Browse by Topic
More than 40,000 members value HFMA's thought leadership and practical strategies. HFMA is where you need to be.
Get acquainted with the
healthcare finance industry's leading professional association. Find out why our
members rely on HFMA as their go-to source for insight and
Members have many
options for helping them advance their careers. Conferences, seminars,
eLearning, certification, and more -- our education and events will keep you
Connect the dots on today's big issues, explore collaborations, get career-boosting tips, and network with colleagues nationwide at the leading finance conference. Save $100 off the full conference rate when you register by May 8.
Real-time presentations with nationally recognized experts, networking opportunities, and industry solutions—no travel required!
Get the latest, practical education in key areas of healthcare finance over 1, 2, or 3 days. Choose Essentials Programs or Master Sessions in DC or Seattle. Register early and save $100.
If you're a subscriber to any of our three newsletters, you have access to online education. Learn more or subscribe.
Get the perspectives of leading healthcare finance professionals on today's hottest issues.
Information about leading vendors helps your buying decisions.
Forum members can network during live webinars or access a library of past webinars on topics such as bundled payment, charity care, and ICD-10.
An ever-expanding collection of spreadsheets, policies, job
descriptions, checklists, and more that you can adopt and adapt.
Forum members can submit vexing questions to a panel of experts
using our Ask the Expert service.
Your source for employment solutions.
Find new employment opportunities or
reach out to qualified candidates.
Distinguish yourself as a
leader among your peers and advance your career by earning certification in our
healthcare finance programs.
Get an objective third-party evaluation of products and services used in the healthcare finance workplace.
MAP App is a web-based application that helps organizations improve revenue cycle performance based on industry-standard metrics called MAP Keys.
Find suppliers and products in this comprehensive vendor directory for healthcare finance professionals.
Guidance for understanding and communicating about the price of health care.
Guidelines on how to make it easier for consumers to get information about healthcare prices.
Improve your revenue cycle performance through standard metrics, peer comparison, and successful practices.
It looks like healthcare reform and the health insurance exchanges are going to happen in some form or fashion, despite current problems with enrollment in the exchange program. However, one additional controversy has arisen that creates an area of concern for healthcare providers and successful management of the revenue cycle in this new era. Although expansion of health insurance coverage seems like a good thing for providers, I would argue that that benefit comes with some additional challenge. Originally, the common perception was that people who liked their health plans would be able to keep those health plans. Obviously, that is not entirely true given recent publicity about insurers canceling plans that are not grandfathered under the Accountable Care Act (ACA). Although the cancellations were appropriate under provisions of the act, clearly the American public has a knowledge gap on regarding the significance of ACA with respect to any individual’s particular circumstances. As an industry, we can be instrumental in educating the public about the Act—and hopefully avoid future problems in getting paid for services under these new insurance plans. That statement applies especially to the ”grandfathered” plans that will remain in effect after Jan. 1.
Recall that the “grandfathered” plans are those plans that were in force prior to enactment of the ACA on March 23, 2010. As long as those plans meet the preexisting condition, dependent coverage to age 26, medical loss ratio, and lifetime limit provisions of the Act, they can remain in force after Jan. 1, 2014. Plans lose their “grandfathered” status if they have made any substantive change to plan provisions after March 23, 2010. Important to remember is the fact that those “grandfathered” plans do not have to cover the mandated benefits under the ACA. So we have to be alert to the continued challenge of wide variations in covered benefits available in commercial health insurance plans. As before, failure to verify benefits properly will leave providers with claim denials to resolve and, with that, potential balance billing and the associated patient relations problems. In some respects, expansion of health insurance coverage also expands our need to be thorough and diligent in our front-end revenue cycle processes. I would argue that this is not all bad. Members of HFMA can (and should) be valuable community resources to help our friends and neighbors understand how things will work in this new era of insurance expansion. Helping people understand simple but high-risk details such as that small provision in the patient’s coverage stating that the plan is ”grandfathered” can be a valuable service to the community even as it helps us unnecessary claim denials and delays in payment. Serving in that expert role simply adds to the credibility and community benefit we can provide as representatives of our organization.
No one will mistake the ACA as something easy to read or understand. However, those of us who work in the industry on a daily basis are more able than the average person to understand many of its provisions—and their consequences. What someone understands about an insurance plan today may not be true tomorrow. Let’s be available to our friends and neighbors, and even reach out to them to help them through this challenging time of change.
Jeffrey Helton, PhD, FHFMA, CMA, CFE, is assistant professor, Metropolitan State University of Denver, and a member of HFMA’s Colorado Chapter.
Publication Date: Monday, November 04, 2013
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
Scott Schmidt, vice president, Cerner RevWorks, LLC, shares insights on best practices for maximizing a revenue cycle management partnership.
©2015 Copyright Healthcare Financial Management Association
HFMA.org is best viewed using IE9 or the latest versions of Chrome, Firefox, and Safari.
Join HFMA today and enjoy: