1 Texas Bluebonnet Chapter Gets LinkedIn, Facebook and Twitter By Chris Snyder, HFMA South Texas Chapter, Newsletter and Communications Chair AAHAM Texas Bluebonnet Chapter Members, One of our 2012 initiatives from the board is to enhance chapter communications as well as close the generational gap by implementing social media within the chapter. Below are three ways you can now follow the chapter aside from our website (which is being newly designed this year also): LinkedIn | www.linkedin.com | search for “AAHAM Texas Bluebonnet Chapter” | click “Request to Join” Facebook | https://www.facebook.com/#!/pages/AAHAM- Texas-Bluebonnet-Chapter/288880274477540 | click “Like” to follow our chapter Twitter | www.twitter.com | search for “txaaham” | click “Follow” to follow our chapter At this year’s Annual State Institute in April in San Marcos there will be a session during lunch to launch this initiative and help answer any social media questions about the chapter as well as any questions you may have regarding the world of social media in general for your professional and/or personal use. Please feel free to contact Chris Snyder, Communications Chair at [email protected] or 402-943-7701 with any questions. This jam-packed program will feature many knowledgeable and entertaining speakers whose unique industry expertise will provide great insight into Healthcare Administrative Management today and what is in store for the future. An informative and affordable way to earn up to 18 CEUs! ASI 2012 features a great line-up of speakers on topics which include: Medicaid Updates, Uninsured Results: Where our economy is headed and POS Best Practices. Each of these sessions will be packed with information and practical tips for each step in the revenue cycle. You will not want to miss this opportunity to learn how you can apply these techniques. AAHAM is also pleased to welcome John Currier, CPAM, CCT and AAHAM National Second Vice President to this year’s ASI. Don’t miss this outstanding line-up of speakers and topics and earn CEUs to maintain your professional certifications. AAHAM 2012 ASI & Vendor Exhibit April 25-27, 2012 Embassy Suites San Marcos Hotel, Spa & Conference Center Volume 5 Issue 2 Spring 2012 2012-2013 Corporate Partners DIAMOND GOLD Financial Control Services SILVER AccuReg Software Avadyne Health Availity, LLC Emdeon ETACTICS Hollaway & Gumbert MDS Paramount Recovery Systems Parrish Shaw Receivable Management, Inc. Recondo Technology SSI Group, Inc. XAM Business Services 18 CEUs
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Texas BluebonnetChapter Gets LinkedIn, Facebook and TwitterBy Chris Snyder, HFMA South Texas Chapter, Newsletter and Communications Chair
AAHAM Texas Bluebonnet Chapter Members, One of our 2012 initiatives from the board is to enhance chapter communications as well as close the generational gap by implementing social media within the chapter. Below are three ways you can now follow the chapter aside from our website (which is being newly designed this year also): LinkedIn | www.linkedin.com | search for “AAHAM Texas Bluebonnet Chapter” | click “Request to Join” Facebook | https://www.facebook.com/#!/pages/AAHAM- Texas-Bluebonnet-Chapter/288880274477540 | click “Like” to follow our chapter Twitter | www.twitter.com | search for “txaaham” | click “Follow” to follow our chapter At this year’s Annual State Institute in April in San Marcos there will be a session during lunch to launch this initiative and help answer any social media questions about the chapter as well as any questions you may have regarding the world of social media in general for your professional and/or personal use. Please feel free to contact Chris Snyder, CommunicationsChair at [email protected] or 402-943-7701with any questions.
This jam-packed program will feature many knowledgeable and entertaining speakers whose unique industry expertise will provide great insight into Healthcare Administrative Management today and what is in store for the future. An informative and affordable way to earn up to 18 CEUs!
ASI 2012 features a great line-up of speakers on topics which include: Medicaid Updates, Uninsured Results: Where our economy is headed and POS Best Practices. Each of these sessions will be packed with information and practical tips for each step in the revenue cycle. You will not want to miss this opportunity to learn how you can apply these techniques. AAHAM is also pleased to welcome John Currier, CPAM, CCT and AAHAM National Second Vice President to this year’s ASI.
Don’t miss this outstanding line-up of speakers and topics and earn CEUs to maintain your professional certifications.
AAHAM 2012 ASI & Vendor ExhibitApril 25-27, 2012 Embassy Suites San Marcos Hotel, Spa & Conference Center
President’s Message By Angie Box, President, Texas Bluebonnet Chapter
When I need to go to the grocery store, I make a list. When my kids need supplies for a project, I make a list. When I have deadlines at work, I make a list. When I
have a dozen sticky notes on my computer, I start looking for what I need. Usually, I can go to one store to get multiple items. I use Google and Amazon ALL THE TIME! I buy online, and I read reviews. I clip coupons. In a nutshell, I am a smart shopper. A part of being a “smart shopper” means having resources at your disposal.
We all know AAHAM has a group of Corporate Partners that give money each year to help our chapter provide quality educational events for our members. That is not ALL they do! Each company has a healthcare-related product or service that could be a “resource” for a provider. I encourage all providers to review the products and services of our Corporate Partners when making a decision. Without the generous help from these partners, our chapter would not be a success. After all, they have the same vested interested in our chapter that you do. These partners don’t only help providers. Our company recently decided to outsource our patient letters, so
we used one of the AAHAM partners, and they provided excellent service. They also exceeded our expectations.
Day-to-day business decisions are tough for providers and vendors. Make your shopping decisions a bit easier by utilizing a resource right at your fingertips: Our Corporate Partners. All of our partners for this year will be exhibiting at the ASI. Please visit each booth and get some information on the companies. You just might need that resource in the future!
Hope to see you at our Annual State Institute (ASI)!San Marcos, April 25-27, 2012
This IssuePresident’s Message ................p2
Does Revenue Cycle Impact ....p3
Kyphoplasty Settlements .........p4
ASI 2012 - Join Us ...................p5
UnitedHealth UCR Settlement .p5
Calendar ..................................p6
Stay Connected .......................p7
BCBS TN Settlement ...............p7
5010 Challenges.......................p8
5010 Enforcement Postponed .p8
Top 5 Interview Mistakes ..........p9
360,000 New Jobs ....................p9
ICD-10 Postponed .................p10
AAHAM Certification .............. p11
The Hidden KPI .....................p12
Houston Nurses Sentenced ...p12
Movers & Shakers .................p14
New Members .......................p15
Volunteers Welcome ..............p16
Corporate Partners .................p17
Deadlines & Advertising .........p18
Officers and Chairs ................p19
AnnualState Institute
(ASI)April 25-27, 2012
San Marcos
Participants said Spring RegionalConference in Addison was GRRRREAT!
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According to Jennifer Robinson, Senior Editor for the Gallup Management Journal, “for over 20 years or so, healthcare organizations have realized providing exemplary medical care isn’t enough to engage hospital patients. That’s because, from the patient’s perspective, excellent medical attention is the least a healthcare organization can offer. Many hospitals recognize this and now focus on the patient experience.”
So what is the “Patient Experience”? The Beryl Institute collaborated with healthcare professionals and practitioners at hospitals around the county to develop a definition.
Patient Experience – The sum of all interactions, shaped by an organization’s culture, that influence patient perception across a continuum of care
This statement and effort is so powerful that 93% of healthcare leaders say patient experience is among their top 5 priorities. Additionally, HealthLeaders Media Patient Experience Leadership Survey indicated 45% of healthcare executives see this as a priority 5 years from now.
As consumers spend more and more of their disposable income on monthly health insurance premiums, higher co pays and out of pocket expenses, they are demanding more from their chosen “provider.” In addition, the landscape around experience in healthcare is shifting dramatically in part due to the Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS) and the pending value-based purchasing program that will link payments to clinical care. This will, in the future significantly impact the market basket index, that is used to annually adjust the Medicare Inpatient Payment Rates. The level of reimbursement hospitals receive from their largest payer will be directly tied to the HCAHPS survey.
Healthcare economists are advising hospitals with the advent of healthcare reform and future reimbursement levels, one of their financial objective hospitals will need to achieve is to generate positive returns under government reimbursement policies. This places increased significance on the outcomes of HCAHPS surveys and hospitals will need to take a more proactive step in managing their operations as they are reflected within the survey.
The HCAHPS survey consists of 27 questions that cover everything from the cleanliness of the patient room, to nurse-patient communication, to pain management. However there are 2 questions, by their nature transcend the entire spectrum of the healthcare delivery system.
• Rate the hospital on a scale from 0 to 10. • Would you recommend the hospital?
The responses to these questions can definitely be impacted by the administrative processes within the Revenue Cycle. Remember the revenue cycle representatives are usually the last contact with patients upon completion of their healthcare experience. While the time line for the HCAHPS survey
continued on page 4
SPECIAL THANkS to Avadyne for its support of the Texas Bluebonnet Chapter of AAHAM as a Silver Level Corporate Partner.
Does the Revenue Cycle Impactthe Total Patient Experience?And Are Hospitals Missing the Financial Opportunity?By: Steve Chrapla, CHFP, Director Third Party Solutions at Avadyne Health
requires the survey to be administered within 6 weeks of discharge, there is ability, for a deliberate focus on the patient interactions by the revenue cycle representatives, stressing the organization’s culture and responsiveness to assist with the administrative challenges patients deal with, to influence the patient’s perception of the hospital.
This is not only good business sense from an accounts receivable management position, but also allows for a world class customer service environment that is proactively managing the patient’s account portfolio; in contrast to an approach that just puts out the fires and is limited to responding to questions and focused only on the immediate collection of a debt. Make no mistake collecting everything that is due is important but realize the collection of an out of pocket patient liability or even one entire patient account balance has far reaching effect on greater future reimbursements.
In fact hospital revenue cycle representatives are the final personal touch points that usually occur between patients and the hospital.
You need to ask these questions. • Are these touch points/encounters being used to positively support the hospital’s mission statement?
• Is there active participation with patients during these encounters to shape the hospital’s reputation and brand?
The answer to these questions all center around how to guide the patient’s journey through the healthcare reimbursement maze to find the most appropriate solution for the patient’s situation. This journey can be accomplished through the use of specific tools that focus on enhanced communications and a comprehensive resolution of the patient’s account. By using people-driven, technology supported services you can achieve a high level of patient satisfaction. Through this satisfaction you can enhance both patient and physician loyalty to the hospital.
The loyalty of these patients can unlock huge future potential revenue sources. The patient life time revenue value is the amount of revenue a patient can expect to generate for a hospital over their lifetime if they choose to utilize the same hospital for all the medical needs. With the impact of consumerism in healthcare this lifetime revenue value is becoming an important part of hospital’s reputation management process and strategic marketing initiatives.
What are things you need to do to maximize the revenue cycle impact on the patient experience as well as protect your future patient lifetime revenue potential?
• Educate all employees of the patient experience initiatives especially the revenue cycle representatives and their impact on the outcomes. • Create an environment that fosters patient loyalty as a critical outcome. • Design a patient centered revenue cycle process that is focused on customer service excellence while resolving all patient concerns. • Integrate HCAHPS survey completion within the patient revenue cycle communication process. • Utilize technology to support the customer service function with call centers personnel trained and motivated to achieve established goals. • Insure all third-party service providers are fully supporting your mission and your initiatives to enhance the patient experience. • Explore social media sites to communicate your message and encourage patients to be positive spokes persons for your organization.
Remember your reputation matters and what your patients are saying is crucial and these experiences are still be formed long after the patient leave the hospital. That is why revenue cycle operations are critical to effective Total Patient Experience initiatives.
Avadyne Health provides customer service solutions for hospitals nationally that improve profitability while enhancing the Total Patient Experience. Call Steve Chrapla at (847) 395-7655 to learn more about our Patient Experience and Reputation Management programs and how they can assist your organization.
BREAkING NEWS Kyphoplasty Settlements Justice DepartmentAccording to a Justice Department news release, 14 hospitals in seven states settled allegations that they submitted false kyphoplasty claims to Medicare. A total of 40 hospitals have reportedly resolved similar allega-tions with the government. Kyphoplasty is a minimal-ly-invasive procedure that uses orthopedic balloons and bone cement to treat spinal fractures.
The 14 hospitals will pay about $11.9 million in total to settle allegations that they performed kyphoplas-ty procedures at inpatient facilities to increase Medi-care reimbursements from 2000 to 2008.
A whistle-blower lawsuit was filed by two former employees of Kyphon, the company that manufac-tured the kits used in kyphoplasty. In total, the government has settled with the hospitals for about $40 million.
The hospitals include Plainview (N.Y.) Hospital; Syosset (N.Y.) Hospital; North Mississippi Medical Center in Tupelo; Mission Hospital in Asheville, N.C.; Wenatchee (Wash.) Valley Medical Center; Communi-ty Hospital Anderson (Ind.); St. John’s Mercy Medical Center in Creve Coeur, Mo.; Gulf Coast Medical Center and Lee Memorial Hospital in Fort Myers, Fla.; Cape Coral (Fla.) Hospital; and the system that owns Florida Hospital in Orlando, Florida Hos-pital Oceanside, Florida Hospital Fish Memorial and Florida Hospital Heartland Medical Center.
The hospitals said in the individual settlements that the “agreement is not admission of liability.”
Full News Release: http://www.justice.gov/opa/pr/2012/February/12-civ-173.html
Continued from page 4... Does the Revenue Cycle Impact...
BREAkING NEWSUnitedHealth UCR Settlement April 15, 2012
In a final distribution order dated February 3, 2012, a federal court judge cleared the way for releasing payments in the 2009 settlement that ended the historic court challenge led by the American Medical Association against Unit-edHealth Group. Nearly $200 million in awards will be paid to settle claims from physicians for 15 years of artificially low payments from United-Health for out-of-network health services.
For claims sent direct to Claims AdministratorPhysicians that have not received checks by April 15 can contact Berdon Claims, LLC, by:Toll-free phone: (800) 443-1073Fax: (516) 222-0271 [email protected]
For claims sent through the Managed Care Advisory Group (MCAG)Physicians that have not received checks by April 15, 2012 can contact MCAG by:Toll-free phone: (800) 355-0466 - press option [email protected]
AMA FAQshttp://www.ama-assn.org/resources/doc/psa/uhg-settlement-faqs.pdf
Each year, AAHAM asks you to verify your membership information, so that you do not miss out on any updates or annoucements. It only takes a few minutes to update your information, by logging onto the website, www.txaaham.org. Your username is your email address and if you’ve forgotten your password, please contact us by email, [email protected], and we’re happy to assist.
We hope you’ll take a few minutes and verify your information is correct and also to renew your membership if you have not already done so. The new membership year started on January 1st! Don’t forget to renew your membership for the current year so that you won’t lose access to your membership benefits:
• Online Membership Directory • Job Postings • Unlimited networking and information exchange through our website, seminars, and publications • Discount pricing to the Texas Bluebonnet Chapter’s Annual State Institute (ASI) and Professional Education Seminars • Invitation to an active scholarship and awards program • Subscription to The Texas Tumbleweed, the award-winning quarterly newsletter of the Texas Bluebonnet Chapter
The membership year runs January 1 – December 31.
You can renew online! CLICk HERE: https://www.logiforms.com/formdata/user_forms/16822_2754748/77363/.
Please note this is for Local membership ONLY. For AAHAM Dual membership, please visit the AAHAM National website at www.aaham.org
Thank you for your participation, and we look forward to another exciting year! Please let me know if I can assist in this process.
Stay ConnectedUpdate Your Member Info and Renew Your AAHAM Texas Bluebonnet Chapter Membership Today!By: Julie A. Shaw, AAHAM Membership Chairperson
BREAkING NEWS BCBS Tennessee HIPAA Settlement$1.5 Million
On March 13, 2012, the U.S. Department of Health and Human Services (HHS) announced that Blue Cross Blue Shield of Tennessee (BCBST) has agreed to pay HHS $1,500,000 to settle potential violations of the Health Insurance Portabil-ity and Accountability Act of 1996 (HIPAA) Privacy and Security Rules.
The enforcement action is the first resulting from a breach report required by the Health Information Technology for Eco-nomic and Clinical Health (HITECH) Act Breach Notification Rule.
The investigation followed a notice submitted by BCBST to HHS report-ing that 57 unencrypted computer hard drives were stolen from a leased facility in Tennessee. The drives contained the protected health information (PHI) of over 1 million individuals, including member names, social security numbers, diagnosis codes, dates of birth, and health plan identification numbers.
The investigation indicated BCBST failed to implement appropriate administrative safeguards to adequately protect information remain-ing at the leased facility by not performing the required security evaluation in response to operational changes.
(March 15, 2012) The Cen-ters for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) announced that it will not initiate enforcement action through June 30, 2012, against any covered entity that is required to comply with the updated transactions standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA): ASC X12 Version 5010 and NCPDP Versions D.0 and 3.0.
If any entity is experiencing difficulty reaching a MAC, please contact Karen Jackson at [email protected].
We all knew that the federal mandate requiring clearinghouses and providers to upgrade their current HIPAA 4010 transaction standards to the new 5010 standards was coming on January, 1, 2012. Now, both Providers and Payers are experiencing challenges with the new changes. Providers spent many hours updating and testing their claims creation processes to accommodate the new 5010 billing requirements. Payers were doing the same on their side to convert from 4010 to 5010 processing formats. Some
Payers are still running “dual processing” until they finalize their conversions.
Now we are working the problems from all angles as they surface. Are you experiencing more payer rejections in your EDI departments? Is your Billing team seeing more rebill request than normal? Are you calling on claims and finding an increased number of claims not on file? These are just a few questions many Revenue Cycle Operators are verifying in their operations on a regular basis. It’s a good thing you are. You’re most likely seeing some inflated numbers. When you drill down to the root cause, you may find that in the first few months of 2012, it’s very possible they are related to the 5010 changes.
As you start “working the problem,” you may have realized if the claim goes directly from your Billing Editor to one clearinghouse and then to the payer, it is been much easier and timelier to get a permanent solution in place. However if you have to work your way through the “maze of intermediaries” it becomes very problematic.
The biggest 5010 challenge you may be experiencing is a result of the lack of single thread responsibility and contacts through the flow of claims from the claim editor to the payer. In most cases there are one or more claim intermediaries between the claims editor and the payer.
(Ex: RelayHealth Optum Insight Emdeon Payer)
Each entity has a person/team that was responsible for 5010 changes with the next entity in the delivery chain but the same person/team is not involved in the 5010 changes with the next entity in the chain. (Ex: Relay Health has contact A at Optum Insight that they work with to implement their understanding of the changes needed for the Payer to be 5010 compliant. However Optum Insight contact A is not the one working with Emdeon contact A to implement 5010 changes for the payer.)
In the majority of the claim intermediary organizations, there is a team responsible for incoming claims/837s and a different team responsible for outgoing claims/837s and in most cases these teams, are not tuned into what specific changes the other team has made or what 5010 type issues the other is experiencing or having reported to them.
This lack of a single cohesive 5010 inbound/outbound team at each intermediary has caused significant delays in getting 5010 claim issues correctly communicated, in the hands of the correct resolution party and of course in getting the issue completely resolved.
The next biggest 5010 challenge, which most providers have not yet encountered but will in the next 30 days is with the processing of payer v5010 835s. Most payer 835s come through a single entity and because these entities 5010 plan was to focus on 837s, there has been minimal testing on the v5010 835s. This could have a negative impact on the 04.01.2012 compliance enforcement date.
5010 Conversion ChallengesBy: Dean Mitts, Site Director, Frisco National Insurance Center, Conifer Health Solutions and Legislative Chairperson for AAHAM Texas Bluebonnet Chapter
• Over the past 12 months, health care employment has risen by 360,000.
• Houston and Dallas annual job growth rates were reported as 1st and 3rd among largest areas.
• Industries and occupa- tions related to health care, personal care and social assistance, and construc- tion are projected to have the fastest job growth between 2010 and 2020.
• Of the 22 major occu- pational groups, employ- ment in healthcare support occupations is expected to grow most rapidly (34.5 %), followed by personal care and services occupations (26.8 %), and healthcare practitioners and technical occupations (25.9%).
• The four detailed occupations expected to add the most employ- ment are registered nurses (712,000), retail salesper- sons (707,000), home health aides (706,000), and personal care aides (607,000).
• One-third of the projected fastest growing occupa- tions are related to health care, reflecting expected increases in demand as the population ages and the health care and social assistance industry grows.
Source: http://www.bls.gov/
We’ve all heard stories of job candidates who looked great on paper but who were absolute disasters in person. With fewer interview opportunities available in our competitive job market, it’s essential to make the best possible first impression. Learn from the mistakes of others and avoid these top five worst interview blunders:
1. Not preparing for the tough interview questions.Like every job seeker, you probably have your own set of tough interview questions you hope will never be asked. The best strategy is to prepare ahead of time with answers to ALL of these questions. A career coach can be a great resource for helping you work out suitable answers with a positive spin on negative or challenging career situations.
2. Failure to match communication styles.Making a great first impression is easier to do when you communicate effectively with your interviewer. The best way to do this is by mirroring his or her communication style. Allowing your interviewer to set the tone of the conversation will put him or her at ease and makes the conversation flow more naturally.
For instance: • If the interviewer seems all business, don’t attempt to loosen him or her up with a joke or story. Be succinct.
• If the interviewer is personable, try discussing his or her interests. Personal items on display in the office can be a clue.
• If asked a direct question, answer directly. Then follow up by asking if more information is needed.
3. Talking too much.In my recruiting days, I abhorred over-talkative candidates, and so did most of my client employers who interviewed these candidates. Over-talking takes several forms:
• Taking too long to answer direct questions. The impression: This candidate just can’t get to the point.
• Nervous talkers. The impression: This candidate is covering up something or is outright lying.
To avoid either of these forms of over-talking, practice answering questions in a direct manner. Using role-playing in preparing for your interview will help you avoid excessive, nervous talking.
Beware of theTop 5 Interview MistakesBy: Deborah Walker, Certified Career Management Coach, Alpha Advantage
4. Saying negative things about your current or past employers or managers.Even if your last boss was Attila the Hun, avoid stating your ill feelings about the person or work situation. No matter how reasonable your complaints, your negative comments will be viewed as disrespect towards your boss. When faced with the challenge of talking about former employers, make sure you are prepared with a positive spin on your experiences.
5. Giving away too much salary and earnings information.Candidates often weaken their future earning potential by speaking too freely about their current income. No matter the official salary range of the position you are interviewing for, your current earnings have an enormous effect on the size of the offer. Investing in a career coach to help you answer salary questions can add thousands of dollars to your new job offer.
You already know that it takes a strong resume that sets you apart as a candidate of choice to be invited for an interview. The next step is to hone your interviewing skills to actually win job offers. Polishing your interviewing skills can mean the difference between getting the job and being a runner-up.
Deborah Walker, Certified Career Management CoachRead more career tips and see sample resumes at www.AlphaAdvantage.comEmail: [email protected] Tel: 360-260-4965
As changes continue to take shape in Health Care, we’ll all continue modify our processes to meet the needs of the business. Adaptability is a required characteristic of a good Revenue Cycle leader. The Transition from 4010 to v5010 is just another challenge we as providers, payers and clearinghouses will need to overcome in our evolving healthcare industry.
Nevertheless, it is important that we keep in mind the two key factors that are driving the 5010 upgrade, which are the governments’ and industries’ shared goal of providing higher quality, lower cost health care; and the need for a comprehensive electronic data exchange environment for the expanded ICD-10-CM and PCS code set transition mandated for compliance by October 1, 2013.
Continued from page 8... 5010 Conversions Challenges
Continued from page 9... Beware the Top 5 Interview Mistakes
BREAkING NEWS
ICD-10 Postponed
Health and Human Services Secretary Kathleen G. Se-belius announced February 16, 2012 that HHS would postpone the date by which certain health care entities have to comply with Interna-tional Classification of Diseas-es, 10th Edition diagnosis and procedure codes (ICD-10). The final rule adopting ICD-10 as a standard set a compli-ance date of October 1, 2013. HHS will announce a new compliance date moving forward. HHS Press Release: http://www.hhs.gov/news/press/2012pres/02/20120216a.html
December 1, 2011 Registration deadline for February 2012CPAT/CCAT/CCT exams
NEW!CPAT online learning op-portunities available with exciting new partnership with BridgeFront. Need training? Need CEUS? Need to stay current with changes and regulations? Take educational courses from the comfort of your home or office. Find out more athttp://www.bridgefront.com/clients_aaham_cpat.php
Certification CornerBy Jennifer Urlaub, CMPE, CPAM, Client Relations Director for PFS Group and Certification Committee Chair, AAHAM Texas Bluebonnet Chapter
Important DatesApril 23-28, 2012: CPAM/CCAM Exams
May 14 - 25, 2012: CPAT/CCAT/CCT Exams
June 1, 2012: Registration Deadline - August CPAT/CCAT/CCT Exams
Good luck to all!
Questions…Jennifer Urlaub, CPAMPFS Group7670 Woodway, Suite 250Houston, Texas [email protected]
AAHAM would like to extend its congratulations to the following professionals who passed the February 2012 Certification Exams. Your commitment towards professional development will provide lasting benefits throughout your healthcare career. Congratulations!!
The next exam period will be held April 23-28, 2012. This is the Spring Management Certification testing series. Please note the exam proctors may be a CPAM, CCAM or any person who holds a management position, excluding the examinee’s director supervisor or subordinate. Proctoring CPAM/CCAMs will earn valuable CEUs to maintain certification distinction.
Additional information regarding exam confirmations as well as the new AAHAM CPAM/CCAM Professional Study Guide will be distributed shortly.
How would you like to discover a hidden key to improving your revenue cycle—one that gives you a powerful strategic performance indicator, yet actually changes the outcome by virtue of the tactical activity required to track it? That key measure, which can be found at the front end of the revenue cycle, is registration accuracy.
Registration accuracy refers to more than verifying a patient’s demographic information or an insurance policy number or plan code. Hundreds of financially potent error types occur every day when registrars input critical demographic, medical, and insurance data.
Most of the information required to bill claims is collected at the front end by patient access employees working in highly complex environments that emphasize speed, service, and collections over accuracy. These registrars are committed to high-quality work; however, a variety of environmental factors (changing payer and hospital rules, poor-quality data from patients and providers, etc.) diminish their ability to regularly deliver accurate registrations.
By focusing on improving registration accuracy, healthcare organizations can improve their revenue cycles overall and strengthen their performance on revenue cycle key performance indicators. However, it is not easy to measure how well multiple standards have been met by front-end staff working through complex human and technical processes. It requires implementing a quality assurance (QA) process, which can vary in the number of errors targeted for review.
When the QA process is manual, the percentage of accounts reviewed and the consistency of the reviewers can vary considerably. A systematic, defined QA process is needed—whether manual or automatic—to find and correct the errors with financial-impact. A few of the registration errors that affect the revenue cycle include:
• Incorrect insurance plan• Policy or group number missing or invalid• Medicare listed as primary when should be secondary• Minors listed as guarantors• More than one medical record number per patient• Failure to list medical necessity• Misspelled name (the #1 reason for Medicare return-to-provider rejections)
Using such a defined QA process reduces the complexity and variety of errors to one simple and powerful metric that revenue cycle managers can track and use to improve revenue cycle performance: the registration accuracy rate.
A best-practice registration QA process allows errors to be corrected before bills are dropped, and more important, those who made the errors learn from their mistakes and improve over time because they receive ongoing feedback on quality. In this way, QA becomes a tactical “find-and-fix”
The Hidden kPI: Registration AccuracyBy Paul Shorrosh, CEO, AccuReg Software
continued on page 13
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BREAkING NEWSHouston Nurses Sentenced for Medicare Fraud
In a February 14, 2012, the Department of Justice, the FBI and the Department of Health and Human Service (HHS) advised that two Houston-area nurses and two of their co-conspirators have been sentenced in Houston for their participation in a $5.2 million Medicare fraud scheme.
