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.
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 5/6, save $100.
Earn the credentials that distinguish you as a leader in the healthcare industry. CHFP. CRCR. FHFMA. CSBI. CSPPM. CSMC. CSAF. Get certified today. Learn more.
Learn about timely healthcare industry topics and earn CPEs with HFMA live and on-demand webinars. View the latest schedule.
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.
Patients at El Camino Hospital, a two-campus health system serving Silicon Valley, used to struggle to understand how their hospital bills correlated with their insurance benefits and their year-to-date out-of-pocket spending.
No more. In early 2013, El Camino began providing patients with online statements that include all bills from all healthcare providers—even those not associated with El Camino—fully reconciled with patients’ insurance benefits and adjusted to reflect patients’ deductible balances. The result: Patients pay their bills more quickly. In addition, El Camino experienced the following improvements within the first six months of launching the billing system:
Judi Ashline, El Camino’s director of patient financial services when the new billing system launched, says combining information from multiple sources into the easy-to-understand statement (see the exhibit below) is a patient-friendly service that benefits the health system. “Even though I am a healthcare professional, sometimes I even get a little confused about my own bills,” she says. “This really brings clarity around a process that is very confusing.”
As patients’ out-of-pocket responsibilities have increased in recent years, El Camino patients often struggle to understand exactly what is expected of them. Matching billing statements against an insurer’s explanation of benefits is daunting, especially when multiple providers are involved.
Ashline offers an emergency department (ED) visit as an example of how even a brief encounter with the healthcare system can turn into a confusing financial situation for patients. “After an ED visit, the patient gets a facility bill and an ED physician bill and, if there are X-rays, there will be a bill from the radiologist, and there may be a bill from a pathologist for some of the blood tests we do,” she says. “If the patient is getting four bills and then four separate explanations from the insurance company, it gets a little hairy.”
Typical patient behavior is to wait until all statements arrive, stare at the confusing paperwork for a while, and then call the health system for help, Ashline says. Patient financial services representatives field the same questions repeatedly: “Why am I getting this bill from an El Camino ED physician?” “What’s a radiologist?” “Who are these people?”
That is why El Camino’s interim CFO, Ned Borgstrom, was willing to try a patient-payment technology, suggested by the health system’s CIO, which offered a new way of communicating patients’ financial responsibilities. “I was intrigued with the fact that maybe we could improve patient satisfaction by giving patients bills that they could understand,” he says.
Participating in the online service is optional. Patients who prefer to receive regular paper bills, which are not consolidated with insurance benefits, simply do not sign up for the service.
Those El Camino patients who do want to sign up start by going to the health system’s website to set up a password-protected account with the vendor that developed the online payment service. Patients provide the names of their health, dental, drug, and vision insurance plans, plus their log-in information to their online accounts for those plans. After the insurance accounts are linked, the technology pulls claims from the insurers’ websites daily and presents the information on a dashboard so patients can see all their healthcare bills, regardless of the provider.
The dashboard explains every line of the statements, including why coinsurance applies to certain bills, why a copayment is required for others, and why some expenses listed on the bills do not have to be paid. Insurance claims are pulled each day so patients’ deductible balances and out-of-pocket spending tallies are current. Patients can also see the deductible status and spending breakdown by family member, as well as total year-to-date healthcare spending by provider.
Patients who sign up for the insurance-reconciled online statements and other information provided on the patient-engagement platform receive an email message when an El Camino bill is owed. Patients can pay their bills directly on the website. “We are getting paid quicker because patients understand their liability,” Ashline says. “Many patients pay as soon as they get that email, so we don’t need to send multiple statements to them, which is fabulous from our perspective.”
El Camino and its patients—even those who choose not to sign up for online access to consolidated bills—receive several other benefits from the new approach:
Improved customer support. Some patients who sign up for this service prefer not to go online to see their hospital bills, electing instead for regular paper bills. However, when patients call to ask questions about paper statements, patient financial services staff can send the patients their online consolidated bills by email to ensure they are viewing the same information. “We say ‘Hang on a sec, let me email you something so that you and I are looking at the exact same thing,’” Ashline says. “Then we can walk through it line by line so that we are not talking about apples and oranges. Customers respond really well to it, and our employees really like it.”
Payment plans. Patients can set up payment arrangements online, creating orders for payments to be made automatically every month. Conversely, patients can opt to be notified each month when payments are due and then use the website to make payments.
Patient eligibility and cost estimates. Because patient financial services staff have access to patients’ insurance information, they use the web tool to verify insurance coverage for specific tests and procedures. They can also provide cost estimates that reflect patients’ real-time deductible balances.
The easy-to-understand bills have reduced El Camino’s revenue cycle workload. “We reduced staff by a half-FTE in the customer service area, and we have reduced our overall talk time on the phone with our patients by an average of approximately 20 percent,” Ashline says.
One surprise area of savings: reduced fees for collecting past-due accounts. El Camino does no in-house collecting; after three statements, patient bills are referred to an agency for “soft” collections. About six months after adopting the new online billing approach, the agency called Ashline to find out why the volume of accounts had fallen by nearly 50 percent.“The reason is because people are paying their bills more quickly, so we save the collection fees,” she says.
Ashline shared the following tips from her hospital’s experience to date.
Email addresses are essential. Before launching the new online approach, El Camino had not collected patient email addresses, which are needed so that auto-generated email messages can notify patients when their bills are due. Thus, Ashline encourages hospitals that may want to adopt a similar approach to start collecting email addresses now. That will allow them to notify their patients about the service and how to sign up, independent of a medical encounter.
Old technology may impede savings. El Camino’s computer system is currently set to send three statements and “turning off” that function has been a technical challenge. “We are working to fix that, and considering that it costs us $1.50 per statement, eliminating the extra statements will be a significant savings,” Ashline says. “We are finding that for many patients, we do not need to send three statements because they pay when they get the emails.”
One thing that has not been a challenge: Getting patients to try the portal. “It has not been difficult to convince patients to use the portal. Maybe that is because we are in the very tech-savvy Silicon Valley,” Ashline says. “We are just keeping up with today’s technology.”
Lola Butcher is a freelance writer and editor based in Missouri.
Ned Borgstrom is interim CFO, El Camino Hospital, Mountain View, Calif.
Judi Ashline was previously director of patient financial services at Camino Hospital, Mountain View, Calif.
Publication Date: Friday, January 17, 2014
In this business profile, Amy Gross, senior vice president of Key Government Finance, discusses the benefits of private placement transactions to support large-scale financing projects.
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.
In this business profile, Doug Polasky, executive vice president at Xtend Healthcare, explains the importance of having sound workflow processes in a consolidated business office to ensure optimal performance and reduce costs.
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.
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
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.
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.
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.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
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.
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.
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.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
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.
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.
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.
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.
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.
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.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
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.
HFMA's print, email, online, and mobile opportunities provide you maximum reach and impact. We will work with you to build a plan that meets your needs. Contact a sales rep.
HFMA offers online, email, and print opportunities to help you recruit the most talented healthcare finance professionals. Place your classified ads today.
Drive down costs while improving quality in a reform environment.
Stay informed about new directions in healthcare finance. Share tools and strategies for improving performance. Be an active participant in your profession. Together, we’ll reshape the business and practice of healthcare. Join us.
Copyright 2016, Healthcare Financial Management Association.
Join HFMA today and enjoy: