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  • One CFO’s Role in a Merger
    First Illinois Chapter This article is based on an interview and a presentation at the HFMA s Capital Conference in Chicago in April 2014 Discussion Starters What do you think Please share your thoughts in the comments section below Alternatively use the inshare button at the top of this web page to share this article and your comments on the CFO Forum s LinkedIn board What have been your biggest challenges and opportunities in a merger Where would you focus your efforts during the first 100 days of a merger Have you transitioned your defined benefit plan to a defined contribution plan Any lessons learned Publication Date Tuesday July 08 2014 BACK TO PAGINATION CFO Vincent Pryor discusses how a history of operational improvement helped the newly formed Edward Elmhurst Healthcare identify 31 million in savings just nine months after a merger In 2013 two health systems in suburban Chicago Edward Hospital and Health Services and Elmhurst Memorial Healthcare followed the national trend and merged Thanks to the finance team s 10 year track record of leading operational improvement efforts the new health system has achieved significant savings in the first year of the merger Vincent Pryor system executive vice president and CFO of the newly formed Edward Elmhurst Healthcare with annual revenues of approximately 1 billion from three hospitals and more than 50 outpatient clinics discusses the role of finance in the integration On the newly merged system s capital strategy in the first 100 days After the merger we moved very quickly to refinance some fixed rate tax exempt bonds with fixed and variable rate bonds for a savings of 3 million annually Pryor says In addition we trimmed the number of banks we were using to back our bonds from five banks to three banks and reduced the overall cost of the letters of credit through private placements and replacement letters of credit Prior to the merger Elmhurst had been renewing its letters of credit year to year he added We were able to extend that to five years for private placements and to three years for letters of credit Down the road this will eliminate a time consuming annual task and give the finance team more time to focus on strategy On moving to a defined contribution plan We inherited a defined benefit plan from Elmhurst that was more than 60 million underfunded Pryor says To limit the volatility of that balance sheet item we froze the defined benefit plan and moved to a defined contribution plan System executives took several steps to quell employee anxiety We chose to be very honest and upfront with the staff and invited them to attend several state of Elmhurst meetings we hosted where we spelled out our finances in terms everyone could understand Pryor says On their operational improvement process Each year our senior leadership team establishes about a dozen initiatives that total approximately 15 million in opportunity Pryor says For each initiative we set an annual goal and establish a project team leader usually an up and comer who can drive the process The team leader selects a multidisciplinary team that includes leaders in finance clinical and other areas Some of the teams look at ways to improve top line revenue through inpatient and outpatient growth which is what makes an organization sustainable he says After all you can t expense your way to salvation The teams also look at the quality of that revenue and how to enhance the revenue cycle through collections managed care contracting and other processes These initiatives are focused on broad areas but they are broad on purpose We don t want to restrict the teams as they look for opportunities The health system also has teams focused on the expense categories such as supply chain benefits and pharmacy On the process side some teams have worked on patient throughput in the OR and ED discharge times case management and clinical documentation However our biggest wins typically come from the revenue cycle inpatient and outpatient growth and non salary expenses because these categories are so broad Pryor says In the other areas the opportunities tend to be more cyclical On a biweekly basis each project leader reports back to Pryor the CEO and other senior leaders sharing any results and seeking executive level assistance as needed This approach has been extremely effective Pryor says Over the past 10 years we have achieved 90 percent of our goals on an annualized basis Part of this success is the result of the natural competition that develops between the project leaders and we use a scorecard to take advantage of that Access related tool Edward s Operational Improvement Team Scorecard On integration management After the merger health system leaders established a goal to identify 25 million in savings for FY14 with a focus on reducing costs in the supply chain revenue cycle insurance and other areas see the exhibit below After nine months we have achieved more than 31 million in savings Pryor says A lot of that success is the result of our history of operational improvement We approach integration management the same way Integration management is like operational improvement on steroids Advice for other finance leaders in a merger You need to act quickly after a merger while still recognizing the different cultures in both hospitals Pryor says Even if you feel like your organizations will be a good fit there will still be cultural issues that can derail your progress And you need to decide early on who is going to lead so you have one voice determining the direction Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff Ill Interviewed for this article Vincent Pryor system executive vice president and CFO Edward Elmhurst Healthcare Naperville Ill and a member of HFMA s First Illinois Chapter This article is based on an interview and a presentation at the HFMA s Capital Conference in Chicago in April 2014 Discussion Starters

    Original URL path: http://www.hfma.org/Content.aspx?id=23700 (2016-02-10)
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  • Automated Payment System Optimizes Working Capital
    they could with the corporate purchasing card P card The P card s days payable outstanding DPO allowed NMC to realize a much needed cash flow bump Then Daubert and Cahill analyzed their accounts payable records and saw that 80 percent of NMC s spend involved about 20 large suppliers They approached these companies and asked whether they would accept the P card in lieu of paper checks but most refused because they would have to pay the interchange fee that credit card companies impose Mike Carmody the representative assigned to NMC s account by one of these large vendors saw that his company s refusal to take the P card did not help solve the hospital s problem At a meeting with NMC CFO Bill Dinsmoor an idea was born create an electronic payment system that would serve the function of the P card without the high interchange rates that make it cost prohibitive from a vendor s standpoint Dinsmoor and Carmody reasoned that for large spends an automated payment exchange could bring measurable financial benefit by achieving the following Eliminating the need to deal with a credit card company Charging vendors half the interchange fee that traditional P cards charge Assuring vendors quicker payment than invoice based transactions Optimizing the hospital s working capital Providing the hospital with greater efficiencies and more control over the payables process Reducing costs for both the suppliers and the providers Working with a consulting firm and some financial experts NMC and Carmody began testing the concept in early 2004 The results were so positive that they formed a separate company late that year and called it H Card LLC Known today as HAP X aka Healthcare s Automated Payment Exchange this innovative company now serves more than 100 hospitals in 32 multi hospital systems across the country A Win Win Win There is no risk no cost and a lot of upside Daubert explained recently as she described how HAP X works Say we get a bill for 100 000 worth of supplies We send it to HAP X and they pay the vendor minus a negotiated discount which might be 1 percent The vendor receives 99 000 promptly in electronic format without having to worry about collection efforts Then NMC receives a statement from HAP X for 100 000 as though it were a credit card bill We pay the HAP X bill on its due date which is a few weeks later than the vendor s invoice due date would have been In the meantime we have use of that money Cahill the AP manager agrees that it s a win win win situation HAP X s revenue is the 1 000 vendor discount which after costs is shared with NMC in the form of rebates In return for providing the discount the vendor gets paid much sooner and avoids the costs and uncertainties of collection And NMC gets the float receives a rebate on its spend no longer needs to cut paper checks and avoids the headaches of invoice reconciliation In addition because the entire process is electronic there are fewer opportunities for human error and NMC has only HAP X s payment format to deal with rather than a different one for each vendor Costs Saved Efficiencies Gained Dinsmoor said that the automated payment system saved the hospital about 8 million in cash the first year the average increase in days payable outstanding DPO compared to a 30 day vendor invoice and it has continued to save cash each year since as the supply purchases have grown Plus it generates significant rebates on our spend Before the HAP X system took effect NMC s days in accounts receivable were higher than the payment period on vendors invoices Since they began using HAP X the hospital s DPO number has increased and the ratio of receivables to payables is now considerably less than 1 This has had an extremely positive effect on cash flow and on the hospital s bond ratings NMC has also been able to reduce the staffing level in the accounts payable department by about 10 percent The exhibit below reflects NMC s improved days cash on hand Access the exhibit NMC s Days Cash on Hand NMC s CEO Fosdick is a total believer in the automated payment system and he believes other CEOs and CFOs should jump at the chance to take advantage of automated opportunities We were cash poor a few years ago Fosdick said Now HAP X saves us money and improves our management of working capital Plus basically they re paying us to pay our bills for us What s not to like Displaying his interest in the details and the potential savings Fosdick pointed out that another benefit of using the automated payment exchange is a reduction in the cost of check processing It costs a heck of a lot to cut a manual check he said and this automated process saves us having to write more than 20 000 checks a year It s all done electronically A 2010 study by the Aberdeen Group showed that the cost of cutting a paper check is about 7 15 compared to 3 96 for each commercial card transaction Pezza S et al The E Payables Solution Selection Report A Buyer s Guide to Accounts Payable Optimzation Aberdeen Group October 2010 Cahill agrees with those estimates and she calculates that NMC has eliminated about 20 700 paper checks a year That being so the hospital saves more than 66 000 in check processing costs annually by using the automated system All the NMC personnel feel their new system is a prescription for success It may seem too good to be true Fosdick said but that doesn t mean it doesn t work J Stuart Showalter JD MFS is a contributing editor to HFMA s Forums Interviewed for this article Stephanie Daubert controller Nebraska Medical Center Omaha Neb and a member of HFMA s Nebraska chapter sdaubert nebraskamed com Leanne Cahill manager of disbursements Nebraska Medical Center lcahill nebraskamed com Bill Dinsmoor CFO Nebraska Medical Center and a member of HFMA s Nebraska chapter Glenn Fosdick CEO Nebraska Medical Center Publication Date Thursday September 15 2011 BACK TO PAGINATION By J Stuart Showalter An Omaha hospital s creative solution forming a separate company to handle automated payment exchange has improved efficiency saving the facility about 8 million in cash in the first year alone Following the 1997 merger of Omaha s Clarkson and University Hospitals the newly created Nebraska Medical Center NMC had 20 days cash on hand After the Balanced Budget Act of 1998 took effect that slim reserve began to shrink even more and by 2002 it was down to a dangerous 9½ days That s when NMC s CEO Glenn Fosdick issued an edict Hold onto cash as long as you can This is a sample article from HFMA s CFO Forum an online discussion community that encourages networking and sharing among senior financial executives in hospitals and health systems Learn more about and subscribe to the CFO Forum From P Cards to HAP X Controller Stephanie Daubert and Leanne Cahill manager of disbursements took the challenge to heart They began by holding bills as long as possible and paying as many as they could with the corporate purchasing card P card The P card s days payable outstanding DPO allowed NMC to realize a much needed cash flow bump Then Daubert and Cahill analyzed their accounts payable records and saw that 80 percent of NMC s spend involved about 20 large suppliers They approached these companies and asked whether they would accept the P card in lieu of paper checks but most refused because they would have to pay the interchange fee that credit card companies impose Mike Carmody the representative assigned to NMC s account by one of these large vendors saw that his company s refusal to take the P card did not help solve the hospital s problem At a meeting with NMC CFO Bill Dinsmoor an idea was born create an electronic payment system that would serve the function of the P card without the high interchange rates that make it cost prohibitive from a vendor s standpoint Dinsmoor and Carmody reasoned that for large spends an automated payment exchange could bring measurable financial benefit by achieving the following Eliminating the need to deal with a credit card company Charging vendors half the interchange fee that traditional P cards charge Assuring vendors quicker payment than invoice based transactions Optimizing the hospital s working capital Providing the hospital with greater efficiencies and more control over the payables process Reducing costs for both the suppliers and the providers Working with a consulting firm and some financial experts NMC and Carmody began testing the concept in early 2004 The results were so positive that they formed a separate company late that year and called it H Card LLC Known today as HAP X aka Healthcare s Automated Payment Exchange this innovative company now serves more than 100 hospitals in 32 multi hospital systems across the country A Win Win Win There is no risk no cost and a lot of upside Daubert explained recently as she described how HAP X works Say we get a bill for 100 000 worth of supplies We send it to HAP X and they pay the vendor minus a negotiated discount which might be 1 percent The vendor receives 99 000 promptly in electronic format without having to worry about collection efforts Then NMC receives a statement from HAP X for 100 000 as though it were a credit card bill We pay the HAP X bill on its due date which is a few weeks later than the vendor s invoice due date would have been In the meantime we have use of that money Cahill the AP manager agrees that it s a win win win situation HAP X s revenue is the 1 000 vendor discount which after costs is shared with NMC in the form of rebates In return for providing the discount the vendor gets paid much sooner and avoids the costs and uncertainties of collection And NMC gets the float receives a rebate on its spend no longer needs to cut paper checks and avoids the headaches of invoice reconciliation In addition because the entire process is electronic there are fewer opportunities for human error and NMC has only HAP X s payment format to deal with rather than a different one for each vendor Costs Saved Efficiencies Gained Dinsmoor said that the automated payment system saved the hospital about 8 million in cash the first year the average increase in days payable outstanding DPO compared to a 30 day vendor invoice and it has continued to save cash each year since as the supply purchases have grown Plus it generates significant rebates on our spend Before the HAP X system took effect NMC s days in accounts receivable were higher than the payment period on vendors invoices Since they began using HAP X the hospital s DPO number has increased and the ratio of receivables to payables is now considerably less than 1 This has had an extremely positive effect on cash flow and on the hospital s bond ratings NMC has also been able to reduce the staffing level in the accounts payable department by about 10 percent The exhibit below reflects NMC s improved days cash on hand Access the exhibit NMC s Days Cash on Hand NMC s CEO Fosdick is a total believer in the automated payment system and he believes other CEOs and CFOs should jump at the chance to take advantage of automated opportunities We were cash poor a few years ago Fosdick said Now HAP X saves us money and improves our management of working capital Plus basically they re paying us to pay our bills for us What s not to like Displaying his interest in the details and the potential savings Fosdick pointed out that another benefit of using the automated payment exchange is a reduction in the cost of check processing It costs a heck of a lot to cut a manual check he said and this automated process saves us having to write more than 20 000 checks a year It s all done electronically A 2010 study by the Aberdeen Group showed that the cost of cutting a paper check is about 7 15 compared to 3 96 for each commercial card transaction Pezza S et al The E Payables Solution Selection Report A Buyer s Guide to Accounts Payable Optimzation Aberdeen Group October 2010 Cahill agrees with those estimates and she calculates that NMC has eliminated about 20 700 paper checks a year That being so the hospital saves more than 66 000 in check processing costs annually by using the automated system All the NMC personnel feel their new system is a prescription for success It may seem too good to be true Fosdick said but that doesn t mean it doesn t work J Stuart Showalter JD MFS is a contributing editor to HFMA s Forums Interviewed for this article Stephanie Daubert controller Nebraska Medical Center Omaha Neb and a member of HFMA s Nebraska chapter sdaubert nebraskamed com Leanne Cahill manager of disbursements Nebraska Medical Center lcahill nebraskamed com Bill Dinsmoor CFO Nebraska Medical Center and a member of HFMA s Nebraska chapter Glenn Fosdick CEO Nebraska Medical Center Publication Date Thursday September 15 2011 Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This white paper written by Apex Vice President of Solutions and Services Carrie Romandine discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs but it will maximize the amount collected before sending to collections Further targeted messaging should be applied across all points of patient interaction i e point of service customer service patient statements and analyzed regularly for maximized results HFMA Business Profiles Ontario Systems Optimizing Accounts Receivable in a Rapidly Changing Environment Steve Scibetta senior director of channel sales for Ontario Systems healthcare product line shares insights into effectively managing receivables HFMA RESOURCE LIBRARY The Future of Online Patient Billing Portals This white paper written by Apex President Patrick Maurer discusses methods to increase patient adoption of online payments Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections This white paper shows why patient centric approaches to online payment portals are important complements to traditional provider centric approaches HFMA Business Profiles Optum Enabling Transformative Change Elena White vice president of risk quality and network solutions for Optum discusses how healthcare providers can leverage data and technology as they enable risk in their organization HFMA RESOURCE LIBRARY Payment Portals Can Improve Self Pay Collections and Support Meaningful Use Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs This article written by Apex Founder and CEO Brian Kueppers explores a number of strategies to create synergy between patient billing online payment portals and electronic health record EHR software to realize a high ROI in speed to payment patient satisfaction and portal adoption for meaningful use HFMA Business Profiles Somnia Bending the Healthcare Cost Curve Toward Improved Anesthesia Value Somnia President and CEO Marc Koch MD MBA explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes HFMA RESOURCE LIBRARY Large Health System Drives 10 UP Patient Payments and 10 DOWN Billing related Costs Faced with a rising tide of bad debt a large Southeastern healthcare

    Original URL path: http://www.hfma.org/Content.aspx?id=761 (2016-02-10)
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  • Tool: Sample Revenue Cycle Governance Council Charter
    members include c Meeting Frequency i Monthly ii 9AM 2PM iii Meetings in person or via V Tel iv Other meetings may be required as needed d Member Roles Responsibilities i Attendance at meetings is expected Designees are allowed if circumstances prevent member s from attending or voting ii Read and review relevant materials and outside literature iii Work between meetings may be required iv Represent the needs of the member organization v Serve as a communication link between RCGC and all interested stakeholders at the member organization vi View decisions and vote according to what is best for the entire health system vision vii Following the vote s outcome members will take accountability and ownership for RCGC s decision regardless of personal affiliate position viii Sponsor major initiatives or projects chartered by Affinity Group ix Member is accountable for implementation of best practice at the affiliate location x Members will adhere to the Guiding Principles xi The Executive Sponsor is a member of the Senior Leadership Group SLG This position will provide system leadership for the RCGC under the guidance of SLG xii The Facilitator is a Management Leadership Academy MLA or Physician Leadership Academy PLA graduate They are not a subject matter expert but will help support the Executive Sponsor Chair and RCGC as needed The Facilitator will also organize the meeting agendas and annual planning and will facilitate the meetings They can also handle minutes and follow up items if necessary e Decisions i Scope of Authority 1 RCGC will make recommendations to CFOs for final approval a Changes to Health System Policies b Changes affecting the patient statements or patient collection bad debt financial assistance process c Unbudgeted expenditures d Significant changes up or down to cost to collect e Selection of vendors f Requests for new technology g Changes to organizational structure i e centralization of function 2 RCGC will make the following decisions and keep CFOs informed as appropriate via site Revenue Cycle representative and or on CFO call a Changes to process impacting revenue cycle components registration HIM CBO etc b Implementation of best practice c Changes to optimization of software to improve work flow or implement best practice ii Decisions will be made in a timely manner iii The group will work toward consensus iv When a vote is called for 1 A super majority 60 of voting members is required 7 of 11 unless someone abstains v Some issues or decisions will require multiple affinity groups to weigh in before decisions processes can be finalized 2 Members should vote in the best interest of the system 3 Once a vote passes the change will be implemented across the entire system There are to be no exceptions 4 When a vote needs to occur a motion will be made at the monthly meeting but the vote will not occur until the following month s meeting to allow time for discussion research The motion will again be stated on a draft agenda that will go out in advance of the meeting A vote can be in person V Tel or via email Designees to stand in for a voting member will be allowed if the voting member cannot participate at the time of the vote f Communication i The members of the RCGC will be informed of a vote at the monthly meeting before the vote will occur ii Members should submit their agenda items to the Facilitator at least three business days in advance of the scheduled monthly meeting iii The agenda and other pertinent documents will be distributed via email to members two business days prior to the scheduled meeting iv Minutes of each meeting will be documented by the Executive Assistant of Revenue Cycle and shared with the RCGC members as well as each affiliate s Finance Director and CFO The Facilitator will handle minutes of the meeting if needed v RCGC members are expected to share the RCGC s work decisions and outcomes with their Finance Directors and CFO s and other appropriate persons including physicians following each meeting vi RCGC will report to health system s CFO Leadership group as needed requested vii RCGC will report on an annual basis to the health system SLG via RCGC s Executive Sponsor viii RCGC may choose to have sub committees manage some projects but progress on these will be communicated at monthly meetings 6 Organizational Chart a RCGC reports to the system s CFO Leadership group b The following affinity groups report up to RCGC i RAC Affinity Group ii Health Information Management HIM Affinity Group 1 CDI Specialists iii Registration Affinity Group known as State Registration Managers iv Revenue Cycle Directors meets on ad hoc basis v Utilization Management will have a designated member from their group serve as a non voting liaison on RCGC 7 Escalation Process a The Escalation Process for any issues will follow the Organizational Chart outlined above If the issue or risk cannot be resolved at the level where it has been identified it will be the responsibility of the respective chair to escalate the issue to the next higher level committee in the governance structure It is expected that these issues will be escalated at the next regularly scheduled meeting of the higher level committee b If the issue or risk requires immediate attention the chair of the reporting committee will note the level of urgency to the chair of the higher level committee so that a special meeting can be called It will be the prerogative of the higher level committee chair to determine if the issue or risk warrants that an extra meeting be held in person or via conference call or if the issue should be resolved via e mail c It is expected that any issue or risk that is escalated will be placed on an open issues list by the Executive Sponsor who will keep a current status on the item The open items will be identified and placed on the agenda for discussion at each subsequent meeting until resolved 8 The RCGC Charter will be formally reviewed six months after adoption and annually thereafter Source Reprinted with permission from a large U S health system that did not want to be named Publication Date Tuesday May 14 2013 BACK TO PAGINATION This is a sample tool from HFMA s CFO Forum Learn more about the CFO Forum and HFMA s other Forums here 1 Purpose To serve as the governing council for the revenue cycle function of the Health System To ensure sustainability the Revenue Cycle Governance Council RCGC will execute system wide revenue cycle initiatives and drive optimization by identifying where opportunities exist determining best practice and driving to implement standard process for hospital physician group and home care operations Charter for 2013 2 Definition The revenue cycle is the set of activities in our health care environment that brings about reimbursement for medical care supplies and treatments The primary focus is on Patient Access and Billing Office responsibilities across the organization It also covers or intersects with other core functions such as admitting and registration financial counseling case management and utilization review health information management coding and documentation charge capture billing compliance accounts receivable cash posting customer service collections underpayment review and audit analytics and the business systems used to maintain the aforementioned tasks 3 Guiding Principles When making decisions and recommending policy changes the Revenue Cycle Governance Council will adhere to the following guiding principles System Sustainability RCGC will ensure financial viability through a culture of financial discipline and adoption of best practice and business process RCGC will focus on areas to improve results related to the revenue cycle including lowering costs increasing cash collections and decreasing days in A R Patient Centered RCGC will advocate for processes which enable care coordination and seamless process from a patient perspective Cost to Collect RCGC will focus on standardization and implementation of best practice to drive down total cost to collect in the Central Billing Offices Standardization Standard Work RCGC will support and advocate for standardization of process use of technology and other ways in which we can reduce variation across operations of the revenue cycle at all sites and care settings This will include standardizing software systems and vendors We recognize there are differences in best practices in hospitals home care and physician groups While best practice should be integrated when possible they could be unique based on the care setting RCGC recognizes there may be differences in the rural affiliates based on billing offices and IT resources used The local Senior Affiliate RCGC lead will be the point person to share best practices and standard work processes with them However RCGC is not the authority to change the tools used by these rural affiliates Best Practice Implementation RCGC will support advocate for and execute implementation of best practices as evidenced by HFMA or other literature HFMA MAP Keys MGMA Resources and or other respected professional organizations in each industry as well as internal metrics Compliance RGCG will support policies and processes with are compliant with all health system compliance policies all laws with heightened awareness of fair collection practices and governmental regulations Mitigation of Risk RGCG will support policies and processes which balance effective and efficient process with mitigation of risk for patient complaints or any undue legal exposure Use of Technology RCGC will maximize the capabilities of our software systems to use them most fully and to the highest levels RCGC recognizes that not all affiliates are currently on the same common platforms but will aim for long term implementation of standardized technology to enhance process or eliminate manual work and potential for human error Research RCGC will support and encourage seeking best practice through literature review peer networking and educational sessions to bring innovation and potential new technology solutions to the health system Documentation RCGC will prepare business proposals as needed or summary information for documentation purposes around implementing best practices or process policy changes RCGC or assigned delegates will collaborate with appropriate persons to further the process of developing business plans as needed Contracts RCGC will understand the contractual obligations affiliates may have to current vendors and take that into account when making decisions 4 Roles and Responsibilities Strategy RCGC s strategy is to o Research and implement best practice Reduce variation across health system affiliates through standardization and standard work process and continually increase awareness of changes in the industry or regulations for which the health system needs to be prepared so that the health system can proactively implement compliance changes Annual Planning Develop annual plan objectives to achieve the RCGC strategy Regularly review annual plans to ensure achievement of objectives in specified timeframes Take corrective action when necessary Metrics Establish a systemwide scorecard and annual targets to ensure revenue cycle competencies Regularly review core metrics Implementation of Best Practice Individual members of RCGC will ensure that best practice is implemented at each affiliate Best practices will also be evaluated after implementation to ensure objectives are being met sustained over time Communication RCGC members are expected to share the RCGC s work decisions and outcomes with their Finance Directors and CFOs and other appropriate persons including physicians following scheduled meetings to keep other key stakeholders informed Networking Meet with peers to creatively address issues and also to have a support group for challenges being faced across the system Establish necessary standing or ad hoc groups to carry out the work of RCGC and appoint members to these groups 5 Membership a Voting Members i Include one member from each regional affiliate one member from physician group one member from home care and one member from hospital central billing office That member should be the highest ranking person who has the operational responsibility for the revenue cycle ii Current voting members include c Meeting Frequency i Monthly ii 9AM 2PM iii Meetings in person or via V Tel iv Other meetings may be required as needed d Member Roles Responsibilities i Attendance at meetings is expected Designees are allowed if circumstances prevent member s from attending or voting ii Read and review relevant materials and outside literature iii Work between meetings may be required iv Represent the needs of the member organization v Serve as a communication link between RCGC and all interested stakeholders at the member organization vi View decisions and vote according to what is best for the entire health system vision vii Following the vote s outcome members will take accountability and ownership for RCGC s decision regardless of personal affiliate position viii Sponsor major initiatives or projects chartered by Affinity Group ix Member is accountable for implementation of best practice at the affiliate location x Members will adhere to the Guiding Principles xi The Executive Sponsor is a member of the Senior Leadership Group SLG This position will provide system leadership for the RCGC under the guidance of SLG xii The Facilitator is a Management Leadership Academy MLA or Physician Leadership Academy PLA graduate They are not a subject matter expert but will help support the Executive Sponsor Chair and RCGC as needed The Facilitator will also organize the meeting agendas and annual planning and will facilitate the meetings They can also handle minutes and follow up items if necessary e Decisions i Scope of Authority 1 RCGC will make recommendations to CFOs for final approval a Changes to Health System Policies b Changes affecting the patient statements or patient collection bad debt financial assistance process c Unbudgeted expenditures d Significant changes up or down to cost to collect e Selection of vendors f Requests for new technology g Changes to organizational structure i e centralization of function 2 RCGC will make the following decisions and keep CFOs informed as appropriate via site Revenue Cycle representative and or on CFO call a Changes to process impacting revenue cycle components registration HIM CBO etc b Implementation of best practice c Changes to optimization of software to improve work flow or implement best practice ii Decisions will be made in a timely manner iii The group will work toward consensus iv When a vote is called for 1 A super majority 60 of voting members is required 7 of 11 unless someone abstains v Some issues or decisions will require multiple affinity groups to weigh in before decisions processes can be finalized 2 Members should vote in the best interest of the system 3 Once a vote passes the change will be implemented across the entire system There are to be no exceptions 4 When a vote needs to occur a motion will be made at the monthly meeting but the vote will not occur until the following month s meeting to allow time for discussion research The motion will again be stated on a draft agenda that will go out in advance of the meeting A vote can be in person V Tel or via email Designees to stand in for a voting member will be allowed if the voting member cannot participate at the time of the vote f Communication i The members of the RCGC will be informed of a vote at the monthly meeting before the vote will occur ii Members should submit their agenda items to the Facilitator at least three business days in advance of the scheduled monthly meeting iii The agenda and other pertinent documents will be distributed via email to members two business days prior to the scheduled meeting iv Minutes of each meeting will be documented by the Executive Assistant of Revenue Cycle and shared with the RCGC members as well as each affiliate s Finance Director and CFO The Facilitator will handle minutes of the meeting if needed v RCGC members are expected to share the RCGC s work decisions and outcomes with their Finance Directors and CFO s and other appropriate persons including physicians following each meeting vi RCGC will report to health system s CFO Leadership group as needed requested vii RCGC will report on an annual basis to the health system SLG via RCGC s Executive Sponsor viii RCGC may choose to have sub committees manage some projects but progress on these will be communicated at monthly meetings 6 Organizational Chart a RCGC reports to the system s CFO Leadership group b The following affinity groups report up to RCGC i RAC Affinity Group ii Health Information Management HIM Affinity Group 1 CDI Specialists iii Registration Affinity Group known as State Registration Managers iv Revenue Cycle Directors meets on ad hoc basis v Utilization Management will have a designated member from their group serve as a non voting liaison on RCGC 7 Escalation Process a The Escalation Process for any issues will follow the Organizational Chart outlined above If the issue or risk cannot be resolved at the level where it has been identified it will be the responsibility of the respective chair to escalate the issue to the next higher level committee in the governance structure It is expected that these issues will be escalated at the next regularly scheduled meeting of the higher level committee b If the issue or risk requires immediate attention the chair of the reporting committee will note the level of urgency to the chair of the higher level committee so that a special meeting can be called It will be the prerogative of the higher level committee chair to determine if the issue or risk warrants that an extra meeting be held in person or via conference call or if the issue should be resolved via e mail c It is expected that any issue or risk that is escalated will be placed on an open issues list by the Executive Sponsor who will keep a current status on the item The open items will be identified and placed on the agenda for discussion at each subsequent meeting until resolved 8 The RCGC Charter will be formally reviewed six

    Original URL path: http://www.hfma.org/Content.aspx?id=16887 (2016-02-10)
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    Communicating with Underwriters March 2014 Taxes Single Tax ID and Reimbursement November 2015 Technology Medical Record Integration and Provider Based Clinics September 2014 Upgrading to an Integrated Physician Practice Management System February 2013 Pose a new question to our CFO Forum experts BACK TO PAGINATION Pose a new question to CFO Forum experts Recent Q As Business Metrics January 2016 Preparing for the Annual Bond Rating Review November 2015 Method for Resolving Operational Pain Points October 2015 Q A Archive Accounting Changing the FY End July 2015 New Revenue Recognition Standards February 2015 Accounting Rules for Posting Claim Payments May 2014 Greatest Staffing Needs for the Revenue Cycle May 2014 Benchmarking Business Planning Metrics July 2012 Most Important Performance Indicators June 2012 Billing and Collecting Thresholds for Financial Assistance May 2012 Developing Self Pay Rates April 2012 Capital Finance Locking in Rates January 2015 Disclosing Bank Placements September 2014 Market Rates for Bonds October 2013 What Will a Tax Exempt Public Offering Cost Us July 2013 Public Bond Offering or Direct Placement April 2013 Estimating a Coupon September 2012 Terminating a Pay Fixed Swap May 2012 Locking or Not Locking Bond Rates March 2012 To Lease or Not to Lease Medical Equipment February 2012 Bond Ratings and Mortality Ratings April 2011 Capital Budgeting Process Capital Sources and Allocation Funding Deferred Compensation Plans May 2015 Underwriter Fees May 2015 Resources on Capital Budgeting Allocation February 2013 Financing Construction of a Specialty Hospital January 2012 Fixed Rate Bond Issue Versus Bank Facility January 2012 Quantifying Financial Risks of Investments January 2011 Charges and Prices Medicare Charge Markup Formula April 2014 Premium Subsidies for Self Pay Patients April 2014 Charity Care and Financial Counseling Prioritizing Patient Accounts for Financial Counselors April 2015 Covering Copays Under Charity Care Policies February 2014 Costing and Managerial Accounting A More Meaningful Cost Metric July 2014 Estimating Future Use of Banked Illness Hours by Employees January 2014 Underpayments and Contractual Write Offs as Uncompensated Care March 2012 Recording Meaningful Use Payments March 2011 Compliance Healthcare Compliance Resources for CFOs April 2012 Gainsharing Gainsharing Programs October 2013 Labor Cost Management Benchmarks for CAH Lab FTEs August 2015 Employee Turnover Benchmarks October 2014 Employee Turnover Data February 2011 OR Surgery Issues Scheduling Robot Surgery Time September 2013 Performance Improvement Bottom Line Savings from Performance Improvement Activities November 2013 Physician Relationships The Future of PHOs and IPAs January 2015 Verifying Physician Contracted Services June 2013 Physician Compensation Committees May 2013 Merging Charity Care Policies with Acquired Physician Practices March 2013 Crediting Physicians for Hospital Services Under RvU November 2012 Physicians and Deliquent Charges July 2011 Pricing Does Inpatient and Outpatient Pricing Need to Be the Same November 2011 The Future of Chargemasters January 2011 Privacy Security HIPAA HITECH Security Assessment Survey January 2011 Reimbursement Hospital Transfer Payment February 2012 Service Line Management Service Line Productivity October 2012 Staff Development How to Break Into Healthcare Finance March 2013 Employee Performance Improvement Plans January 2013 Tips for CHFP Success September 2012 Strategic Planning The SEC s Municipal Advisor Rule and Communicating with Underwriters March 2014 Taxes Single Tax ID and Reimbursement November 2015 Technology Medical Record Integration and Provider Based Clinics September 2014 Upgrading to an Integrated Physician Practice Management System February 2013 Pose a new question to our CFO Forum experts Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This white paper written by Apex Vice President of Solutions and Services Carrie Romandine discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs but it will maximize the amount collected before sending to collections Further targeted messaging should be applied across all points of patient interaction i e point of service customer service patient statements and analyzed regularly for maximized results HFMA Business Profiles Ontario

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    June 2013 How HIPAA Impacts Business Associates February 2012 Masking AMA CPT Descriptions for Sensitive Services May 2011 HITECH Security Assessments January 2011 Stark Anti Kickback and Related Regulations Physician Comanagement October 2013 Pose a new question to Legal Regulatory Forum experts BACK TO PAGINATION Pose a new question to Legal Regulatory Forum experts Recent Q As Paying Patient Premiums August 2015 How Anti Kickback Impacts Pilot Tests of New Innovations January 2015 Ending the Patient Physician Relationship April 2014 Q A Archive Clinical Topics Defining Medically Necessary Procedures May 2013 Healthcare Legal Promoting Physician Services Under Stark Anti Kickback March 2013 Legally Asking Patients to Pay Past Due Accounts April 2012 Compliance Issues and Comanagement Arrangements March 2012 Retaining Old Billing System Records April 2011 Human Resources M A Due Diligence and Immigration Paperwork May 2013 IRS Compliance Taxation on Staff Lodging November 2011 Medicaid Compliance Collecting and Refunding Small Copays February 2012 Medicare Compliance RAC OIG Can You Bill Medicare and Commercial Insurers Differently February 2014 Staying on Top of Medicare Changes January 2013 Preparing for an Audit Using the OIG Work Plan March 2012 Patient Signatures on Release Forms January 2012 Transfer DRG Policy March 2011 Miscellaneous Compliance Issues Compliance Budgets April 2013 What Compliance P Ps Tend to Be Outdated or Missing February 2013 Compliance Report to the Board January 2012 Privacy HITECH and HIPAA HITECH Regulation on Not Billing Insurer January 2014 MAC Disallowing Bad Debt for Charity Care Portions June 2013 How HIPAA Impacts Business Associates February 2012 Masking AMA CPT Descriptions for Sensitive Services May 2011 HITECH Security Assessments January 2011 Stark Anti Kickback and Related Regulations Physician Comanagement October 2013 Pose a new question to Legal Regulatory Forum experts Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This white paper written by Apex Vice President of Solutions and Services Carrie Romandine discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs but it will maximize the amount collected before sending to collections Further targeted messaging should be applied across all points of patient interaction i e point of service customer service patient statements and analyzed regularly for maximized results HFMA Business Profiles Ontario Systems Optimizing Accounts Receivable in a Rapidly Changing Environment Steve Scibetta senior director of channel sales for Ontario Systems healthcare product line shares insights into effectively managing receivables HFMA RESOURCE LIBRARY The Future of Online Patient Billing Portals This white paper written by Apex President Patrick Maurer discusses methods to increase patient adoption of online payments Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections This white paper shows why patient centric approaches to online payment portals are important complements to traditional provider centric approaches HFMA Business Profiles Optum Enabling Transformative Change Elena White vice president of risk quality and network solutions for Optum discusses how healthcare providers can leverage data and technology as they enable risk in their organization HFMA RESOURCE LIBRARY Payment Portals Can Improve Self Pay Collections and Support Meaningful Use Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs This article written by Apex Founder and CEO Brian Kueppers explores a number of strategies to create synergy between patient billing online payment portals and electronic health record EHR software to realize a high ROI in speed to payment patient satisfaction and portal adoption for meaningful use HFMA Business Profiles Somnia Bending the Healthcare Cost Curve Toward Improved Anesthesia Value Somnia President and CEO Marc Koch MD MBA explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes HFMA RESOURCE LIBRARY Large Health System Drives 10

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    Productivity and Process Improvement Productivity Measures for Managed Care Auditors October 2013 Quality and Cost Reporting Achieving Transparency January 2011 Technology Shopping for Claim Scrubbers September 2013 Mobile Technology for POS May 2013 Pose a new question to Payment Reimbursement Forum experts BACK TO PAGINATION Pose a new question to Payment Reimbursement Forum experts Recent Q As Non Contracted Insurer Payment Rates January 2016 Reimbursement Implications of Pediatric Trauma Designation October 2015 Paying for New Expensive Inpatient Drugs August 2015 Q A Archive Bad Debt Early Out Percentage and Bad Debt Collection Agencies January 2011 Billings and Collections Can Expanded POS Collections Reduce Bad Debt November 2014 Refunding Insurance Overpayments October 2014 Billing for LMSW Services in the ED October 2012 Negotiating Benefit Maximums September 2012 CDM Charge Capture Coding CCI Edits at the Department Level January 2013 E Prescribing Coding July 2012 Splitting Charges for Multiple OR Procedures May 2012 Benchmark for Overcoding E M March 2012 Best Practices for HIM Coding March 2012 Labor and Delivery Admitting Category June 2011 Chargemaster Determining Anesthesia Charges April 2014 Denials Management Adjusting Appealed Medicare Charges February 2012 Healthcare Legal Small Claims Court Proceedings February 2011 Legislative Requirements for Refunds November 2010 Healthcare Payment Reform Average PMPM Payments for Medical Homes September 2011 Laboratory Reimbursement Medical Necessity and Genetic Tests March 2014 Managed Care Multiple Procedure Discounting January 2015 Dis enrolling a Patient from a Group Plan While on FMLA April 2013 Commercial Rates for Dialysis Services March 2013 High Cost Drug Carve Outs February 2013 Retro Termination and Insurance Overpayments January 2013 Closed Health Plan Panels July 2012 Negotiating Reimbursement Rates May 2012 Reimbursement Rates for Physician Practices March 2012 Overpayment Adjustment Process for Managed Care May 2011 Payer Rates for Medical Groups May 2011 Managed Care Payment Trends April 2011 Adjusting and Automating Self Pay Accounts March 2011 Calculating Weighted Averages in Favored Nation Clauses March 2011 How Far Can Plans Make Patients Travel March 2011 Percentage Add On for Medicare Managed Care Claims January 2011 PMPM Payments for Case Management January 2011 Medicaid Risks Associated with Medicaid Expansion January 2014 Medicare Reimbursement Medicare Penalties Rewards and T18 Payments May 2015 Ensuring MSP Forms Are Completed April 2015 Over Spending in Relation to Medicare s MSPB Measure February 2015 Wound Clinic Reimbursement Changes March 2014 Re Enrolling Providers in Medicare June 2013 updated July 2013 Reimbursement Rates for Holter Monitors June 2013 Chemotherapy Carve Outs May 2013 IME Payments and Terminated Residency Programs November 2012 Accepting Cash from Medicaid Patients April 2012 Appropriate Charging for Observation Status April 2012 Charging Facility Fees February 2012 Billing for Nonphysician Providers January 2012 Payer Requests for Medical Records January 2012 Charging for Outpatient Services at Another Hospital November 2011 How to Post IME Payments November 2011 Does Medicare Payer APC or Lower of Actual Charges September 2011 Billing Observation Hours July 2011 Small Balance Adjustments and Anti kickback June 2011 Medical School and Residency Reimbursement May 2011 When Physicians Terminate Medicare Part B Contracts March 2011 Medicare Payment for Home Health February 2011 Medicare Crossovers to Medicaid Bad Debt November 2010 Payer Trends Payer Mix Stats November 2013 Physician Reimbursement Potential Conflicts in Physician Payment Arrangements October 2014 Billing for Locum Tenens with Q6 Modifier September 2014 Billing for Physicians Who Work at Multiple Sites February 2014 Pricing and Charges Facility Based Outpatient Versus Physician Office Billing July 2015 RAC Recoveries and Medicare Cost Reports July 2014 Room and Board Markups May 2014 Productivity and Process Improvement Productivity Measures for Managed Care Auditors October 2013 Quality and Cost Reporting Achieving Transparency January 2011 Technology Shopping for Claim Scrubbers September 2013 Mobile Technology for POS May 2013 Pose a new question to Payment Reimbursement Forum experts Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This white paper written by Apex Vice President of Solutions and Services Carrie Romandine discusses the importance of patient segmentation and messaging

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    2013 Determining Call Center Staffing January 2013 Work from Home Arrangements July 2012 Interview Questions for Revenue Cycle Leader Positions July 2011 Technology Using iPhones or iPads for Inputting Patient Data March 2012 Pose a new question to Revenue Cycle Forum experts BACK TO PAGINATION Pose a new question to Revenue Cycle Forum experts Recent Q As Attorney Fees for Collections February 2016 ICD 10 Transition January 2016 Medical Record Documentation January 2016 Charity Care November 2015 Collection KPIs November 2015 Q A Archive Bad Debt Evaluating Bad Debt Agencies November 2012 Percentage of A R Bad Debt Outsourced to Collection Agencies February 2012 Benchmarking Forecasting Aging of Patient Balances October 2014 Benchmark for Measuring Coding Productivity June 2011 Billing and Collection Billing Staff Metrics October 2015 Charges Billed Versus Charges Collected February 2015 CAH Billing Productivity January 2015 Patient Statement Mail Return Rates April 2014 CDM Charge Capture and Coding Lab Coding on Specimens September 2014 Charge Capture for Robotic Surgical Assistance March 2013 Hospitalist Coding Billing November 2012 Capturing NICU Inpatient Discharges May 2012 Changing Admit Type November 2011 Critical Access Hospitals CAH Upfront Collections November 2014 Customer Service Revenue Cycle Performance and Patient Satisfaction September 2013 Setting Industry Standards for Call Center Activities April 2011 Denials Management Rebilling Denials July 2015 Measuring Denials May 2014 Aging Denials October 2013 Denials Overturn Rate July August 2013 Calculating and Rebilling Claims January 2012 Benchmarks for Denied Claims Overturned Rates October 2011 Appealing a Hospital Stay Denial June 2011 Medicare Compliance RAC OIG MSP Questionnaire for Blood Draws February 2012 Medicare Reimbursement Emergency Health Service Payments April 2015 Lab Test Billing February 2014 Staying on Top of Medicare Changes January 2013 UB 04 Requests from Patients June 2012 Primary Payer Responsibility November 2011 Productivity and Process Improvement Physician Practice KPIs May 2015 Exchange Plan Impact on Revenue Cycle Processes January 2014 Organ Donor Records January 2014 Preauthorization Processes November 2013 Productivity Measures for Managed Care Auditors June 2013 Productivity Standards for Patient Balance Calls May 2013 Patient Access Productivity Standards February 2011 Registration Verification and Patient Access Holding Charges July 2014 Exchange Plan Impact on Revenue Cycle Processes January 2014 ED Collections November 2013 Cost to Collect Copayments October 2013 Benchmarks for POS Cash Collections April 2013 Including HIM in Cost to Collect Metrics February 2013 Resolving Small Balance Accounts October 2012 Calculating PFR September 2012 Reducing Patient Calls About Bills September 2012 Number of Accounts per Biller June 2012 Finding Out Why Patient Accounts Are Held in DNFB May 2012 Benchmark for Providers Assigned to Billers April 2012 Cost to Collect Percentage for Physician Group April 2012 Employees in Collections and Bad Debt March 2012 Benchmark for Point of Service Collections January 2012 Collecting and Refunding Small Copays January 2012 Cost to Collect Benchmarks for an ED Physician Group November 2011 DNFB Benchmarks and Calculation Method November 2011 Single Account Number for Services at Multiple Facilities September 2011 Best Practice for Billing Transfers June 2011 Collection Agency Written Agreements June 2011 Cost per Claim and Cost for Rebill May 2011 Cost to Collect Benchmark and Calculations May 2011 Patient Responsibility Estimation April 2011 CMS Statements for Medicare Patients March 2011 Patient Price Estimation March 2011 Getting Staff to Embrace Bedside Registration February 2011 Insurance Claims Worked per Collector January 2011 Average Days in Receivables Self Payment Collection POS Estimates and Overpayments March 2014 Invoicing Across Departments September 2013 Self Pay Amnesty Programs September 2011 Specialist Co Payment in Hospital Staff Development Financial Clearance KPIs and Productivity April 2013 Improving Productivity for Credit Balance Resolutions March 2013 Financial Counseling Careers February 2013 Determining Call Center Staffing January 2013 Work from Home Arrangements July 2012 Interview Questions for Revenue Cycle Leader Positions July 2011 Technology Using iPhones or iPads for Inputting Patient Data March 2012 Pose a new question to Revenue Cycle Forum experts Please login to add your comments Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results HFMA Business Profiles Accretive Health Partners with Providers to Excel in a Rapidly Transforming Revenue Cycle Environment Emad Rizk MD president and CEO of Accretive Health discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management HFMA RESOURCE LIBRARY 10 Ways to Reduce Patient Statement Volume and Reduce Costs No two patients are the same Each has a very personal healthcare experience and each has distinct financial needs and preferences that have an impact on how when and if they chose to pay their healthcare bill It s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients The need to tailor financial conversations and payment options to individual needs and preferences is critical This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach but take control of rising collection costs HFMA Business Profiles Conifer Health Solutions Helping Providers and Employers Build a Foundation for Better Health Jim Bohnsack vice president solution corporate development for Conifer Health Solutions explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements HFMA RESOURCE LIBRARY Reduce Patient Balances Sent to Collection Agencies Approaching New Problems with New Approaches This

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  • Assisting Patients with Insurance Premiums
    issuers to reject such third party payments The possibility of hospitals helping their patients pay for insurance coverage also drew opposition from American s Health Insurance Plans the nation s largest health insurance advocacy group A Court Decision Whether a premium payment made on an insured s behalf would be considered a violation of the kickback laws or other anti fraud statutes remains an open question Regardless of an HHS opinion or even that of the Department of Justice it would ultimately be for the courts to decide J Stuart Showalter JD MFS is a contributing editor to HFMA s Legal Regulatory Forum Publication Date Monday November 11 2013 BACK TO PAGINATION Do anti kickback laws preclude providers from paying premiums for uninsured patients This article was updated and revised on Nov 11 to reflect opinions and statements from various federal agencies and law makers For further updates on this issue please stay tuned to HFMA News If the health insurance exchanges evolve as envisioned by the Affordable Care Act ACA more than 90 percent of the 41 million uninsured individuals in this country will qualify for a federal financial subsidy to help pay for health insurance Even so there most likely will be individuals who qualify for the benefit but still are unable to afford coverage Without insurance these patients will continue to require charity care a scenario the ACA was meant to minimize In light of this hospital and patient advocates are asking Can hospitals and other providers assist patients in paying for an insurance plan that is purchasing through the exchanges After two weeks of back and forth opinions from two federal agencies the answer remains a matter of considerable uncertainty HFMA articles have cautioned from the beginning of this debate that there is a broader set of issues that need to be addressed and that competent legal advice should be sought Possible Obstacles Many Questions An obvious stumbling block to helping patients with premiums is the federal anti kickback statute which prohibits giving or receiving anything of value to induce the purchase of healthcare services paid for in whole or in part by a federal health program Similar state kickback laws may also apply However the following scenarios present opportunities to assist patients without using federal or state money A hospital agrees as part of its charity care policy to make in lieu of a discount a one time payment of the premium for an individual s coverage A group of hospitals in a particular area sets up a charitable foundation for the purpose of funding premiums for people who meet certain criteria These are interesting ideas and as usual the devil is in the details Here are a few questions To be independent would the foundation need to be an entirely new entity or could it be part of an existing charity or other organization such as a state or local hospital association Would all the contributors need to be from healthcare providers or would funds from non hospital benefactors be welcome Who would those non hospital benefactors be What criteria would be used to decide which patients get premium support and who makes those decisions How would the decisions be made consistent with the hospitals charity care policies Would the hospitals seek publicity for their beneficent acts or would they just count it as part of their community benefit on the Schedule H to IRS Form 990 From the Federal Government So Far Conflicting messages are emerging from Washington In an Oct 30 letter to Congressman Jim McDermott D WA HHS Secretary Kathleen Sebelius said that HHS does not consider qualified health plans QHPs and other programs related to the federally facilitated exchanges to be federal health care programs Her answer is significant because it is an indication that the federal anti kickback statute may not be a bar to assisting patients with their premiums However the HHS secretary s opinion is not the end of the matter given a Nov 7 letter that Senator Charles Grassley R Iowa sent to Sebellius and the U S Attorney General Eric Holder In addition on Nov 4 CMS had released a FAQ that discourages hospitals giving patients premium support HHS has significant concerns with this practice of third party premium payments because it could skew the insurance risk pool and create an unlevel field in the Marketplaces The guidance added HHS discourages this practice and encourages issuers to reject such third party payments The possibility of hospitals helping their patients pay for insurance coverage also drew opposition from American s Health Insurance Plans the nation s largest health insurance advocacy group A Court Decision Whether a premium payment made on an insured s behalf would be considered a violation of the kickback laws or other anti fraud statutes remains an open question Regardless of an HHS opinion or even that of the Department of Justice it would ultimately be for the courts to decide J Stuart Showalter JD MFS is a contributing editor to HFMA s Legal Regulatory Forum Publication Date Monday November 11 2013 Comments Please login to add your comments Add Comment Text Only 2000 character limit Advertisements HFMA Business Profiles McKesson Leveraging Predictive Analytics to Rein in Operating Costs A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow HFMA RESOURCE LIBRARY 6 Patient Revenue Cycle Metrics You Should Be Tracking and How to Improve Your Results Patient financial engagement is more challenging than ever and more critical With patient responsibility as a percentage of revenue on the rise providers have seen their billing related costs and accounts receivable levels increase If increasing collection yield and reducing costs are a priority for your organization the metrics outlined in this presentation will provide the framework you need to understand what s working and what s not in order to guide your overall patient financial engagement initiatives and optimize results

    Original URL path: http://www.hfma.org/Content.aspx?id=20082 (2016-02-10)
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