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.
Despite a series of letters from HHS Secretary Kathleen Sebelius and FAQs addressed by the Centers for Medicare & Medicaid Services (CMS), it’s unclear what role hospitals can play in purchasing coverage for economically challenged individuals. Hospitals, because of EMTALA, have a pretty good idea of who’s uninsured and sick in a community. Allowing them to purchase coverage for sick individuals who lack the means to obtain coverage would seem to be the most efficient way to achieve the goal under the Affordable Care Act (ACA) of making affordable health care available to those who need it most. Allowing hospitals to fulfill this role is particularly reasonable because, for some families, coverage through a healthcare insurance exchange isn’t affordable even after the subsidy.
Initially, a letter from Secretary Sebelius to Congressman Jim McDermott (D-Wash.) found the exchange subsidies weren’t a federal program. This finding appeared to open the door for direct purchase by providers. However, that interpretation was cast into doubt almost immediately.
Even though the IRS rules related to premium assistance appeared to permit third-party purchase of coverage, CMS’s Center for Consumer Information & Information Oversight (CCIIO) discouraged the practice in a response to an FAQ issued Nov. 4, 2013, just days after McDermott’s letter. Further, payers were encouraged to reject insurance payments from third parties. The CCIIO’s comments regarding the FAQ were in response to an inquiry from Sen. Chuck Grassley (R-Iowa) and concerns from the payer community about increased risk of adverse selection. Payer concerns are certainly warranted given lower-than-expected exchange enrollment and the various tweaks to ACA implementation allowing relatively healthy individuals to remain outside of the exchange risk pool for an extended period of time.
On Feb. 7, 2014, due to concerns that some health plans were using the CCIIO’s response to the Nov. 4 FAQ to justify rejecting payment for exchange coverage using federal Ryan White/AIDS Program funds, CMS issued its response to a second FAQ. The agency clarified that the November FAQ didn’t apply to payments for premiums and cost sharing made on behalf of enrollees by federal programs and Indian tribes. Further, CMS stated that not-for-profit, private foundations also could make premium and cost-sharing payments as long as they were means tested, did not consider the individuals’ health status, and were made for the entire year. Under both scenarios, payers were “encouraged” to accept third-party payments.
The unfortunate effect of this regulatory waffling is that patients with real needs (both clinical and financial) continue to suffer despite the ACA’s prohibition on medical underwriting. Even after the February FAQ, it appears some payers aren’t accepting third-party payments from sources deemed permissible in CMS’s response to the FAQ. In a court case that will bear watching, an advocacy group has filed a class action suit against three payers in Louisiana for failing to accept Ryan White subsidies to assist with the purchase of an exchange plan.
The confusion also has stalled provider efforts to offer a more effective form of financial assistance. A small number of organizations have made donations to independent local charities who then oversee the purchase of coverage for individuals with demonstrated financial need.
Although CMS’s response to the Feb. 7 FAQ appears to sanction this type of arrangement, many providers are still weary. First, a change in stance by CMS or the Office of Inspector General to a less permissive position with respect to the FAQ would not be surprising to providers, if past experience is any indication. Should such a change in position occur, an added consideration is that FAQ responses have tended to lack the force in court of a regulation published in the Federal Register. Given such concerns, most organizations that HFMA has spoken with are waiting for further clarity and working with their internal and external counsel to determine the most effective way to facilitate health insurance enrollment for those in the community who need it most.
Providers have already seen some fresh guidance—at least to a degree. On March 14, CMS issued an interim final rule (IFR) on third-party payments to qualified health plans. Unfortunately, the IFR provided little additional clarity on the issue, beyond mandating that health plans accept third-party payments from Ryan White HIV/AIDS Program, Indian tribes, tribal organizations, and urban Indian organizations; and for state and federal government programs, the IFR mainly codified CMS’s earlier positions. HFMA will submit comments to CMS on the rule and would encourage provider organizations to do likewise.
Chad Mulvany is director, healthcare finance policy, strategy and development, in HFMA’s Washington, D.C., office.
Publication Date: Tuesday, March 18, 2014
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.
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.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
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.
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 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.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
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.
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.
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.
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.
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.
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.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
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 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.
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: