Money Follows Mission

Introduction

Accend is committed to a system of documenting and billing for services, payroll, and accounting that:

• has integrity and accuracy;
• complies with all legal, statutory and rule requirements per service type; and
• applies rates for services equitably and fairly to services and clients regardless of the funding source;
• maintains records with safety, privacy, and security; and
• ensures a financially stable organization

Four Simple Concepts

Money follows Mission: If we pursue the mission of high quality services, the money will follow.

Compliance follows Quality: High quality services include proactive, high quality assessment and planning. If we follow best practices there, we should not have to worry about compliance.

Productivity follows Person-Centered Services: If we are providing person-centered services that respond to client needs, they will engage in services, and productivity will follow.

Earnings follow Outcomes: Staff reimbursement should heavily emphasize effective treatment services and clients achieving measurable outcomes. If clients are achieving outcomes, that means they are getting their needs met and are likely engaged, and productivity is less of a concern or not at all. We find this to be true with our top performers.

The Budget

The Executive Director prepares and annual budget for the board.

Our top budget item is people. When we develop our annual budget, our top priority is to develop wages and benefits that are competitive and fair for the hard work you do. In a typical year, wages, payroll taxes, benefits and expense reimbursements for all the people who work at Accend are 80-85% of our budget. This includes all provider staff, supervisors, adminstrative support an maintenance.

The largest line item in Operating Expenses is developing, improving, and maintaining our Electronic Health Record and other software and technologies, including hardware.

Maintaining our offices - mortgages, property taxes, maintenance, property insurance, equipment and supplies - comes next. Operating expenses also include professional liability (malpractice) and other insurance, and of course office supplies and treatment resources.

We pay corporate taxes on our profits only so this line item is only a small percent of our annual budget.

After the tax bill is paid, what remains is strategic reserve. Strategic reserve gets us through hard times and helps us develop new programs.

What is Strategic Reserve?

Strategic Reserve refers to liquid assets (savings) accumulated as a rainy day fund (8% of annual expenses) to support payroll and other expenses in case there is a problem with revenue, and to support new development.

Insurance

Accend maintains liability and other insurance at or higher than the highest minimum required by any contract we hold with payers. This insurance includes the following:

• Directors & Officers Liability
• Professional Liability
• General Liability
• Building and Property
• Owned and Non-owned Automobile Insurance
• Crime
• Cyber-Liability
• Worker's Compensation

Audits, Oversight and Quality Assurance

Accend uses several methods for auditing financial and billing records to assure quality and fideility. These include the following:

Provider Timecard Authorization and Approval

All provider time records require review and approval before they are accepted for billing. All provider staff must document concurently as defined in our Documentation and Electronic Health Records policy and procedures and submit time daily for review and approval.

Additionally, when services provided fall outside of certain norms, as established by business rules, this policy also requires additional review and authorization by the supervisor before it is submitted for approval.

Individual Provider Time Audits

At random intervals, or if a problem is suspected, individual provider time records are audited as described in the Documentation and Electronic Health Records policy and procedures. The purpose of audits is to assure patterns of accurate and concurrent documentation, and to identify and intervene with patterns that might lead to inaccuracy.

External Review

Annually, revenue and expense reports are reviewed and approved by an external Certified Public Accountant.

Monitoring Ongoing Eligibility For Services

We confirm ongoing finanical and programmatic eligibility for services and payment for services using the following methods:

• The Billing Department:
• confirms health insurance program eligibility for all clients monthly, and informing clients and providers for each client who becomes ineligible for a qualifying health insurance program;
• invoices any individuals who have required co-payments, deductibles or spenddowns monthly;
• obtains prior authorization for services for all clients as required at intervals required by the authorizing authority and notifying clients and their providers if there is a problem; and
• monitors service delivery to assure that it falls within limits/caps for the specific service and informs providers when services are nearing limits.
• The Clinical Supervisor of each individual's services:
• confirms appropriateness of continuing services based upon a review of service provision and progress, andupdates to assessments in consultation with the client, guardian and treatment team.

