The
Georgia
Scroll
Summer
2001
Eddie Phillips, CPA
Hello everyone! This is my first opportunity to address the entire Chapter
membership, and I would like to begin by letting everyone know what an honor it
is for me to represent you as the Chapter's President. I would also like to
express my congratulations to Past President, Tim Beatty. Tim had a very
successful year. He and I are leaving next week to attend ANI in San Antonio to
pick up some hardware. The Georgia Chapter has been awarded four Helen M.
Yerger Special Recognition Awards. You will hear more about our success of last
year after we return. I am even going to try to take some photos to
share with everyone.
As for this year, we are off to a great start. As I said at our Callaway
Gardens meeting, I am very excited about the leadership team we have assembled
for this New Year. Our officers, board members, and TEAMS leaders are already
hard at work. Most of us met for a daylong planning meeting in late March to
set and define our goals for the year. Afterwards, the TEAMS chairpersons met
with their individual TEAMS to review these goals. In addition, in April, I and
seven other Chapter leaders attended the National Leadership Training
Conference in Phoenix, Arizona where we had a chance to meet with the leaders
of other Chapters and representatives of the nation-al organization to share
ideas and discuss issues. I think every-one from Georgia enjoyed the meeting.
Representing the Georgia Chapter at national meetings such as LTC and ANI is
truly an eye-opening experience. You quickly realize that the Georgia Chapter
has a reputation of excellence. This reputation was developed through the work
of all of the prior HFMA
Chapter leaders and members, and it is recognized by all the other HFMA
Chapters. With this recognition comes great expectations.
This year, we will work hard to fulfill these expectations by continuing to
dedicate ourselves to the Chapter's mission of providing high quality,
affordable education to our membership. Our Spring Institute at Callaway
Gardens was a great success. In addition, we already have several workshops
scheduled this summer with many more to come throughout the year. The agenda
for our Summer Institute in Hilton Head is complete. It looks like it will be a
terrific meeting. Later this year, we host the Region V Dixie
Institute; and, of course, our nor-mal Fall Institute in Savannah.
As the year plays out, you will notice a few changes, such
as on-line payment and registration for all educational offerings; the use of
CD ROM and e-mail for certain publications and member communication; and
increased reliance on our website for sharing information. We plan to add a
sample CPAR test with answers to our website to assist our CPAR candidates in preparing
for the exam. We also plan to survey the Chapter's membership later this year
via the web. If you have not done so, please visit our website at
www.georgiahfma.org. Be sure to add our website to your list of bookmarks and
visit it frequently.
I look forward to serving you this year. I would like to note that the theme
National Chairperson Ron Long has selected this year is "Leading @ the
Speed of Light." Our theme is a simple response, "Georgia HFMA, Up to
the Challenge!"
See you at Hilton Head!
Sincerely,
Eddie Phillips, President Georgia Chapter HFMA
COVER STORY
Tanner Health System
Bremen, Carrollton and Villa Rica
Tanner Health System has provided comprehensive healthcare services for the
West Central Georgia region for more than 50 years. To meet the challenges of
this rapidly growing suburban area, Tanner is committed to an ongoing strategic
plan which calls for providing patients with convenient access to the latest
advancements in medical technology.
In recognition of this goal, Tanner during the past year has opened two new
community primary care health centers, recruited several new physician
specialists to the area, signed a lease agreement to operate Higgins General
Hospital in Bremen, installed new cardiac catheterization equipment and added
the latest technology for the diagnosis and treatment of cancer.
"Tanner continues to add new
facilities and services to keep pace with the healthcare needs of our g rowing
population," said Loy Howard, Tanner President/CEO. "The partnership
between Tanner and the community has always been strong and we're continuing to
work together to provide individuals with easier access to quality medical
care." Tanner Health System is a
not for profit, regional healthcare organization serving seven West Georgia
counties and two counties in East Alabama. Tanner Health System includes three
hospitals:
Tanner Medical Center/Carrollton, a 202-bed acute care hospital;
Tanner Medical Center/Villa Rica, a 53-bed acute care hospital; and
Higgins General Hospital/ Bremen, a 57-bed acute care hospital.
Tanner also operates a series of primary care clinics and several centers of excellence throughout its service. Tanner Health System has more than 1,600 employees and approximately 150 physicians and dentists on its active medical staff. Tanner is the second largest employer in Carroll County.
Cardiac Services Tanner continues to expand its cardiac services
since heart disease remains the number one killer both in West Georgia and the
nation. Tanner/Carrollton
completed a $1.1 million renovation of its cardiac catheterization/special
procedures laboratory during 2000. This addition included new Philips imaging
equipment which greatly improved the image quality and increased the lab's
capabilities for other diagnostic x-ray procedures. The lab added a compact
disk (CD) image storage system which replaced older videotape for storing
images of arterial studies. Tanner also added an extensive cardiac
rehabilitation program which provides exercise and lifestyle programs,
monitored by c a radiologists, to help guide patients back to good heart health
following heart attacks and cardiac surgery. Tanner plans to expand its cardiac
services in the near future with the construction of a heart center on the
Carrollton campus and the recruitment of additional cardiologists.
Cancer Care Tanner Cancer Center provides full ca re for cancer
patients, backed by the latest innovations in technology and a professional,
caring staff. Daily radiation therapy and chemotherapy are provided, under the
direction of fulltime radiation and medical oncologists. The Cancer Center also provides radioactive
seed therapy for prostate cancer patients, and through cooperation with
Tanner/Villa Rica, provides PET scanning. This innovative technique uses
radioactive isotopes to help diagnose and stage cancer so that the most
effective treatment can be prescribed. The Cancer Center meets the full range
of patient needs with nutritional counseling and assistance with social,
financial
and emotional support for patients and families.
Community Health Tanner began operating Higgins General
Hospital/Bremen in January, 2001, under a long-term lease agreement signed by
the two hospitals. Tanner has committed $9 million in capital improvements at
Higgins to improve healthcare in Haralson County. These enhancements will
include laboratory and emergency room renovation, installation of a new
hospital information system, renovation of the building exterior and addition
of several new services. During 2000 and 2001, Tanner Health System has
continued to expand its network of primary care health centers. West Carroll
Family Healthcare Center in Bowdon opened in January 2000. This 10, 160
square-foot facility was built through the cooperation of Tanner and the Bowdon
Area Hospital Authority to provide services for patients in the western part of
Carroll County, following the closing of Bowdon Area Hospital. The Haralson
Family Healthcare Center and West Georgia Pediatrics/Bremen moved into a new
4,5000 square-foot building in April, 2000. Located near Higgins, the facility
houses three family practice physicians and the first
pediatrics practice to locate in Haralson County. The Tallapoosa Healthcare
Center opened in April, 2001. This 7, 510 square-foot facility was built
through a joint effort of the Tallapoosa Lions Club and Tanner Health System.
It houses four family practice physicians. Tanner also operates other primary
care community clinics in Buchanan, Carrollton, Temple and Villa Rica.
Tanner Medical Par k The Carroll-Paulding-Douglas tri-county area along Interstate-20 is one of the fastest growing are as in Georgia. Tanner/Villa Rica is continuing to expand its medical specialties to serve this growing population. The 10-acre Tanner Medical Park was opened in 1998 with a three-story medical building adjacent to the hospital. The building houses the Tanner/Villa Rica outpatient surgery, along with specialists' offices in family practice, pediatrics, gastroenterology, general surgery, internal medicine, orthopedics, ophthalmology (eyes), otolaryngology (ear-nose-throat) and urology.
