Healthcare Financial Management articles from September 2008

Healthcare Financial Management archives from September 2008

HHS proposes adoption of ICD-10 code sets and updated electronic transaction standards.(Clinical Documentation)
September 1, 2008... The Department of Health and Human Services (HHS) on Aug. 15 announced a long-awaited proposed regulation that would replace the ICD-9-CM code sets now used to report healthcare diagnoses and procedures with greatly expanded ICD-10 code sets,...

Ever wonder about the impact of one measly percentage point?(NEWS WATCH)
September 1, 2008... Every percentage-point increase in the unemployment rate means 1.1 million more uninsured Americans and 1 million more on Medicaid, according to the Kaiser Commission on Medicaid and the Uninsured.

Pharmacists advising physicians about cost-effective treatments in South Carolina pilot program.(State Watch)
September 1, 2008... The South Carolina Department of Health and Human Services and the South Carolina College of Pharmacy have launched a pilot program that aims to educate physicians who treat Medicaid beneficiaries about the most cost-effective treatments,...

... Medicare contractors are required to educate Medicare providers regarding the specific way that the Centers for Medicare and Medicaid Services (CMS) uses Medicare Cost Report (MCR) data.(CMS)
September 1, 2008... ... Medicare contractors are required to educate Medicare providers regarding the specific way that the Centers for Medicare and Medicaid Services (CMS) uses Medicare Cost Report (MCR) data. Medicare providers are statutorily required to submit...

... Ambulatory surgical centers (ASCs) have been able to bill for certain diagnostic services since Jan. 1, 2008.(CMS)
September 1, 2008... ... Ambulatory surgical centers (ASCs) have been able to bill for certain diagnostic services since Jan. 1, 2008. CMS has determined that beginning Jan. 1, 2009, the ordering/ referring physician must be reported on claims for diagnostic...

... To safeguard providers' information prior to revealing information on claims status, beneficiary eligibility, and other provider-related questions, CMS has added an additional provider authentication element--the last five digits of the provider's tax identification number--to complete interactive voice response transactions and to complete a call with a customer service representative.(CMS)
September 1, 2008... ... To safeguard providers' information prior to revealing information on claims status, beneficiary eligibility, and other provider-related questions, CMS has added an additional provider authentication element--the last five digits of the...

You probably already knew this.(NEWS WATCH)
September 1, 2008... YOU PROBABLY ALREADY KNEW THIS: The United States spends $2.4 trillion per year to keep us ticking and healthy--and that number is predicted to increase another $175 billion in 2008, says the National Conference of State Legislatures (NCSL).

New Mexico implements statewide electronic medical records.(NEWS WATCH)(Brief article)
September 1, 2008... The New Mexico Department of Health has implemented electronic medical records in all of its 49 public health offices that provide clinical services across the state, announced New Mexico Health Secretary Alfredo Vigil, MD, on July 28. The...

... A series of edits developed by the Medicare carrier for Florida to deny claims with potentially improper payments associated with infusion therapy have helped to reduce improper payments in Florida but with a considerable cost to the carrier's operating budget.(CMS)(Brief article)
September 1, 2008... ... A series of edits developed by the Medicare carrier for Florida to deny claims with potentially improper payments associated with infusion therapy have helped to reduce improper payments in Florida but with a considerable cost to the...

However, programming these edits and associated reviews requires a considerable operating expense for contractors, who must carry out their activities within their operating budgets.(CMS)(Brief article)
September 1, 2008... However, programming these edits and associated reviews requires a considerable operating expense for contractors, who must carry out their activities within their operating budgets. As a fraud moves from state to state, the need for a low-cost...

Consequently, CMS convened a fraud edit module workgroup to develop requirements for a proactive fraud edit module that would allow Medicare Carrier System (MCS) users to implement on-the-fly edits when potentially fraudulent claims are found locally or nationally.(CMS)(Brief article)
September 1, 2008... Consequently, CMS convened a fraud edit module workgroup to develop requirements for a proactive fraud edit module that would allow Medicare Carrier System (MCS) users to implement on-the-fly edits when potentially fraudulent claims are found...

Change Request (CR) 5725, issued March 7, 2008, will implement the fraud edit module for MCS in July 2008, and CR 6035, issued May 16, 2008, will implement the fraud edit module for VIPS Medicare System (VMS) in October 2008.(CMS)(Brief article)
September 1, 2008... Change Request (CR) 5725, issued March 7, 2008, will implement the fraud edit module for MCS in July 2008, and CR 6035, issued May 16, 2008, will implement the fraud edit module for VIPS Medicare System (VMS) in October 2008. This transmittal...

