hapter MASS MEDIA...William E. Grigg, FHFMA, CPA HFMA New Members - February 1, 2010 to March 31, 2010 Timothy Hogan, FHMFA Kathleen Kenny, CPA Gerald O’Neill, FHFMA Beth O’Toole

The Newsletter of the Massachusetts-Rhode Island Chapter Volume XXXVII • Number 3 • March 2010

MASS MEDIA

Patient Receivable Loan Programs: Finding Resurgence in Today’s Economy

Improving Self Pay: A Caring Stewardship of the Uninsured

How To Write a Perfect Cover Letter

Interview with CFO of Tufts Medical Center

2010 Revenue Cycle Conference Committee: back (Left to Right) Sub-Committee Chairs: Bill Wyman, Jennifer Samaras,

Karen Bowden, Patrick McDonough; front (Left to Right) Co-Chairs: Ames Ryba, Angela Confoey

REVENUE CYCLE:

What is Hiding in Your Vendor Inventories?

Essays on Reform: Medicare Physician Fees Need Immediate Fix

THE MASSACHUSETTS - RHODE ISLAND CHAPTER OF HFMAGRATEFULLY ACKNOWLEDGES THE 2009-2010 CORPORATE SPONSORS

HBCS has been the leader incustomized outsourcing for hospitalbilling and collection for more thantwenty years. With over 60 hospitalclients nationwide and a dedicatedteam of 500 employees, we fullyunderstand the unique financialchallenges faced by hospitals today.As your financial partner, we have theexpertise to help hospitals fullymaximize profit to create a strongerbottom line.

Learnmore about our financialsolutions, contact Kathleen Maher at781-279-8465 or [email protected].

Your Cash Flow!

www.hb c s . o r g

New Ca s t l e , D EWak e f i e l d , MASa l i s bu r y , MD

Third Party BillingAccounts Receivable ManagementInsurance Follow-UpSelf-Pay Billing and Follow-UpBad Debt CollectionsInterim Business Office Staffing

PLATINUM

Bank of America • Beecher Carlson • BESLER Consulting Deloitte • Feeley & Driscoll P.C. • Harvard Pilgrim Health Care

KPMG LLP • PricewaterhouseCoopers LLP • Siemens Medical Solutions, USA, Inc.

GOLD

HBCS • Ropes & Gray LLP • TriNet Healthcare Consultants, Inc.

SILVERFoley & Lardner LLP • Gragil Associates, Inc.

Healthcare Financial, Inc. • Medical Bureau/ROI • Phillips DiPisaPhysician Insurance Agency of MA (PIAM) • Public Financial Management

BRONZE

Accelerated Receivables Management Solutions, LLC • Action Collection Agencies, Inc.Baker Newman & Noyes, LLC • Balanced Healthcare Receivables, LLC • Citizens Bank

Computer Credit, Inc • Health Management Associates, Inc.• Marcam AssociatesMedAptus • Perot Systems • ProMedical, LLC • Shields Health Care Group

Bank of America 9

Beecher Carlson Healthcare 19

BESLER Consulting 28

Deloitte 14

Feeley & Driscoll, P.C. 21

Harvard Pilgrim Health Care 13

HBCS 2

KPMG LLP 6

Phillips DiPisa 18

Physician Ins. Agency of Massachusetts 20

PricewaterhouseCoopers LLP 17

Public Financial Management 22

Ropes & Gray, LLP 16

Siemens Medical Solutions, USA, Inc. 11

TriNet Healthcare Consultants, Inc. 24

REVENUE CYCLE

2 0 0 9 - 2 0 1 0Volume XXXVII Number 3 March 2010

TABLE OF CONTENTS

MASS MEDIA is a publication of the Massachusetts - Rhode Isand Chapter of the Healthcare Financial Management Association devoted to keeping membership current on national & local healthcare financial topics. Opinions and views expressed in the articles and features of the publication are those of the author(s) and do not necessarily reflect the position of the Massachusetts-Rhode Island Chapter or The National Chapter of Healthcare Financial Management Association. Articles submitted are subject to editorial changes made by the committee. Article submissions, comments and requests for further information and advertising rates may be forwarded to: Anne Farmer and Deb Wilson, CPA, HFMA Massachusetts-Rhode Island Chapter, 411 Waverley Oaks Road, Suite 331B, Waltham, MA 02452, [email protected]

OFFICERS & DIRECTORS

PresidentJerry Vitti

President ElectMichael Connelly, CPA

SecretaryJeffrey Dykens, CPA

TreasurerRoberta S. Zysman

Immediate Past PresidentMarvin Berkowitz, FHFMA

DirectorsPaul Breslin

Dennis ChalkeDavid Dillon, FHFMA, CPA

Anne FarmerWilliam E. Grigg, FHFMA, CPA

Timothy Hogan, FHMFAKathleen Kenny, CPA

Gerald O’Neill, FHFMABeth O’Toole

Mark Rich Rosemary Rotty, MHA, FHFMA

Jeanne Schuster J. Mark Waxman

Richard WichmannDeborah Wilson, CPA

Ex OfficioRoger C. Boucher

Frank E. Byrne, CPAMarc A. Proto, FHFMA, MBA

4

5

HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION

8

20

27

15

2526

28

Anne Farmer, Vice PresidentTriNet Healthcare Consultants

N e w s l e t t e r C o m m i t t e e

Deborah Wilson, Senior Vice President,Ambulatory Services & Physician Network

Signature Healthcare

President’s Message I by: Jerry VittiThe Massachusetts-Rhode Island Chapter provides quality and value to its members in all that we do.

What is Hiding in Your Vendor Inventories? I by: Jon Puz and Steve LevinDespite best intentions, current operating routines are prone to enable inconsistencies between the inventory records of a hospital and its vendors.

CFO Interview Interview Featuring Chibueze Okey Agba, Senior Vice President, Chief Financial Officer and Treasurer, Tufts Medical Center

Patient Receivable Loan Programs: Finding Resurgence in Today’s Economy I by: Steve ChraplaThere is a new equation in healthcare finance and receivable loan programs are gaining popularity again!

Improving Self Pay: A Caring Stewardship of the Uninsured I by: Daniel A. SchulteThe larger hospitals can spend upwards of $3 million dollars per year in internal and vendor costs to manage the self pay population.

In MemoriamNick Arloro, HFMA Past President 1988-1989.

How To Write a Perfect Cover Letter I by: Deborah WalkerYour cover letter has only one job. It is meant to entice the reader to open and read your resume.

Essays on Reform: Medicare Physician Fees Need Immediate Fix I by: Marvin BerkowitzDoctors on March 1 will face a 21% cut to Medicare physician payments because of the Senate’s inability to act on a temporary measure to halt the scheduled reduction.

MA/RI HFMA 2010 Revenue Cycle Conference Pictures and synopsis of Revenue Cycle Conference Held on January 22, 2010 at at Gillette Stadium, Foxboro, Massachusetts.

New MembersHFMA New Members - February 1, 2010 to March 31, 201030

Dear Colleagues,

During my presidency, I have repeatedly talked about how the Massachusetts-Rhode Island Chapter provides quality and value to its members in all that we do. Our affordable educational programs are second-to-none, always low-cost, and provide high impact networking opportunities which allow all of us time to connect with colleagues and lifelong friends. The information we provide through our quar-terly newsletter, Mass Media, our webcasts and other media compares favorably against any national offerings.

A great example of what makes our chapter so special is our recent annual Revenue Cycle meeting at Gillette Stadium. First of all, I am extremely proud to say that this years’ event broke all past attendance records! Second, the event Quality Survey came back with high marks across the board for yet another successful chapter program. There was praise all around for the venue, speakers and vendors – with comments such as; “The entire day was well done …”, “Topics were relevant and timely in the current environment …”, “Great day! Can’t wait until next year!” and finally “Best conference I have been to in years!” Once again, a special thanks to Amy Ryba, Angela Confoey, and our board liaison Beth O’Toole, for working so hard to make this event such a tremendous hit!

Another wonderful example of our excellent educational events was our February 12th Enterprise Performance Committee’s program entitled “The Performance Imperative in a Time of Health Care Reform”. Among the outstanding line up of speak-ers and panelist was the keynote presentation by John Glaser, PhD, Vice President and Chief Information Officer for Partners Health Care and an advisor to the Obama Administration. The survey results showed a very high level of satisfaction with the program. Comments included, “The level of expertise was of the highest caliber …” and “This was one of the best HFMA meetings I have been to! The speakers were all excellent and the topics very relevant.” Hats off to Roger Price and Gail Robbins, CPA who headed this year’s committee.

Achieving an important milestone, our chapter held its first Webinar on February 16th entitled “Reform Revolution: Massachu-setts to Washington D.C.” I was honored to have provided the Massachusetts’ overview, while Rick Gundling, HFMA National’s Vice President of Financial Practices, and their chief person in Washington, presented the national perspective. Over seventy five members throughout New England participated on the call.

Upcoming events that everyone should be aware of are the:

- Region One Ninth Annual Healthcare Conference at Mohegan Sun. Please note the new dates which are May 13th and 14th. This is a “must attend” event which provides the best in health care educational sessions and outstanding networking with your colleagues in the Northeast.

- Annual Social and Awards Night on May 26th at the downtown Harvard Club. This year’s event will feature wines of Australia as we honor deserving recipients with some of HFMA’s most prestigious awards.

- Annual Spring Golf Tournament on June 8th at the Agawam Hunt Club in Rhode Island. HFMA’s golf impresario Tony Slabacheski always does a terrific job organizing a special day for our members.

- Finally, on June 18th, we have our annual Managed Care meeting which promises to be an informative and well attended session.

I would be remiss if I did not congratulate Bill Wyman who recently became a Certified Healthcare Financial Professional (CHFP). A big congratulations and great job Bill!

Many thanks to our Officers, Board, Volunteers, Sponsors and our membership for all their hard work, dedication and loyalty to the chapter. We truly have a dynamite and dynamic chapter!

All the best,

Gerard A. Vitti

Most hospital business offi ces rely on third party vendors – collection agencies, extended business offi ce partners and eligibility fi rms – to augment internal collection efforts. Every day accounts and fi nancial updates fl ow back and forth between a hospital and its vendors. Despite best intentions, current operating routines are prone to enable inconsistencies between the inventory records of a hospital and its vendors.

Always thought to be a relatively minor issue, recent Connance research suggests the inventory reconcili-ation problem is signifi cant, pervasive and critical. Reconciliation issues between providers and their vendors can lead simply to lost cash and high oper-ating costs or go so far as to create regulatory issues and major public relations problems.

The Magnitude of Inventory Reconciliation Issues Can Be Signifi cantBased on fi ndings from inventory reconciliation initiatives at multiple providers around the United States, between 5% and 34% of inventory held at vendors had reconciliation issues with the providers’ records.

The average reconciliation error rate across this sample of providers was 13%. Even in situations where the provider had only a single vendor, the reconciliation error rate was high.

Reconciliation issues broke down into fi ve categories:

Vendors also appear to demonstrate different perfor-mance on account and inventory reconciliation

(continued on page 6)

By:Jon Puz and Steve Levin

Connance Inc.

What is Hiding in Your Vendor Inventories?

Source: Connance Research

5Issue 3

REVENUE CYCLE

6 Mass Media


activities. In the Connance research, some vendors seemed to systematically operate at lower than 90% accuracy while others were close to 98% accurate.

How do Inventory Reconciliation Problems Happen?For each account, countless financial events (i.e., payments, adjustments, reversals, etc.) occur every day both in the hospital business office and in vendor operations. All of these events need to be dutifully credited, debited and noted in both provider and vendor inventory records in exactly the same way.

An event as simple as a patient going to the hospital to pay a past-due bill previously sent to a collection agency creates a string of follow-on events in the hospital’s patient accounting system that need to be connected to and mirrored in the collection agen-cy’s inventory records. That same check, subse-

quently failing to clear at the patient’s bank, will lead to another series of reversal transactions that need to be mirrored yet again. If the reversal occurs in the next month, it means that all the unwind-ing activity will be part of a different monthly close effort. As shown here, there are multiple opportuni-ties for reconciliation issues to percolate in even the simplest, most common events.

In processing thousands of account placements and recalls every day between providers and vendors around the United States, Connance finds:

1. Accounts closed in the patient accounting system, but not recalled from the vendor;

2. Accounts closed by the vendor, but not updated as such in the patient accounting system;

3. Accounts on payment plan at the vendor,

(continued from page 5)

REVENUE CYCLE

© 2006 KPMG LLP, the U.S. member firm of KPMG International, a Swiss cooperative. All rights reserved. 12098BOS0105

Industryexperience.

Qualityresources.

We'd sayour vital

signs lookpretty good.

Monitoring your healthcare business requires a lot. Fortunately, KPMG can help. We combine years of industry experience with the latest knowledge of audit and tax issues to offer you key insights and practicalbusiness advice. It is why our clients – from start-ups to Fortune 500 companies – rely on us every day. For more information, contact Sheila Harrington, KPMG Healthcare Partner, at 617-988-1111.

www.us.kpmg.com

C

M

Y

CM

MY

CY

CMY

K

12098_HFMA Ad.ai 10/26/2006 12:13:32 PM

but not documented as such in the provider’s records;

4. Accounts on hold for review at the provider, but the vendor is continuing collection efforts; and,

5. ‘Missing transactions’ or transactions recorded in patient accounting system, but not sent to the vendor, and vice versa.

Over time, the small numbers of account problems compound and mature into the 5% to 34% inven-tory reconciliation issues noted earlier.

Possible Negative Outcomes from Reconciliation IssuesNot only are the number of accounts involved significant, but these reconciliation problems lead directly to problematic outcomes. Some of the more concerning problems include:

In almost every situation, reconciliation issues, in addition to elevating operating costs, distracting management attention and reducing cash recovery, create the opportunity to undermine patient satis-faction, generate negative PR in the local commu-nity, and put the provider at risk with regulators,



REVENUE CYCLE

Account open at hospital,but not at agency

No work is being done on the account so no money is being collected.Patient may incorrectly be told that their financial obligations arecomplete.

Hospital and vendor havedifferent balance due

Vendor is either pursuing too much or too little money, both of whichare problematic. Too much exposes the hospital to legal and publicrelations issues. Too little leaks cash.Unexplained changes to the balance due undermine patient confidencein the accuracy of the bill now and in the future. This breakdowndelays patient payment as the patient is expecting the billed amount tochange.Creates unproductive administrative costs at both the vendor andprovider when the gap is identified and needs to be explained.

Account closed at hospital,but open at vendor

Vendor is requesting payment on an account that has been resolved orotherwise closed.In the event that the account has been written off to charity or taken asbad debt on a cost report, significant legal and compliance issues arecreated.Patient goodwill and community relations put at risk.Vendor is incurring costs to collect.

Account at wrong vendor Collection efforts may be inappropriate for the type of account.Different agencies are often contracted to operate under differentpolicies, processes, and commission rates.Patient satisfaction risked by exposure to more aggressive collectiontactics than warranted.

Account at two vendors Patient is pursued by more than one vendor, creating frustration withthe provider and potentially excess payment.Hospital potentially paying commissions to both vendors.Extra collection costs incurred by vendors.

7Issue 3

Mass Media

Chief Financial Officer Interview

Featuring

Chibueze Okey Agba Senior Vice President, Chief Financial Officer and Treasurer

Tufts Medical Center


8

Current Position: Senior Vice President, Chief Financial Officer and Treasurer

Start Date: August 17, 2009

Responsibilities:

• Financial Management, Financial Operation,

Accounting and Treasury Functions

Positions Prior to Current:

• Chief Financial Officer, Harvard Medical School

College: Mercer University, Atlanta, GA

Professional Profile

CFO Interview

Issue 3 9



1. Can you comment about your experience as an HFMA member? How have you been able to use your HFMA experience to support you in your current position?

A. Through most of my healthcare career I’ve used HFMA as a resource. I read a lot of the materials that are available on the web and through the emails. Some of the materials confirm what I already know, but I also pick up a thing or two about how to move the processes forward.

2. Tell us a little about your organization and its mission?

A. Tufts Medical Center is one of the major academic medical centers in Boston. Our mission is to heal the patients, to comfort them, and to educate medical students. Tufts Medical Center is the primary teaching hospital of Tufts University School of Medi-

cine. Our Faculty teaches medical students at the university as well as educates interns, residents and fellows. Part of our mission is also to promote health and prevent diseases. To accomplish that we become involved with our patients and their families and we dedicate ourselves to making sure that we provide innovative and highest quality care to them in a cost-effective manner. We also serve an urban, poor community.

3. From your current perspective, what do you view as the 2-3 most significant challenges in today’s healthcare environment?

A. From my viewpoint the single most impor-tant challenge that I have as CFO is mak-ing sure that we get reimbursed for the care we have delivered; that is, when we have delivered care to patients that have the

CFO INTERVIEW

�

�

�

��

��

��

��

�

��

Mass Media


10

ability to pay or when we delivered care to patients that have insurance. This is a challenge because it is easy for a third party payer with no medical credentials to second guess a treatment and deem the treatment not medically necessary with the sole aim of denying the claim. This is the only business whereby you don’t really know the cost or what you will be reimbursed until after the patient has left. This uncertainty can lead to, for lack of a better term, gamesmanship by some health insurance companies, doing everything possible to deny payments for legitimate claims.

The second challenge is managing costs, par-ticularly pharmaceuticals and custom devices that we have little control over, and in some case may not be adequately reimbursed for.

4. How do these challenges affect your industry and Tufts Medical Center in particular?

A. These challenges limit most hospitals’ ability to achieve a decent operating margin. As you know hospitals are very capital inten-sive businesses and so when your ability to achieve operating margin is restricted, that in turn limits your ability to borrow money to fund basic infrastructure. It’s somewhat of a Catch-22.

5. Could you pick out the top challenges you faced when you first came into your current posi-tion? How did you approach these challenges and what strides have you made?

A. One of my top challenges was ever dwindling reimbursement from the state to cover Med-icaid patients. This is a significant challenge when you consider that I am getting paid about 55 cents on every dollar of spending on over 20% of my business.

I’m approaching this challenge by analyzing all our services, looking at opportunities for cost reduction and making trade offs. But hospitals can’t solve the state budget prob-

lems solely by cutting cost because to do so might affect the ability to deliver adequate care to patients.

6. How has your organization changed since your arrival?

A. I have been here almost a year so change is in process, as it constantly is and should be in any organization. One of the greatest pluses about this organization is the incredible man-agement team, and my recruitment I hope will help accelerate process improvement.

7. How has Massachusetts Health Reform affected your business? What do you see as the major challenges for health reform over the coming year, in addition to the obvious challenge of affordability?

A. Massachusetts health reform is a significant challenge on many levels. There is a general assumption that 95-98 percent of citizens of the Commonwealth have insurance. How-ever, when you peel the onion it is impor-tant to ask the question about the type of insurance that the citizens really have. Is it insurance, or is it the same old charity care? In theory, the media is relaying the message that the citizens of the Commonwealth have insurance and that, as a result, hospitals are doing well. In actual practice, some of the so called insurance is laddened with high copays/deductibles for citizens that cannot afford the copays. This basically means an increase in bad debt for hospitals in the Commonwealth.

8. What are the key performance indicators that you strive to achieve all the time?

A. The number one indicator for us is days cash on hand, for two reasons. First, our debt covenant dictates that we have to maintain a minimum number days cash on hand. Second, as we achieve more days cash on hand we can obtain more external funding


CFO INTERVIEW

11


Issue 3

for capital. That’s the primary indicator that I watch on a daily, weekly and monthly basis. A second indicator that I watch on a monthly basis is the operating margin. This is the measure of our productive engine – the hospital operation.

9. Tell us about your management and staff struc-ture? How do you keep your staff and leader-ship apprised of the key performance issues?

A. Finance at Tufts Medical Center is orga-nized into four major areas: Accounting and Financial Analysis, Revenue Cycle, Decision Support, and Revenue and Reimbursement. Within these four structures there are certain overlaps. I have directors for each of the four areas reporting to me and the VP of Finance.

My style has always been hands on and I am intimately involved at a detailed operating level. That means that I’m communicating

with staff on a daily and weekly basis. I have an open-door policy where anyone can walk into my office at anytime, and we collabora-tively deal with whatever issues we have to deal with. I believe in constant communi-cation and instant feedback. The finance team at Tufts Medical Center has responded positively to that.

10. What is your prediction for the next few years in terms of the strength and health of your organization?

A. In the next couple years we will be much stronger than we are today, based on a number of factors. Before I started, the senior leadership of Tufts Medical Center had engaged in a great deal of network develop-ment, and those investments that were made over the past 2-3 years are beginning to bear fruit. For example, an IPA from Winchester

CFO INTERVIEW



Mass Media12

has joined with us. We have also announced relationships with Jordan Hospital and Brock-ton Hospital, whereby Tufts Medical Center is the tertiary provider of choice. Together, tertiary and quaternary care is sent to Tufts Medical Center and other care can stay in the community where it is most cost effective. This aligns with state and national trends to create effective and efficient Accountable Care Organizations. We believe our network will be very attractive to health plans. Based on these endeavors and other agreements we are developing, we are actually projecting, in a very flat market, an increase in inpatient volume over the next 5 years.

11. How is your current CFO role different from other similar positions you’ve held and how have other institutions differed from your current organization?

A. Prior to being here, I was the CFO of Har-vard Medical School and before that I was at Brigham and Women’s Hospital. My situa-tion at the Harvard and the Brigham were not very different from my situation here. Each of the jobs that I’ve had in the past had its own challenges and opportunities. For example, at Harvard Medical School, despite its endowment, it had a poor operational performance which I helped to correct. Tufts Medical Center has its own challenges and opportunities. My objective is usually to help stabilize the challenges and move the organization forward. It’s the same as what I did at Brigham and Women’s Hospital and at Harvard Medical School.

12. Do you have any predictions about how national health reform initiatives will affect Massachu-setts and Rhode Island hospitals like yours?

A. When we talk about healthcare reform and how to reduce costs, it is unfortunate that the people who know how to reduce costs have no seat at the table. My sense is that there will be more pain at the beginning

than gain. The level of pain that we’re go-ing to experience is totally unknown. It is unfortunate that the cost reduction efforts have been focused primarily on the provid-ers despite the fact that the providers are the ones seeing patients, and bearing the brunt of the medical cost inflation.

13. How do you expect your hospital and Massa-chusetts and Rhode Island to fare in terms of national funding/support for health I.T. initia-tives?

A. I don’t really think that our states are going to fare well because we have proven to be early adopters of technology. Since Massa-chusetts and Rhode Island have been invest-ing in healthcare I.T. over the past few years, we’re not going to benefit from this as much as other states. In a way, you are penalized for doing the right thing when no one else is doing it.

14. What suggestions do you have for HFMA members who may wish to follow a career path to healthcare CFO and how would you suggest they take advantage of their HFMA membership?

A. HFMA is an important source of information on many levels, including finance, manage-ment and administration. The networking opportunities available through HFMA are also very important. Professionals outside of our industry can learn a lot about healthcare management by reading newsletters, emails, and other HFMA resources. It has been a very important source of information for me. Years ago, when I changed career from Banking to Healthcare, I combed the website and read as much as I could, in order to understand the terms and acronyms and become familiar with the healthcare termi-nology. HFMA is a very important source, particularly for people that have no experi-ence in healthcare and want to understand the basics. ❐

CFO INTERVIEW

CMS and other oversight organizations.

What Can a Provider Do to Address Inventory Reconciliation Issues?Many hospital business offices only do spot checks or “rough reconciliations” due to the volume of activ-ity, inaccessible account data and limitations with patient accounting system. Many hospitals use time consuming, manually intensive account matching thinking they can solve their reconciliation prob-lems with people.

Reconciliation issues can be best resolved by intro-ducing technical automation into the mix. The scale and scope of Connance research suggests providers and their vendors need to focus on a few fundamen-tal practices.

These practices, shared by providers and their vendors, have been shown to identify reconciliation issues and, if implemented, prevent new issues from occurring:

1. Check placement files for misplaced accounts and identify root causes of problems. Despite best efforts, hospitals do occasionally send a handful of accounts to a vendor that either should not have been sent to a vendor or were already sent to a vendor. When this happens, it is critical that the accounts are identified, inventory records are corrected, and the underlying reasons for the account being incorrectly placed are identi-fied and corrected.

2. Reconcile balances for all accounts in placement and recall files. It is not suffi-cient to simply confirm receipt of the place-

13Issue 3

Control health care costs with a solution that’s right for your company.

Harvard Pilgrim's consumer-driven health plans have great potential to helplower health care costs — for employers, consumers and the health care system ingeneral.

To find out more, call your broker, call us at (800) 848-9995,or visit www.harvardpilgrim.org/bestbuycdh


REVENUE CYCLE


reasonable situations and are understood by employees in the business office and at vendors. The provider also needs to monitor adherence to these policies and procedures.

5. Ensure comprehensive and common report-ing. Numerous hospitals unknowingly rely on incomplete information or reports generated using different variable definitions. Having accurate reports that are common across vendors to track inventory reconciliation is central to having clean, accurate account inventories.

By applying these practices, providers and agencies can work together to prevent inventory reconciliation issues. This benefits patients, reduces risk for provid-ers, and allows vendors to be more effective, thereby enabling a true win-win-win. ❐

ment file and total number of accounts. Indi-vidual account balances need to be verified as well, preferably by cross checking account-level financial transactions.

3. Reconcile full inventory at each vendor, at least monthly. Given the compounding effect of problems over time, full reconcilia-tion at least monthly is necessary. In many situations, weekly reconciliation of the entire inventory may be appropriate.

4. Update policies and procedures and moni-tor adherence. A number of inventory issues are created as a result of inadvertent customer service activity, such as incorrectly moving or closing an account or applying an incorrect transaction code. Good practice is to review policies and procedures at least once per year to check that they are up to date, cover all

REVENUE CYCLE

Helping Health Care Providers Solve Complex Issues.Deloitte’s Health Care practice offers a full range of services to help your organization maximize opportunities and address complex marketplace and regulatory challenges. You’ll benefit from the innovation and knowledge of our professionals, our extensive involvement in industry associations, our thought leadership, and our experience serving all segments of the health care industry.

© 2009 Deloitte Development LLC. All rights reserved. Member of Deloitte Touche Tohmatsu

www.deloitte.com/us


Mass Media14

we can expect is a slowdown in the level of increases.

• Consumerism in healthcare is generating stron-ger demands for customer service and payment options from hospitals.

All of these trends have resulted in hospitals extend-ing more credit to patients for longer periods of time. This is occurring when hospitals themselves are challenged fi nancially to provide more services for less reimbursement.

We are also seeing the role of patients, as healthcare consumers, change over time. Patients have a greater say in when and where their healthcare services will be provided. In addition, patients usually do not plan for their healthcare expenditures. In fact, in today’s challenging economy 24% of patients with large out of pocket costs stated that their current healthcare debt has caused them to seek care at an alternative facility to ensure treatments are received. For the fi rst time we are seeing healthcare providers delay-ing or denying non-urgent treatments to patients with previous unpaid medical bills.

This shift to more consumerism in healthcare impacts the patient’s fi nancial obligations as follows:

• Patients control how their out of pocket costs are expended.

• Patients choose healthcare services based on their fi nancial situation and their fi nancial obli-gations.

Loan programs that provide external hospital fi nancing for patient receivables are nothing new. There have been various approaches over the years to provide patient alternatives and options to satisfying healthcare obligations over an extended period of time. With consumerism in healthcare on the rise and patients expecting more payment options……………….

there is a new equation in healthcare fi nance and receivable loan programs are gaining popularity again!

The current state of the US economy has placed extreme pressure on US households. The current economic recession has for maybe the fi rst time impacted the fi nancial health of our hospitals. Hospital CFO’s have stated this has never occurred in previous recessions.

Here is the current economic reality:

• 74 year low in consumer savings rates.

• Credit markets that have dried up except for those who do not need credit.

• Highest unemployment in over 25 years.

• Trends in healthcare plan designs have increased co-pays, deductibles and out of pocket costs for consumers to an all time high.

• Uninsured population of working adults has grown signifi cantly.

• Healthcare costs will continue to rise; the best (continued on page 16)

REVENUE CYCLE

Patient Receivable Loan Programs:Finding Resurgence in Today’s Economy

By: Steve Chrapla

Revenue Cycle Partners

15Issue 3

• Patients expect to be treated as valued consum-ers and may not be willing to take direction from insurers or providers with respect to healthcare delivery.

• Patients are better educated regarding healthcare services.

Healthcare debt is perceived by consumers to be different than other types of debt and typical financ-ing and collection techniques are only marginally successful. Patients are not traditional debtors as found in other industries. There have been many studies on the payment priorities of patients. Clearly, it is recognized that hospitals are last to receive payment from the patient. Here is an overview of how patients prioritize their monthly expenditures:

• Mortgage or Rent payment

• Car/Utilities/Bank loans

• Furniture/Credit card loans

• Insurance premiums

• Physician bills

• Hospital bills

With the hospital at the end of the list, how can we facilitate changing this priority?

Hospitals have traditionally attempted to establish monthly payment plans to assist patients in satisfy-ing their obligations. These plans are usually inter-est free and managed and monitored internally by the patient accounting staff. While these plans may be convenient for the patients they place significant burdens on the hospital. There is the obvious loss of capital while they wait for the cash flow; additionally there are extensive administrative burdens encoun-tered when managing these payment plans. Another challenge with extended payment plans is the potential for new debt to be incurred by the patient. Unplanned future debt may impact the patient’s ability to continue making monthly payments and result in short or missed payments.

Patient receivable loan programs, when properly designed, can cause reprioritization of patient finan-cial obligations. They raise the level of priority to ensure the obligations are met. In addition, loan programs can be designed to provide for immediate reimbursement to hospitals, removing the patient receivable from the hospital’s balance sheet. Loan programs can provide significant benefits to cash starved hospitals as well as provide relief for patients finding themselves with few other options. Loan programs can be designed to provide funding directly to the hospital within days of the executed loan documents, while establishing manageable payment terms up to ten years, for the patient. Loan terms provide flexibility for patients seeking to minimize their monthly obligation.


REVENUE CYCLE

You Know Health Care.We Know Health Care Law.

With more than 50 professionals dedicated to health care, Ropes & Gray guides health

care organizations through complex regulatory, organizational, and competitive challenges.

ropesgray.com


Mass Media16

17


Issue 3

So, what type of program works best?

There are two types of programs, Non-Recourse and Recourse. Each provide value, but with very specific distinctions. The Non-Recourse program removes any contingent liability from the hospital, regardless if the loan is paid or not. The Recourse program, on the other hand, provides that the hospital repay the outstanding loan balance in the event of default. This significant difference in risk sharing of the patient’s loan is based on the design of the loan portfolio. Non-Recourse program funding may be impacted by the patient’s credit worthiness; whereas under a Recourse program all patients can qualify since the hospital is at risk for default.

Here are the features of both Non-Recourse and Recourse Loan Programs:

Non-Recourse Loan Programs:

• Hospital receives upfront cash for loan value.

• Simple and expedient loan application and approval process.

• Loan portfolio performance does not impact hospital/no bad debt reserves required.

• Loan values will likely be discounted. Hospi-tal will receive less than 100% of the account balance.

• Patients may be assessed an interest charge which is usually impacted by the loan discount rate.

• Patient credit worthiness may impact patient’s ability to qualify.

REVENUE CYCLE

ASSURANCE / TAX / ADVISORY

��

��

��



• Inability of a patient to qualify may present chal-lenges in implementing a comprehensive collec-tion policy. How do you handle a patient that does not qualify for loans and are not eligible for financial assistance?

• Loans are unsecured with no personal assets at risk.

• Payment terms can be extended over many years.

Recourse Loan Programs:

• Hospital receives upfront cash for loan value.

• Simple and expedient loan application and approval process.

• Hospitals should establish a reserve for bad debt

Mass Media

for loan portfolio defaults. National experience is between 15% to 22%.

• Loans that default should move directly to bad debt without consuming more administrative resources or expense.

• Loan valued at 100% of receivable. No discount applied and hospital receives 100% of account balance.

• Hospital guarantees loan. All patients qualify.

• With all patients qualifying for a loan the hospi-tal has the ability to implement more consistent credit policies since all patients will have a loan option available to them.

• Patients assessed an interest rate. Usually below current market trends.

• Community relations can improve when all patients will qualify for loans.

• Patients with questionable credit rating have opportunity to improve credit history.

• Loans are unsecured with no personal assets at risk.

• Payment terms can be extended over many years.

Both types of loan programs when properly imple-mented can achieve desired results. It is critical however to ensure proper steps are taken to maxi-mize the effectiveness of the programs. A well defined credit policy communicating all options available to patients is essential. Policies need to provide options for patients. Consistent support from administration as well as the medical staff is required to ensure exceptions to policies are mini-mized. A high touch patient sensitive model needs to be utilized in presenting the loan program. Hospi-tal staff needs training in how to communicate the

18

REVENUE CYCLE

(781) 740-9699www.PhillipsDiPisa.com

Search resultsas exclusive as your needs.

Recruiting top talent in healthcare andlife sciences demands focus. And that’s whyexecutive searches for these industries are allthat we do. Call today to connect with one ofour leaders, Dan Phillips or Ralph DiPisa.



• Improved recovery of term payments made to a bank vs. to the hospital. Patients less likely to miss a payment to a bank than to the hospital.

• Enhanced patient and community benefits when the hospital is viewed as providing options to assist patients with their financial obligations. ❐

19

benefits of the program while presenting alternatives. In other words the loan programs need to be sold to patients. Including why the program is good for the patients describing all the benefits and presenting the alternatives to not establishing a loan.

What type of benefits can you expect?

• Increased cash flow from self pay receivables.

• Reduced bad debt expense.

• Reduced days in AR.

• Improved liquidity.

• Removes the hospital from the financing business.

• Reduced administrative costs resulting from fewer billing statements and cash posting transactions.

Issue 3

��

��

��

��

��

��

��

��

��

��

Thereʼs a Word That Describes WhatBeecher Carlson is Doing for Healthcare Risks.

��

REVENUE CYCLE

For more information on how to effectively implement a patient receivables loan program or to learn more about hospitals that have achieved improved performance through such programs contact Jeff Morgan, CHFP at Revenue Cycle Partners. 866.855.6905 or [email protected] contact the author: [email protected].

About the Author

Mass Media

Executive Overview

The current self pay account process is nearly as complex as the clinical delivery system any hospital faces, with many entry portals to the hospital system increasing the diffi culty of managing this growing population. When the hospital employs one or more outsourcing partners (eligibility advocates, for example), the entire process becomes more complex. The larger hospitals can spend upwards of $3 million dollars per year in internal and vendor costs to

manage the self pay population. The hospital usually manages the self pay process in a distributed fashion, following the clinical pathways—clinics, emergency room, inpatient, and referral pathways--with various cross-functional teams (patient access, clinicians, vendors, business offi ce) attempting to coordinate efforts across a lengthy timeline and across interde-pendent eligibility processes. There can be signifi -cant confusion as to which role each of the parties serves, or is meant to serve, in the process.

In order to protect its assets more effi ciently, the hospital should consider streamlining the processes involved in managing this portfolio. There should be a single Revenue Process Manager responsible for all aspects of self pay fi nancial risk management, including the fi nancial counselors, onsite county eligibility workers, the relationship with Medicaid and state/county program eligibility vendors (onsite and remote operations), disability determination vendors, self pay collections (onsite and outsourced), and collection agencies. This focused management will improve communications, ensure that processes are complete, and help optimize the collection of the self pay portfolio for the hospital.

Most patient accounting applications have unused potential regarding the self pay process. This poten-tial includes the use of responsibility codes, activity and credit codes, insurance plan codes, and fi nan-cial classes in a logical account fl ow whose account movement is driven by completed events. The rede-sign of the process will include signifi cant controls on each phase of the process, from registration to write-off, increasing the hospital’s ability to improve cash fl ow from Medicaid, from state and local programs, from responsible parties who are able to pay, and (in

20


REVENUE CYCLE

Specialty Programs for the Healthcare Industry

a subsidiary of theMassachusetts Medical Society

InsuranceMedical Malpractice - choice of carriersHospital Professional LiabilityBusiness Office & Workers CompHealth & Group Dental Insurance

Financial ServicesDiscounted Disability & LifePhysicians Retirement Program

Practice ServicesHealthcare Linen ServicesCopiers, Printers, FaxesBanking ServicesEHR FinancingMedical Supplies

800.522.7426www.piam.com

hfma_0909.indd 1 9/22/09 12:13:22 PM

Improving Self Pay:A Caring Stewardship of the Uninsured

By: Daniel A. Schulte, Senior Vice President, Provider Solutions

Apollo Health Street


21

time) from the various payment sources associated with the permanently disabled.

Policy FormulationCaring Stewardship: Many U.S. hospitals have a longstanding legacy as charitable, teaching or community-based healthcare institutions, and this great history demands its presence in the policies each hospital formulates regarding the care of the poor. At the same time, hospitals need to protect their assets and resources. Hospitals also need to carefully document the medical indigence of their patients in order to claim the available local, state and federal funds made available to support the treatment of the poor. The current regulatory climate requires that this entire process be done in a respectful, patient-friendly way, ensuring shared responsibility without causing undue burdens on any of the parties.

In order to complete a functional account flow of the self pay population, the hospital may need to clarify certain policies. The hospital may want to consider a seamless set of policies regarding the hospital’s self pay populations, adjusted to the hospital’s needs. In this regard, the hospital may consider timely imple-mentation of the following policies:

m A written, board-approved policy regarding Point of Service collection efforts at all entry sites

m A written, board-approved policy defining appropriate collection efforts in the Emergency Department

m An enforceable policy regarding point of service collections from patients who have qualified for a sliding scale discount in the hospital’s Charity Care program

Issue 3

REVENUE CYCLE

Feeley & Driscoll, P.C.Healthcare Services Group | www.fdcpa.com

Feeley & Driscoll’s Healthcare practice reflects the three major forces in the industry - hospitals, physicians and senior care providers. We are one of the largest regionally-based providers of accounting and business advisory services to the healthcare industry in New England. Our experience in the field covers an extensive and diverse range of clients and engagements.

Stephen J. Doneski Director of Healthcare Audit

[email protected] | (617) 456-2449

Feeley & Driscoll, P.C. | 200 Portland Street | Boston, MA 02114 | 617 742 7788 | www.fdpca.com

Douglas J. McGregorDirector of Healthcare Services


HumanService

Providers

HospiceProviders

HomeHealth/VNA

Physician Group Practices

Physician Hospital Organizations

Senior Care Providers

Acute and SpecialtyHospitals

CommunityHealthCenters

AncillaryServiceProviders

Helping you solve the puzzle.


Mass Media

m A comprehensive policy regarding demand efforts on self pay accounts once eligibility for unsponsored care programs has been eliminated

• Equitable valuation of self pay accounts where no charity care discount is given (perhaps matching the most-prevailing HMO discounts)

• Patient-friendly statements and demand letters

• Courteous but effective phone campaigns • Third party loan programs from

local financial institutions • Outsourced payment arrangements

m A clearly defined set of policies for effective collection agency efforts

• Agency focus on collec-tion of payment in full

• Defining acceptable payment arrangements • Determining when suit for garnish-

ment of wages is appropriate.

Eligibility Efforts: There are four distinct patient groups who are eligible for some type of unsponsored care program. All self pay patients require screen-ing for Medicaid eligibility prior to being screened for any other sponsorship. There can be concurrent reviews for eligibility for other programs, including any state or locally sponsored charity care programs and federal disability programs. In order to success-fully complete the process (for the best possible outcomes for the patient community and the hospital) the cross-functional teams involved need strong, focused leadership. Patient Access, county case workers, eligibility vendors, Patient Account-ing and General Accounting, Utilization Manage-ment, and Medical Records need to coordinate efforts to ensure successful eligibility and billing of the claims to the correct payers. Hospitals should carefully consider the following points to build on and to improve efforts to manage this segment of the patient population:

m Assign a single manager responsible for all duties relating to patient financial risk management:

• Cashiering • Management of financial counselors • Management of county case workers onsite • Management of Medic-

aid eligibility vendors • Management of disability deter-

mination vendors • Management of outsourced

self pay vendors

m Assign a single Medicaid eligibility vendor for front-line efforts at obtaining eligibility for the entire class of patients.

m Assign a single disability determination vendor to review all accounts for possible disability determination.

m Assign a single eligibility vendor for secondary placements of all accounts, to be placed with the secondary vendor no later than 120 days from placement with the primary vendor.


22

REVENUE CYCLE

CAPITAL PLANNING

FINANCIAL PLANNING

INVESTMENT ADVISORY

ARBITRAGE COMPLIANCE

DEBT MANAGEMENT

STRATEGIC CONSULTING

INVESTMENT CONSULTING

LEADING THEWAY IN

HEALTHCARE FINANCE

June MatteManaging [email protected]

Christine DoyleManaging [email protected]

99 Summer StreetSuite 1020Boston, MA 02110

617 330-6914617 951-2361 fax

www.pfm.com


23

m Assign two collection agencies for placement of all self pay balances where a proven ability to pay exists, and where the responsible party has refused to pay.

m Assign a single second placement collection agency for placement of all collection accounts 180 days after placement with the primary collection agencies, where no payment arrange-ment or legal process has been initiated.

Self Pay Efforts: There are two classes of self pay accounts; discounted charity care accounts, and accounts classified as full self pay accounts, either at total charges (responsible parties with incomes that do no qualify them for a discount) or balances after insurance. In both cases, but particularly in the former case, it is very important for the hospital to establish a policy regarding responsible collection of patient balances. There are a number of practical elements that should be discussed in other dialogues to ensure both timely collection efforts and respect-ful patient relationships.

In addition, the healthcare industry has worked for a number of years on patient-friendly billing. The statements and letters sent to the self pay patient population should reflect the high level of profes-sionalism recommended by the industry, and in keeping with the reputation of the hospital.

Collection Agency Policies: Interviews with collection agencies, and audits of selected accounts, may help identify a gap between the hospital’s collection practice and its collection policies. The first-tier agencies should report on the average age of accounts from discharge to placement date. It is important to maintain appropriate contact with the patient or responsible party throughout the collec-tion process, and the practice of turning accounts over to an agency many months after the treatment date (except where insurance denials rightly delay the process) should be avoided. The number of accounts placed each month should be about the same - peaks and valleys indicate problems in the account flow logic. The collection agency should be

able to define the hospital’s philosophy of collection practices at every level within the agency - sales, operations, customer service, and account represen-tative. There should be no inconsistency between how each of the agencies processes through the collection process. The hospital is responsible for supplying sufficient information to perform success-ful collections. There should be a flag on the refer-ral medium to segregate Medicare self pay accounts - not to distinguish collection efforts, but to report collection success. Providers may want to review the following policies to improve self pay collections of delinquent accounts:

m Timely referral of accounts deemed uncollectible in the inhouse process

m Regular placements of accounts with agencies. Weekly placements are optimal.

m Clearly defined collection and reporting strate-gies for each type of account referred:

• Medicare deductible and coin-surance balances

• Patient balances after insurance • Self pay accounts not quali-

fied for any state programs • Collection efforts by primary agencies • Secondary placement of accounts

not in a payment arrangement, or in the legal process (suit, adjudica-tion, or other paralegal process)

m Comprehensive data file for each patient account, to ensure continuity of effort from hospital to primary to secondary agency

m Improved placement methodology (FTP trans-fer of data is optimal)

m Updated, written agreement on agency expecta-tions

m Signed Business Associate Agreement for all third party agencies



Issue 3

REVENUE CYCLE


Account Flow RedesignDefining Financial Counseling: In the new process, the financial counselors need to focus on two elements: identifying valid third party cover-age for patients with such coverage, and coordinat-ing efforts with outside vendors (county workers, Medicaid advocates, and disability determination companies, for example) to ensure timely followup and successful enrollment of the highest number of eligible patients. The hospital’s financial counselors should focus on the most visible and most likely eligi-ble accounts, and obtain coverage for a benchmarked percentage of the inpatient and outpatient popula-tion, without any referral to an outside vendor.

To manage the assignment of accounts to multiple portfolios over time, all parties will need to accept a new protocol for assigning accounts to their respec-

tive portfolios. The proposed Patient Financial Risk Manager will monitor all the portfolios, ensur-ing that there is an end-game for every account: eligible accounts flow to billing, and non-eligible accounts to the self pay process for collections, in a very tightly managed timeframe. The Risk Manager must identify ways to track these accounts within the patient accounting system, so that they are not lost in the shuffle. Rules of engagement should be clear: ownership means each team must actively monitor progress toward eligibility, and contribute to the process. The teams must forward the account to the next process owner according to defined, specific protocols; all events are timed, and require strict observation of engagement rules.

Patient Access Roles and Responsibilities: Every inpatient with undocumented payer cover-age, or presenting as an unsponsored patient, should be assigned an entry insurance code of Risk1 [user-defined]. Financial counselors will review this portfolio daily to ensure timely startup of eligibility efforts. Accounts assigned to the county casework-ers will be assigned Risk2. Accounts the financial counselors keep will be assigned Risk3, with an account-level flag specific to each financial coun-selor. The financial counselors are responsible for completing their work on these accounts within 30 days of receipt.

Vendor Roles and Responsibilities: Accounts forwarded to Medicaid Eligibility companies will be assigned an insurance plan code of Risk4. These companies are responsible for identifying accounts that were eligible prior to referral, and returning them to the hospital at no charge. The first-tier eligibility companies should be responsible for the accounts for 120 days from receipt, and will forward incomplete accounts, including history, to the secondary agency at that time.

When the first-tier eligibility companies identify a completed eligibility, they are responsible for chang-ing the insurance plan code from Risk4 to the appropriate plan code for that payer type - Instate

Mass Media24

REVENUE CYCLE

TriNet HealthcareConsultants, Inc.

Meeting the Challenge of Change(for over 25 years)

PartnersMark Toso, President

Lisa Blumstein Anne Farmer Michael Connelly Michael Foley

riNet is pleased to announce thatTMichael Connelly

has become a partner of the firm.

ServicesStrategic Financial Planning - Managed Care Strategies

Physician Practice Analysis - Decision Support/Cost AccountingFinancial Planning and Modeling - Hospital Reimbursement

Hospital and Physician Practice OperationsRevenue Cycle Assessments - Physician Compensation Planning

Behavioral Health Finance and Operations

w w w . t r i n e t h e a l t h . c o m

3 Littleton Road, #4Westford, MA 01886

Phone 978-692-1009Fax 978-692-9890

�

�

�

��

��

��

��

�

��


25Issue 3

Medicaid, other states’ Medicaid programs, state or local Charity Care programs, stating whether full charity or sliding scale, a third party insurance plan, or self pay. The details of these plan codes will be clearly documented in the written protocols given to each team.

Business Office Roles and Responsibilities: The business office is responsible for billing all accounts that qualify for billing. This means, of course, that all criteria for any third party financial class are met by the accounts in the self pay financial classes, as well.

General Accounting Roles and Responsibilities: It is essential that the financial team in General Accounting understand the nuances of the eligibil-

ity and reimbursement processes for Medicaid and community benefit accounts. Errors in cost report management can significantly impact the hospital’s position at the federal and state levels, and can decrease net cash receipts as a result.

This cross-functional approach to managing a highly visible portfolio will ensure positive outcomes on a number of levels. The hospital’s mission is clearly incorporated into the day-to-day practices of the revenue cycle. The patient community is given every opportunity to find the best solution for its finan-cial needs. All hospital teams are coordinated, and working together to minimize hospital risk. Vendors clearly understand their roles, and have the tools to be successful partners. That’s a good outcome! ❐

In MemoriamNick Arloro, HFMA Past President 1988-1989, passed away on December 6, 2009 at the

D’Youville Senior Care Center after a brief illness. Nick, age 70, retired from Lowell General

Hospital after serving for over 30 years as Chief Financial Officer.

Many current and former employees paid tribute to Nick as a kind, generous, and fun loving

boss, mentor, and friend at the funeral services. Nick leaves his wife, Helen, three adult

daughters and three grandchildren.


REVENUE CYCLE

Your cover letter has only one job. It is meant to entice the reader to open and read your resume. Sounds simple, but job seekers often stress as much over their cover letter as they do the resume. If this sounds like you, relax, there is a simple approach to cover letters that will streamline your applica-tion process and give you confi dence every time you send out your resume. Just keep these three cover letter tips in mind and you’ll never stress over writ-ing them again.

1. Keep it short.More often than not you’ll send your cover letter via email or some other electronic system. Your reader won’t be looking at a piece of paper, but at their computer screen. Ever notice how short your read-ing attention span is when you’re reading text on your computer? That’s why online articles are typi-cally shorter than print articles. The same holds true for email messages. If you’ve got 60 messages in your inbox you don’t have the patience for lengthy text. Now imagine you’re a recruiter or resume screener and you must get through a couple hundred resumes in a day. If you want your cover letter read keep it short, concise and to the point.

2. Focus on qualifi cations.Most job seekers freeze up when writing cover letter because they don’t know what information recruit-ers want to see. The fi rst person in an organization to read your resume is a recruiter or HR professional who acts as a screener. They are interested only in identifying candidates who match their set of quali-fi cations. The better the match the higher the inter-est. Don’t worry about explaining why you are inter-ested in the position, the screener probably doesn’t care. He/she only want to know if you qualify as a viable candidate. Use the job posting as a guide to know exactly what qualifi cations to mention in your cover letter.

3. Don’t try to get fancy.Job seekers get frustrated writing cover letters because they try to make it into a creative writ-ing exercise. That’s not necessary. It’s much more important that you keep your ideas clear and easily understood. When writing about your qualifi cations do use the same verbiage to describe your skills as the job posting. You’ll make the resume screener’s work much easier and they will recognize you as a perfect candidate match much quicker.

Using this simple approach will allow you to take a customized approach with each cover letter you send. Generic cover letters usually sound canned no matter how much time was spent writing them. Worse, a one-size-fi ts all cover letter looks like it was borrowed off the page of a sample cover letter book. Would you take the time to read a mass-produced letter?

I’m often asked if cover letters are still relevant in today’s fast-paced job market. While the form has changed from paper to electronic they are still a vital part of your job-search marketing materials. Cover letters provide your fi rst opportunity to make a good impression on your potential new employer. It pays to write them with clarity and simplicity. ❐

REVENUE CYCLE

By:Deborah Walker, Alpha Advantage

How To Write a Perfect Cover Letter

Deborah Walker, CCMC is a career coach help-ing job seekers compete in the toughest job markets. Her clients gain top performing skills in resume writing, interview preparation and salary negotiation. Read more career tips at: http://www.AlphaAdvantage.com

About the Author

Mass Media26

Doctors on March 1 will face a 21% cut to Medicare physician payments because of the Senate’s inability to act on a temporary measure to halt the scheduled reduction

Physicians are facing an imminent 21% reduction in fees paid for treating Medicare patients. Such wild instability in payment levels has been built into the Medicare physician payment systems for many years. This is the result of Congress failing to enact a legis-lative fi x of the fl awed Medicare physician payment formula. Since the early 1990s Medicare physician payment has been calculated based on a formula that compares actual expenditures for physician services to an allowable expenditure target based on the so-called “Sustainable Growth Rate (SGR)” formula. This approach to controlling physician payments has failed to control the growth in expenditures. In addition it places physicians in a different position than all other providers paid under the Medicare system.

Where Medicare has moved to paying other provid-ers using a bundled payment approach for entire patient encounters with modest annual increases built into the formulas, physicians are paid using a fragmented fee-for-service approach based on a unique method for calculating expected growth. Not only does this system not provide incentives recognized for the entire health care system under current health reform efforts: high quality at the lowest possible cost, it provides incentives for physi-cians to increase volume and costs that have no connection to quality improvement. This behav-ior compensates for Medicare’s minimal payment

increases or payment reductions that do not keep up with medical infl ation.

Efforts to “fi x” the physician fee formula often focus on making changes to the SGR formula. Yet it is not clear that any tinkering with this formula will achieve the goals of higher quality and cost-effec-tiveness for physician services that health reform efforts are now seeking. The Medicare Payment Advisory Commission (MEDPAC) in its 2007 report to Congress assessing the SGR stated a preference to replace the current physician payment system with an approach that treats physicians consistently with other providers.

Reform efforts now underway are seriously looking at ways to bundle provider payments for hospital, physician and potentially other provider services. This bundling may take the form of combined DRG based payment, episode based payment and some sort of global capitated based payment. Such a complex restructuring of the payment system will only be achieved with carefully designed and carefully phased-in models that are evaluated and refi ned to meet all stakeholder needs. During this transitional period physicians should receive reason-able and stable payment levels similar to other provider organizations that will not compromise care and the fi nancial health of providers during the diffi cult process of health care system re-design that lies ahead. ❐

Marvin BerkowitzPresident, BHC [email protected]

Issue 3 27

REVENUE CYCLE

Essays on Reform: Medicare Physician Fees Need Immediate Fix

By:Marvin BerkowitzBHC Consulting

MA/RI HFMA 2010 Revenue Cycle Conference“Season for Change: Tackling the Future of Healthcare Finance”

January 22, 2010


This year’s Revenue Cycle Conference at Gillette Stadium was a record breaking event! It was a day packed with outstanding keynote speakers and an exciting and rele-vant educational program that attracted 395 attendees.

The day began with Lynn Nicholas, President and CEO of Massachusetts Hospital Association, who addressed our constituents with a pertinent and insightful presentation entitled “Hospitals, Reform and the Economy: Taking the Political Pulse in Massachusetts”. Later in the day we heard from Amy Whitcomb Slemmer, Esq, President and CEO of Healthcare for All, Elizabeth Roberts, Lt. Governor of Rhode Island, Ellen Zane, President and CEO of Tufts Medical Center and Karen Ferrell, Presi-dent and CEO of Ferrell Consulting Group. This panel of visionary healthcare leaders discussed both compli-

menting and opposing views regarding healthcare reform both national and local. The panel discussion was led by Andrew DeVoe, President and CEO of Apollo Health Street, Inc. The closing keynote speaker was Joe Andruzzi, former New England Patriot, three time Super Bowl player, and part of the offensive line that claimed the XXXVIII Super Bowl championship for New England! Joe Andruzzi’s inspiring speech was followed by autographs and photo opportunities for our attendees as well as a guest appearance from Pat Patriot, New England’s favorite mascot.

A record breaking 395 attendees filled the chairs at Gillette

Angela Confoey,Caritas Christi Healthcare

Ames RybaApollo Health Street, Inc.

Co-Chairs

Six educational breakout sessions featured local and national speakers chosen for their subject expertise, and focused on rele-vant current topics including Revenue Integrity, Managing CDM Risk and Audits, Patient Kiosk Technology, Self-Pay Strategies, Vendor Management and RAC Appeals. A great deal of hard work and preparation went into these highly regarded presenta-tions and we thank our both our speakers and our committee sub-chairs Bill Wyman, Karen Bowden and Jennifer Samaras for all that they did to make the day’s sessions a success!

We once again thank our supporting vendors. This year’s event was sponsored by 36 of our industry’s leaders in healthcare technologies and services. We can thank Patrick McDonough of ProMedical for coordinating the vendor tables this year and for coming up with an incredibly fun way to help our attendees interact and get to know out vendor sponsors. The attendees had a great time playing “Healthcare Hold ‘Em” and 36 lucky winners took home Boston sports jerseys as a result of the game. One lucky HFMA member took home the grand prize from the vendor raffl e – a Nintendo Wii with Wii Fit!

Many of our attendees invited guests to join us for our post conference events. We hope everyone enjoyed Joe Andruzzi and Pat Patriot. Joe Andruzzi’s speech was followed by the drawing of the chance raffl e, where Joe pulled the winning ticket and presented Amanda Sandman-Fallows with 2 tickets each to see the Celtics, Bruins, Red Sox and Patriots. The raffl es were followed by a networking cocktail hour (or two) and guided tours of Gillette Stadium. The after-party featured free drink tickets, a wonderful spread of cheese and carving tables, passed hors d’oeuvres and exciting entertainment. We enjoyed Irish music performed by the Celtic Clan and a company of magi-cians from Top Hat Productions that wow’ed our guests as they mingled with the crowd.

The hard work and careful planning of the Committee members was evident throughout the day and the record breaking attendance made this year’s event a huge success. Thank you, Committee members and all of the HFMA volunteers who helped throughout the day. Special thanks to Beth O’Toole, HFMA liai-son for the event and Ames Ryba and Angela Confoey, the event co-chairs!

Also, Special thanks to our Corporate Sponsors as well as the following Event Sponsors:

Venue Sponsor:Bank of America

Breakfast Sponsors:ARMSHealthcare Revenue Strategies

Pat Patriot Sponsor:PV Kent

Lynn Nicholas, President and CEO, Massachusetts Hospital Asso-ciation and Jerry Vitti, President MA/RI HFMA start the day at Gillette Stadium for our 2010 Revenue Cycle Conference


Photos courtesy of Tony Slabacheski,

Apollo Health Street, Inc.

Our power-packed keynote panel participants: (left to right) Eliza-beth Roberts, Lt. Governor, Rhode Island, Amy Whitcomb Slemmer, President and CEO, Health Care for All, Ellen Zane, President and CEO, Tufts Medical Center and Karen Ferrell, President and CEO, Ferrell Consulting

Co-Chairs on a mission! Angela Confoey, Corporate Director, CDM, Caritas Christi Healthcare and Ames Ryba, Regional Vice President, Provider Solutions, Apollo Health Street

Co-Chairs on a mission! Angela Confoey, Corporate Director,

Entertainment Sponsor:Action Collection Agency

After-Party Sponsors:Apollo Health StreetDell Perot SystemsMedical Bureau/ROI

Mass Media

The following members recently joined the Massachusetts-Rhode Island Chapter of HFMA. We welcome you to the Chapter and encourage you to take advantage of the many professional development, networking and information resources available to you at HFMA. Other HFMA members are a terrifi c resource for your everyday professional challenges – we encourage all members, current and new, to get involved with HFMA committees and social activities. And… use the Membership Directory – it’s a great resource! We value your membership, so please send us feedback or questions on your HFMA experiences to [email protected].

Welcome New Members!

Alicia BecoInnSeason Management Inc.

Eric E. BromageGeneral Investments

Judith M. DeWolfMedAssets

Bill Griffi nSeniorLink Inc

Janice HenryNeighborhood Health Plan

Dan JandreauWinchester Hospital

Susan Jenney

Hugh Kennedy PJA

Giao LeChildren’s Hospital Boston

Nicole MarsoobianTufts Medical Center

James McGaffi ganBoston Medical Center

John W. MurphymTuitive, Inc.

Carl W. NelsonNortheastern University

Gregory J. ParsonsLawrence General Hospital

Terry QuinnUMass Memorial Health Care

Richard RenehanCardiovascular Associates of Rhode Island, Inc

Kathy Risatti Berkshire Health Systems

Laura SchredniCaritas

Matthew SmithMass Eye & Ear Infi rmary

Brett A. Smith

Michael G. TauberHinckley, Allen & Snyder LLP

David ThibodeauChildren’s Hospital Boston

Glenn TrindadeRecondo Technology Inc.

Kristin E. VoseSurgical Information Systems

Jane E. WillisRopes & Gray LLP

New Massachusetts-Rhode Island Chapter Members February 1, 2010 to March 31, 2010

30

Feeley & Driscoll, P.C.Feeley & Driscoll’s Healthcare practice reflects the three major forces in the industry - hospitals, physicians and senior care providers. We are one of the largest regionally-based providers of accounting and business advisory services to the healthcare industry in New England. Our experience in the field covers an extensive and diverse range of clients and engagements.

Helping you solve the puzzle.

Stephen J. Doneski Director of Healthcare Audit


Feeley & Driscoll, P.C. | 200 Portland Street | Boston, MA 02114 | 617 742 7788 | www.fdpca.com

Douglas J. McGregorDirector of Healthcare Services


Auditing/Accounting Services Tax Issues and RepresentationStrategic and Financial Advisory Services Revenue Enhancement StrategiesRevenue Cycle Management Services Third Party Audit/AppealsForensic Accounting and Litigation Support Mergers/Acquisitions/AffiliationsPractice/Business Valuation Procurement (RAP/RFP) PlanningPreparation/Review of Cost Reports Government Liaison ServicesFinancial Feasibility Analysis Reorganization PlansOIG Compliance Advisory Services ERISA AuditsGovernment Reporting/Regulatory Issues Bankruptcy Related ServicesArbitrage Rebate Accounting 990 and Tax ReportingFinancial Planning and Analysis Compliance and Risk Management

HumanService

Providers

HospiceProviders

HomeHealth/VNA

Physician Group Practices

Physician Hospital Organizations

Senior Care Providers

Acute and SpecialtyHospitals

CommunityHealthCenters

AncillaryServiceProviders

Healthcare Services Group | www.fdcpa.com

HFMA Massachusetts-Rhode Island Chapter411 Waverley Oaks Road, Suite 331BWaltham, MA 02452

NOTE: Please keep in mind that the themes listed for the programs are general. The programs themselves address current issues pertaining to these themes.

Date Event Location Coordinator(s)

05-13-2010 to Region 1 Ninth Annual Mohegan Sun Region 1

05-14-2010 Healthcare Conference Uncasville, CT

06-18-2010 Managed Care Meeting Doubletree Hotel Chuck Agro and

Westborough, MA Linda Guerra

P r o g r a m & S p e c i a l E v e n t S c h e d u l e

2009

-201

0

Education/Program Administration Committee, Co-Chairs: Michael Connelly, CPA, [email protected], and Catherine Robinson-Skeen, [email protected]

hapter MASS MEDIA...William E. Grigg, FHFMA, CPA HFMA New Members - February 1, 2010 to March 31, 2010 Timothy Hogan, FHMFA Kathleen Kenny, CPA Gerald O’Neill, FHFMA Beth O’Toole

Documents