Women's Health Tanner Women's Center, with locations in Carrollton,
Villa Rica and Bowdon, provides women with the latest medical technology in
private, homelike settings. A trained staff of female professionals perform
mammography, ultrasound and bone density evaluations. A nurse breast specialist
offers one-on-one self-examination education and clinical breast exams . All
Tanner mammograms are read by ImageScanner, a machine which assists the
radiologists' trained eyes by using the latest computer technology to scan all
mammograms and pinpoint suspicious spots. Tanner was one of the first hospitals
in Georgia to purchase the Image Checker, which functions like a 'spell checker'
for medical images. The Image Checker ' s advanced technology alerts
the radiologist to any suspicious features which may warrant a second review of
the x-ray image.
Maternity Services Maternity services have always been an important part of Tanner. More than 100 babies are delivered at Tanner each month. Tanner/Carrollton opened a newly renovated maternity center in 1999, featuring family-oriented labor/delivery suites. The suites a re furnished in a home bedroom style and each has its own adjacent family waiting room. Tanner has a staff of 10 OB/GYN physicians, 3 nurse-midwives and nurses certified in maternity care.
Intensive Care The rapid are a growth has bro u g h t about a steady
increase in demand for intensive care services. Tanner/Carrollton is currently
constructing a 17,000-square-foot intensive care unit (ICU) ex pansion. This
unit will have 12 patient rooms, with
capability to expand to 24 beds. Modern equipment will include bedside monitors
and power columns in each room that suspend from the ceiling and rotate 180
degrees for easier access and flexibility. A family waiting room, with
amending/kitchen area, shower and privacy room, is part of the project.
Outpatient/Short Stay Surgery
More than 75 percent of all surgical procedures and diagnostic testing are
now conducted on an outpatient basis. This allows most patients to enter the
hospital in the morning for the procedures and return home the same day. Tanner
hospitals have been upgraded in recent years to meet this demand. During 2000, Tanner
outpatient facilities conducted more than 15,200 procedures.
24-Hour Emergency Services All Tanner hospitals provide 24-hour emergency rooms, staffed by specialized emergency physicians and nurses. Tanner emergency rooms average more than 50,000 patient visits per year.
Home Health Tanner Health System is also active in health care
services which provide
medical care outside the walls of the hospital. Tanner Home Health Services
provides patients with comprehensive nursing and therapeutic services in the
security and comfort of their homes. Hospice Care is part of Tanner's home
health program. Hospice provides physical, spiritual and emotional support for
people with terminal illness.
Community Outreach Tanner's Wellness/Health Promotion Department provides a variety of health screenings, health fairs and educational programs throughout the region. A mobile medical unit is available to take these services out to communities, churches, neighborhoods and shopping centers. Tanner offers regular weekly diabetes/hypertension clinics at all its hospitals, under the direction of diabetes educators, registered nurses, dietitians, podiatrists and exercise specialists.
Occupational Health A full range of services for local business and industry includes injury treatment, drug testing, physicals, health screenings and other services to help employers meet their employees' health needs and comply with governmental regulations.
Sleep Studies Tanner's Sleep Lab conducts overnight sleep studies in a bedroom setting to detect sleep apnea and other sleep disorders . The sleep lab staff includes pulmonologists, neurologists and specialized sleep study technologists (polysomnographers).
Rehabilitation Services Tanner offers both inpatient and outpatient
rehabilitation services, including speech/ language, physical and occupational
therapy.
Databases:
A new way to think about business problems
First a little history, eons ago the advent of the spreadsheet was credited with making the PC a practical reality. Prior to then small computers were used to replace typewriters and for purposes of playing games. The spreadsheet provided the ability to solve complicated real world problems. When I was in college we were assigned projects involving the analysis of income statements and balance sheets that took days to complete. Most of the time was spent checking math and doing the simplest of revisions. The spreadsheet reduced the process to minutes and recalculations were done in seconds. This shifted the time spent to building more complex models and analysis.
However, even the most complex models were little more than electronic
versions of accounting ledgers. The spreadsheet became the perfect tools for
the desktop. It also became the focus of the emerging conflict between corporate
IT and the end user. It was no longer necessary to explain the rules to a
programmer and wait months for a solution.
Early on users found that a spreadsheet could be used as a simple database.
Each row on the sheet became a record and each column became a field in the
records. It became possible to sort information by the values in the columns.
Ordering information alphabetically, numerically or by date is a powerful tool.
Spreadsheet jockeys further annoyed IT by demanding downloads of information from
the "Main Frame" to massage with the spreadsheet. While this was a
very big step, the information was static and it was difficult to add new
information to make the analysis relevant to small business units.
Shortly after the advent of the spreadsheet, two men named Ashton and Tate
modified software developed at Boeing Aircraft called dBase II. (I don't think
there was a dBase I.) dBase provide three new tools, forms and reports to
present information, a way to use information in table format (rows and
columns), and a way to relate multiple tables. This had the advantage of
organizing information without a large "flat file" spreadsheet. While
dBase was a marvelous tool, it lacked the friendly user interface of the
spreadsheet. It also required using a programming language, which was the
beginning of SQL (Structured Query Language). It was the perfect tool for IT to
regain control of information presented to the desktop.
This started a revolution that changed American business. Ordinary business
people became aware of a new way of thinking about information. In the early
1980's, I attended a meeting in Chicago, IL. It was a meeting demanded by a
group of desktop jockeys who had the idea that the company needed a shared
database. The word "enterprise" had yet to be invented. For two days,
twenty people sat in a room designing the system that was wanted. After lunch
on the second day, the two people representing IT confirmed what we wanted
could not be done and they were right. Shortly both were offered an opportunity
to enrich the lives of people elsewhere. Work began on the new system,
but it became the province of IT and the spreadsheet continued as the primary
analysis tool at the desktop.
It would take ten years for this change to occur. In the early 1990s several new database systems arrived. Among them were Lotus Notes, Improve, and Microsoft Access. They offered some new tools "the object" and a graphical user interface (GUI). Of these, IT was quick to embrace Lotus Notes. Access remained a desktop tool and the others fell to a distant third place. Access was easy to use and underneath was a set of tools that made it very powerful. A Query tool enabled hooking tables together. A true programming language provided extended power and an excellent report writer was built into the software. Finally, a set of wizards was provided to get the user started.
With the history out of the way, what is a database and how are they
different? At the heart of Access is a new way of thinking about information
and how to present it. Access is "object orientated", "event
driven" software. Without getting into a lot of technical mumbo jumbo,
"object" means the components can be described using properties and
"event driven" means the object can be con-trolled based on timing.
An example is probably in order. Let's use a little dog Phydeaux (he's a Cajun
puppy). The dog is our object. We can describe him in terms of his properties.
He has leg properties that equal four. He has other properties such as skin and
eyes. In fact, little Phydeaux has many things in common with other objects
like people or cows. The difference is in the detail of the properties and one
additional concept called a "method." A method is how the property is
used. Dogs and people both have walk methods. A dog uses the
four-leg property and people use the two-leg property. How they use the
property is the method and when they use the property is the event.
What does this have to do with databases? The answer is databases are an
attempt to organize and describe the real world. So it is helpful to have
tools, which emulate the real world. When we create a form, the form and
everything on it is an object and each object has its own properties and
events. As you dig into Access, you may want to learn more about how to use
these elements.
While this is all helpful, it is not necessary to get started using a
database. The most important thing is to have a problem you understand and feel
could be better organized using a database. An existing spreadsheet is a great
way to start and spending a little
time learning to use the built-in wizards is a good way to begin.
The strength of a database is in the ability to separate information into small understandable areas and then select only the information of interest. Perhaps the most important strength is the ability to simultaneously share information with many people. This means that some people can be adding or changing information while others are running reports. Another important ability is enforcing business rules to make sure all information is accurate. This can provide the ability to report on the information based on the business rules. As an example, a query could be used to fine all records which are "open" and that do not have a "sales amount" entered.
Learning to use a database, like most new tools, requires time and the first time is always to hardest, but the steps are actually simple:
1. Sit down with a blank piece of paper and describe the objective of the
database. The following is an example:
I need to organize information about my clients, the people who place orders,
when and where the order was shipped, the number and price of items ordered and
where we get the items.
2. This described the essence of every system used to manage sales and inventory
from the largest to the smallest company. The difference is in the complexity
of the system, but the process is identical.
3. Create a list of the individual pieces of information with the information
type.
i.e. Customer Name = text, Item Amount = Currency.
4. Arrange the information into logical groups, Client information, Orders
information, Supplier information etc.
5. Use the table Wizard to help create the tables, forms and reports.
6. Learn how to use simple queries. Will everything work perfectly? No, but at
the end of a couple of hours you will be well down the road to using a new tool
to increase your productivity. In many ways, using a database is easier that
trying to solve the same problem with a spreadsheet.
Let's say you need to keep track of sales on customers and total them by a
category such as sales person or region, this would not be a difficult task
with a spreadsheet for a few records, but what if you had thousands of new
records that were added every month? It could take several hours to create each
spreadsheet needed. A database can reduce this to minutes. At the Hilton Head
seminar you will learn how to create a database by designing the tables, forms,
queries and reports. We will also cover how to enforce business rules and make
sure your information is as accurate as possible. Reference materials and some
helpful web sites will also be offered to make your learning easier. More
importantly you will learn a new way to thing about business problems.
New Study Reveals How Patient Satisfaction Impacts Hospital Revenue and
Profit
There is a phenomenon going on that is having a subtle but negative impact
on cash and hospital executives need to be aware. The phenomenon is that
patient satisfaction has a direct correlation to profitability of a hospital.
Recent studies by Zimmerman & Associates show the level of patient
satisfaction impacts hospital cash flow
and profit in two distinct ways:
1. Loyalty Factor: Good customer service equates to patient loyalty and
consistent revenue. Poor customer service negates patient loyalty and decreases
revenue.
2. Patient Pay Factor: Poor customer service by the business office and/or
patient access areas causes patients to delay or refuse to pay their portion of
the bill. Studies show hospitals with the highest patient satisfaction scores
are also the most profitable. Also,
research shows improvement in retention rates can have a meaningful effect on
profitability; a five-percentage point improvement may be worth more than $2
million on a five-year hospital contract covering 50,000 lives. Customer
service has indeed become the new battlefield for providers in this day of the
new paradigm in healthcare delivery. Profit and excellent customer service will
go hand in hand. More and more, the service
and patient relations context that surrounds the medical care given will give
providers added value and will differentiate them from the competition. Future
business in the form of patient volume will swing in the balance, based a great
deal on provider customer service.
Research shows when patients feel they do not get good customer service from
patient access and/ or the business office they delay paying their portion of
the bill. To compound that situation, Zimmerman & Associates studies show
that patients now make up a greater portion of hospital's net revenue than at
any time since the early 1960s.
Zimmerman & Associates research indicates over 20 percent of the hospital's
net revenue comes directly from the patient. Fifteen years ago, self-pay made
up less than ten percent of net revenue. Increasing deductibles and contractual
allowances have changed the percent of patient pay to net revenue dramatically
in recent years. Hospital patients from across the country indicated that
almost four out of ten are unhappy with the billing
and collection process. The Zimmerman & Associates survey revealed that six
percent of the patients were so disappointed with billing and collection
procedures that they would not return to the same hospital for future care or
recommend it to others. This means hospitals are losing more than six percent
of future revenue for reasons that could be avoided. Zimmerman &
Associates, a consulting firm in Milwaukee, Wisconsin, has developed a new
white paper that details a convincing argument that patient satisfaction does
indeed impact hospital cash flow and profit. The white paper also includes
recommendations for hospitals to improve their customer service and a detailed
case study of a success story in hospital patient satisfaction.
For your complimentary copy of this new and provocative white paper
entitled, How Patient Satisfaction Impacts Hospital Revenue and Profit, please
call 800-525-0133 or
e-mail info@zimmassoc.com and request a copy!
The Office of Insured Health
Facilities:
"Helping You Survive on the Island”
For the past several years, rural hospitals have been operating in
"survival" mode. Not only have they been competing against each
other, but they have also been dealing with challenges such as reductions in
Medicare from the Balanced Budget Act and tight
state budgets for Medicaid reimbursements.
The Capital Problem Technology advances, aging facilities, and
increased healthcare demands from the Baby Boom generation have resulted in a
pent-up demand for capital at reasonable rates. Those funds are desperately
needed for anything from the replacement of equipment to the full replacement
of facilities, many of which were constructed during the Hill-Burton period
decades ago.
Unfortunately, due to the great challenges that rural healthcare systems face,
investors and other usual providers of capital have been reluctant to provide
attractive rates on funds. This dilemma has truly left rural healthcare on an
"island" of its own with no choice but to survive the elements. Many
have been forced to "make do" by entering into unfavorable equipment
leases or depleting available cash and investment reserves. Some have been
forced to close their doors and leave entire communities without adequate
healthcare. Some, unable to survive on their own, have turned to for profit
hospital organizations who have come to the rescue by acquiring or leasing the
facility.
New Hope Small, rural hospitals have new New Hope Small, rural
hospitals have new hope for survival thanks to the recent Relief Act and much
more liberal regulations related to Critical Access Hospital (CAH)
designations. The revision of the CAH designation has opened up new relief
options from the lesser-known Office of Insured Health Facilities of the
Federal Housing Administration (FHA). This office has remained relatively
obscure to rural hospitals since its formation in 1968. Under the auspices of
the U. S. Department of Housing and Urban Development, the office can help meet
the bond insurance needs of many rural hospitals through the HUD 242 program,
making it possible for them to attain financing for capital projects.
The HUD 242 Program Since the Office of Insured Healthcare Facilities
and the HUD 242 program began 32 years ago, the FHA has insured more than $9
billion in mortgages for about 300 hospitals. Hospitals helped by the program
range in size from small hospitals to some of the largest teaching hospitals in
the nation. Historically, the program has generally been unavailable to rural
hospitals because it was difficult for them to meet the financial-projection
requirements. The Critical Access Hospital designation provides
enough financial stability to put the HUD 242 program within reach. The HUD 242
program enhances the credit worthiness of the hospital because the debt is
backed by the full faith and credit of the US government, resulting in very
attractive low-interest rates. Those rates can range as low as 51/ 2 to 6
percent as opposed to the 8.25 or 8.5 percent on the open market.
Qualifying for HUD 242 To qualify for the HUD 242 program, hospitals
must meet certain criteria in the ratio of services they provide. For example,
acute care hospitals must obtain less than 50% of their revenue from rehab,
convalescence, substance-abuse treatment, mental patients, or tuberculosis
treatment. The application process includes preparing a financial projection
simulating the impact of additional capital costs on Medicare CAH reimbursement
as well as the hospital's bottom line. The hospital must be financially strong
enough to service the loan and must be able to pay 0.8% of the loan up front,
along with a fixed annual mortgage insurance premium of 0.5% of the remaining
balance. This application process typically takes less than four months. New
initiatives have been implemented to help streamline the application process
for Critical Access Hospitals, and often the FHA will arrange for and pay for
the feasibility study.
Summary These long-awaited capital options have brought a guarded optimism to the surface for rural hospitals. T h rough the Office of Insure d Health Facilities and the HUD 242 program, many hospital management teams and their board members have begun the process of attaining sufficient capital for construction and other projects, taking them from "survival" mode into a new era of financial stability. Ed Cody is the partner in charge of Crisp Hughes Evans' Western North Carolina Practice Unit. His responsibilities include coordinating audit, tax and consulting services for clients in the healthcare, not for profit and governmental industries. Ed has significant experience with mergers and acquisitions, forecasts and projects, and strategic planning. He has recently completed the extensive requirements and examinations for recognition by HFMA as a Certified Healthcare Financial Professional (CHFP).
John Frank is a senior manager in Crisp Hughes Evans' Atlanta Office. His
responsibilities include supervising and reviewing the preparation of cost
reports for hospital clients in the healthcare industry. Prior to joining Crisp
Hughes Evans LLP, John had experience in regulatory and financial consulting
with Ernst & Young LLP as well as experience with Blue Cross/ Blue Shield
of Maryland in the Medicare Audit and Reimbursement Department. John has over
13 years of regulatory and financial experience in the health-care industry.
By Ed Cody, CPA, CHFP and John Frank
CPAR CPAR CPAR CPAR CPAR CPAR
Fall is fast approaching and that means the annual CPAR exam is just around
the corner. Each year the Georgia chapter of HFMA strives to continue CPA R
education throughout the state. The goal of the CPAR committee is to have more
people sit for and pass the exam. The CPAR committee has committed itself to
having the updated manual ready for distribution in mid July. This year there
will be seven options for coaching sessions and ten options for testing.
Remember the more people that take CPAR the more educated we will be as a
chapter. Please visit our website at WWW.GeorgiaHFMA.org for CPAR updates.
Below are the coaching and testing dates and locations.
By Ellen Silva
Congratulations to this Year’s Award Winners!
As in years past, we had a wonderful time at the HFMA Spring Institute at
Callaway Gardens. Once again awards w e re presented to some of the most
respected, active and contributing members in the Georgia Chapter. Each HFMA
member is an asset to the Chapter, but these members were recognized at the
officer installation dinner for
their special qualities and contributions to the Chapter.
2000-2001 Awards were presented by President, Eddie Philips; Board Member, Rick Childs; Committee Chairperson, Michelle Lee; Treasurer, Becky Black; and Scroll Editor, Carmen Sessoms. Award winners are nominated by members of the Awards Committee and awards based on varying criterion. Please join all HFMA Georgia Chapter members in expressing your congratulations and appreciation to these special individuals.
2000-2001 AWARDS/ WINNERS
°Charles H. Anderson President's
Award
Terri Tillery, Board Member and Chairperson, Communications Council
°Ann P. Longshore Distinguished Service Award Susan Clark, Chairperson, Education Content Committee
°Sister Rose Margaret Schweers' Most Valuable Member Award
Greg Clark, Chairperson/ Faculty Professional Development Committee
1st Runner-Up Alan Goldberg, Member/ Faculty
Professional Development Committee
°Most Valuable New Member Award Pete Hogan, Member Data Base Committee
°OJ Booker Scholarship Award Kimberly Farmer, Chairperson Hotline Committee
°Georgia Scroll Best Article
Jim Piper, Chapter Historian for the Anniversary article
1st Runner-up Glenn Pearson, contributor for
Streamlining Claims Processing article.
By Gal Scarboro-Hriz
MEMBER
Spotlight
Thomas Y. McBride, III, FHFMA
Senior Vice President and CFO at Gwinnett Health System
By Ellen Silva
It is very unlikely you will ever meet a more pleasant HFMA member than
Tommy McBride. His quiet, unassuming demeanor is not to be confused with
meek-ness.
His commitment to the financial performance and regulatory compliance at
Gwinnett Health System is indisputable. Tommy has been Senior Vice President
and CFO at Gwinnett since 1992. Prior to Gwinnett, he was at St. Joseph
Hospital in Augusta, Georgia. He began as Accounting Supervisor in 1976, and
worked his way up the ladder to CFO by 1984. Tommy received his BBA and MBA
from Augusta State University. Prior to making the plunge into healthcare in
1976, he worked in the corporate office of a multi-state retail jewelry store
operation.
The feedback among his peers at Promina is that he has become a sort of
"elder" statesman of CFO's who can always seem to draw on his
professional experiences to help resolve the complex financial issues of the
day at just the right moment. The only puzzling part about Tommy's skills is
how his golf handicap keeps improving the more demanding this healthcare
environment gets.
No surprise that Tommy is an avid golfer, growing up in the Augusta area
(it's home of The Masters, you know). When his busy schedule permits, hunting
and sporting clays are among his non-healthcare interests. Tommy and Brenda
have been married for 12 years. He has 3 children, Marla, Jennifer and Bryan.
As if he did not have enough to do, he also serves on the board of the Gwinnett
County Boys and Girls Club. A long-term member of the Rotary Club of Gwinnett
County, it is fitting that Tommy is the Fundraiser Chairman.
When asked for a quote, Tommy stated, "I will always remember my success
is and has been dependent on family, friends, associates and mentors, who encouraged
me, challenged me, and supported me with high levels of performance." Over
the years, Tommy has chaired various HFMA committees, in addition to serving as
a Board Member.
The future of healthcare will be very challenging according to Tommy. He comments
there will be a number of issues surrounding compliance. Some of the challenges
will include conveying and improving quality in healthcare, improving financial
performance
and maintaining access to capital. The key to success will be dedicated and committed
individuals.
HFMA and
Habitat for Humanity
While brainstorming ideas for a public service activity, the Public
Relations TEAM for our Chapter decided to ask our members to participate in a
home building project with Habitat for Humanity. After the recent loss of HFMA
member, Dwight Sims, the decision to work on the project in Newnan, Georgia,
home of Dwight's family, seemed to be a fitting way to honor a valued friend
from our HMFA community. The purpose and mission of the activity was very simple.
We wanted HFMA members to have an opportunity give to serve the public through
volunteerism with the hope that others would benefit from our efforts.
Habitat for Humanity has been around for many years. Working under the notion
that homeownership builds community, homes are built all over the world for
families that otherwise might never experience the joy and security of owning a
home of their own. It is not a "giveaway" program; the homeowners are
required to pay off the house with a 25-year mortgage. Homeowners have to apply
for the house, and they must have lived and worked in the building area for
more than one year. After applications are
submitted, the Habitat for Humanity staff assesses each one and makes their
decision based on need, ability to pay for the house and the applicant's
willingness to participate
by agreeing to 300 hours of "sweat equity."
Homes are typically funded and have labor provided by area churches, corporate
grants, and private donations. Early Saturday morning, at the end of March
2001, members of our Chapter met in Newnan to begin building a home. When we
arrived, it was muddy and damp. Parking was scarce, but an abundant supply of
doughnuts and orange juice "rushed" a helping of energizing sugar
into our bodies so we could begin our work. The house consisted of a raw block
foundation. After arming a willing group of healthcare financial professionals
with hammers, nails, and aprons, (probably a risky venture in itself), we
worked diligently to assemble the floor of the new house. The rains came, but
the pounding of eager novice carpenters continued. As we broke for lunch,
exhausted and soaked to the bone, many of us were smiling and feeling a great
sense of accomplishment. A true "team" effort was required and our
members and friends, several with their spouses or children in tow, delivered
beautifully.
Our committee would like to issue a special "thank you" to each
member who contributed to the Habitat for Humanity project in Newnan. Your
leadership and community spirit is a direct reflection of the high standards
consistently upheld by the Georgia Chapter of HFMA. Great things can happen
when we work together! For the coming
year, we would like to repeat this adventure (even if it rains again) with
Habitat. Habitat for Humanity's north Fulton branch is going to begin a 16-home
project in a collaboration between 15 area churches and other sponsors to
provide affordable housing to 16 families who otherwise would not be able to
afford a home. The Public Relations TEAM will be
exploring this and other opportunities for our members to "lend a helping
hand" in Georgia.
Joe Hall Co-Chairperson
Public Relations TEAM
Founders POINTS
It is that time of year again to make sure our members are well educated on the Founders Merit Award Series. Much of the following information is taken from my article from last year giving the history of the program. I think it is a good review for current members and gives new members a quick summary of what the Series is and how it was developed.
The Founders Merit Award Series was created in 1960 as a way to recognize
the contributions of time, talents, ideas and energy of the members of HFMA.
HFMA grows
through the efforts of its volunteers. Participation provides opportunities to
grow in our profession in the healthcare financial industry and make HFMA a
stronger organization
for its membership. The Founders Merit Awards are part of a rating plan that
assigns a range of points to activities each member participates in throughout
the year. There are
four awards in the series.
First, the Follmer Bronze Award. This award is named after William G.
Follmer, who is credited with the creation of the American Association of
Hospital Accountants (AAHA), now known as HFMA. It takes 100 Founders points to
obtain this award. Second, the Reeves Silver Award. This award is named after
Robert H. Reeves, who was instrumental in creating the structure of AAHA. This
award is given after the member reaches 200 Founder Points. Third, Muncie Gold
Award. This award is named after Fredrick T. Muncie, who was the first
president of AAHA and assisted in organizing the first AAHA Chapter -First
Illinois. This award is received after the member accumulates 300 points. The
Forth and final award in the series, the Founders Medal of Honor, recognizes
the member for significant service to the organization. This award must be
nominated by the Chapter Board of Directors and can be awarded three years
after the Muncie Gold
Award and three additional years of active participation in HFMA.
The Founders Award Series rewards continuous active participation in HFMA
both at the local Chapter and on the National Level. The Award system allows a
maximum of 40
points to be accumulated during each fiscal year. This means that it will take
a minimum of three years to obtain each level of the Award series. This
promotes the continuous active participation. Points earned during the year are
tracked and reported by the Chapters Founders Contact or Data Base Chairperson
to National by the 1oth of August each year. National tracks points that are
accumulated at the National level, such as, membership, certification, etc. The
Chapter tracks points for attendance at Local Institutes, workshops, Telnets,
articles and publications and committee participation. Your points will follow
you from one Chapter to another.
That is the history and now it is time to get involved. You get 2 points just for being a member! Our institutes and workshops give you more points as well as National activities. The two best ways to gain points and be involved in our Chapter (the best Chapter in the Country!) is to join a Team and get involved in the Teams' activities. The second thing you can do is to write an article for The Georgia Scroll (our Quarterly magazine). There are three more issues this year and here are the deadlines for submission:
September 10, 2001
Fall 2001 Issue
December 10, 2001
Winter 2002 Issue
February 24, 2001
Spring 2002 Issue
You can contact Carmen Sessoms for details on article submission requirements at Carmen. sessoms@itb.mckhboc.com
We will be submitting the Chapter level points during June for the 2000
-2001 reporting year. Remember that if you are Georgia member and you have
activities that qualify for the Founders Points program you need to contact me
with that detail so I can include it with our submission in June to National.
Examples would be articles in other newsletters or speaking for other chapters
or organizations. If you have any questions concerning your total points, or
you feel that you have not received points that you may have earned, please
contact Rick Childs via e-mail to review your points.
Childs_Richard@Piedmont.Promina.org
Follmer Bronze Award
Reeves Silver Award
Muncie Gold Award
Medal of Honor
Richard L. Childs, FHFMA
GEORGIA CHAPTER HFMA'S INFORMATION HOTLINE
The Information Hotline of HFMA Georgia Chapter is offered as a service to
keep its
members up to date on various topics. Current topics include Institute
information, CPAR, Advanced CPAR, and Reimbursement updates. As new information
becomes available, the Hotline is updated. The Information Hotline provides 24
hours, seven day a week access. Is the Hotline easy to use? The phone numbers
are (404) 250-7507 for metro Atlanta members or 1-800-388-4154. Choose the
option of the topic that you want to hear and sit back and relax. Some topics
will give you the option to leave a message. If
you are instructed to leave a message at the end of the pre-recorded
information, simply
leave your message after the tone.
What can I get by using the Information Hotline? Receive updated information
regarding HCFA rulings; CPAR test dates and sites; and C PAR Coaching Sessions
dates and sites. In addition we will be providing information regarding
Advanced CPAR dates and sites; upcoming Institute information, including dates,
session topics and reservation prices and
deadlines; and much more.
If you have any questions or comments regarding the Information Hotline,
please contact Kimberly Farmer at Chamberlin Edmonds & Associates, Inc.
either by email at farmer@ce-a.com or phone at 404-634-5196 ext 1260.
By: Kimberly Farmer
Client Services Manager Chamberlin Edmonds & Associates, Inc.
Successfully Implementing HCFA Category Codes
Appropriate outpatient Medicare reimbursement requires ongoing maintenance of your Charge Master file to include valid codes for medical devices designated for Pass Through payment methodology. Many hospitals have found that the working team assigned to Pass Through code assignment has become disillusioned with the unwieldy and constantly changing volume of codes. To the industry's satisfaction (and due to the device manufacturing industry's heavy lobbying), HCFA announced that effective April 1, 2001, it has replaced the 486 previously published Pass Through codes with 92 codes representing general categories of devices. New codes and definitions of Pass Through items were effective April 1 and are required by July 1.
To assist in the device coding transition within the Charge Master file, we have summarized key points and included Medicare regulatory citations.
Background Effective April 1,
2001, the BIPA (Medicare, Medicaid and SCHIP
Benefits Improvement and Protection Act) of 2000 mandated
Medicare's conversion to category codes for pass-through devices. The
"Category Codes" are included in HCPCS Level II coding standards and
so named because they are based on categories of devices. This means that
earlier released codes for devices billed with a date of service up to June 30,
2001 (90-day grace period) will be retired. Updates based on this new guidance
does not merely reflect coding changes, but introduces a change in
reimbursement. The new category coding methodology allows payment for some
devices which were not paid separately in previous months under the former
guidelines. Transitional pass-through payments for drugs or biologicals are not
affected by conversion to any generic method of coding.
In the future, Medicare does not intend to make item-specific determinations of
pass through devices, but plans to use codes representing categories of
devices. As noted in the APC Final Rule, pass-through codes are temporary, and
used for proper payment until the payment rates for associated procedures can
be adjusted accordingly. For example, most codes released in the March 22
transmittals will expire January 1, 2003. Intermediary Transmittal A-01-41 of
March 22, 2001 provides general guidelines for converting to this streamlined
coding methodology. This transmittal contains three attachments which are of
importance:
Attachment I (Release 2001-01)
General Coding and Billing Instructions and Explanations
Attachment II. C-Codes for Categories
Attachment III. Cross-Walk from Item-Specific "C" Codes to New
Category C-Codes (Subscribers -please note that we are providing this
cross-walk information within your Chargemasters.com Pass-Through file for easy
access to
new codes.)
Assess your Pass-Through Status Prior to moving forward with code conversion tasks, determine your facility 's past success with pass-through code assignment within the Charge Master file. If your hospital has updated pass-through codes based on each Medicare revision, your conversion to category codes will be straightforward. You may not be required to apply all recommended steps listed within the next section.
If your facility has partially implemented pass-through codes, we recommend taking a 'clean sweep' through all new codes and applicable devices used within the facility. This ensures complete Charge Master updates for full reimbursement opportunity.
If your facility has not implemented pass through codes, you have lost reimbursement for all applicable devices since the implementation of APCs in August, 2000. Pass through code assignment using the new category codes should be a facility priority to obtain proper Medicare outpatient payments.
Steps for Implementing New Category
Codes
1) Reference the Medicare Transmittal A-01-41 and provide copies of
applicable sections to the appropriate department managers. (ex. Surgery,
Cardiac Catheterization Lab, Radiology, Endoscopy, Central Supply and/ or
Materials Management).
2) Assign a project team. First, name a Project Leader, and develop a brief pass-through Conversion Work plan including tasks, task owners, due dates, sign-off requirements, and any specific billing or file update contingencies. Administrative support for enforcing managers' completion of the required priority tasks is crucial for the Project Leader's success. Understandably, department managers become frustrated with the changing rules, man-hour requirements for code updates, and lack of support staff to implement Charge Master updates. Often Charge Master updates lose priority and are incomplete. While new coding methodology will make future updates much easier, Manager ownership will still be necessary.
3) If you are unsure of whether select devices used by your facility qualify
under this category -based coding system, contact manufacturers for new
Category C-Code
updates for your purchased or con-signed devices. We have found that
Manufacturers often include more model-specific information than Medicare,
which is helpful for
identifying specific devices. File all Manufacturer supporting documentation
in your Charge Master Compliance files, as HCFA regards such information as
reasonable support for coding decisions.
4) Review the criteria for pass-through codes in a team meeting, and encourage questions and discussions from the applicable managers. Explain to your team that the release of Category C-Codes introduces an expanded payment philosophy. (Inaccurate assignment of Category codes would create compliance risk, so be sure your managers understand the revised rules.) References for C-Code criteria are available in this article and within A-01-41. Medicare plans to release more specific criteria for creation of additional categories in the near future.
5) Determine which charge items must be created or modified within the
Charge Master file to allow proper code assignment. (Note that some past codes
have been split into multiple codes to reflect varied device components.) Also
determine whether charges which were created specifically for the previous
device-specific pass through methodology should be consolidated into more
general charge items which are assigned
the category codes.
6) Submit for data entry replacement codes or other modifications to the Charge Master file. Remove pass-through codes which are now expired and revise the Revenue Codes for those charge items as appropriate. (ex.. change 278 to 270 if no longer a pass through item)
7) After data entry, perform quality audits of Charge Master revisions to ensure accurate HCPCS, Revenue Code, and charge structure changes for all pass-through charge items.
8) Set claims editor and/ or billing software parameters to withhold printing of pass-through device codes on the UB-92 for payors which do not require the HCPCS Level II codes.
9) Create a claims editing and follow up plan to ensure appropriate feedback
to managers. As with all charge improvement initiatives, we recommend that the
billing staff documents any rejected code for immediate Charge Master
resolution
by the Department M a n a g e r. We also recommend ongoing review of claims
editor or
billing system error reports to monitor for any coding discrepancies.
Criteria and HCFA Clarifications According
to A-01-41, "Each item previously determined to qualify fits in one of
these categories. Other items may be billed using
the category codes, even though HCFA has not qualified them on an item-specific
basis, as long as they:
A. Meet the definition of a device that qualifies for transitional pass-through payments and other requirements and definitions...;
B. Are described by the long descriptor associated with an active category code ...; and
C. Accord with definitions of terms and other general explanations issued by HCFA to accompany coding assignments in this or subsequent instructions... "
Item A, above, refers to the definition of devices posted in the Federal Register
on August 3, 2000 and subsequently listed under 42 CFR 419.43. As noted in
transmittal A-01-41, the aspect determining whether a device was paid for as of
December 31, 1996
no longer applies.
Criteria listed in "C" above, in and of itself does not give rise to pass-through payment. The device must meet the description and other coding instructions of an established category.
As documented on page four of A-01-41, use the following guidelines to
determine which devices are eligible for transitional pass-through payments. In
addition to
Medicare's medical necessity requirements, all of these requirements must be
met to qualify for payment:
A. They are described by the long descriptor of a C code issued by HCFA for
this purpose and meet other definitions and general coding instructions in this
or subsequent
instructions.
B. They have been approved or cleared for use by the Food and Drug
Administration (FDA), if such approval or clearance is required and subject to
the exception
for certain investigational devices noted in C.
C. They are considered to be reasonable and necessary for the diagnosis or
treatment of an illness or injury or to improve the functioning of a malformed
body part, as required by sec-tion1862( a)( 1)( A) of the Act. Some investigational
devices are refinements or replications of existing technologies and may be
considered reasonable and necessary. Such devices that have received an FDA
investigational device exemption (IDE) and are
classified by the FDA as Category B devices are eligible for transitional
pass-through payments if all other requirements are met.
D. They are an integral and subordinate part of the procedure performed, are
used for one
patient only, are single use, come in contact with human tissue, and are surgically
implanted or inserted whether or not they remain with the patient when the
patient
is released from the hospital out-patient department.
E. They are not equipment, instruments, apparatuses, implements, or such
items for which depreciation and financing expenses are recovered as
depreciable assets as defined in Chapter 1 of the Medicare Provider
Reimbursement Manual (HCFA
Pub. 15-1).
F. They are not materials and sup-plies (such as sutures, customized
surgical kits, or clips, other than radiological site makers) furnished
incident to a service or
procedure. Supplies include pharmacological imaging and stressing agents other
than radiopharmaceutical or contrast agents (for which transitional
pass-through payments are authorized under section 1833( t)( 6)( A) of the
Act).
G. They are not materials such as biologicals or synthetics that may be used to replace human skin.
H C FA states that it plans to post instructions and explanations for coding and billing of pass-through Devices on its website. Information included in Attachment I of A-01-41 is referenced as Release 2001-01. In this release, six general instructions are provided, and thirty-four items are clarified for terminology and usage applicable to pass-through guidelines. General Instructions as posted in the transmittal are as follows:
Supplies Contained in Kits -HCFA has not established codes for kits, but
recognizes that providers purchase kits through their materials management
agreements with vendors. Hospitals may not bill for transitional pass-through
payments for supplies contained in
kits. If kits contain an individual pass-through item, HCFA suggests separately
billing the item with the applicable pass-through Code. If your Hospital
Information System allows "charge explosion" functionality within the
Patient Accounting application, this
would be the most effective Charge Master structure. If not, separate charges
should be created to differentiate the pass-through item( s) from other
packaged items. (Note: we are not suggesting 'unbundling' of all supply items.)
Any order entry menus, charge forms, bar codes, stickers, or other charge
capture tools must be expanded for all component charges.
Multiple Units -HCFA instructs hospitals to enter the number of units in the
units field of the UB-92 claim form for pass-through devices. Modifiers do not
apply. Old Codes and Grace Period
Device-specific pass-through codes will remain active through a 90-day
grace period. Either the specific code or the category code may be billed
during this time.
Items with a date of provision after June 30, 2001 must be billed with earlier
category codes to receive payment and pass claims edits.
Reporting of Multiple Categories -Eight device-specific pass-through codes
have been split into multiple category codes. These include: separate coding
for pulse generator, neurostimulator lead, and neurostimulator extension for
neurostimulator systems (C1102,
C1353); catheter, advancer (sheath) and, guidewire (as applicable) for
atherectomy systems (C1043, C1035, C1500); catheter and introducer/ sheath for
peripherally inserted catheters (e. g. PICC lines) (C2597, C2598, and C2599).
