’s Financial Controllership is Key to Success
During a rare lull in Steve Zicherman and Sam Pirutinsky’s day as the Executive VP and VP of Finance, respectively, we took the opportunity to ask them some questions pertinent to owners and operators in today’s climate. During this discussion, we explored the benefits to operators when they outsource their financial controllership duties to dedicated professionals who specialize in the long-term care industry.
The financial health of SNFs should be front of mind for any operator. Zicherman and Pirutinsky dive deep into the complexities of managing a SNF’s financials and why outsourcing can be an essential tool for operators looking to ensure proper oversight and processes are in place.
Q. What does outsourcing to LTC Ally’s financial controllers do for long-term care operators?
We take on the role of everything from bookkeeper to accountant to financial controller for a wide range of operators. One of the core things we do is implement an electronic approval system and bring some automation into the operator’s organization for accounts payable. We also pay their bills, reconcile their bank accounts, and manage their cash flow. When we’re managing a client’s cash, we’re constantly analyzing the metrics. If we need to use a line of credit, we do a lot of work to make sure we’re projecting appropriately and understand exactly how much money we will have on hand.
Beyond the day-to-day management of that type of finances, we’re also producing monthly statements and real-time financial reports so operators can have their finger on the pulse and understand the financial health of their organization.
When we interface as the financial controller, we’re coordinating closely with the client’s cost report consultant, their tax preparer, and coordinating any bank exams. We’re also producing investor reports and taking the lead on financial audits. In sum, we handle all day-to-day and month-to-month financial operations.
Q. What does onboarding look like for the average operator?
Now, it’s a really seamless process. I remember the days when we saw a group of five homes and thought, how are we going to onboard these homes at once? Over time we’ve figured it out. We’ve seen many situations where an operator has bought 20, 30, 40 homes within a few months. We’ve had months where we’ve onboarded 50 homes and taken on their finances and reporting needs. We have a defined implementation team in place that lets us do this seamlessly. Their sole focus is on the intricacies that come with a change in management.
Whether the type of operator is someone who’s expanding by 20 facilities, or a new operator—maybe someone who was a regional administrator and this is their first or third home—we provide all the support they need. In fact, most of the newer operators don’t have the money or experience needed to build out a full management team, so we help them navigate all the intricacies of a change of ownership and get them set up for success from day one.
When our clients are growing, whether that’s one or 10 homes, they continue to trust us to oversee their financial operations because they have seen firsthand the value we bring them—a tremendously robust back office—as they scale.
Q. How do LTC Ally’s Financial Controllership services help operators with their accounts payable and cash management?
The main pain points that we help with are verification of invoices, managing vendors, and making sure financial statements are accurate and timely. In order to make sure everything is being managed in the most accurate, efficient way, we start by uploading all of the operator’s invoices and statements into our financial system. This allows us to put the numbers in front of operators in the most timely manner possible so they can see everything that’s happening in their facilities. By centralizing where and how the data is being handled, we can deliver operators’ reports quickly and accurately.
Specifically, in skilled nursing, there’s much more regulation over the financial statements of nursing homes. They have to go to banks on a monthly basis and operators are very focused on watching trends. In certain states, you have to be very careful how invoices are coded or the facility is not going to be able to maximize its reimbursements. Our hyper-focused people make sure invoices and line items are being coded correctly.
When the accounts payable are not processed in a timely manner and aren’t coded correctly, operators don’t have enough insight into their business. They can’t react quickly enough to address issues that arise. Additionally, many states have a cost-based reimbursement system, and if costs aren’t being coded and managed properly, a facility isn’t going to have the correct figure per resident per day next year. This is another area where in-house back offices might struggle, so we provide a lot of support with AP on this front.
When it comes to invoice approval, we have a very strong technology that allows for tremendous transparency. Every person, from department heads to administrators and owners, can be involved in the approval process of every invoice. Supporting that, we have our own custom processes and software that help us manage critical vendors. When a facility might be going through a tough time and cash is tight, we work very closely with vendors so they can be assured they’re going to get paid while giving operators the space they need to keep their facilities running in a balanced and efficient manner.