Mary Ellis, 56, a registered nurse, was sentenced to 63 months in prison followed by three years of supervised re-lease and was ordered to pay $401,000 in restitution. Ellis was convicted of one count of conspiracy to commit health care fraud, one count of conspiracy to pay kickbacks, three counts of receiving ille-gal kickbacks and two counts of making false statements.
Caroline Njoku, 46, also a registered nurse, was sentenced to 63 months in prison followed by one year of supervised release and was ordered to pay $631,295
activity that fulfills a strategic objective: The reduction of errors over time, with cleaner claims entering the revenue stream, results in less rework, lower claims processing costs, fewer denials and payment delays, and faster payment. Most important, the results are achieved without expecting perfection from human beings in the demanding environment of today’s patient access department.
Suggested Practices for Manual QABy implementing the following practices, PFS and patient access managers can implement a defined QA process that helps patient access staff improve registration accuracy:
Determine a fixed number of error types to consistently audit.Establish benchmark goals for registration accuracy based on the number of edits being reviewed
Benchmark Goals:Number of Edits: <25 Good, Better, Best = 85% 95% 98%Number of Edits: 25-50 Good, Better, Best = 83% 93% 97%Number of Edits: 75-100 Good, Better, Best = 79% 89% 95%Number of Edits: 100-125 Good, Better, Best = 77% 87% 94%Number of Edits: 125-150 Good, Better, Best = 75% 85% 93%Number of Edits: 150-175 Good, Better, Best = 73% 83% 92%Number of Edits: 175-200 Good, Better, Best = 71% 81% 91%Number of Edits: >200 Good, Better, Best = 70% 80% 90%
Create and use review checklists to promote auditing consistency, a record-keeping system, and a tally system for reporting registration accuracy by facility, location, and employee.
Provide the registrars with time and training to review 30 to 100 percent of accounts for the given number of error types.
Outsource or dedicate enough FTEs to conduct full-time manual review at the desired levels above.
Provide the reviewers with easily accessible verification information, such as internal coding rules and tables, eligibility verification systems, address verification systems, payer sites, payer contracts, physician orders, medical necessity, and scanned insurance and ID cards.
Require corrections to be made before bills are dropped.
Meet monthly to review registration accuracy rates, denials, and write-offs, and evaluate ongoing performance of the QA process and revenue cycle impact.
Use accuracy and error rate trend reporting for goal setting, performance evaluations, and incentives.
Continued from page 12... The Hidden kPI: Registration Accuracy
continued on page 14
BREAkING NEWS,CONTINUED...Houston Nurses Sentenced for Medicare Fraud
in restitution. Njoku was convicted of one count of conspiracy to commit health care fraud and one count of conspiracy to pay kickbacks.
Terrie Porter, 48, was sen-tenced to two years in prison and two years of supervised release and was ordered to pay $482,380 in restitution. Porter was convicted of one count of conspiracy to receive kickbacks and one count of receiving il-legal kickbacks following.
Florida Holiday Island, 62, was sentenced to 20 days in prison, five months of home detention and two and a half years of supervised release and was ordered to pay $59,739 in restitution. Island pleaded guilty in March 2011 to one count of conspiracy to receive kickbacks and one count of receiving illegal kickbacks.
Continued from page 13... The Hidden kPI: Registration AccuracyConduct weekly performance reviews with registrars to review individual measures, including each employee’s top five errors for the previous week and goals for the next week.
Tools for Performing Registration QAMany hospitals are using automated QA tools, which enable greater depth of auditing and 100 percent account review for a fraction of the cost of performing the work manually. Still, manual QA is better than no QA. The bottom line is that if hospitals want to significantly improve their revenue cycle performance, they need to provide their patient access departments with some form of QA. Several automated QA tools can be used to support a defined registration QA process that is performed by patient access staff manually. There are a number of software vendors that can provide tools that can automate functions, such as listing the most common registration errors and tallying employee-specific errors and accuracy rates.
Finding the keyThese tips and tools should help justify and simplify implementing a consistent registration QA process. Once the process is implemented, financial, patient access, and revenue cycle managers should be able to calculate and track registration accuracy metrics weekly and monthly. As a result, the cost of back-end rework, denials management, and fatally denied write-offs will be shifted to the front end, where denials can be prevented rather than managed, and for a fraction of the cost of back-end rework. Whether manual or automated, the ROI for performing registration QA is found not only in errors corrected before billing, but also in fewer errors being made to begin with as registration accuracy improves. To see their organization’s accounts receivable days, clean claim rate, denials rate, and unbilled days improve, revenue cycle leaders should take another look at the no longer- hidden key: registration accuracy rate and its prerequisite, registration QA.
About the AuthorPaul Shorrosh has 20 years of hospital management experience including Patient Access, Patient Financial Accounting, Managed Care and IT. As a Business Office Director, Paul saw the disconnect between the front and back end of his departments and developed a way to audit and report common registration errors to his registrars so they could self-correct prior to billing. This automated quality assurance system improved the morale, competency and revenue cycle impact of Registration employees and managers. Today Paul is the founder and CEO of AccuReg Software and is on a mission to transform patient access departments and highlight their value to hospital operations and finance. You can reach him at [email protected] or 866.872.7498.
[Reprinted with permission from hfm magazine, Sept. 2011, copyright Healthcare Financial Management Association.]
Movers & Shakers The “Movers and Shakers” column is used to report important events in the lives of our members….new jobs, promotions, academic achieves, new babies, etc.
Please contact Publication Chair, Carolyn Gay, if you have some important news to report [email protected]
Terry Allison Conifer Revenue Cycle SolutionsTonie Bayman Memorial Herman Healthcare SystemMichael Boase Children's Medical Center DallasMelissa Bosworth Dental Life NetworkKaren Boudoin OchsnerAngie Box Healthcare Recovery AllianceLanette BoyettSandra Bryan Methodist Health SystemTerry Bumpus The SSI Group, IncNoemi Chavez Titus Regional Medical CenterGuillermo Chavez G.J. Chavez & Associates, P.C.Susie Clark Baylor Health SystemSara Beth Collins Lafayette General Medical CenterJosie Cox University Medical Cener of El PasoKelley Crisp Children's Medical CenterRichard CurrySharon Davis Kindred HealthcareLisa Dixon Cardon HealthcareRhonda Fain Texas Childrens HospitalMaria Follett Titus Regional Medical CenterMaria Footman JPS Health NetworkCarolyn Gay Hollaway & GumbertJulie Haluska TransEngenDarlene Hattier Ochsner Health SystemJames Hawkins Conifer Health SolutionsJohn Hemenes PFS GroupMarina Hernandez Texas Childrens HospitalKarol Hopkins Scott & White HealthcareApril Hotard St. Tammany Parish HospitalJennifer Huber Tulane UniversityKay Jackson Iatric SystemsTheresa Jett Christus-St. Elizabeth HospitalJenny Johnson Childrens Medical CenterNina JonesLavanda Kennimer Texas Health PartnersNancy Klock Denver Health Medical CenterCynthia Kretlow Texas Children's HospitalLynne Landry Lynne Landry Inc.Kendra Lowery Omega Healthcare
Welcome New and Renewing Members!
The Texas Bluebonnet Chapter of AAHAM would like to welcome it’s new members! Just a reminder, local Chapter membership benefits include: • Discounted registrations to chapter meetings • Staying up to date with chapter events and topics via our membership email distribution list.
Please let me know if I can assist in this process in any way and feel free to contact me if you have any questions. Again, welcome new members!
Julie A. Shaw, Membership Chairperson 800-872-1818 [email protected]
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Continued...Welcome New and Renewing Members!Laura Markel Methodist Health System CBORickey Mays Memorial HermannLamonica Miles JPS HospitalLeah Montez Children's Medical CenterChase Oswalt MRC BlacksheepDavid Plotkowski NHI Billing ServicesStephen Powelson Penn CreditMitzi Power CymetrixSharla Price Titus Regional Medical CenterCephus Roupe US ArmyFelicia Shade EOS CCA HealthcareJulie Anne Shaw Noel ParrishShawHunter Shofner Medical Arts HospitalMichael Stroope MedSynergies, Inc.Lois Taylor Christus, St. MaryBobbette Taylor Titus Regional Medical CenterDavid Taylor Titus Regional Medical CenterLenda Thomas Titus Regional Medical CenterKathy Ward Baylor Health SystemSheila Weber St. Luke's Episcopal HospitalShari Wilcoxon eReceivables, LLCJoseph Ximenez Baptist Health System
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If you want to get more involved in our Chapter’s activities, please contact one of the following com-mittee chairpersons, regarding your areas of interest…
For a list of the benefitsand to apply for orrenew your sponsorshipplease visit us at www.txaaham.org/pages/partner. If you have anyquestions contact ourChapter Administrator,Debbie Peterson,CMP Management,at [email protected].
Thank You 2012 Corporate Partners!
We would very much like to thank our corporate sponsors for their continued partnership and financial support of our Texas Bluebonnet Chapter. As always, your commitment allows us to provide exceptional educational opportunities to our members free or for nominal fees through-out the year.
We appreciate all that you do for the Texas Bluebonnet Chapter of AAHAM and look forward to another year of partnership, education and good times at all of our events.
With sincere gratitude,
Lora WillisCorporate Partners Committee Chair and Chapter Treasurer
The Texas Tumbleweed is published quarterly by the Texas Bluebonnet Chapter of American Association of Healthcare Administrative Management as a communication medium to Chap-ter members. Opinions expressed in articles are those of the authors and do not necessarily reflect the views of the Texas Bluebonnet Chapter or its members.
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