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Cultural competence and multilingual communications are increasingly important for the nation’s hospitals because of changing demographics. According to U.S. Census data, the percentage of individuals with limited English proficiency (i.e., speak English "less than very well") grew from 8.1 percent in 2000 to 8.7 percent in 2007, and remained at 8.7 percent in 2011. In addition, many new immigrants are settling in states (e.g., Georgia, Nevada, South Carolina) that have not historically had large immigrant populations (see exhibit below).
Many individuals with limited English are newly eligible for healthcare coverage from state Medicaid expansions or health insurance marketplaces, but language and cultural barriers may make it difficult for them to access coverage or the financial assistance they need.
“Just because someone appears to not want to provide you with information, it doesn’t mean they have something to hide,” says Sheldon Rock, Lutheran Medical Center’s vice president, patient accounts. “They just might not understand you. You need to go that extra step to reach that person, either with a document in their language or another person who can speak to them in their language.”
Lutheran Medical Center is located in Brooklyn’s Sunset Park neighborhood, where 49 percent of residents are foreign-born. About 50 percent of residents are Latino, and 25 percent are of Asian heritage. To ensure accurate communications about financial matters, Lutheran Medical Center ensures that patients who have limited English proficiency get one-on-one help from a staff member who speaks the same language, as well as translations of important documents.
See related sidebar: Translating Patient Financial Documents
This tactic has paid off. One measure: The denial rates for Medicaid applications at Lutheran Medical Center and Lutheran Family Health Centers, the system’s network of federally qualified health centers, are “almost non-existent because patients with limited English-language proficiency have assistance in completing the paperwork,” Rock says.
The Affordable Care Act (ACA) requires that healthcare professionals provide information to patients in plain language, which is defined as “language that the intended audience, including individuals with limited English proficiency, can readily understand and use…”
The ACA does not specify that written documents must be translated into a language other than English if a certain percentage of patients use that language, although some states have such requirements. In New York, for example, written documents must be translated if 1 percent of patients primarily use a certain language.
Lutheran Medical Center provides written documents, including financial assistance applications, in Spanish, Creole, Arabic, Russian, Mandarin, and other languages when the need arises.
“I don’t know how many of our patients need language assistance,” Rock says, adding that the hospital does not track the percentage of patients who need a specific language translation. His main concern is the ability to communicate with any patient who seeks care at the hospital. “What I do know is that, if one patient comes in and speaks a different language, then we can communicate in that language.”
In addition to the translated documents, Rock ensures that patients have access to a revenue cycle staff member who shares their native language. He does so by hiring employees who live in Lutheran Medical Center’s primary service area. “We try to hire as many employees as possible from within our diverse community, so our employees have the same cultural mix as our patients,” he says.
“It makes financial sense to have somebody who speaks the language,” says Virginia Tong, Lutheran Medical Center’s vice president for cultural competence. “Language shouldn’t be an obstacle to getting the necessary information to send a bill and collect payment for services your organization has provided.”
The hospital mandates that every staff member participate in annual cultural competence training, and Rock recommends more for his staff. He wants someone from the patient accounts staff to attend every cultural competence training opportunity offered in the hospital, and that person is expected to share the information with the entire department.
Beyond that, Rock invites presenters to his department to reinforce cultural competency skills and an appreciation for the diversity among his staff members. “The cultural training is not only between employees and patients, it’s among ourselves,” he says. “The patient accounts department is so diverse that we have to be respectful of each other. And if we can’t be respectful of each other, how are we going to be respectful of our patients? So we work at it.”
Communicating effectively with people from different cultures eases the process of finding payment sources for Lutheran Medical Center’s patients, Rock says.
For example, some patients with limited English struggle to communicate in English because they think it is required. Lutheran Medical Center staff are trained to recognize when that is happening and seek translation assistance from a staff member who speaks the patient’s native language.
“Once you provide that service, you’re going to make someone a lot more comfortable. And when you provide the documentation—a financial assistance summary or financial assistance application in their language—the fear that you’re going to do something to them goes away,” he says. “We get better information and we spend less time capturing the information because we have developed a rapport with the patient by trying to communicate in the best way possible.”
The patient accounts staff is trained to write letters to employers or landlords seeking documentation that will help with financial assistance applications. Furthermore, Lutheran Medical Center adjusts its policies to accommodate cultural differences.
For example, when Rock attended a community meeting, he heard members of the Arabic community say they did not want to provide a lot of financial information. He told the group that Lutheran Medical Center will accept a letter from an employer or even a self-attestation of employment to help patients seek assistance or insurance. “My goal is to help the patients get the services they need and get paid for those services,” he says. “And if I can do that by helping them get approved for Medicaid, Health Plus Amerigroup [another public insurance program in New York], or any other insurance, then I think we can all win.”
Lutheran HealthCare, the medical center’s parent organization, supports the patient-friendly bilingual services with hospital signs posted in up to six languages and patient education materials available in five languages. In addition, Chinese, Arabic, and Orthodox Jewish community liaisons are assigned to help patients navigate the healthcare system.
Chinese, Latino, and Arab advisory committees also work with Lutheran HealthCare executives to make decisions of significance to their cultural communities. For example, Kosher and Halal meals are available for Jewish and Muslim patients, and the hospital has an interfaith chapel, a mosque, and a mediation and support room for Jewish families.
This complete package of culturally competent practices serves Lutheran HealthCare’s diverse population and positions the health system to adapt its services, policies, and procedures to meet cultural changes in the community down the road.
Lola Butcher is a freelance writer and editor based in Missouri.
Quoted in this article:
Sheldon Rock is vice president, patient accounts, Lutheran Medical Center, Brooklyn, N.Y.
Virginia S. Tong is vice president, cultural competence, at Lutheran HealthCare, Brooklyn, N.Y.
Related sidebar: Translating Patient Financial Documents
Publication Date: Monday, November 18, 2013
In this Business Profile, Shawn Yates, director of healthcare product management at Ontario Systems, discusses the growing challenge of managing self-pay accounts and provides insight on how providers can successfully collect patient payments.
In this business profile, Cathy Smith, leader of the revenue transformation consulting practice at The Claro Group discusses how the organization helps hospitals and medical groups reimagine their revenue cycle.
In this business profile, Deloitte & Touche LLP executives Anne Phelps, principal and U.S. healthcare regulatory leader, and Daniel Esquibel, senior manager, explain ways health systems, health plans, and physician practices can prepare for MACRA.
In this Business Profile, Bruce Haupt, president and CEO of ClearBalance, discusses how a patient loan program can increase patient collections, reduce bad debt, and speed cash flow.
In this Business Profile, Jerry Bruno, principal with Deloitte Consulting LLP, discusses the importance of choosing revenue cycle solutions that help an organization meet the challenges of a quickly evolving healthcare environment.
In this business profile, Lane Jackson, a partner in the Grant Thornton LLP Health Care Advisory Services practice, with extensive experience in overseeing system implementations and revenue cycle reorganizations, discusses best practices for elevating revenue cycle performance during an EMR implementation. Grant Thornton LLP is a sponsor of the Large System Controllers Council Affinity Group.
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
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To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
Drive down costs while improving quality in a reform environment.
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