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By Kathleen B. Vega
“We knew this effort would be complex and time-consuming, and we decided to start early so we could effectively prepare for the ICD-10 transition,” says Cynthia D. Fry, PhD, vice president revenue for CHE. “We also wanted to leverage our system’s size and identify any ‘one and done’ components that we could implement systemwide to gain efficiencies and streamline work. Not everything can be done at the system level, but items such as a project plan, financial impact analysis, assessing payer readiness and software vendor preparation do lend themselves to a global approach.”
This is a sample article from HFMA's Revenue Cycle Strategist newsletter, a print newsletter that helps hospitals and health systems achieve peak revenue cycle performance.
Learn more—and subscribe—to Revenue Cycle Strategist.
Taking the First Steps
To begin, CHE developed a business plan. “We started information gathering early on—reading about ICD-10, attending webinars, and talking with colleagues in other organizations,” says Howard Walker, ICD-10 program manager for CHE. “All the research was used to form an initial business plan, which included a concise description of the core changes that would result from the new coding system.”
Once the plan was created, Fry and Walker met with senior leadership to educate them on the plan and garner support.
“We brought in an outside speaker who was a former senior leader in a multihospital system and an acknowledged expert in ICD-10,” says Fry. “She talked about the potential impacts of the new coding system and spelled out the risks to our organization if we did not have a well-defined, comprehensive approach to implementation.”
After the speaker laid the groundwork, Fry and Walker presented the initial business plan and obtained leadership support as well as a budget for the work. "I believe this approach of having a peer introduce the topic of ICD-10 was beneficial, because she was able to effectively pave the way for our presentation," comments Fry.
In conjunction with developing the business plan and meeting with senior leadership, CHE also created a core team at the system level to guide the ICD-10 work. Made up of representatives from the revenue cycle, IT, health information management, and nursing, this team meets bi-weekly to talk about ICD-10 implementation and other related topics.
“We have found there is always something to discuss,” says Fry. “Our various hospitals also have ICD-10 teams, but the system-level team covers many of the issues that will impact the entire organization. For example, we searched and selected an ICD-10 Web-based training tool designed to accommodate the various stakeholders from coders to physicians. As a system, we leveraged our size to get preferred pricing and purchased unlimited licenses. Every stakeholder group at all our hospitals is now assured to receive the same training, and we can track who is attending and who is not.”
Creating Five Goals for Implementation
As CHE was laying the groundwork for implementation, the following five goals for the work emerged as part of the business plan:
“We basically segmented the implementation process into five distinct buckets,” comments Walker. “These efforts not only drive the ICD-10 work, but are also significant initiatives on their own with dedicated committees, budgets, project plans, and processes. At the system level, we are planning for and working toward all of these goals to ensure an effective ICD-10 transition.”
Goal 1: Eliminating erosions in coderproductivity. CHE is turning to technology to help address this goal. “We are implementing a computer-assisted coding tool across the system,” says Walker. “We want to get this tool in place well before the switch to ICD-10 so we can get past the learning curve before the code sets change.”
To further enhance productivity, CHE also partnered with a local community college to provide online training to coders systemwide in anatomy and physiology. “Because the level of detail is much greater in ICD-10, we wanted to supplement coder knowledge and be sure all received the same level of training,” comments Fry. CHE is also evaluating its coder backfill strategy and coder retention plan.
Goal 2: Avoiding any unfavorable financial impacts through the analysis of current coding and documentation patterns. “We found a tool to help us expedite data analysis at an ICD-10 conference,” says Fry. “An accounting firm developed a software tool that analyzes the impact of ICD-10 based on current claims data. This tool answers the question, ‘What would the financial impact be at the DRG level if we flipped a switch to ICD-10 today?’ We have completed a first pass on the data for all our hospitals and are now drilling down to the specific issues identified at each hospital.”
CHE is also assessing payer readiness and whether the payers will be processing claims in ICD-10 or mapping back to ICD-9. Expecting an increase in claim denials and payment variances, CHE is developing a resource plan to support central billing offices (CBOs).
Goal 3: Minimizing disruptions in patient throughput in the outpatient setting. The switch to ICD-10 will not affect every department in an organization in the same way. For example, what happens if an inordinate amount of patients present themselves on Oct. 1, 2014, with an order for a test that does not have an ICD-10 code or the written diagnosis is not specific enough? How will medical necessity be checked? Outpatient areas that currently use ICD-9 codes will need specific attention in updating their processes for ICD-10. To identify departments that need attention, CHE created a 31-question online survey to assess department needs.
“We piloted the survey with one facility to see if the questions were relevant and generated meaningful answers,” says Fry. “Once we determined we could glean the necessary information using the survey, we are starting to implement hospital by hospital. We identify high-risk outpatient departments and then go on site to conduct a review and develop recommendations.” (See the workflow analysis survey questions.)
Even without the survey, CHE knows that certain departments will need more attention than others. To understand the scope of ICD-10 impact in these areas, CHE is developing a picture of current state process flow that identifies the flow of paper, use of systems, and where current ICD-9 and future ICD-10 codes are and will be used. The organization is then performing a gap analysis, evaluating risk along the process flow to further pinpoint areas that will need focused attention. Two exhibits illustrate this effort for one of CHE's emergency departments. The Emergency Department Patient Flow diagram shows a current state process flow for the department at one hospital.
In addition an ED-specific ICD-10 Analysis shows how CHE assigns risk to the different components of the process flow.
Access related tool: ICD-Impact on ED Patient Flow
Goal 4: Ensuring that physician documentation is ICD-10 compliant. “Prior to starting work on ICD-10, we did not have a systemwide clinical documentation program,” says Fry. “We developed a business plan, created a steering committee, and have implemented a clinical documentation program across the organization. The clinical documentation improvement (CDI) specialists are completing our ICD-10 Web-based training now and will start coaching physicians on some of the basics of ICD-10 documentation such as specificity, underlying cause, and documentation of associated relationships. Physicians will learn proper documentation without knowing it is ICD-10 documentation that they are learning.”
Goal 5: Implementing information systems to support the work. Progress toward meeting this goal can be seen in the work involved with all the other goals. Specifically, the implementation of a computer-assisted coding tool will help realize a smooth ICD-10 transition. CHE is also working to develop structured templates in the electronic health record that support the documentation requirements for ICD-10.
Looking Externally for Support
As CHE pursues its ICD-10 goals, it is also leveraging relationships with external partners. “We maintain strong relationships with all our vendor partners, and they have been very helpful as we work to get ready for implementation,” comments Walker. “They have provided resources, education, and creative thinking to help us identify solutions that address the unique needs and characteristics of our system.”
CHE is also sharing information with other hospitals and health systems. “Most of the time you don’t collaborate with your competitors, but ICD-10 is one thing we can work on together,” says Walker. “We have regular conference calls with several hospitals in our geographic area in which we discuss our work toward implementation, problems we are having, information we have learned, and so on. We talk about payer issues, vendor readiness, and training needs and resources. We have even brought in speakers to talk with the group on specific topics.”
The Effects of the Delay
CHE started focusing on ICD-10 early and experienced tremendous momentum toward implementation. The recently announced delay in the ICD-10 deadline to Oct. 1, 2014, has slowed organizationwide progress but not halted it.
“Although we were frustrated by the delay at first, because we were afraid the ICD-10 work would become a lesser organizationwide priority, we are now seeing a benefit to the delay,” says Walker. “Some of our technology that will support the transition, such as the computer-assisted coding tool, has taken longer to move forward than we originally anticipated, so it's nice to have the extra time. As it is now, we can continue to work toward achieving our implementation goals and make sure we are truly ready when the new deadline arrives.”
Kathleen B. Vega is a freelance healthcare writer and editor, La Grange, Ill. (firstname.lastname@example.org).
Interviewed for this article were Cynthia D. Fry, PhD, vice president revenue for Catholic Health East, Newtown Square, Pa., and a member of HFMA’s Metropolitan Philadelphia Chapter (email@example.com); and Howard Walker, ICD-10 project manager for Catholic Health East, Newtown Square, Pa. (firstname.lastname@example.org).
Catholic Health East is a not-for-profit health system headquartered in Newtown Square, Pa., with facilities in 11 eastern states. The health system comprises 35 acute care hospitals, four long-term acute care hospitals, 26 freestanding and hospital-based long-term care facilities, 12 assisted-living facilities, four continuing care retirement communities, eight behavioral health and rehabilitation facilities, 31 home health/hospice agencies, and numerous ambulatory and community-based health services. Catholic Health East facilities employ more than 60,000 FTEs.
The health system is the largest not-for-profit provider of home healthcare services—ranked by number of visits—in the nation, as well as the nation’s leading provider of Program of All Inclusive Care for the Elderly (PACE), based on the number of programs.
Publication Date: Monday, October 01, 2012
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.
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, 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.
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.
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.
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.
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.
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.
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.
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.
In this business profile, sponsored by SSI, Jay Colfer, vice president of sales and marketing, shares how patient access solutions are reversing the trend toward increased bad debt resulting from the rise in high-deductible consumer health plans.
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.
In this business profile of Deloitte Consulting, Matthew Hitch and David Betts explore the potential benefits of elevating the customer experience and outline strategies to change service delivery.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
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.
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.
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.
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.
From payment incentives to value-based purchasing penalties, the national focus in healthcare is on improving patient care and lowering costs. Coordinating care for patients as they move from one care setting to another can help meet these goals, but the greatest success will come when the patients healthcare providers work together. By enhancing a team approach to care and providing cost efficiencies, partnerships between acute and post-acute settings benefit patients and the healthcare providers taking care of those patients.
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Copyright 2016, Healthcare Financial Management Association.
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