But did you know this?(NEWS WATCH)(Brief article)
September 1, 2008... There are nearly 200 companies that produce personal health records, according to analysts at the Markle Foundation, an organization that promotes the use of IT to address public needs.

Explosive growth in medical tourism and rise of retail clinics provide cost savings for patients--and challenges for providers.(Healthcare Cost)
September 1, 2008... More than 750,000 Americans left the country last year for less expensive medical treatments, a number projected to grow to 6 million by 2010, potentially costing the U.S. healthcare system billions. The number of retail clinics in operation...

... A CMS final rule (Federal Register, July 28, 2008) prohibits Medicare Advantage (MA) organizations, including organizations offering MA plans to employer and union group health plan sponsors, from making midyear changes to nonprescription drug benefits, premiums, and cost-sharing submitted in their approved bids for a given contract year.(FEDERAL REGISTER)
September 1, 2008... ... A CMS final rule (Federal Register, July 28, 2008) prohibits Medicare Advantage (MA) organizations, including organizations offering MA plans to employer and union group health plan sponsors, from making midyear changes to nonprescription...

... By means of a final rule (Federal Register, Aug. 8, 2008), CMS sets forth the hospice wage index for FY09.(FEDERAL REGISTER)
September 1, 2008... ... By means of a final rule (Federal Register, Aug. 8, 2008), CMS sets forth the hospice wage index for FY09. In addition, this final rule finalizes the policy to phase out the Medicare hospice budget neutrality adjustment factor, and...

Where's the teeth?(NEWS WATCH)
September 1, 2008... New Jersey is the first slate to require that children have healthcare coverage; the law is very similar to the mandatory coverage law in Massachusetts. However, New Jersey won't punish parents who don't comply, according to the NCSL.

... A CMS final rule (Federal Register, Aug. 8, 2008) updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for FY09.(FEDERAL REGISTER)
September 1, 2008... ... A CMS final rule (Federal Register, Aug. 8, 2008) updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for FY09. It also discusses CMS's ongoing analysis of nursing home staff time...

... The prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal FY09 (for discharges occurring on or after Oct. 1, 2008, and on or before Sept, 30, 2009), were updated by final rule (Federal Register, Aug. 8, 2008) as required under section 1886(j)(3)(c) of the Social Security Act.(FEDERAL REGISTER)
September 1, 2008... ... The prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal FY09 (for discharges occurring on or after Oct. 1, 2008, and on or before Sept, 30, 2009), were updated by final rule (Federal Register, Aug. 8, 2008)...

Maybe that saying should be, 'go east, young man'".(NEWS WATCH)
September 1, 2008... MAYBE THAT SAYING SHOULD BE, 'GO EAST, YOUNG MAN'": In an attempt to attract healthy young workers to the Dirigo health plan, Maine Gov. John Baldacci signed a law creating an affordable insurance policy aimed at residents younger than 30. More...

Survey: 82 percent of Americans think healthcare system needs overhaul.(Quick Hits: Top News Stories of the Month)
September 1, 2008... Americans are dissatisfied with the U.S. healthcare system and 82 percent think it should be fundamentally changed or completely rebuilt, according to a survey released Aug. 7 by the Commonwealth Fund.

CMS announces more accurate payments for IRFs in FY09.(Quick Hits: Top News Stories of the Month)
September 1, 2008... The Centers for Medicare and Medicaid Services (CMS) on July 31 issued a final rule to improve the accuracy of payment for services furnished to people with Medicare who need the intensive rehabilitation services provided by inpatient...

CMS increases nursing home payment rates.(Quick Hits: Top News Stories of the Month)
September 1, 2008... Medicare payment rates to nursing homes will increase by $780 million next year, CMS announced on July 31. The boost in payments is the result of a 3.4 percent increase in the annual market basket calculation of the cost of goods and services...

Surgical errors cost nearly $1.5 billion annually: study.(Quick Hits: Top News Stories of the Month)
September 1, 2008... Potentially preventable medical errors that occur during or after surgery may cost employers nearly $1.5 billion a year, according to new estimates by the Department of Health and Human Services' Agency for Healthcare Research and Quality.

Medicare pays more for medications under Part D: report.(Quick Hits: Top News Stories of the Month)
September 1, 2008... Using confidential information on drug prices to compare the costs of drugs purchased under the Medicare Part D program with the costs of drugs purchased under traditional Medicaid, the House Committee on Oversight and Government Reform found...

HHS takes new steps to accelerate adoption of electronic prescribing.(Quick Hits: Top News Stories of the Month)
September 1, 2008... Beginning in 2009, and during the next four years, Medicare will provide incentive payments to eligible professionals who are successful electronic prescribers. Eligible professionals will receive a 2 percent incentive payment in 2009 and 2010,...

How not to tick off a gator.(Member Spotlight)
September 1, 2008... Jim Grigsby is the author of a book on how to deal with problems ("gators") that torment us, personally and professionally. Jim Grigsby combined a love of writing with a keen sense of humor in creating a handbook on how to deal with...

What's new on our Web site.(ETCETERA)
September 1, 2008... The following documents are located in the Resource Library (www.hfma.org/library) unless otherwise noted. 990 Coalition for Hospitals Web Page. The 990 Coalition for Hospitals, of which HFMA is a member, has launched a web site to provide...

All's fair in love and politics.(ETCETERA)
September 1, 2008... It's a question that puzzled many of those in attendance at a keynote presentation by political insiders James Carville and Mary Matalin, held at ANI: The Healthcare Finance Conference: How can two people who are such polar opposites...

What we have yet to learn from the Massachusetts health plan.(VIEWS)
September 1, 2008... In regard to Mitt Romney's argument for the effectiveness of the Massachusetts Health Plan (The Wall Street Journal, July 12, 2008): Mr. Romney describes a form of the community rate-based rating program for insurance that was originally...

Navigating the path to connection: making connections is my passion, but if not done thoughtfully, it can be too much of a good thing.(making connections)
September 1, 2008... Let me share a few ideas for ensuring that the ease of communication today does not get in the way of what you want your connections to achieve. Think before you push "send." As I walk through our health system offices, everyone's fingers...

No apologies: "explain to me again why it benefits patients for hospitals to get money from them.".(FROM THE EDITOR)
September 1, 2008... A while back, a freelance writer was working on a piece for HFMA about up-front collections, and I sent her an e-mail message reminding her to be sure that the article explained the benefits for patients, not just for hospitals. She wrote...

Patient Friendly Billing initiative receives Board of Directors Award.(HFMA NEWS)
September 1, 2008... HFMA's Board of Directors honored the PATIENT FRIENDLY BILLING[R] project for its substantial contributions to health care during the 2008 ANI: The Healthcare Finance Conference, held June 23-26 in Las Vegas. The Patient Friendly Billing...

HFMA honors winners of Best Article Awards.(HFMA NEWS)
September 1, 2008... Each year, HFMA recognizes authors who have demonstrated outstanding editorial achievement in hfm magazine with the Helen Yerger/L. Varm Seawell Best Article Award. Winners are selected by a panel of five leaders in the healthcare industry and...

U.S.-U.K. exchange focuses on improving quality of care.(HFMA NEWS)
September 1, 2008... More than 40 representatives from HFMA's United States and United Kingdom associations met in Toronto, Ontario, to learn more about ways to improve quality and effectiveness in health care during the 28th annual U.S.-U.K. Exchange, held July...

Tom Peters talks healthcare excellence.(An HFMA News Special: 2008 ANI: The Healthcare Finance Conference)
September 1, 2008... Since co-authoring the best seller In Search o] Excellence. Tom Peters has been regarded as a business guru and a highly sought-after consultant, credited with launching the management revolution. Today, Peters' ideas--and more than a dozen of...

Healthcare organizations must have an identity theft policy: FACTA or fiction? It's a fact. Under a 2003 law called FACTA (Fair and Accurate Credit Transactions Act), healthcare organizations will soon be required to have in place a policy on identity theft.(EYE ON WASHINGTON)
September 1, 2008... A June 2008 Federal Trade Commission Business Alert has helped draw attention to FACTA's Nov. 1, 2008, deadline by which affected businesses are to have identity theft programs in place. While the law's focus is on financial institutions, it...

Take the IT high road toward health reform: no health reform plan is complete without acknowledging the importance of IT in improving the quality of patient care.(HEALTHCARE REFORM)
September 1, 2008... Creating a health IT network that crosses providers and states is a vision shared by many. But getting all the pieces in place to achieve this endpoint is complicated at best. Two pieces of this IT pie are particularly important to reform...

What's mine is mine, what's yours is ... mine: noncontracted services and discounted rates.(MANAGED CARE)
September 1, 2008... Some plans think they should pay your hospital for noncontracted emergency services at the discounted rates in your contracts with other plans. A health plan chooses not to find any role for your hospital in its network of contracted...

10 tips for survival under MS-DRGs.(MEDICARE/MEDICAID)
September 1, 2008... The phase-in of Medicare severity-based diagnosis-related groups (MS-DRGs) began in October 2007 and will be complete in FY09. The new system replaces the previous schedule of 538 DRGs with 745 new severity-adjusted DRGs. Reimbursement under...

Sen. Bill Frist, MD: healthcare reform begins with payment reform.(hfm Q&A)(Interview)
September 1, 2008... [ILLUSTRATION OMITTED] A new payment system can be the driver of healthcare reform, and HFMA is uniquely positioned to bring together the stakeholders to discuss the challenges in our payment system and suggest a wide range of potential...

Securing revenue with improved data use.(HFMA EDUCATIONAL REPORT)
September 1, 2008... Denials. Underpayments. Rejects. Unbilled inventory. These are some of the most common areas where hospitals fail to realize revenue for services they have delivered. And while most hospitals routinely target these functions for...

What hospitals can learn from banks: patient collection teams are essentially managing portfolios of aged $500 and larger consumer loans. Applying tested banking practices can help hospitals shore up against this rising tide.(Cover story)
September 1, 2008... [ILLUSTRATION OMITTED] When it comes to collecting revenue from patients--whether from insured or uninsured patients with payment responsibilities--hospital business offices should think like loan management teams of local banks and credit...

3 pillars of a successful denials management program: with a strong denials management process in place, hospitals can reduce their denial rate and increase cash recoveries.(FEATURE STORY)
September 1, 2008... [ILLUSTRATION OMITTED] The business office director of a large academic health system was faced with a quandary: Trending of monthly cash was flat, accounts receivable (A/R) days were stable, yet contractual allowances were trending higher...

Successfully implementing a revenue cycle self-pay solution: uncompensated care and bad debt continue to be among the healthcare industry's most pressing problems.(FEATURE STORY)
September 1, 2008... The changes and challenges for the U.S. healthcare industry today are widely publicized. Employers have seen dramatic rises in healthcare costs, while employees have watched their healthcare deductibles as much as double from the previous year...

Workflow key to real-time claims adjudication success: outpatient providers should evaluate the impact of real-time claims adjudication on workflow and assess ROI before adopting this approach.(FEATURE STORY)
September 1, 2008... Medical offices are accustomed to dealing with a variety of payers, but they are starting to see patients who have consumer directed health plans (CDHPs), which place greater financial responsibility on patients. With CDHPs comes a potential...

And never the twain shall meet? Integrating revenue cycle and supply chain functions: by aligning the departments responsible for revenue cycle and supply chain success, hospitals can increase their competitive advantage--and enhance their bottom lines.(FEATURE STORY)
September 1, 2008... Healthcare organizations have traditionally undertaken revenue cycle and supply chain initiatives independently of one another--but the benefits of a distinctly separate approach have been limited. During the late 1990s, for example, many...

Hospital zero-base pricing can make a difference: point-of-service estimates won't mean much if they are based on irrational and indefensible line item prices.(FEATURE STORY)
September 1, 2008... How did hospital prices become irrational? Healthcare organizations have experienced years of inadequate inflationary update factors and other adjustments under the federal inpatient and outpatient prospective payment systems. As a result,...

National trends in uncompensated care and profitability: despite a 28 percent rise in the average cost of uncompensated care over five years, hospitals have thus far been able to maintain their margins.(FEATURE STORY)
September 1, 2008... U.S. hospitals have seen a steady rise in uncompensated care over the past five years. From federal fiscal year (FFY) 2003 through FFY07, short-term acute care hospitals (STACHs) that are subject to the Medicare inpatient prospective payment...

Considering a billing system conversion? Change workflow processes first: taking time to redesign workflow processes before implementing a new hospital billing system allows an organization to maximize the system's value.(FEATURE STORY)
September 1, 2008... The pressures facing hospitals demand an unprecedented level of revenue cycle performance. Consumer-directed health care, participation in payfor-performance programs, Medicare severity-adjusted diagnosis-related groups (MS-DRGs), HIPAA...

Selling written-off A/R: the concept of selling written-off accounts receivable (A/R) is slowly gaining acceptance, but concerns about risk to hospital reputation and loss of control over accounts have made hospitals cautious. Learn strategies for evaluating the sale of these accounts to enhance the bottom line.(FEATURE STORY)
September 1, 2008... A hospital's decision to sell its written-off accounts receivable (A/R), or bad debt, has been a subject of debate in the hospital C-suite since 1998, when the first hospital took the bold step of doing so. Since that time, a small but growing...

Improving financial services for the uninsured.
September 1, 2008... A five-hospital system in the Southeast was not able to include many deserving patients in its charity care program because the patients were unable to meet paperwork requirements, including corroborating documentation such as pay stubs and...

Medicare add-on payments.(hfm TOOLBOX)
September 1, 2008... Medicare add-on payments are often forgotten factors in hospital financial analyses. When considering whether to add or discontinue procedures related to particular service lines, payers, or physicians, hospitals typically focus on the...

5 Approaches to leading successful organizational change: how CFOs handle staff resistance to change is crucial.(LEADERSHIP AND MANAGEMENT)
September 1, 2008... Many of the ideas and concepts presented in this issue of hfm require numerous new approaches in the way things have always been done: new processes, new systems, new behaviors. In a word, change. To the human mind, change is a bad thing,...

Hospitals have collected mountains of patient and clinical data--now what? When Google announced in March that it was testing a new web site on which patients could store their personal health records online, the company was following in the footsteps of many U.S. hospitals, which began implementing electronic health record (EHR) solutions 10 years ago.(INSIDE IT)
September 1, 2008... Almost 40 percent of hospitals now have the basics of an EHR system in place, according to market research firm Healthcare Information and Management Systems Society (HIMSS) Analytics. A decade of EHR use has given some hospitals mountains of...

The summer of our discontent: as the calendar advances to the fullness of summer and the inevitable intimations of the coming autumn, investors find themselves with a distinctly empty feeling. A prevailing mood that calls to mind the "winter" of Steinbeck's famous novel.(CAPITAL FINANCE)
September 1, 2008... Four dollars-plus for a gallon of gas, "'agflation," teetering financial institutions, and festering geopolitical strife have taken a healthy bite out of investment portfolios. While there is no sure antidote to the pain inflicted by this...

Calendar.(Calendar)
September 1, 2008... The following HFMA chapter events are scheduled to occur in September 2008. To learn more about these HFMA chapter events, please visit www.hima.org/events, and select "September" and "Chapter Events." September 9 New Jersey Chapter...

Linda K. Burt.(PEOPLE)(appointment of Linda K. Burt at Methodist Health System)(Brief article)
September 1, 2008... [ILLUSTRATION OMITTED] Burt has been appointed corporate vice president of finance and CFO, Methodist Health System, Omaha, Neb. Formerly, she was CFO, Saint John's Health Center, Santa Monica, Calif.

Janet Crain, CPA.(PEOPLE)(appointment of Janet Crain at St. John Health)(Brief article)
September 1, 2008... [ILLUSTRATION OMITTED] Crain has been appointed director of corporate responsibility, St. John Health, Warren, Mich. Previously, she was director, compliance services, CHAN Healthcare Auditors, Warren, Mich.

Raymond H. Custer.(PEOPLE)(appointment of Raymond H. Custer at MeGladrey & Pullen LLP)(Brief article)
September 1, 2008... [ILLUSTRATION OMITTED] Custer has joined MeGladrey & Pullen LLP. Kansas City, Mo., as director, healthcare services. Previously, he was a director, Pricewaterhouse Coopers LLP, Des Moines, Iowa.

Timothy O. Morgan.(PEOPLE)
September 1, 2008... [ILLUSTRATION OMITTED] Morgan has been promoted from executive vice president of consulting solutions to COO, B.E. Smith, Lenexa, Kan.

J. Larry Tyler, FHFMA.(PEOPLE)
September 1, 2008... [ILLUSTRATION OMITTED] Tyler, CEO, Tyler and Company, Atlanta, has been named one of the world's most influential headhunters by BusinessWeek magazine.

Michael R. Albion.(PEOPLE)
September 1, 2008... Albion has been appointed assistant vice president, strategic alliances, AHA Solutions, Inc., Chicago. Formerly, he was director, business development, Metropolitan Chicago Healthcare Council, Chicago.

Debbi Johnstone, JD.(PEOPLE)
September 1, 2008... Johnstone has been appointed partner, Fulbright & Jaworski, LLP, Houston. Previously, she was partner, Health Section, Vinson & Elkins, Houston.

Pedro A. Ramirez.(PEOPLE)(appointment of Pedro A. Ramirez at regional contracting)(Brief article)
September 1, 2008... Ramirez has been appointed director of regional contracting, Southern California, Kaiser Permanente, Pasadena, Calif. He had been director of contracts and operations, Providence Health & Services, Little Company of Mary Service Area, Torrance,...

Robert C. Tyk, FHFMA.(PEOPLE)
September 1, 2008... Tyk has been appointed vice president and CFO, Skaggs Community Health Center, Branson, Mo. Previously, he was owner/principal, Kaizen Consulting, Ruidoso, N.M.

Political realities of payment reform.(FROM THE PRESIDENT)
September 1, 2008... "I love the principles outlined and discussed in the paper." This quote and several other positive comments were made by former Senate Majority Leader Bill Frist, MD, on HFMA's white paper Healthcare Payment Reform: From Principles to...