by Michelle Lee
TIM BEATTY - Tim Beatty, the 2000-2001 President, first joined the chapter in 1987. Tim has always been impressed with the professionalism of the chapter and the people involved. Presently, Tim is Director of Reimbursement/ Budget for Wellstar Health System. He has a BS degree in accounting and MIS and a Masters in MIS. What he likes most about his job is the opportunity to solve problems and to teach healthcare finance.
He is married and has one child, Brandon. Tim enjoys playing golf, reading, and coaching his son's baseball team. His favorite movie is Last of the Mohicans.
He despises slack work ethics and dirty cars! Tim believes the keys to success are honesty, loyalty to current employer, and providing excellent customer service. He also believes that continuing education and working to improve productivity in your area will add to your success.
EDDIE PHILLIPS - President Elect, Eddie Phillips is a Principal in the accounting firm of Ernst & Young. Eddie also joined HFMA in 1987. He joined HFMA because of the networking opportunities and for professional development.
Eddie graduated from the University of Alabama with a B.S. degree in Accounting.
Eddie enjoys his job because of the opportunity it provides him to interact with people. Eddie enjoys playing golf and reading. He mostly enjoys espionage or murder mysteries. One of his all time favorite books is Day of the Jackal by Frederick Forsyth. Eddie's favorite movie is Casablanca but another favorite is the Clint Eastwood western, Pale Rider.
He has been married to his wife Helen for 14 years. They have one son, Kevin. His pet peeve is when people do not follow through.
Eddie's key to success is simple. Enjoy life (including your job).
Is Your Frontline Staff Still Qualified To Do Their Jobs?... Probably Not!
By Kimberly Farmer, Admissions Manager, Northeastern Georgia Medical Center.
With ever changing demands in the healthcare industry, Patient Access staff must be more cognizant than ever to the daily changes. The days of acting in simple clerk-typist roles are long gone. Complex payor requirements make it necessary for frontline staff to have a greater understanding of managed care contracts. Decreasing bottom lines within most organizations has required Patient Access staff to shift into the role of collectors. As front-end collections continue to climb, registration should be classified with other revenue producing departments. With the implementation of Ambulatory Payment Classification (APC's) in August 2000, Patient Access staff will find themselves in positions requiring them to learn certain aspects of coding. APC's will also put a new emphasis on the importance of collecting complete and accurate data up front. With all the new demands being placed on them, the traditional registrar will no longer have the skills that will enable them to perform their jobs effectively. A job that once only required that an employee be able to type, answer a phone and smile, now encompasses a great deal more. The question is what should your organization do to help Patient Access staff transition into their new and very complicated roles.
Education should be a priority during these times of transition. In the Information Age that we currently find ourselves in, it is astonishing to find that the majority of front line staff do not understand fairly simple concepts such as days in accounts receivable or operating margin. A large population of Patient Access staff still operates under the premise that they do not effect anyone or anything else. Educating your staff to understand their impact on the "bottom line" is critical. It will give your staff the perspective of how their work fits into the big picture of the organizations overall operations and potential success.
As managers and supervisors, we seem to be in a constant rush to get things done. In our rush we would expect the same from our staff. Many times we neglect to give them the guidance or tools they need to meet the goals that we have placed before them. This neglect is a sure path to failure for our staff as well as the entire department. So what can we, as a management team, do to ensure the success of our staff? Give them the tools to do their jobs. The "tools" you can give your staff could range from simple job aids and could be as complex as developing a training program for the department.
Simple tools include some type of sticker on the associates PC to remind them to ask a certain questions or put in "cheat sheets" that contains data necessary to help front line staff make quicker decisions. The more complex tool is proper training. It is imperative that front line staff receive complete and on going training. Without training, we all lose.
Organizations should push for a dedicated training department to achieve goals such as consistency, accuracy and excellent customer service. This department should not only be involved with the training of new staff that is hired but also provide the continual monitoring with recommended feedback Feedback is an important part of the training process. What may seem simple to one individual may be extremely complex to another. Associates will perform at higher levels if they have a better understanding of all the processes.
The complexity of registration now demands that we look for highly qualified applicants. Registration can no longer be classified as a simple clerical job. Applicants must have skills and abilities that no longer fit into the definition of clerical. Applicants must have excellent customer service skills as well as interpersonal communication. They must be able to learn and adapt quickly to change. Technology plays a major role in the everyday workflow of a registrar. Potential applicants must know how to use technology and not be afraid to use it. Applicants must be assertive and become problem solvers to handle their fast paced environments. Managers and supervisors must be more selective in the hiring process. Hiring based on "warm body syndrome" can hurt the entire organization in the long run.
The bottom line is that registration plays a major role in an organization with a definite impact the bottom line. Patient Access staff are important pieces to a puzzle that makes an organization fit together and operate smoothly. Front line staff must wear many hats in today's healthcare environment. How we choose to cultivate and encourage our staff may determine the success of our department as well as the organization. Given the proper training and tools, Patient Access staff can rise above all the demands placed upon them. They will meet the challenges; exceed the goals set for them; and prove time and time again that their importance to the organizations overall success.
The Awards Committee is seeking nominations for the Ann P. Longshore Distinguished Service Award and the Oliver J. Booker Scholarship Award.
The Ann P. Longshore Distinguished Service Award recognizes an outstanding Chapter member for his/her efforts. Nominations for candidates are based upon the member's service to the Chapter and are submitted to the Awards Committee with the recipient approved by the Board. The Recipient must be a member of the Georgia Chapter (with current officers and board members excluded) and can only receive the award once every five years.
Prior year's winners include:
Teresa Singley - 2000
Terri Tillery - 1999
Bill Eikost & Tammy Herndon, FHFMA - 1998
Cathy Dougherty, FHFMA - 1997
Susan Singleton - 1996
The O.J. Booker Scholarship Award was established as a continuing memorial to Mr. Booker, who died passed away in 1987. Colleagues remember him as a highly effective manager who always encouraged employees to further their education and enrich themselves. Nominees for the scholarship are selected from among students of the highest academic standing in the financial fields who expect to enter the healthcare financial management industry. The $1,500 award is designed to help a member of HFMA in their educational endeavors. Any member can make nominations and the recipient does not have to be a member of the chapter. Nominations should include name, address, phone number, place of employment, HFMA member or relationship, degree/program pursuing, college/school, and reason for nomination.
The Ann P. Longshore Distinguished Service Award and the O.J. Booker Scholarship Award will be presented to the 2001 Recipients during the Spring meeting at Callaway. Please submit your nomination by March 30, 2001 in order to be considered.
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SEND NOMINATIONS TO:
Judy King Williams, FHFMA |
HFMA Joins Coalition to Protect America's Health Care
HFMA has joined with more than 100 hospitals, major associations, and businesses to create the Coalition to Protect America's Health Care.
HFMA President and CEO Richard L. Clarke, FHFMA, says, "The coalition has been formed because the record budget surpluses being announced by Washington and some state governments have been produced on the backs of healthcare providers."
On the one hand, the Federal government is reporting the largest budget surplus in U.S. history. Many state governments also are reporting record budget surpluses. Members of Congress are pushing for tens of billions of dollars in tax relief. And the Clinton Administration and many members of Congress from both parties want to add an expensive outpatient prescription drug benefit to Medicare.
On the other hand, the Balanced Budget Act of 1997, even with amendments, has resulted in serious cuts in Medicare and Medicaid payments to healthcare providers causing significant financial hardship. Hospital and health system profitability is declining markedly, and the number of downgrades to hospital credit ratings is outpacing upgrades. Hospitals are laying off staff and curtailing services.
Clark says, "To talk about tax reductions and/or benefit expansions while subjecting provider organizations to a financial squeeze is inexcusable. Something must change."
The purpose of the coalition is to develop broad-based support and raise funds for a major media campaign aimed at the public and key healthcare funding decision-makers.
The coalition's short-term goals are to achieve additional relief from the Balanced Budget Act during the current legislative session, and make relief from the Act an acknowledged political issue in the upcoming elections. The longer-term goal of the coalition is to help shape the healthcare debate for the new President and the new Congress in the next legislative session.
Clarke says, "Something must be done. Because of the importance of this issue to HFMA members, their organizations, and the Association's standing in the industry, HFMA has joined the coalition as a co-founder." Clarke continues, "We will provide financial, technical, and communication assistance to help ensure the success of the coalition's efforts."
HFMA and AHA Examine Hospital Billing
HFMA is announcing plans to work with the American Hospital Association (AHA) to improve hospital billing.
Patient billing is confusing and complex. To help fix the problem and improve current practice will take a coordinated effort among all stakeholders to identify the barriers to and best practices for producing and communicating clear, concise, and correct billing information to patients. That is the objective of a new initiative led by HFMA in part with AFA.
HFMA President and CEO Richard L. Clarke, FHFMA, says, "Hospitals and health systems must produce clear, concise,and correct bills to redirect resources to patient and community services and reduce complexity, cost and the potential for error." Clarke continues, "The best care, and great customer service provided during the patient's hospital encounter can be destroyed quickly by confusing, complicated, and incorrect billing afterwards. And potential compliance problems are inherent in the complicated and cumbersome system we use. It is a problem that must be fixed."
AHA President Dick Davidson says, "If we're to truly improve the billing system, everyone - hospitals, insurers, government regulators, and other payers and providers - needs to be involved. This isn't something that will happen overnight. It will take enormous time and commitment from all stakeholders."
Clarke says, "Patients often do not understand what is being charged, what their insurance should pay, what they owe, and why they should owe it. Research suggests it is the main complaint by the public about hospitals. A few days stay can result in 10 to 15 pages of detailed charges. The process of accumulating these charges is a nightmare of automatic and manual input, and electronic and paper hand-offs. Hospital change masters often contain more than 15,000 chargeable items, all of which must be coded and maintained on a routine basis."
HFMA'a and AHA's initiative to make billing more "patient friendly" will examine the issues involved in collecting and communicating billing information to patients and other interested parties by hospitals and health systems. The expected outcome of this project includes identification of the reasons for the complexity of the current billing system, the barriers to simplifying this complexity, and the best practices inpatient billing communication that currently exist. The project also will develop recommendations of actions that can be implemented by hospitals and health systems without legislative or regulatory changes that may be needed to further simplify the system.
HFMA is working with a major university and major providers, payers, and auditing and consulting firms to develop an approach that will produce these outcomes.
How HIPAA's Impact Will Affect PFS Processes and Planning
The hype surrounding the Health Insurance Portability and Accountability Act of 1996 may be more promise than achievement. The government has attempted to provide simplification of billing before, with UB-82 and 92 forms. This did not accomplish standardization regarding insurance and patient billing.
However, after reviewing the HIPA Act of 1996, I believe that the changes stipulated in this law will provide an awesome vehicle for today's PFS leaders to improve both their operations and results.
With the new HIPAA mandates, healthcare providers will no longer need to jump through major hoops to comply with differences in information transfer rules, formats and communication requirements with payers on their receivables. The days of using as many as 16 different tables in our charge master to ensure that the correct procedure code is used for each specific financial class requirement will be eliminated.
Benefits to the Provider
The mandate to use the ANSI ASC X12 format will allow providers and review organizations to replace ineffective and costly paper and telephone certification and authorization methods with electronic inquiries and submissions. The payment delays we currently experience due to paper submissions will be minimized as care approval processes and appeals of denials will be handled electronically.
It should improve operations on the front-end. Patient wait times will be reduced due to expedited insurance verification processes relating to data collection, co-payment and patient portion determination, and improved knowledge of benefits available for specific procedures. It should also result in improved cash flow, decreased bad debt adjustments, and improved days outstanding.
The standardization of claims submissions and payment posting processes will eliminate many local payer formats. Electronic follow-up capabilities will reduce the frustration now experienced by those who work the phones, waiting on hold for up to 10 to 15 minutes to check claim status for as little as three claims at a time. Erroneous data will be flagged automatically, facilitating problem resolution quickly and effectively. In addition, this should improve the coordination of benefit issues that currently hold payment up for our claims from the Commercial and Insurance financial classes.
In short, HIPAA implementation should be a champion of PFS' causes once it begins. However, HIPAA alone will not improve our experience because of its mere existence.
Begin Now
PFS Managers should begin now to move their daily processes throughout the revenue cycle operations to best practice stipulations. This will ensure that the approach to your revenue cycle operation mirrors some of the transaction requirements that will be required once HIPAA is started. Examine each functional area to ensure that the tasks performed are done so within a comprehensive approach to the cycle, with the understanding that each checkpoint will affect the success of the next phase.
Service access is affected by service documentation, which affects the success of collection, which will lead to improved patient satisfaction. Shun the temptation to focus only on specific tasks performed within a certain function, but build best practice business models that lead to effective communication with each department within the facility, including all revenue producing entities and the drivers such as physicians and physician office staff.
Preparing for the "Kick-off"
Start with bringing the issue up with your Administrative Steering Committee, that includes the CFO, CIO, Managed Care Director, Health Plan Administrators for those facilities that are payers, HIM Director, Business Office Managers and any technology or business office consultants currently onsite at your facility. Establish objectives and planning strategies as it relates to the following items.
Perform a technology assessment of the formats currently utilized by your facility regarding the transactions stipulated in the HIPA Act, and have the findings reported to the committee. This includes all vendor relationships that are shared by the facility. The findings establish the required work your facility will have to perform in order to be successful after the implementation of the ANSI ASC X12 formats.
I suggest reading materials in the meetings to your peers to ensure that your meetings will be harmonious as possible, raising the awareness of the group and providing urgency to prepare for what is being called the biggest item impacting healthcare since the Y2K fiasco.
Let's have vision and gather talent and change business office models to capitalize on the utilization of technology. Planning and acting now will allow us to shine as the stars that we are, and will lead to an improved healthcare encounter experience for the patients and communities we serve, which is what this is about in the first place.
Franklin Smith is a manager with Zimmerman & Associates and has over nine years experience in healthcare receivables management.
The Georgia Chapter Healthcare Financial Management Association Annual Report 1999-2000
by Lex Klamke
Executive Summary
The Georgia Chapter of the Healthcare Financial Management Association is proud to acknowledge the significant contributions of its members and their leaders through this annual report of activities for the year 1999-2000. The Chapter received the following awards for this year's work:
We approached the turn of the century with strength, dedication and determination, as set forth in our Mission, Values and Purpose. Our incentives were straightforward, our goals, objectives and strategies clear. We wanted to make breakthroughs. The Georgia Chapter has a strong history of service to its members, continuing the "old" but successful ways would have been the easy choice. To experience true growth, we adopted the theme "Breakthrough 2000" to reflect our determination to step outside our usual bounds and move forward.
The Georgia Chapter provided 32 occasions of meetings; there were 72 actual events. Of these, 37 were co-sponsored with other organizations. There were 4,617 registrants at these functions, resulting in 32,644 hours of education provided to members, non-members and Medicare recipients. That is a staggering amount of time. Registrant hours per member were up almost 28% to 24.22 hours per member, and there are 1,250 members in the Georgia Chapter alone. We hoped to improve our philanthropic efforts by expanding education to health care consumers, particularly senior citizens and their caregivers. We developed a program entitled "Making Sense of Medicare for the Senior Population (Medicare 101)" and identified 15 sites to provide this session free of charge. There were 834 attendees. Because relations with managed care carriers can be strained and difficult, we wanted to be the catalyst to improving these relationships. We developed a program entitled "Enhancing Communications with Managed Care Carriers," and 633 registrants paid more than $24,000 to attend. The Georgia Chapter met or exceeded every education goal set forth in this year's strategic plan.
All four issues of The Georgia Scroll, our quarterly newsletter, provided interesting, insightful articles that appealed to urban, rural, profit and non-profit facilities and their professionals. We continued our Helpline and Hotline, both telephone links to members and non-members, promoting education, compliance, CPAR certification and membership. Well over 1,000 calls were made to the Hotline alone in this fiscal year. Our membership directory and pictorial history provides the information our members need to know about HFMA, on a national and local level. The Georgia Chapter is particularly proud of the improvements in our website, and the steps taken toward implementation of on-line registration for educational sessions, links to National, electronic publications and e-mail notification.
Other services worthy of note in this fiscal year include our Corporate Compliance Survey of Hospitals. We learned about how these compliance programs are developed and how successful they are perceived. We learned new opportunities for educational sessions on this topic in the immediate future. We published the results to our members and are working hard to standardize the interpretations of compliance requirements. The ProAction Council played a very big role in responding to HCFA's development of Ambulatory Payment Classifications. In a collaborative effort with the Georgia Hospital Association, a detailed response to the Proposed Rules was prepared and forwarded to HCFA.
The Georgia Chapter continued to keep the membership involved by expanding our TEAMS positions to 254 members, for a 20% increase from the prior year. A mentoring program was developed to ease the transition to new leaders for councils and committees. Realistic deliverables were developed for our TEAMS, in an effort to spread the workload and reward the efforts of the players. New evaluation forms were developed for educational sessions and automated worksheets implemented for use in the tabulation and reporting process, which also included a process to collect feedback from faculty. Everyone in the Georgia Chapter that put forth effort toward achieving our goals and objectives was recognized and rewarded with a "You Make A Difference" pin, presented personally by the Chapter President.
Financially, the Georgia Chapter increased its "Bottom Line" by $71,714 from the prior year. Revenues increased nearly 10%, and expenses decreased nearly 11%. These results were achieved in spite of the educational sessions offered free of charge to seniors and their caregivers. Our Corporate Sponsor program grew nearly 7%, and workshop revenues increased 235%. Although retention rates are down slightly, new members increased by nearly 15% this year and over 100 members have achieved certification.
The financial professionals in the state of Georgia know the value that HFMA can provide. The healthcare professionals that belong to the organization, the employers we support, the sponsors we embrace and the consumers in the healthcare market, know the benefits of participation. The Georgia Chapter has worked hard to achieve our goals and objectives and those set forth by the Davis Chapter Management System, and we exceeded nearly every one of them. We will continue "Leading With Integrity," because that is how we get to "The Bottom Line."
ELIGIBILITY: The Root of All Evil
Healthcare eligibility is the number one cause for claims to be rejected and never paid. In most hospitals and doctors offices, eligibility is never checked with the exception of inpatient admissions and outpatient surgery. Without current eligibility, the provider is blind as to where to send the bill, who is covered under the plan, the correct insured information and the benefits available for the particular type of treatment. The most prevalent result is a miss-routed claim mailed to the wrong insurance paypoint or intermediary such as a preferred provider organization (PPO) or management services organization (MSO). Frequently, these claims require ten times the amount of follow-up energy and time to collect or end up as bad debt. Not to mention the impact these delays have on patient satisfaction. This all adds to the frustration level for customers.
If twenty-five percent (25%) of the claims processed today are rejected by the payer, over eighty percent (80%) of those claims are rejected because a thorough eligibility verification was not made prior to or at the time of service. Most frequently, registration staff rely on existing information that was provided months or years previously or information that has probably changed several times since the patient's last visit.
With the advent of PPOs and MSOs, the initial paypoint has changed dramatically. In many instances, the PPO requires that the provider send the claim to the PPO for repricing to contractual rates and then be sent to the payer for payment. If the claim is misdirected to the payer, it has to be mailed from the payer to the PPO and back again frequently adding three to four weeks onto the collection cycle.
MSOs are even a greater problem because their involvement is not listed on the patient ID card. MSOs process risk-bearing claims for doctors who accept capitation from HMOs. As part of their contract with the HMO, the primary care doctors accept the risk of paying specialists and their own fees from their capitation amount so the hospital and specialist bills go to the MSO-not the HMO first. The patients ID card says to submit all bills to the HMO. If the MSO address is not clearly identified as the initial paypoint and the practice or hospital is not aware to ask, the bill is routinely routed to the wrong address and the payment cycle is well over 120 days.
Medical providers also lose a valuable opportunity to collect copayments or deductibles at the time of service as well, which requires an inordinate amount of follow-up effort once the insurance payment is received. A self-pay portion requires, on average, 60 to 120 days to pay after the insurance payment is received and represent the single highest risk for any provider. Self pay balances to medical providers rank dead last in typical consumers' hierarchy of bills to pay.
Officers & Board Members Georgia Chapter HFMA 2000-2001
| President
Tim Beatty, FHFMA |
President Elect
Eddie Phillips |
Program Chairperson
Cynthia Perley, FHFMA |
| Secretary
Chip Mann |
Treasurer
Becky Black, FHFMA |
Board Member Communications
Terri Tillery |
| Board Member Quality
Beth Foote, FHFMA |
Board Member Forum
Tom Morris, FHFMA |
Board Member Membership
Services
Cathy Dougherty, FHFMA |
| Board Member Diversification/Collaboration
Bill Eikost |
Board Member ProACTION
Cal Calhoun, FHFMA |
Immediate Past President
Lex Klamke |