Privately-Owned For-Profit Company vs Non-Profit Organization

Accend Services, Inc. is a privately-owned, for-profit company. What does this mean?

We founded in 2006, Accend Services Inc. as a for-profit, not a non-profit corporation. There were several reasons for this, including the following:

• All of the founders had worked previously for non-profit organizations. Our exprience was that, at the end of the day (or the end of the fiscal year), profit or loss was the same concern for an non -profit organization as for an for-profit one: did expenses match or exceed revenue?
• For many non-profit organizations, revenues far-exceeded expenses and these organizations built tremendous wealth. All the while while paying employees lower wages, convincing them that their work supported this non-profit "mission." Meanwhile, these organizations pay nothing for income taxes or for property taxes for large accumulated property holdings, often in neighborhoods that decrease in value and quality as a result   - failing to support their communities in the big picture.
• Our goal was not wealth, rather mission. If we could meet community needs and pay the bills, we were successful.
• All employees, including owners, would be employees, whose income was a salary, and profits would be recycled back into the organization. Since our founding, this has been true.
• Profits at Accend have always been use for purposes supporting the Accend Servicese, Inc. business operations, including purchase of properties and program resources to support the mission. No "owner" of Accend has ever taken a dividend unrelated to these mission-driven costs. And we pay taxes on the income we receive, and the properties we rent/have purchased for use, further supporting our community and neighbors.        
• Properties and other resources purchased with Accend profits have been managed to support the mental-health service mission of Accend, and have not been profit enterprises, rather assets that support the mission and (hopefully) support themselves.
• For these reasons, we prefer to call ourselves a for-benefit organization. While we operate as a for-profit, and pay taxes that support our community, our mission is the benefit of the communities we serve.

In short, for-profit or non-profit, the bottom line is key. Owners of Accend are employees. We work on salary and we have never taken divends from profit other than to invest in resourcesa to suppor out mission. We pay taxes in in given year with higher taxes in profitable years, and receive refunds in less profitable years, based on the performance of the company.

Owners are responsible to ensure that Accend remains viable and functioning. This has been hard at times, with owners lending personal savings to keep the company operating for short periods of time while funds are short. Yet we owe gratitude to our many staff over the years to help us support our mission.

Productivity and Stewardship

Productivity

Productivity refers to the ratio of billable services you provide (plus some other prior-authorized, but not billable activities) to the total hours you work. Travel to billable services is included in productive, or target time.

You can maximize your productivity using several strategies. These include, but are not limited to:

• Doing as much assessment and planning work as possible with the people you serve. Assessment and planning work done at your desk is not billable time for most services. This also happens to be the most person-centered approach.
• Fill your schedule with services. You will likely have cancellations. When you have documentation work to do, use cancellations as an opportunity to do it.
• Work proactively on assessment and planning to avoid the last-minute rush that takes more time.
• Keep a list of people who are flexible, and would be happy to see you anytime. When you have a cancellation, call them.
• Manage your caseload proactively. Seek guidance when individuals disengage or have low engagement, and take new referrals when your productivity is dipping low.
• Be responsive to new referrals when you recieve them.
• Provide all of the services in each plan, or modify the plan if it appears someone you serve does not want services at the intensityin the plan. This, like responsiveness, is another core element of our mission.
• Use the scheduler and schedule recurring apppointments as much as possible.
• Document concurrently! It's not just a rule. It saves time.

Stewardship

Stewardship refers to working efficiently and planning work to be as efficient as possible while using agency, community, and client healthcare resources wisely and without waste. Here are just a few examples of stewardship:

• Planning services and travel routes efficiently so as to not bill travel excessively
• Providing services only within scope of practice and as defined as medically necessary by assessments and the treatment plan
• Meeting assessment and planning deadlines to assure quality and continuity of services.
• Using measurable outcomes to monitor the effectiveness of treatment services as a criteria and justification for continuing or discontinuing care.

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Updates to this Chapter

October 4, 2024

Some words added about why Accend founded and continues to operate as a for-profit organization.