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  • Six Ways to Address Non-Performance-Related Variation in ACO Contracts
    measures etc Access related article Accounting for Non Performance Related Variation in Shared Savings Contracts Karen Wager is a freelance writer who regularly contributes to HFMA publications and Forums Quoted in this article Phil Kane is director in the network and competitive analytics group for Florida Blue an independent licensee of the Blue Cross and Blue Shield Association Jacksonville Fla Discussion Starters Forum members What do you think Please share your thoughts in the comments section below What other ways can providers and payers account for non performance related variation in ACO contracts Have you tried any of the approaches described above Please share your experience Publication Date Thursday January 22 2015 BACK TO PAGINATION Before entering into a shared savings contract payers and providers should discuss how to account for factors unrelated to the cost or quality of care that can skew incentive payments An ACO can be doing all the right things and end up getting penalized for some events that are somewhat out of their control says Phil Kane director in the network and competitive analytics group for Florida Blue the Blue Cross Blue Shield brand in Florida As described in a related article Accounting for Non Performance Related Variation in Shared Savings Contracts factors unrelated to performance such as patient attribution and product mix often come into play when determining shared savings incentive payments While not yet a perfect science payers and providers can begin to address non performance related variation in a number of ways This is a sample article from HFMA s Payment Reimbursement Forum Learn more and subscribe Apply Risk Adjustment Payers should use risk adjustment to account for varying acuity levels of members throughout the contract term of an ACO For example if an ACO adds a pediatric practice a risk adjustment method that accounts for the change in demographics can address the resulting variation in PMPM costs This process may include using demographic factors such as age gender or risk score factors such as the Centers for Medicare Medicaid Services hierarchical condition categories model Control When Practice Groups or Members Can Be Added The addition or withdrawal of providers or members to an ACO has a material effect in how measurements are calculated Requiring that providers and members can only be added at predetermined intervals agreed on by both payer and provider or at the end of a particular measurement contractual period will promote consistency and reduce variation The downside is that if a provider leaves a practice but is still part of the measurement the ACO s incentives may not reflect the actual efficiency of the remaining providers Find Other Measures that Demonstrate Performance Improvement Kane suggests using a PMPM trend comparison to market The incentive is tied to how the ACO is performing against other organizations in the market The downside is that many ACOs are already high cost relative to the market see the table below Although the ACO may outperform the market trend in terms of xx percent say 6 5 percent versus 7 percent the ACO s costs may still remain much greater than the market say 386 versus 353 Yet the ACO receives an incentive ACO Trend Comparison to Market ACO Target ACO Actual Market Baseline PMPM cost 362 362 330 Trend 5 0 6 5 7 0 Actual PMPM cost 380 386 353 Provider performance may also be gauged on factors other than total cost of care such as utilization specific measures for example ED visit rates inpatient days per thousand members or avoidable readmission rates The downside to this approach is that these measures may not move in the same direction as the total cost of care PMPM performance We have seen instances where ED rates have declined but the actual PMPM has increased says Kane Because of the dynamics of medical expense trend we ve encountered many instances where there s a decline in a performance measure e g ED rates per 1 000 admits per 1 000 and still observed a PMPM increase Pool Incentive Arrangements with Other Entities Incentives for several independent ACOs are aggregated and each ACO receives a portion of the total which can spread out the variability helping to reduce the impact The downside is that the incentive is tied to the performance of all the ACOs not an individual ACO Truncate High Cost Members Under this method the ACO covers the cost of care up to a predefined amount say 100 000 limiting the out of scale influence of high cost members on overall PMPM costs The downside is that because costs of care for the patients still have to be covered payers are required to retain additional savings to fund that cost Account for Quality Quality performance is often a trigger for ACO financial incentives or at least a requirement for participation Florida Blue doesn t pay incentives for quality in our commercial ACO arrangements says Kane However an ACO is not eligible for an incentive unless they can pass pre defined quality measurements We call this a quality gate for payment Other payers will adjust the ACO incentive payment based on their quality performance says Kane For example the ACO will receive 100 percent of the eligible incentive if they meet 100 percent of the quality measures 80 percent of the incentive if they meet 80 percent of the measures etc Access related article Accounting for Non Performance Related Variation in Shared Savings Contracts Karen Wager is a freelance writer who regularly contributes to HFMA publications and Forums Quoted in this article Phil Kane is director in the network and competitive analytics group for Florida Blue an independent licensee of the Blue Cross and Blue Shield Association Jacksonville Fla Discussion Starters Forum members What do you think Please share your thoughts in the comments section below What other ways can providers and payers account for non performance related variation in ACO contracts Have you tried any of the approaches described above Please share your

    Original URL path: http://www.hfma.org/Content.aspx?id=27609 (2016-02-10)
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  • Accounting for Non-Performance-Related Variation in Shared Savings Contracts
    actual PMPM costs can be due to several factors including legitimate reasons that truly reflect the performance of the ACO Kane says For example an ACO may achieve efficiency by shifting care to more appropriate settings improving care coordination and increasing the use of generic medications The resulting metrics would show a reduction in costs resulting from a reduction in the number of admissions outpatient visits and brand name medications Kane says But other reasons for variation while not reflective of provider performance still affect incentives Some of these non performance related reasons include the following Provider expansion contraction Adding or losing a physician practice during the contract period can affect the ACO s risk level A new pediatrics practice for instance would likely lower the overall PMPM cost Kane says Pediatric populations typically have a lower risk of illness and use fewer resources than an adult population If for example adding a pediatrics practice results in a 10 percent decline in morbidity PMPM costs would reflect that decline The cost savings however is not reflective of the efficiency of the ACO but the demographics of the patient population Member expansion contraction The addition of a large group of individual members can also affect PMPM costs For example early claims experience from members who obtain insurance through the new health insurance marketplaces has shown a greater use of resources Kane says The greater need may not be due to higher acuity levels but to a pent up demand for healthcare services Kane says These members may have previously avoided obtaining care due to a lack of insurance For example if the average annual cost of an ACO with 20 000 members was 4 558 but 200 health exchange members are added with 54 percent higher costs 7 000 per member the total annual medical expense cost would rise from 91 2 million to 92 6 million resulting in a 0 5 percent increase in the PMPM cost from the targeted 380 to 382 Again the variation is not due to an ACO s care management strategies Kane points out but to a change in patient population Product mix The mix of insurance products can also produce variation For example if the ACO includes a large self funded employer group with 500 members and the employer carves out or does not cover certain benefits such as pharmacy the PMPM costs of that patient population will be lower than the rest of the ACO again irrespective of the efficiency of the ACO Kane says This has occurred in our ACOs says Kane We ve added a substantial number of members who obtained coverage under the Affordable Care Act In these cases the addition of these members increased the actual PMPM and is not a reflection of the ACO s care management If this comes up during discussions with providers we indicate that risk adjustment methods should account for the addition of these members High cost members Just one member with a serious condition can cause significant variation A candidate for a heart transplant who is attached to a device that helps his heart pump may incur costs as high as 500 000 significantly skewing the PMPM costs and incentives by considerable amounts Kane says The accuracy of estimated trend increases e g medical trend estimation for PMPM costs can also cause variation between targeted and actual PMPM costs If the trend used to project a target was inaccurately estimated the ACO may end up performing worse or better For example suppose an ACO uses a projected medical trend of 3 percent based on past experience to establish a target PMPM says Kane Then suppose there s a bad flu season and medical trends actually increase at a 5 percent rate The ACO would be penalized due to factors that are somewhat outside of its control Attribution Additionally PMPM cost levels can be affected by how members are assigned or attributed to the ACO Ideally there should be an established relationship between the patient and the primary care physician PCP For example the patient chose the PCP This scenario improves the likelihood that the PCP can effectively manage the patient s care as the physician is familiar with the patient and his or her health history etc However attribution does not always work that way Some health plans have not yet developed product and benefit designs around ACO payment models which require members to choose a PCP says HFMA s Susan Horras director healthcare finance policy health plan and population heath initiatives So consumers members are not aware they have been attributed to an ACO or what an ACO even is Therefore accountability of the patient member hasn t been established and leakage occurs that impacts the ACO care model from the provider perspective In some methods of attribution a member is automatically assigned to a PCP perhaps by a computer generated algorithm In such a method there may not be an established relationship between the physician and member Kane says Members may instead be assigned to physicians based on claims utilization For an ACO to work and provide care and coordinate care you really need to have a relationship between the patient and the primary care provider Kane says That s the kind of the basis on which you want to provide quality care and really do the assignment in theory The reality is that in some of the attribution models that I ve seen it s an arbitrary decision Kane says Not Ready for Risk Managing the inherent variability within an ACO is not yet a perfect science although there are some steps that providers and payers can take See related article Six Ways to Address Non Performance Related Variation in ACO Contracts Ultimately this requires the payer and provider to work very closely together says Kane We re trying to get a little more understanding around the ups and downs and how to jointly work through it Karen Wager is a freelance writer who regularly contributes to HFMA publications and Forums Quoted in this article Phil Kane is director in the network and competitive analytics group for Florida Blue an independent licensee of the Blue Cross and Blue Shield Association Jacksonville Fla Susan Horras director healthcare finance policy health plan and population heath initiatives HFMA Discussion Starters Forum members What do you think Please share your thoughts in the comments section below How can providers and payers work together to solve these variability issues around shared savings incentives Is your organization involved in talks around these issues What lessons learned have you identified to date Publication Date Thursday January 22 2015 BACK TO PAGINATION Understanding and adjusting for the variety of reasons why PMPM costs rise and fall is a critical challenge that must be confronted if the industry is going to successfully adopt value based contracts In theory the fundamental purpose of any value based payment model is rewarding the provision of high quality cost effective care In practice however factors unrelated to performance such as patient attribution and product mix often come into play says Phil Kane director in the network and competitive analytics group for Florida Blue the Blue Cross Blue Shield brand in Florida As a result accountable care organizations ACOs are sometimes rewarded or fail to be rewarded with shared savings incentives due to factors unrelated to the cost or quality of care provided to ACO members Kane explained during a September 2014 HFMA webinar One of the key takeaways for us is that small changes in medical expense performance can have a large impact on the financial incentive arrangement Kane says This is a sample article from HFMA s Payment Reimbursement Forum Learn more and subscribe Obtaining a reliable estimate of shared savings incentives is important to both providers and payers Hospitals and health systems often use the incentives to fund improvement initiatives and recruit physicians Payers meanwhile rely on projections to forecast cash flow and determine the amount of funds that should be set aside for the incentive pool Faulty estimates that fall well below the projected mark can cause frustration and confusion Kane says The key is looking at the difference between the target and the actual results and making adjustments to those particular calculations that reflect the true efficiencies of the care system itself Kane says How Variation Affects Incentives The upside for providers participating in ACOs is the potential to share in cost savings that result from the cost effective delivery of care The reward comes in the form of incentives which are often based on the savings derived from the difference between actual and targeted per member per month PMPM medical expenses Kane says For example let s say an ACO contract sets a baseline PMPM cost of 362 based on the previous 12 months of patient claims see the exhibit below The contract might also estimate that PMPM costs will increase by an estimated 5 percent over the following year resulting in a target PMPM payment of 380 If the actual PMPM expense turns out to be 375 the savings is 5 PMPM For an ACO with 20 000 members the incentive pool would amount to 1 2 million 20 000 x 5 x 12 However just slight variations in the PMPM cost over the course of a year can produce wide swings in the incentive pool an activity Kane refers to as leveraging A PMPM cost that swings from 375 to 376 then to 371 and again to 377 from one quarter to the next can mean the gain and loss of thousands of dollars in year end incentives For instance consider an ACO arrangement that calls for a 50 50 sharing of savings If the total yearly savings averages 3 PMPM versus 5 projected incentives can slide from 600 000 1 2 million 2 to nearly half that amount 375 000 by the end of the contractual year Reasons for Variation That variation between targeted and actual PMPM costs can be due to several factors including legitimate reasons that truly reflect the performance of the ACO Kane says For example an ACO may achieve efficiency by shifting care to more appropriate settings improving care coordination and increasing the use of generic medications The resulting metrics would show a reduction in costs resulting from a reduction in the number of admissions outpatient visits and brand name medications Kane says But other reasons for variation while not reflective of provider performance still affect incentives Some of these non performance related reasons include the following Provider expansion contraction Adding or losing a physician practice during the contract period can affect the ACO s risk level A new pediatrics practice for instance would likely lower the overall PMPM cost Kane says Pediatric populations typically have a lower risk of illness and use fewer resources than an adult population If for example adding a pediatrics practice results in a 10 percent decline in morbidity PMPM costs would reflect that decline The cost savings however is not reflective of the efficiency of the ACO but the demographics of the patient population Member expansion contraction The addition of a large group of individual members can also affect PMPM costs For example early claims experience from members who obtain insurance through the new health insurance marketplaces has shown a greater use of resources Kane says The greater need may not be due to higher acuity levels but to a pent up demand for healthcare services Kane says These members may have previously avoided obtaining care due to a lack of insurance For example if the average annual cost of an ACO with 20 000 members was 4 558 but 200 health exchange members are added with 54 percent higher costs 7 000 per member the total annual medical expense cost would rise from 91 2 million to 92 6 million resulting in a 0 5 percent increase in the PMPM cost from the targeted 380 to 382 Again the variation is not due to an ACO s care management strategies Kane points out but to a change in patient population Product mix The mix of insurance products can also produce variation For example if the ACO includes a large self funded employer group with 500 members and the employer carves out or does not cover certain benefits such as pharmacy the PMPM costs of that patient population will be lower than the rest of the ACO again irrespective of the efficiency of the ACO Kane says This has occurred in our ACOs says Kane We ve added a substantial number of members who obtained coverage under the Affordable Care Act In these cases the addition of these members increased the actual PMPM and is not a reflection of the ACO s care management If this comes up during discussions with providers we indicate that risk adjustment methods should account for the addition of these members High cost members Just one member with a serious condition can cause significant variation A candidate for a heart transplant who is attached to a device that helps his heart pump may incur costs as high as 500 000 significantly skewing the PMPM costs and incentives by considerable amounts Kane says The accuracy of estimated trend increases e g medical trend estimation for PMPM costs can also cause variation between targeted and actual PMPM costs If the trend used to project a target was inaccurately estimated the ACO may end up performing worse or better For example suppose an ACO uses a projected medical trend of 3 percent based on past experience to establish a target PMPM says Kane Then suppose there s a bad flu season and medical trends actually increase at a 5 percent rate The ACO would be penalized due to factors that are somewhat outside of its control Attribution Additionally PMPM cost levels can be affected by how members are assigned or attributed to the ACO Ideally there should be an established relationship between the patient and the primary care physician PCP For example the patient chose the PCP This scenario improves the likelihood that the PCP can effectively manage the patient s care as the physician is familiar with the patient and his or her health history etc However attribution does not always work that way Some health plans have not yet developed product and benefit designs around ACO payment models which require members to choose a PCP says HFMA s Susan Horras director healthcare finance policy health plan and population heath initiatives So consumers members are not aware they have been attributed to an ACO or what an ACO even is Therefore accountability of the patient member hasn t been established and leakage occurs that impacts the ACO care model from the provider perspective In some methods of attribution a member is automatically assigned to a PCP perhaps by a computer generated algorithm In such a method there may not be an established relationship between the physician and member Kane says Members may instead be assigned to physicians based on claims utilization For an ACO to work and provide care and coordinate care you really need to have a relationship between the patient and the primary care provider Kane says That s the kind of the basis on which you want to provide quality care and really do the assignment in theory The reality is that in some of the attribution models that I ve seen it s an arbitrary decision Kane says Not Ready for Risk Managing the inherent variability within an ACO is not yet a perfect science although there are some steps that providers and payers can take See related article Six Ways to Address Non Performance Related Variation in ACO Contracts Ultimately this requires the payer and provider to work very closely together says Kane We re trying to get a little more understanding around the ups and downs and how to jointly work through it Karen Wager is a freelance writer who regularly contributes to HFMA publications and Forums Quoted in this article Phil Kane is director in the network and competitive analytics group for Florida Blue an independent licensee of the Blue Cross and Blue Shield Association Jacksonville Fla Susan Horras director healthcare finance policy health plan and population heath initiatives HFMA Discussion Starters Forum members What do you think Please share your thoughts in the comments section below How can providers and payers work together to solve these variability issues around shared savings incentives Is your organization involved in talks around these issues What lessons learned have you identified to date Publication Date Thursday January 22 2015 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 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

    Original URL path: http://www.hfma.org/Content.aspx?id=27611 (2016-02-10)
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  • What Lies Ahead for Healthcare Reform?
    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

    Original URL path: http://www.hfma.org/Content.aspx?id=26716 (2016-02-10)
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  • On-Demand - Implementing Value Based Payment Models: Lessons Learned from CoxHealth Plans
    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

    Original URL path: http://www.hfma.org/Content.aspx?id=23544 (2016-02-10)
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  • Price Transparency for Health Plans
    format Download Understanding Healthcare Prices A Consumer Guide Health plans and related organizations are encouraged to post this document on their websites as a resource for their members and for the general public No permission is needed BACK TO PAGINATION Because health plans will in most instances have the most accurate data on prices for their members HFMA s Price Transparency Task Force recommends that health plans serve as the principal source of price information for their members Many health plans have already developed or are in the process of developing web based or telephonic transparency tools for their members There are also a growing number of independent vendors that use data from health plans and or employers in web based tools and telephonic products to inform employees about price These tools have the potential to benefit both patients and health plans providing patients with needed information while strengthening the health plan s value to its members Employers with self funded health plans have the option of working with health plans which often serve as third party administrators for self funded plans or other vendors in developing transparency tools for insured employees and their dependents Transparency tools for insured patients should include some essential elements of price information including The total estimated price of the service A clear indication of whether a particular provider is in the health plan s network and information on where the patient can try to locate a network provider A clear statement of the patient s estimated out of pocket payment responsibility Other relevant information related to the provider or the specific service sought e g clinical outcomes patient safety or patient satisfaction scores To provide the most helpful price information these tools should be tied to the specifics of an individual s benefit design and include information on applicable copayment coinsurance or deductible requirements They should also assist members in identifying in network providers and identify any impact that selection of an out of network provider is expected to have on the patient s responsibility for payment Both health plans and providers should alert patients to the need to seek price information from out of network providers Many health plans have developed price transparency tools These are a few examples Aetna s Price Transparency Tool United Healthcare s Price Transparency Tool To feature your health plan s price transparency tool on this page contact Susan Horras Read the full report Price Transparency in Health Care Report from the HFMA Price Transparency Task Force PDF format Download Understanding Healthcare Prices A Consumer Guide Health plans and related organizations are encouraged to post this document on their websites as a resource for their members and for the general public No permission is needed 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

    Original URL path: http://www.hfma.org/Content.aspx?id=27729 (2016-02-10)
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  • Policy & Perspectives | HFMA
    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

    Original URL path: http://www.hfma.org/policy/ (2016-02-10)
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  • Principles and Practices Board Statements and Publications
    for Single Fund Reporting by Institutional Healthcare Providers hfm 6 86 Statement No 9 Accounting and Reporting Issues Related to Continuing Care Retirement Communities hfm 11 86 Statement No 10 Accounting and Reporting Issues Related to Corporate Reorganizations Involving Tax Exempt Institutional Healthcare Providers hfm 2 89 Note Replaced by Statement No 19 Statement No 12 Accounting for Resource Transfers Among Affiliated Entities hfm 10 90 Note Replaced by Statement No 19 Statement No 13 Timing Differences Pertaining to Third Party Payment hfm 1 92 Statement No 14 The Presentation of Patient Service Revenue and Related Issues hfm 10 92 Statement No 19 Transactions Among Affiliated Entities Comprising an Integrated Delivery System 6 96 BACK TO PAGINATION Below is a history of all publications from HFMA s Principles and Practices P P Board P P Board statements are originally published in hfm magazine The printed edition is the definitive version of the statement P P Board Statements Statements are available online free of charge for the public For hard copies contact the HFMA Member Services Center 800 252 4362 ext 2 Statement Number Title hfm Publication Date 20 Healthcare Mergers Acquisitions and Collaborations 10 97 18 Public Disclosure of Financial and Operating Information by Healthcare Providers 8 94 17 Assessments and Arrangements Similar to Taxes on Tax Exempt Institutional Healthcare Providers 5 94 16 Classifying Valuing and Analyzing Accounts Receivable Related to Patient Services 5 93 15 Valuation and Financial Statement Presentation of Charity Service and Bad Debts by Institutional Healthcare Providers 12 06 revised 12 12 11 Accounting and Reporting by Institutional Healthcare Providers for Risk Contracts 8 89 Issue Analyses P P Board issue analyses are available below for free download If you have questions regarding P P Board issue analyses please email the HFMA Member Service Center or call 800 252 4362 ext 2 Title Monograph Publication Date Risk Accounting What are the Issues and Trends in These Revenue Arrangements 1 16 Questions and Answers on the Affordable Care Act s Premium Stabilization Programs 9 15 Medicare Incentive Payments for Meaningful Use of Electronic Health Records Accounting and Reporting Developments 12 11 Accounting for RAC Audit Adjustments and Exposures 06 10 Sample 501 c 3 Hospital Charity Care Financial Assistance Policy Procedures 04 09 The Relationship of Community Benefit to Hospital Tax Exempt Status 4 05 Recognition of Other Than Temporary Decline in Investments for Tax Exempt Organizations 11 02 Compliance with Laws and Regulations for Healthcare Organizations 9 98 Assessing Managed Care Contracting Risk 4 97 Acquisition of Physician Practices 9 95 Withdrawn Statements Statement No 1 Uniform Accounting and Uniform Reporting in Hospitals hfm 6 77 Statement No 2 Defining Charity Service as Contrasted to Bad Debts hfm 7 78 Note Replaced by Statement No 15 Statement No 3 Supplementary Reporting of Hospital Financial Requirements hfm 12 80 Statement No 4 Reporting of Certain Transactions Arising in Connection with the Issuance of Debt hfm 6 82 Statement No 5 Accounting and Reporting for Agency Relationships 12 83 Statement No 6 How to Measure Working Capital Classification and Definition Issues hfm 9 84 Statement No 7 The Presentation of Patient Service Revenue and Related Issues hfm 4 86 Note Replaced by Statement No 14 Statement No 8 The Use of Fund Accounting and the Need for Single Fund Reporting by Institutional Healthcare Providers hfm 6 86 Statement No 9 Accounting and Reporting Issues Related to Continuing Care Retirement Communities hfm 11 86 Statement No 10 Accounting and Reporting Issues Related to Corporate Reorganizations Involving Tax Exempt Institutional Healthcare Providers hfm 2 89 Note Replaced by Statement No 19 Statement No 12 Accounting for Resource Transfers Among Affiliated Entities hfm 10 90 Note Replaced by Statement No 19 Statement No 13 Timing Differences Pertaining to Third Party Payment hfm 1 92 Statement No 14 The Presentation of Patient Service Revenue and Related Issues hfm 10 92 Statement No 19 Transactions Among Affiliated Entities Comprising an Integrated Delivery System 6 96 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

    Original URL path: http://www.hfma.org/Content.aspx?id=1069 (2016-02-10)
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  • Studies Conducted by HFMA
    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

    Original URL path: http://www.hfma.org/HFMAstudies/ (2016-02-10)
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