Healthcare Financial Management articles from October 2004

Healthcare Financial Management archives from October 2004

Proposed 2005 outpatient PPS rule includes 3.3 percent update.(Policy Watch)(Prospective Payment Systems)(Brief Article)
October 1, 2004... Medicare's proposed hospital outpatient PPS rule for 2005, published in the August 16 Federal Register, would allow a full market basket increase of 3.3 percent to most payment rates and reflects the emphasis on preventive services also seen in...

Payment for care to undocumented aliens moves closer.(Policy Watch)(Brief Article)
October 1, 2004... CMS has begun outlining the process for providers to be paid their part of the $1 billion called for by the MMA for emergency health services to undocumented aliens. To be eligible for payment, providers are required to fill out an enrollment...

IRS targets not-for-profit compensation practices.(Policy Watch)(Internal Revenue Service)(Brief Article)
October 1, 2004... The IRS announced a new initiative to end abuses by tax-exempt organizations that award excessive compensation and benefits to their officers and other insiders. Under the new Tax Exempt Compensation Enforcement Project, the IRS will request...

... In an August 17 letter directed to states, CMS encouraged Medicaid directors to adopt approaches that would give elderly and disabled individuals more control over how they obtain the long-term care services they need.(United States Centers for Medicare and Medicaid Services)(Brief Article)
October 1, 2004... In an August 17 letter directed to states, CMS encouraged Medicaid directors to adopt approaches that would give elderly and disabled individuals more control over how they obtain the long-term care services they need. The letter included...

... Effective October 1, Medicare hospice rates for FY05 will increase 3.3 percent, according to a recent CMS transmittal.(Brief Article)
October 1, 2004... ... Effective October 1, Medicare hospice rates for FY05 will increase 3.3 percent, according to a recent CMS transmittal. The increase equals the total market basket increase projected for FY05. Annual updates to the hospice wage index were...

CMS seeks help with drug benefit subsidy options.(Policy Watch)(Centers for Medicare and Medicaid Services)(Brief Article)
October 1, 2004... CMS has asked employers that sponsor retiree drug benefits for their feedback on the proposed implementation of the employer/plan sponsor subsidy provided for in the MMA. In a discussion paper, CMS acknowledged the uncertainty of how employers...

CMS clarifies use of SNF bill type 22X.(Policy Watch)(United States Centers for Medicare and Medicaid Services)(Skilled Nursing Facilities)(Brief Article)
October 1, 2004... At an August 31 Open Door Forum, CMS clarified a February transmittal, Change Request (CR) 3031 which stipulated that bill type 22X should be used for skilled nursing facilities' billings for Medicare inpatient Part B. Many Medicare...

CMS issues instructions on CAH distinct part units.(Policy Watch)(United States Centers for Medicare and Medicaid Services)(Critical Access Hospital)(Brief Article)
October 1, 2004... Effective October 1,2004, inpatient rehabilitation facilities (IRFs) can be located in a critical access hospital (CAH), will be paid under the IRF PPS, and will be identified by provider number xx-Rxxx, CMS announced in an August 13...

CMS enhances QIO scope of work.(Policy Watch)(United States Centers for Medicare and Medicaid Services)(Quality Improvement Organizations)(Brief Article)
October 1, 2004... CMS will be unable to process claims for these units until January 3, 2005. Providers should submit their distinct part unit claims, but Medicare will not release the claims for payment until January 3. These claims will qualify for interest....

New CMS council to speed medicare coverage of new treatments/technology.(Policy Watch)(United States Centers for Medicare and Medicaid Services)(Brief Article)
October 1, 2004... CMS is launching a new council to increase access to new medical treatments and technologies, according to an August 18 announcement. The Council on Technology and Innovation (CTI) will enlist senior CMS staff and experts on clinical, coverage,...

Are the states' budget crises over? Higher education. Chop! Social services. Chop! Health care. Chop!(State Policy Watch)
October 1, 2004... Since late 2001, state programs and services have fallen under the axe again and again as states have struggled with gaping deficits. The fiscal crises have dominated state legislatures' agendas. During the past four fiscal years, the states...

Setting the quality standard: everyday healthcare publication I read these days has an article about another organization that is creating hospital "report cards.".(From The Chairman)
October 1, 2004... Any group with a vested interest in healthcare costs and/or outcomes is sponsoring these data bases. Sponsors range from health plans to state or local governments to private foundations. These groups start with Medicare or statewide all-payer...

Employer-sponsored health premiums average 11.2 percent increase.(Industry Watch)(Brief Article)
October 1, 2004... Employer-sponsored health insurance premiums increased an average of 11.2 percent in 2004, less than last year's 13.9 percent increase, but still the fourth consecutive year of double-digit growth, according to the 2004 Annual Employer Health...

Capital outlook holds challenges, opportunities.(Industry Watch)
October 1, 2004... Limited capital access may force some hospitals to fall further behind, lead to facility closures, and cause quality to suffer in institutions that fall to keep up with technology improvements, according to a panel of experts interviewed for...

Lifepoint to acquire Province Healthcare.(Industry Watch)(LifePoint Hospitals L.L.C.,, Province Healthcare Co.)(Brief Article)
October 1, 2004... On August 16, LifePoint Hospitals announced that it would acquire Province Healthcare Company for about $1.7 billion in cash, stock, and the assumption of debt. The transaction will create a hospital company focused on providing healthcare...

5 medical conditions account for 31 percent of healthcare spending growth.(Industry Watch)(Brief Article)
October 1, 2004... Five medical conditions account for 31 percent of growth in healthcare spending, according to a Health Affairs article, "Which Medical Conditions Account for the Rise in Health Care Spending?" The study looked at data for nearly 60,000 patients...

Number of uninsured continues to rise.(Industry Watch)(Brief Article)
October 1, 2004... The number of uninsured increased 1.4 million between 2002 and 2003, to 45 million, while the number of people with insurance rose by 1 million to 243.3 million in 2003, according to a report by the Census Bureau. Also, the percentage of people...

Report questions value of consumer-directed health care.(Industry Watch)(Brief Article)
October 1, 2004... Consumer-directed health care's high deductible plans could fail to reduce healthcare costs and have the potential to worsen health outcomes if patients don't get needed preventive and chronic condition care, says Karen Davis, PhD, president of...

For-profit hospitals sued.(Industry Watch)(Brief Article)
October 1, 2004... Three for-profit hospitals now face lawsuits over what they charge uninsured patients, news sources reported August 6. Lawyers associated with those who filed for class-action status lawsuits against not-for-profit hospitals over billing issues...

Medicare carrier identifies top 10 billing errors.(Industry Watch)(Brief Article)
October 1, 2004... Duplicate claims constitute the most common billing error made by healthcare providers, according to TrailBlazer Health Enterprises, a CMS-contracted intermediary. Top billing errors in ranked order, according to Trail Blazer, are: 1....

Study: drugs are not fastest-growing hospital cost.(Industry Watch)(Brief Article)
October 1, 2004... Hospital costs for prescription drugs are rising at a slower rate (22 percent) than many other hospital costs, according to a recent study conducted by Solucient. This rate is slower than hospital costs for diagnostic imaging (36 percent),...

Access to medical care improves for low-income population.(Industry Watch)(Brief Article)
October 1, 2004... Even with sluggish economic growth and rapidly rising healthcare costs, Americans' access to necessary medical care improved slightly between 2001 and 2003, especially among low-income children end adults, according to a national study released...

Quotes of note.(Industry Watch)
October 1, 2004... "Non-liquid assets are not going to be counted." --CMS administrator Mark McClellan, describing the low-income test to be used in determining eligibility for drug subsidies under the MMA, effective January 1, 2004. "In our view, it is...

Hospital wholesale prices leap.(Industry Watch)(Brief Article)
October 1, 2004... The July Producer Price Index (PPI) for hospitals jumped by 1.1 percent, following five months of flat or moderate increases, the Bureau of Labor Statistics reported August 13. The PPI measures the monthly change in transaction prices received...

Coding and billing tool available.(HFMA News)(Healthcare Financial Management Association)(Brief Article)
October 1, 2004... HFMA's Resource Center recently released Self-Assessment Tool: Coding and Billing. This coding and billing checklist ensures that key processes are covered, allowing providers to check their performance against targeted benchmarks. The tool is...

Clarke makes 100 most powerful list.(HFMA News)(Richard L. Clarke)
October 1, 2004... HFMA President and CEO Richard L. Clarke, FHFMA, was named one of the 100 most powerful people in health care in the August 23 issue of Modern Healthcare magazine. The list, in its third year, was compiled from readers' votes on people...

HFMA offers third-party evaluation through peer review.(HFMA News)(Healthcare Financial Management Association)(Brief Article)
October 1, 2004... HFMA members now have an objective source for finding out more about a product or service. HFMA's Peer Review Process is designed to provide healthcare financial managers with a third-party evaluation of products or services used specifically...

Moderating spending on prescription drugs: as the election period goes into high gear, increased attention is being paid to prescription drug prices.(Eye On Washington)
October 1, 2004... Democrats, both individually and as part of the presidential campaign, are pushing hard for reimportation of drugs from other countries. At his confirmation hearing last March, Mark McClellan, the new CMS administrator, was asked whether he...

Healthcare joint ventures a CFO primer.(Business)(Chief Financial Officer )
October 1, 2004... Given the current revenue and cost pressures in the healthcare industry, joint ventures are more important than ever. Reduced hospital payments, coupled with increased bond downgrades, have limited the provider sector's access to cash....

3 steps for optimizing self-pay outsourcing.(Revenue Cycle)
October 1, 2004... Are you thinking about outsourcing your sell-pay receivables? If so, you're not alone. Accounts receivable (A/R) outsourcing has become more common in health care as hospitals seek ways to improve their operational performance. Self-pay...

Job: security 7 steps for HIPAA compliance: taking a proactive stance is your top job for effective information security.(Health Insurance Portability and Accountability Act of 1996 )(Cover Story)
October 1, 2004... With the security compliance deadline quickly approaching, healthcare leaders should take several steps to prepare their organizations for a smooth transition into compliance with HIPAA's security regulations. 1. Study the Security...

Tightrope walk: setting defensible prices: the balance between generating a reasonable ROI and setting reasonable prices is not always easy for hospitals to maintain.(Feature Story)(Return On Investment)
October 1, 2004... When setting prices, most hospitals have two major conflicting management goals. On one hand, hospitals need to generate a reasonable return on their investment to remain financially viable. On the other, hospital executives are concerned with...

Pardon me: that's our money! Healthcare organizations need to protect their not-for-profit corporate assets from charitable trust treatment.(Feature Story)
October 1, 2004... Not-for-profit hospitals and health systems and other tax-exempt healthcare providers are under increasing financial stress--much of it the result of the government's mandates and its refusal to pay fair value for services it purchases or...

Medicare's compare databases with a long-term care mission: because consumer perceptions of quality today may substantially affect tomorrow's healthcare revenues, hospitals should learn about and use Medicare's new long-term care databases.(Feature Story)
October 1, 2004... A hospital struggles when a joint venture with two long-term care (LTC) providers generates substantially less revenue than was projected. A second hospital is stung when several discharged patients complain about the quality of care rendered...

There's no profiting from a joint venture misadventure: can a not-for-profit hospital enter a 50/50 joint venture with a for-profit organization and retain its tax exemption? The answer in some circumstances appears to be "yes.".
October 1, 2004... Any business arrangement that is not profitable to the other person will in the end prove unprofitable for you. The bargain that yields mutual satisfaction is the only one that is apt to be repeated. --B. C. Forbes What should a...

Raising the performance of owned physician practices: owning a group practice remains a viable strategy for hospitals and health systems. For one system, success has come by vesting the group with control of the financials.(Feature Story)
October 1, 2004... Does it pay to own a physician group practice? For many hospitals and health systems that acquired physician practices in the 1990s, the answer seemed to be "no"; many divested physician groups that failed to meet financial performance...

Medical necessity denials: prevention pays off.
October 1, 2004... Hospitals are always looking for ways to improve operating margins. One reason for a drain in cash flow is due to payment denials because medical necessity is not met. Medical necessity denials are a significant challenge to hospitals not only...

5 reasons CFOs get fired: CFOs are accustomed to taking a lot of heat, but when the heat turns into a firing, charred CFOs may be left asking the question, "What went wrong?".(Leadership And Management)(Chief financial officers)
October 1, 2004... Although CFOs lose their job for myriad reasons, five reasons predominate industrywide and perhaps even across industries. But take heart. There are several practical strategies CFOs can use to avoid failing victim to termination. 1....

Management's role in IT project failures: senior managers obviously have great interest in seeing that projects become successful. Yet despite best intentions, all too often they wind up playing a pivotal role in ensuring project failure.(Digital Perspectives)(Information technology )
October 1, 2004... How does this happen? Frequently leadership contributes to failure by permitting poor project management or by abdicating its roles as Business sponsors and business owners. Of course, such errors apply to any project that attempts to...

Progress review: essential to keeping your plan on track: many healthcare organizations report great success in developing sound growth plans. And some are even quite effective at following through with their plans.(New Revenue Growth)
October 1, 2004... Yet one of the most frequent concerns cited by healthcare managers is that after a good start, their growth plans somehow veer off course. Many explanations are offered, but it usually comes down to one basic flaw: failure to manage growth in a...

Financial Strategy for Managed Care Organizations.(Book Review)
October 1, 2004... Charles William Wrightson, Jr., PhD Health Administration Press 363 pages; $69 www.ache.org/hap.cfm Financial Strategy for Managed Care Organizations provides an effective overview of insurance rate setting--past, present, and future. The...

Calendar.(Illustration)(Calendar)
October 1, 2004... Fall 2004 Seminars 10/11-14 11/8-11 Cambridge, Orlando, 12/6-9 Level Seminar MA FL Chicago ...

Spotlight on HFMA members: reflections on the 2003 and 2004 HFMA U.S./U.K. Exchanges.(People)(Healthcare Financial Management Association)
October 1, 2004... Last year, I couldn't have imagined that HFMA's U.S./U.K. Exchange could have been a better experience than it was that summer in the United Kingdom. But after participating in this year's U.S./U.K. Exchange at the Grand Hyatt Hotel in New...

Michelle Kakazu.(People)(Brief Article)
October 1, 2004... (Hawaii Chapter) Ms. Kakazu has been promoted from director, financial planning', to vice president, finance, Hawaii Pacific Health, Honolulu.

Joseph M. Lemaire, CPA.(People)(Brief Article)
October 1, 2004... (New Jersey Chapter) Mr. Lemaire has been appointed vice president, operations, Besler Consulting, North Brunswick, N.J. Previously, he was vice president, operations, Cap Gemini, Clark, N.J.

David Okabe, CPA.(People)(Brief Article)
October 1, 2004... (Hawaii Chapter) Mr. Okabe has been promoted from vice president, treasurer, to senior vice president, CFO, Hawaii Pacific Health, Honolulu.

Julie Apel.(People)(Brief Article)
October 1, 2004... (Maryland Chapter) Ms. Apel has joined The Centers for Medicare & Medicaid Services, Baltimore, as budget analyst. She had been decision support analyst, St. Joseph Medical Center, Towson, Md.

Colleen Koppenhaver, FHFMA, CPA.(People)(Brief Article)
October 1, 2004... (Virginia Chapter) Ms. Koppenhaver has been appointed CFO, Oaklawn Hospital, Marshall, Mich. She had been director of finance, Bon Secours Hampton Roads HeaRth System, Norfolk, Va.

Laurence Abramson, FHFMA.(People)(Brief Article)
October 1, 2004... (San Diego Imperial Chapter) Mr. Abramson has been named senior vice president, Wellspring Partners, Ltd., San Diego. Formerly, he was senior vice president, Supply Chain Solutions, San Diego.

Debra Greene-Lowe.(People)(Brief Article)
October 1, 2004... (Northeast Ohio Chapter) Ms. Greene Lowe has been named regional director, patient financial services, St. Elizabeth Health Center, Youngstown, Ohio. Formerly, she was director, patient financial services, Ashtabula County Medical Center,...

Melony Williams Goodhand.(People)(Brief Article)
October 1, 2004... CPA (Arkansas Chapter) Ms. Williams Goodhand has been named CFO, vice chancellor for finance, University of Arkansas for Medical Sciences, Little Rock, Ark. Formerly, she was vice president for finance and chief compliance officer, Genesys...

DRGs are key to assessing admissions through the ED.(Data Trends)(Diagnosis related groups, emergency department )
October 1, 2004... A high percentage of hospital admissions derive from emergency department (ED) visits. To appropriately allocate resources for the care of patients admitted through the ED, hospitals need to understand which types of conditions prompting ED...

2003-2004 annual report.
October 1, 2004... LETTER FROM THE CHAIRMAN AND PRESIDENT "HFMA has helped me throughout my career by providing educational sessions thai met my needs The education has come at local, regional. and national platforms in an array of topics from the very basic...

Creating community connections: hospitals are losing the public relations battle in the conflict over the appropriateness of charging and billing the uninsured.(From The President)
October 1, 2004... But finding connections rather than conflict can change that dynamic. In August, I wrote about the strange world of hospital charging and billing practices where individuals with limited or no healthcare insurance often are expected to pay...