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.
Cinderella's coach turned into a pumpkin at the stroke of midnight—and your hospital's revenue could likewise be in for a rough ride if you don't pay special heed to the new "two midnights" rule recently issued by the Centers for Medicare & Medicaid Services (CMS).
In August, CMS released its final rule for the hospital inpatient prospective payment system, which goes into effect Oct. 1. A key part of that rule is the new "two midnights" presumption for hospital inpatient admissions, which replaces the 24-hour presumption that has long guided physicians. CMS's criteria for inpatient status now include a valid physician's order, documentation of the patient's medical need for admission, and information supporting the physician's expectation that the patient will require a stay lasting at least two midnights.
CMS has a good reason for changing the timeframe: The agency's researchers determined that 36 percent of payments for inpatient one-day stays are inappropriate, but that the number drops to just 13 percent for two-day stays.
As with any major change in Medicare policies, the two midnights rule is likely to cause a major spike in denials. Here are some ways to prepare for the new rule and avoid getting blindsided by a flurry of recovery audit contractor (RAC) activity and/or additional documentation requests (ADRs).
Liberate your docs from the clocks. Physicians need to focus on their patients' well-being without worrying about timetables. They can benefit from receiving real-time guidance from physicians who are already well versed in the implications of the two midnights rule. Ensuring physicians get timely peer-to-peer advice on how to improve documentation can prevent denials from happening in the first place.
Help educate physicians most affected by the new rule. Emergency department physicians and interventional cardiologists are among those who will be heavily impacted by the two midnights rule. These physicians should be given pointers on how to make admission documentation more thorough and airtight. For example, stent patients with documented risks of a bleed are not "automatic" candidates for two midnight stays anymore because signs of bleeding would likely be evident after just one midnight.
Let physicians know that observation time helps meet the requirement. A patient who spends the first night in observation and the second night as inpatient satisfies the two midnights requirement. Failure to properly document the patient's status on each night, however, can result in significantly reduced payment.
Stay on the lookout for CMS clarification. Because the new rule is a sea change in inpatient admissions, CMS has been actively clarifying its implementation. Hospital leaders should stay tuned to the FAQs on the agency's website to ensure their organizations' documentation remains flawless. For now, CMS has made it clear that there are still legitimate reasons for negative early discharge before two midnights have passed, including the obvious reasons, where a patient worsens and must transfer to another facility, unwisely leaves the hospital against medical advice, or dies. The agency's guidance on positive early discharge—those instances when a patient unexpectedly gets better rapidly—is still a bit sketchy. But that can change quickly, so it is important to keep apprised of all CMS clarifications.
Most hospitals are actively preparing for the revenue cycle impact of ICD-10, but comparatively few hospitals have given sufficient attention to preparing for the two midnights rule, even though, ironically, it takes effect a full year earlier. By proactively dealing with the new documentation standards, your revenue cycle saga will continue to be a Cinderella story.
Glen Reiner is clinical practice leader for Adreima, Chicago, and a member of HFMA's Arizona Chapter.
Publication Date: Wednesday, September 25, 2013
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: