Since the transition from the AWBZ to the WMO (2015) and with it the decentralisation of support and guidance to municipalities, youth care providers have been faced with severely increased pressure on operations. Entering into complex contracts and recording and accounting for the care provided require process management. And this is proving more difficult than the sector ever imagined.
Less money available
Although the primary aim of the decentralisation of youth care was to provide better care and assistance, this appears to have been accompanied by a substantial budget cut. From the government, the original budget for youth care was slashed. Subsequently, municipalities faced an operational execution issue. An administrative apparatus (the back office) was set up to carry out this task.
While the non-earmarked Wmo money for youth care has been allocated to youth care providers, this too has clearly been cut. In short, three budget cuts in a row: one by the government (cut to municipalities) and two by municipalities (rigging its own back office apparatus and a cut to providers).
One of the first problems youth care providers had to cope with concerned the cessation of advance payments. Because municipalities no longer advance but pay actual production afterwards, institutions face an accelerated liquidity issue.
Business of municipalities
Funding has shifted to client level instead of care form total. Institutions are forced to demonstrate in detail which form of care was provided and to what extent. But this was not common practice in the sector. People simply started delivering care. The funding and administrative obligations did follow afterwards. Unfortunately, it often goes wrong at this point in the process.
The problem then only becomes visible at the end of the process, at invoicing. And that is rejected by 80 per cent just like that! How come? Because the registration should match the original order 100 per cent. An error in the care product name, a deviation of one day in the period or an incorrect tariff code are reasons for rejecting the claim. In addition, a discrepancy in personal data, such as the mother's surname instead of the father's, or stating the wrong place of residence, is also a reason for rejection.
You see the municipality galvanising faster than the youth care provider, which remains very loyal to young people. Care providers are too service-oriented and dependent towards municipalities and are constantly behind the times. The trick is to get the process right at the front, to prevent the finance and care administration departments from constantly putting out fires.
Administration
As a result of the transition, municipalities and youth care institutions now conclude contracts among themselves. These contracts are often different for each municipality/region. Youth care institutions therefore face the challenge of translating all these different contracts into their activities, operations and deployment.
Also, municipalities and institutions often enter into contracts that are not fully enforceable. On the one hand, because of the low rates received for the product delivered. On the other, because of the requirements around accountability, invoicing and lead times for applying for decisions.
In addition, many municipalities require communication via the so-called Vecozo. This digital healthcare communication point is a piece of technology which should make it more convenient to communicate with municipalities via standard messages. However, it is necessary to keep your own records to monitor the receipt of messages.
If a youth care institution has not developed anything for monitoring, this is often one of the main causes of not getting complete client records. This results in not starting care or even not being able to invoice the municipality for the care provided.
Because a youth welfare agency now bills a municipality for its care at client level, it is important that all data in the systems are correct and up-to-date. Again, an incorrect date of birth or disposition number leads to immediate rejection of the invoice in almost all cases.
In short
To reduce or even prevent problems or backlogs, it is very important for the youth care institution to analyse the billing breakdown. It is an illusion to solve all problems before the next billing round. Therefore, tackle the problems one by one project by project!
Frank van den Bos, in cooperation with Stijn Hubregtse and Barbara den Ottolander
Consultants at Improven