Multiple Pass Through Items Packaged within Kits -Report all appropriate
category codes where multiple pass-through items are included in a packaged
kit. This may require multiple pass-through codes where only one code applied
prior to April 1. As noted earlier, if your Hospital Information System allows
"charge explosion" functionality
within the Patient Accounting application, this would be the most effective
Charge Master structure. If not, separate charges should be created to
differentiate
the pass-through item( s) from other packaged items. Any order entry menus,
charge forms, bar codes, stickers, or other charge capture tools must be
expanded
for all component charges. Reprocessed Devices -Medicare follows a "single
use" definition for billable pass-through items. HCFA defers to the FDA
guidelines for classification of reprocessed devices that may be considered
"single use".
Summary As summarized in this article, Medicare's new category code guidance introduces important changes relative to Pass Through reimbursement methodology for devices. Failure to implement or maintain these codes will cause loss of reimbursement for a surprising number of items.
While codes, status indicators, and other APC payment information will continue to be modified, we believe the new category code methodology will significantly improve hospitals' success with pass-through device reimbursement.
Rosemary Holliday, MHA Copyright (c) Holliday & Associates 2001
APC SUCCESS -Teamwork is the key
Ambulatory Payment Classifications (APCs) were implemented August 1, 2000,
and you thought your facility had everything in place to submit "clean
claims" to Medicare and receive optimal reimbursement. The hospital
established an APC Team and provided professional development opportunities to
the staff prior to the August 1, 2000 implementation date. You thought that
everyone was knowledgeable of the many new requirements for outpatient billing.
In addition, your APC Team met regularly to discuss the ongoing changes and
problems occurring with the coding and billing processes. You read the Federal
Registers from April and November 2000 and all Program Memorandums, reviewed
numerous articles, and shared the information with appropriate hospital
personnel. Having gone to such great lengths prior to the APC implementation
last summer, why are many hospitals finding that volumes of claims are being
rejected, denied, Returned to Provider (RTP), or even suspend-ed? The reasons
may be found in the hospital's teamwork. It is essential that hospital
stakeholders clearly understand the interrelationships between various hospital
key players and seek every opportunity to
improve the APC processes through the active involvement of all team players.
Any proposed changes must be driven by a well-conceived action plan that
involves these key players. The elements of any plan, which are set forth in
this article, center around informed teamwork.
To maintain cash flow, facilities must focus on significant issues Ñ direct
and indirect Ñ which may cause claims to be returned to the provider. The
"team approach" stressed in hospitals for years, must now become a
reality. Health Information Management departments (formerly called Medical
Records) were the key stakeholder during implementation of the Diagnostic
Related Group (DRG) reimbursement system for inpatients in 1983. HIM personnel
will continue to be a key stakeholder with APC's. However, for an effective
process, the business office, finance, information systems, and
ancillary department directors must also join the team. The Chief Financial
Officer, by necessity, must lead the team, as he/ she emphasizes the importance
of the team's role in revenue enhancement and compliance. The APC Team, with
the direction of the Chief Financial Officer, should work closely with the
facility's compliance committee to ensure compliance with all regulatory
requirements.
CPT and HCPCS codes, which determine APC reimbursement, may be submitted to
the claim by medical record coders. However, approximately 73 percent of the
charges associated with outpatient services and ambulatory surgery are
generated through the hospital's charge description master (CDM). A focused,
comprehensive review of
the CDM is an important Ñ almost mandatory Ñ step, to ensure appropriate
reimbursement. The majority of hospitals charge their line items by assigning
CPT
and HCPCS codes (hard-coding) in the charge master. These codes are selected by
the department performing the procedures and are printed on the claims
automatically by the computer system. If the charge description and appropriate
CPT/ HCPSC code are not submitted on the claim, the claim will be denied or returned
to the provider. To ensure that all billable services provided by the hospital
are accounted for and accurately coded, team members must review each line item
on the CDM. It is imperative that department representatives understand the
services their departments provide and how to match the appropriate CPT code to
each service. They must verify that old codes are deleted, new codes are added,
and the descriptions accurately describe the services provided. If modifiers
are included in the CDM, they must be reviewed quarterly to assure they are
still recognized by Medicare. In addition, the CDM must comply with Medicare
rules and regulations and coding guidelines.
An annual comprehensive review of the CDM is recommended, prefer-ably
soon after the release of the new CPT book in January. Quarterly reviews and
updates of the CDM are suggested since information regarding new technology and
device codes is released in quarterly Program Memorandums, as well as the
Federal Registers. Codes assigned to new devices and technology are often brand
specific so, therefore, once again, it is imperative that each new code and
description be reviewed to determine the applicability of codes for individual
facilities. All new codes, with accurate descriptions, should be added to the
CDM immediately to capture appropriate reimbursement
for the facility.
For example: Insertion of a penile prosthesis procedure is performed. A Dura II
penile prosthesis is insert-ed. The Dura II prosthesis can be coded using HCPCS
C1007 which groups to APC 1007 and is eligible for pass-through payment. If the
HCPCS code is not included on the UB92, the facility will receive only the
payment for the surgical procedure which can be coded using CPT 54400, 54401 or
54405. All three
CPT codes group to APC 182 with a national payment of $2,584.45.
Pharmacy items and their charges continue to challenge hospitals. Drugs,
both packaged and non-packaged, fall into two main categories under APCs.
Packaged drugs billed under revenue code 250 may be reported cumulatively and
do not require a HCPCS code. Non-packaged drugs, submitted with revenue code
636 and the appropriate HCPCS code, would generate a separate APC. The dosage
of drugs must receive careful attention because dosage greatly affects the reimbursement
received. The HCPCS code for reimbursable drugs has been set at the lowest
dosage HCPCS code for the majority of covered drugs. The actual drug dosage
given must be convert-ed to units based on the dosage in the HCPCS code. Drugs
approved for transitional pass-through may
also fall into this category. To receive reimbursement under the APC system for
any item listed in revenue code 636, the claim must show a date of service, the
number of units, and a HCPCS code. If all data are not entered on the UB-92,
the claim will not pass the
Outpatient Code Editor (OCE). When the CDM review is complete and all codes are
deemed accurate for a given facility, there must be a system designed to assure
that the
HCPCS codes match the appropriate revenue codes. The revenue code, after all,
drives packaging in the APC system. Specificity of revenue codes help assure
timely and accurate reimbursement for the facility.
Health Information Management (HIM) coders are responsible for assigning approximately 27 percent of the CPT codes for Medicare outpatient services and ambulatory surgery patients. Policies and procedures should address which procedures/services are coded by HIM coders. A code should never be chosen because of its proven reimbursement record. Accurate and specific coding consists of choosing the most correct code available for the procedure or service rendered to the patient. In addition, codes assigned for services must also be justified by medical necessity. Again, hospitals must determine which codes will be pulled from the CDM and which codes are the responsibility of HIM coders. Information systems (IS) must be involved in this decision to ensure that codes printed on the UB-92 are not duplicated.
Many facilities have purchased an APC grouper that includes all Correct
Coding Initiatives (CCI) edits. The APC grouper may be located in the HIM
Department (Medical Records) or in Business Services. When the grouper is
utilized by HIM, it is advisable to interface the grouper with the mainframe
computer system to allow the
CPT codes submitted from the charge master to run through the grouper
simultaneously. If the interface is in place, CCI edits will run against the
entire claim, including those codes coming from HIM staff and the CPT codes
submitted from the charge master. For monitoring and evaluation purposes, it is
critical for the facility to consider the APC impact of a case prior to
submitting the claim. Utilization of the APC Grouper will identify potential
problems and will allow for clarification and changes or, additional services
to be added
prior to the claim being submitted for reimbursement, thus, decreasing
the number of claims being returned or denied.
If rejections are identified, the billing department must have policies and procedures in place to instruct staff how to correct items on the claim that initiated the rejection or denial. The cause of the rejection and or denial must always be communicated to the responsible department to ensure the same error does not recur.
In essence, there are numerous opportunities to improve outpatient
reimbursement for your facility. An action plan may include the following
steps: * Identify who is responsible for the code that will ultimately be on
the claim. * Perform an in-depth review of the charge master and ensure that
updates are completed based on program memorandums. * Review claims submitted
against source documents to ensure correct
information transferred through the computer system is entered on the UB-92. *
Assure that information submitted meets compliance standards. * Review revenue
codes for proper assignment. * Review all denied claims, claims marked
"Return to Provider", and rejected line items to identify the cause
and take action to assure that other claims are not returned for the same
reason. * Make sure that employees understand how critical their role is to the
overall process and the end result.
Never before has teamwork been as important to the survival of a healthcare facility as demonstrated with the APC reimbursement system. Only with the collaboration of all departments will we be able to seek out hidden opportunities and assure APC success.
Authors: Deanie Auton, MHA, RHIA
Cornelia McClure, RHIA Crisp Hughes Evans,
Student Column: O.J. Booker
Scholorship
Many years ago, I decided to join the Georgia Chapter of HFMA. Although I
had only
been in the healthcare industry for only a few years, many in my organization
were
involved in HFMA especially with the CPAR Committee. From the very beginning of
my membership, I became aware of the traditional advantages of being a member
in HFMA such as networking, sharing ideas and brainstorming with colleagues for
solutions
to a particular problem. I would not find out for several years that there was
another
opportunity that any member can and should take advantage. The opportunity I
am referring to is the O. J. Booker Scholarship. Like many of my peers I had
begun my post-secondary education straight out of high school. I was lucky
enough at
the time to complete a two year Degree in Early Childhood Education (I thought
I wanted to be a teacher. That quickly changed after one semester of student
teaching first
graders). Personal events in my life abruptly changed the direction I was
headed in and
prohibited my continuing education. From the time I entered into the healthcare
industry, I was able to get by without that piece of paper that said I had been
in college for four years. But as I began to climb the proverbial corporate
ladder, I soon found myself at a disadvantage. I was at a crossroad and a
decision had to be made. I had to ask myself if
was I happy staying at the point I was at or did I want more? For most of you
that
know me, it is obvious that I chose the latter. I had toyed with the idea of
going back to college to complete my degree many times in the eight years since
I completed my two-year degree. I never would make the commitment.
In 1998 I made the decision that I had to go back to school or I would never be
more than I was at that very moment. During this time I made a decent salary
for
someone my age, but it would still be very difficult to pay the normal living
expenses
with the cost of a college education in the mix. I wasn't sure how I was going
to do it.
I just knew I had to do it. I was fortunate to have a long-standing member of
the Georgia Chapter as my boss, mentor, and friend. She suggested that I check
into the O. J. Booker Scholarship. I did .
As the recipient of the scholarship for three different years, I can't express
in words how much it has meant to me. The scholarship has allowed me to pursue
my education
without the additional stress of having to worry about my finances. It has
helped me to
complete one of my lifetime goals. I am extremely proud to be part of an
organization
that supports its members as strongly as the Georgia Chapter of HFMA does. And
one last thing, don't make the mistake I made when I first heard about the O.
J. Booker Scholarship. I assumed that the scholarship would only be for
students who had just graduated high school. That assumption was incorrect.
This scholarship can be used for college age, children of members or by any
member who wishes to further their education. All you have to do is ask. I did
and look at me now!
By: Kimberly Farmer Client
Services Manager Chamberlin Edmonds & Associates, Inc.
OFFICERS & BOARD MEMBERS GEORGIA
CHAPTER HFMA 2001 –2002
Congratulations To Our Newly Elected
Officers And Board Members For 2001-2002.
2001-2002 President, Eddie
Phillips
President-Elect, Cynthia Perley
Program Chairperson, Becky Black
Immediate Past President, Tim Beatty
Secretary, Terri Tillery
Treasurer, Cathy Dougherty
Board Member 2000-2002, Beth Foote
Quality & Benchmarking Council
Chairperson
Board Member 2000-2002, Tom Morris
Communications Council Chairperson
Board Member 2000-2002, Tim Pollard
Proaction Council Chairperson
Board Member 2001-2003, Teresa Singley
Diversification/ Collaboration Council
Chairperson
Board Member 2001-2003, Richard Childs
Mambership Services Council Chairperson
Board Member 2001-2003, Sandra Johnson
Forums Council Chairperson
In Addition Thank You To The Following Individuals For Their Continued Commitment To HFMA!
Advanced CPAR, Lil Kloock and
Mary Kay Tam
Awards, Judy King Williams
Benchmarking, Michelle Lee
By-Laws/ Policy & Procedure, Lloyd
Feiler
CFO, Ray Dziesinski
Corporate Compliance, Dawn Lynne
Kacer
CPAR, Karen Newton
Database, Rick Childs
Database, Pete Hogan
Davis Chapter System Mgmt, Beth
Foote
Dixie Institute, Bill Eikost
Education Content, Susan Clark
Education Logistics, Pat Tewalt
Federal Issues, Ron Anspaugh
Forums Logistics, Tammy Bryant
Historian, James Piper
Hotline, Kimberly Farmer
Membership Directory, Diane Dunaway
Member Recruitment & Retention, Gail
Scarboro-Ritz
Newsletter, Carmen Sessoms
Pfs/Practice Management, Susan
Singleton
Professional Development, Greg Clark
Public Relations, Audrey Brooks
Public Relations, Joe Hall
Registration, Julie Totten
Registration, Angie Anderson
State Issues, Frank Powell
Survey, Michelle Lee
Website, Joanne Waters 27
NEW MEMBER
Spotlight
MARC WELLMAN
With the last name of "Well-Man", Marc was destined to work in the
Healthcare industry. He has proven that to be true in various ways. After
obtaining a Bachelor's degree in Finance from the University of Georgia, he
went on to complete a Bachelor's degree in
Physical Therapy from Georgia State University. This unique background has
afforded Marc the ability to enjoy a fulfilling career path. Not only has Marc
worked in the
Marketing Department at GTE Wireless (now Verizon) as a Marketing Coordinator,
but was also on staff at Shriner's Hospital in Chicago, IL, as a pediatric
Physical Therapist. In addition, he worked as a Physical Therapist with
different skilled nursing and home
health companies until the Balanced Budget Act made it difficult for the
companies to operate. At that point, Marc decided to chart his career in
another direction -medical staffing.
Marc is currently an Account Manager with DDS Staffing in Roswell
specializing in the staffing needs of the medical community. In fact, Michelle
Lee, VP of Operations for DDS and HFMA member extraordinaire, was the one that
encouraged Marc to join HFMA. Marc has a passion for learning and it seemed
logical to him to join an organization that would enrich his knowledge base and
professional development.
He looks forward to learning from others in HFMA and feels he can add more
value to his clients by passing along relevant industry information that he
obtains through the organization. Marc has attended the Fall, Winter and Spring
Institutes and is anxious to attend more. Although this is his first year with
HFMA, he has
already joined the Membership Recruitment and Retention Team -give him a round
of applause for his enthusiasm and participation!
Outside of his busy professional life, Marc enjoys golf, is active in the
Holy Trinity Lutheran Church as a lay reader and resides in East Cobb County
with his wife, Belva-Anne (also a Physical Therapist), their two children Rachel
3 and Conrad 8 months, and
two dogs -Bogey and Dolly. Marc grew up in Chicago, IL, before his family moved
to Atlanta in 1985.
Marc feels strongly about the changes needed to improve our Healthcare
system and is eager to share ideas with other HFMA members on this subject.
Let's welcome Marc and
thank him for his interest and support in HFMA.