Since the long-term care industry is not cash-on-demand, we work closely with banks to manage a revolving line of credit. It’s the only way to handle AP in long-term care and is a very involved, complex process. We provide collateral reports showing a facility has enough in their accounts receivable to protect the bank when they lend us money.
On an ongoing basis, we’re conducting a lot of analysis to forecast when and how much we are going to borrow. Skilled nursing is unlike any retail business due to the complexity and regulations. We are producing reports and statements on a daily, weekly, and monthly basis. It’s the only way operators can truly know the health of their facilities and maintain these complex lines of credit.
Q. What do your financial controllership services do to protect operators from billing inaccuracies from third-party vendors?
We have a dedicated ancillary review department that is made up of a specialty team that focuses on the review of resident-specific invoices, such as pharmacy, therapy, X-rays, lab tests, transportation services, etcetera. When a vendor comes into the facility and provides John Doe services, we ask a few questions to assess its veracity. Was John Doe in the facility? Is John Doe on Medicaid, Medicare? Is it the facility’s responsibility to pay or is it the responsibility of the therapy company to bill Medicaid directly?
Our team reviews each invoice and interfaces with the vendor directly. Regularly, we are requesting credits and getting significant sums of money back due to improper billing or irregularities that we find. Without conducting this level of review, facilities are missing out on a whole host of errors that, in the end, are costing them a lot of money.
Q. Your Finance department creates dedicated teams for each operator. What’s the benefit of this approach?
When we give our clients a dedicated team, they know that their controller is there to help them with anything they need. That controller is connected to every part of every process and can give our partners the answers they’re looking for. We put a lot of focus on putting these teams together for two reasons. Firstly, it’s a great employee experience to work in a smaller team, and secondly, it’s a great experience for our clients. They don’t feel like they’re coming in and being thrown on a conveyor belt. They literally have their own team, no different than if we were in their own office.
At any point, no matter the level of complexity that may arise, our controllers and their teams are supported by senior managers and by myself. Even more broadly, if we run into an issue that we see arise and requires some help from other specialists at other departments within LTC Ally, we can leverage their expertise to accommodate the operator and their needs.
Fundamentally, it’s all about delivering quality and results for operators and we won’t compromise on either. That’s why we create dedicated teams tailored to each operator’s situation.
Q. When a client is working with LTC Ally’s Finance team, how often do they decide to then outsource their RCM, or vice versa?
It happens all the time. When they see what we can do with their RCM and what the difference is compared to having their own people manage this in-house, the decision is obvious. Very often a client will approach us and ask us to take over the financial controllership and bring them that same peace of mind. We’re regularly asked to get them up-to-date professionally and get their operations to a place where they can stay up to date with all the regulations and changes.
The other way around happens often too. Maybe a client is working with us and they have their own biller, and they’re asking themselves, Why am I giving myself such a headache? Why is there a lack of experience and knowledge here? They’ll go to Aliza—our EVP of RCM—and ask her to take over their RCM. They see the difference our team brings to their operations as true professionals in these areas and how we handle their finances with care. Pretty quickly, they realize their in-house RCM team can’t deliver these same results. Essentially, it comes down to size and expertise. We have both and operators of all sizes need this to thrive and continue to deliver great care.
When a client then leverages the expertise we have on the financial controllership side and the RCM side, hands down they see the best results. It’s akin to having a right arm and left arm, we all just sync up automatically. Part of that is because we have been working in tandem for many years with numerous operators. When we are able to have their finances and RCM handled at the same time, it’s far more efficient than working with an operator’s in-house AR and collections, or another service. It’s a much smoother experience for our partners and we can deliver the best results in this configuration.
In Part II of this interview, Steve Zicherman and Sam Pirutinsky address current challenges facing the long-term care industry and explain how LTC Ally is pivotal in helping operators navigate these difficulties.