Cornell Health Revenue & Accounts Receivables Transaction Narrative

Overview: 

Cornell Health provides a variety of health services to registered students on campus.  Bursar billing is fed from Point N Click to the bursar system for billing to students for copay on health services if the student opts for this payment method. Otherwise, the student can pay with cash, check or credit card. In addition, Cornell Health bills a health fee to students through the bursar as part of each semester’s tuition billing. All are charged HF if in either the Ithaca area OR NYC area. Students and staff can purchase OTC, prescriptions, or other medical supplies from the pharmacy and pay with cash, check or credit card (or bursar billed for students). Cornell Health bills insurance carriers on behalf of the students, in some cases based on pre-negotiated rates with the provider. Cornell Health reconciles accounts receivable and revenue from each system to the general ledger to ensure revenue is recorded accurately in the financial statements for the month/semester that the income is earned.

Criticality:  High

Frequency:  Daily

Turnaround:  Other

Key Risks

Key Controls

Transactions not fed to Bursar from originating system.

1.       Reconciliations are done monthly to verify all billed transactions in Point N Click and QS1 reconcile to the bursar transactions and the KFS GL total for the month.

2.       Variances are researched and credits or corrections made as needed.

Billing Errors: Mistakes in invoicing, such as incorrect pricing, wrong billing codes, etc. can lead to disputes with insurance providers and delays in insurance payments. Billing errors may result from manual data entry or inadequate review processes.

1.       PNC has a built-in claim scrubbing tool to detect any possible billing issues before a claim is submitted to insurance.  Cornell Health uses an insurance clearinghouse to submit claims, which has an additional scrubbing tool.

Regulatory Compliance: Health Information Privacy Act (HIPAA) compliance is critical.

1.       Staff must complete HIPAA training at hire and annually.

2.       Cornell Health has a HIPAA Compliance Officer.

DEA Registration Certificate or NYS pharmacy license expired or invalid

1.       DEA Certificates and NYS license are valid for 3 years.

2.       The pharmacist tracks expiration dates with notifications 60 days prior to expiration.

3.       Renewals are emailed at 60 days and 30 days.

4.       Vendors require updated licenses and send reminders as well.

5.       Inhouse compliance staff also track and monitor.

Data Security and Privacy: Handling sensitive customer information, such as payment details and personal data, exposes the university to risks of data breaches, identity theft, and PCI regulatory non-compliance.

1.       Employee access is limited to the part of the system needed for their specific job duties.

2.       Access audits are conducted by IT.

Non-payment or discounted payment by Insurance Providers: Can result in higher insurance allowances and write offs.

1.       Cornell Health has contractual agreements with 2 payers and is working to include additional insurances to minimize exposure.