Professional Staff Assessment


Knowledge Base Self-Assessment


What is a self assessment about?

A self assessment should be among the first steps you take when choosing a career direction. Learning about yourself helps you select what direction to pursue. HFMA provides skills self-assessments for healthcare finance professionals.

The self-assessments present HFMA’s finance competencies and are structured to identify required capabilities for the professional staff, managerial and executive levels. Taking the assessment is easy and you can use the results of the skills assessment to initiate career development by acquiring the skills you need for a particular position.


Indicate importance/relevance of each activity to your job and select the level of expertise/knowledge you have in this area.

I. Compliance

ComplianceImportant
for my job
Competency Level
Yes No Novice
1

2
Competent
3

4
Expert
5
A.
Ability to explain the purposes of a compliance program
B.
Understand the role of the Compliance Officer
C.
Understand the role of the Office of the Inspector General (OIG), its work plans and impact on operations
D.
Understand all current and relevant Medicare compliance issues, e.g.Medicare as secondary payer, medical necessity, etc
E.
Understand and explain HIPAA


II. Patient Access

Patient AccessImportant
for my job
Competency Level
Yes No Novice
1

2
Competent
3

4
Expert
5
A.
Explain Patient scheduling
B.
Identify valid physician order
C.
Describe Comprehensive patient access processing
D.
Explain validating patient data
E.
Understand and describe Medicare as secondary payer screening
F.
Identify the steps involved in insurance verification
G.
Explain the Medicare Advanced Beneficiary Notice process
H.
Indentify and explain the steps involved for determining patient liabilities and when to collect
I.
Indentify and explain patient financial education and financial resolution programs
J.
Explain EMTALA and its requirements
K.
Identify and explain patient payment options including Medicaid eligibility, payment discounts, payment plans and charity care


III. Claims Processing

Claims ProcessingImportant
for my job
Competency Level
Yes No Novice
1

2
Competent
3

4
Expert
5
A.
Understand the basic claim form requirements for the UB-04
B.
Understand the basic claim form requirements for the CMS 1500
C.
Identify the different components and advantages of submitting claims electronically
D.
Understand and explain what is required for a "clean" claim
E.
Understand and identify who is responsible for each data element on a claim form
F.
Explain the importance of maintaining the charge master
G.
Describe the importance of using claim edits
H.
Describe typical claims edits and how each is resolved
I.
Identify and explain the basic billing rules for the major payers
J.
Identify and explain the basic billing rules for different healthcare providers
K.
Identify and explain the different types of payer claim rejections and typical reasons for claims rejections
L.
Identify and explain typical billing errors and how to avoid them
M.
Identify and explain the typical reasons for payer denials and how to avoid them


IV. Accounts Resolution

Accounts ResolutionImportant
for my job
Competency Level
Yes No Novice
1

2
Competent
3

4
Expert
5
A.
Articulate basic customer service principles for dealing with patients
B.
Articulate basic customer service principles for dealing with payers
C.
Identify and explain third-party payer follow-up and account resolution activities
D.
Explain follow-up activities for liability payers
E.
Understand and explain lien issues
F.
Explain patient balance billing processes after insurance; explain the potential contract issues and liabilities
G.
Explain how to distinguish between bad debt and charity care
H.
Explain Medicare bad debt rules and their financial impact
I.
Identify and explain the federal collections and reporting regulations
J.
Identify the different types of bankruptcy and how these effect a patient’s financial responsibility to a hospital
K.
Explain the process and requirements for collection agency placement
L.
Identify and explain administrative and technical denials and how to resolve them
M.
Describe clinical denials and the appeals process


V. Cash

CashImportant
for my job
Competency Level
Yes No Novice
1

2
Competent
3

4
Expert
5
A.
Explain electronic funds transfer (EFTs)
B.
Explain the balancing and control requirements for EFTs
C.
Describe the general content of the 835 transaction data set for electronic remittance advices
D.
Explain the balancing and control requirements of the cash posting process
E.
Explain payer contractual adjustments
F.
Identify and explain the difference between in-network and out-of-network payments
G.
Define and explain silent Preferred Provider Organizations (PPO)
H.
Identify and explain required internal controls for cash posting
I.
Describe the daily reconciliation process for cash posting and the importance of daily reconciliation
J.
Identify the different types of general ledger cash(non-A/R cash) and how it is posted
K.
Identify and explain the processing steps for bank deposits
L.
Define a credit balance and identify the reasons there are credit balances in A/R
M.
Explain the processing activities required to resolve credit balances


VI. Financial Management

Financial ManagementImportant
for my job
Competency Level
Yes No Novice
1

2
Competent
3

4
Expert
5
A.
Explain the life cycle of an account and how it fits into the revenue cycle
B.
Explain the difference between the terms gross accounts receivable (A/R) and net A/R
C.
Explain the concept of establishing "reserves" for contractual allowances, bad debts, and charity care and explain how these are presented in the financial statements
D.
Explain the timing of contractual adjustments (time of billing versus time of payment posting) and how the timing impacts the ability to accurately analyze receivables
E.
Explain current pay-for-performance initiatives
F.
Define what Key Performance Indicator (KPIs) mean
G.
Explain how to calculate days in A/R
H.
Identify and explain the components of an A/R aging analysis
I.
Explain "discharged-but-not-final-billed" (DNFB) status
J.
Explain how to calculate cash collected as a percentage of net revenue
K.
Explain how to calculate denials as a percentage of net revenue
L.
Explain credit balances as part of days outstanding
M.
Identify and explain the components of a charge master
N.
Identify and explain common charge master issues, e.g. revenue codes, CPT codes, charging units, etc
O.
Explain what a modifier is, list common modifiers and describe how they are used
P.
Explain "pricing transparency" and its relationship to charges
Q.
Explain outsourcing and why organizations outsource
R.
Identify different outsourcing programs and explain the role of the vendor versus the hospital