Browse by Topic
Learn more about the healthcare finance industry's leading professional association. Find out why our members rely on HFMA as their go-to source for insight and information.
Members have many options for helping them advance their careers. Conferences, seminars, eLearning, certification, and more -- our education and events will keep you motivated.
On February 10-12, Physicians, Payers, and Providers will discover strategies for implementing value-based payment arrangements with both private and public sector payers.
Stay up-to-date in a rapidly changing industry in New Orleans (Mar. 7-9) or Chicago/Rosemont (Apr. 20-22). Register early and save.
Focus on the essentials. Develop strategies that deliver results. Redefine the boundaries of your success. Find out what’s driving innovation at ANI. Register by 2/29, save $150.
Our newsletters offer targeted articles with
technical how-to details and thought-provoking insights from healthcare finance
leaders and industry experts.
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 ICD-10 implementation, CMS audits, bundled payment, charity care, KPIs, and more.
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.
Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
Improve your revenue cycle performance through standard metrics, peer comparison, and successful practices.
Early in November, the healthcare provider community was left scratching its collective head upon reading two apparently contradictory opinions from the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) regarding third-party payment of premiums for qualified health plans (QHPs) purchased on the federal and state-based Marketplaces. In a letter dated Oct. 30, 2013, HHS Secretary Kathleen Sebelius issued an opinion implying that third-party reimbursement of QHP premiums for Marketplace consumers is a legally acceptable financial strategy for the provider community. Five short days later—in an apparent contradiction to Sebelius’s position—CMS issued a curious one-paragraph opinion arguing that third-party payment of QHP premiums would be deemed unacceptable.
The HHS opinion was rendered by Sebelius as a response to a question from Rep. Jim McDermott (D-Wash.) as to whether QHP products on the various healrh insurance marketplaces are considered healthcare programs under Section 1128B of the Social Security Act. Specifically, McDermott was looking for clarity as to whether QHPs fall under the scope of the federal Anti-kickback law. Secretary Sebelius, with input from the Department of Justice, argued that QHPs are not federal programs and do not fall under the anti-kickback provisions—which, on balance, means that third-party payment of premiums is acceptable.
Immediately after Sebelius rendered HHS’s opinion, a number of constituencies began to grumble, including the payer community and CMS. Their collective concern centered on the potential risk pool that might be compromised should third-party payers (i.e., hospitals) reimburse QHP premiums. Specifically, payers were concerned that providers would selectively target patient demographics that are levered to the very sick and high utilizers of services (versus younger healthier people). In such a scenario, medical loss ratios could potentially creep higher for payers, compromising the financial sustainability of QHP products on the marketplace and potentially resulting in higher QHP premiums for consumers in year two of the ACA.
An HHS representative has informed us that the HHS views these two opinions as complementary, not contradictory. Specifically, the representative says, the CMS stance was not intended to imply that third-party payment of QHP premiums is unacceptable—rather, the opinion was intended to discourage “hospitals, other healthcare providers, and other commercial entities” from directly paying QHP premiums. Notably, the HHS contact points out that CMS’s position does not preclude third-party arm’s-length not-for-profit foundations and charities from providing QHP assistance, which is a prevailing model that many hospitals have already been exploring—i.e., foundation set up as a 501(c)(3) organization, which could distribute QHP premiums without undue influence from the parent entity.
HHS tacitly recognizes that Secretary Sebelius’ letter may have led to some irrational exuberance on the part of the provider community, necessitating the follow-up guidance from CMS. It seems that HHS and CMS have no plans to issue further guidance or statements on the subject of the third-party payments.
Ultimately, both the HHS and CMS opinions can be seen as guidance documents—documents that are open to interpretation and may not necessarily be considered hard-and-fast regulation. Confusion on the legality of third-party payments of QHP premiums, in terms of what can and can’t be done by the provider community, is likely to continues. Given that HHS and CMS are unlikely to issue any further statements on this matter (at least for now)—and given the dearth of case law and continued legal ambiguity—we might expect, and even encourage, the provider community to compel an Office of Inspector General (OIG) opinion on this issue to force the legal precedent. It is important for provider organizations exploring third-party foundation arrangements for QHP reimbursement to have their general counsels ponder the HHS and CMS position statements. Ultimately, in the absence of explicit federal guidance, we recommend a prudent approach that balances business need against an aegis of risk management.
Junaid Husain is vice president of finance, Cardon Outreach, The Woodlands, Texas.
Publication Date: Tuesday, November 26, 2013
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
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.
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
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.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
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.
Jim Bohnsack, vice president, solution & corporate development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements.
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.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
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.
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
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.
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
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.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
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.
Copyright 2016, Healthcare Financial Management Association.
Join HFMA today and enjoy: