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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.
A Three-Legged ACO Gets Off to a Running Start
The term “accountable care” was barely in use in 2007 when a California health system, payer, and physician association hammered out the basic model that many new ACOs are now adapting for their own use.
The partners—Dignity Health, Blue Shield of California, and Hill Physicians Medical Group—started with a dual quality and cost agenda. They set a per-member-per-month global budget that required the three partners to collectively reduce costs by at least $15 million in 2010. However, they also agreed to maintain or improve the quality of health care provided: The partnership agreement stipulates that no cost-control initiative can be launched if it would hurt quality.
Launched in January 2010, the ACO serves 41,000 California Public Employees Retirement System (CalPERS) beneficiaries in the Sacramento, Calif. area. At the end of 2011, the partnership had saved CalPERS a total of $37 million compared to what it would have paid without the ACO. And the three partners had split $13 million, courtesy of a shared-savings contract.
Keys to Successful Surgical Quality Improvement
When asked what is critical to a successful surgical improvement program, Scott J. Ellner, DO, MPH, FACS, advises starting with trustworthy data and pinpointing variation. “The best way to get people to buy into a quality improvement program is to share clinical outcomes and data metrics that they will actually believe,” says Ellner, who is vice chairman of surgery and director of surgical quality, Saint Francis Hospital and Medical Center.
The Connecticut hospital is currently standardizing how colon surgery patients are prepared for surgery. For example, an antibiotic is prescribed to all patients prior to colon surgery. Steps are also taken during colon surgery to limit infections. For instance, all of the surgeons are provided a new set of gowns, gloves, and sterile instruments toward the end of the surgery before closing the abdomen. This prevents the spread of contamination from the earlier part of the surgery when the colon was handled.
“As you limit unnecessary variation, you can minimize adverse events,” says Ellner. “After six months of implementing standardized approaches, we are seeing an improvement in our raw data showing a decrease in surgical site infections.”
Staffing and Scheduling: Easing the Management Burden
Unit/department managers at Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, N.Y., used to spend an inordinate amount of time dealing with scheduling and staffing issues. This is a common and frustrating problem for hospital managers. In fact, staffing tasks can occupy 50 percent or more of a manager’s time, according to anecdotal reports.
In 2010, the 381-bed CVPH moved to a centralized approach to staffing and scheduling. It also replaced manual and, at times, paper-based processes with automated scheduling solutions. A time study of inpatient nursing units revealed a return of 7 hours of work per manager for every pay period after the changes were implemented. Managers have been able to redirect their time from scheduling activities to patient care and staff mentoring.
Small, Rural Hospitals Tackle the Challenge of Scale
Small, rural hospitals face unique challenges as they move toward value-based payment models. For example, one obstacle is limited scale, which restricts their access to affordable capital and their ability to take advantage of population management initiatives. However, rural hospitals highlighted in the latest research report from HFMA’s Value Project are tackling the challenge of limited scale with certain strategies.
For example, some small, rural hospitals are determining how many specialty services are realistic and appropriate for community needs and assessing how best to deliver those services. Others have opted to provide certain specialty services through telehealth partnerships. For example, Copper Queen Community Hospital, Bisbee, Ariz., has established telehealth arrangements for cardiology services and strokes and is working on a burn program.
Achieving greater scale is one strategy small, rural hospitals are using to manage the transformation to value-based payment models.
Bellin Health leaders use this Excel document, which they call an energy grid, to track all of the health system's strategic and performance improvement initiatives by department.
Catholic Health Initiatives took control of its clinical engineering costs by forming a systemwide department, saving $18 million in FY12.
The CFO at St. Barnabas is over patient access, clinical financial services, denials, patient financial services, and managed care.
For a hypothetical and typical health system, deciding how to become fully capable of operating under value-based purchasing in five years is an intricate - and critical - understanding.
Learn how states are responding to Medicaid expansion and their decisions
regarding the development of health insurance exchanges.
Revenue Cycle Leadership Team & Functional Organizational Chart Vice President Revenue Cycle Executive Director Middle Revenue Cycle Executive Director Revenue Cycle Patient Access Executive Director Revenue Cycle Patient Financial Services EVP & CFO Finance Executive Director Revenue Cycle Business Support Services Ex
Joseph Koons Managing Director Revenue Cycle 254.5 FTE’s Total Melissa Viohl Director Pt Access 83.9 FTE’s Maria Ramsey Director Patient Accounting 47.8 FTE’s Judy Martin Manager, Rev Integrity Matt Newbill Mgr Customer Svc /Collections Louanne McClure Mgr Claims Processing Transport Acct Specialists Relay Health RN Ch
Real estate investment trusts offer hospital CFOs a nontraditional, cost-effective option for meeting a portion of their organizations' capital requirements.
View a sample dashboard used by Spectrum Health Continuing Care to monitor quality and safety in its post-acute assets.
NorthShore University HealthSystem vets potential clinical quality improvement projects by a list of criteria, such as usability, standardization potential, level of innovation, and opportunity for impact.
In 14 months, leaders at Spectrum Health turned around their lagging post-acute care businesses and launched a comprehensive, continuing care network.
Planning a successful transition from fee-for-service to new revenue models may be the greatest impending challenge for finance executives of hospitals and health systems.
Before saying “Yes” to the next enthusiastically proposed initiative, healthcare leaders might want to ask some hard questions.
Kerri Ruppert Schiller, senior vice president and CFO of the Children's Hospital of Orange County (CHOC), discusses how she and her team worked to make Orange County, Calif., one of the safest, healthiest places in the nation for children.
From the Editor: Amid the complexity and uncertainty of health care, having clear goals can help avoid unintended side trips.
For the short-term, growing profitable services with high acquisition rates may compensate for deeper cuts in less profitable services.
Independent hospitals can follow a six-step process to reassess the viability of maintaining independence.
exhibits detailing estimates of the Medicare Part A Trust Fund balance before
and after the Affordable Care Act was enacted as well as variations in Medicare
spending for 90-day episodes of congestive heart failure.
exhibits detailing estimates of the Medicare Part A Trust Fund balance before
and after the Affordable Care Act was enacted as well as variations in Medicare
spending for 90-day episodes of congestive heart failure.
Forum sponsor Kaufman, Hall & Associates discusses how to strategically plan to ensure a hospital's long-term financial sustainability.
Meeting the challenges for multiyear financial planning posed by value-based payment requires a team approach that promotes good spirits while maintaining a serious focus on getting the job done.
Healthcare finance leaders have an important role to play in guiding clinical and financial improvements in hospitals.
Four strategies can help payers and providers give their customers more value for the dollar as health reforms emerge over the next few years.
Hospitals and health systems require sustainable strategies for integrating with physicians if they are to achieve continued success in the nation's future valued-based healthcare delivery system.
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.
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.
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
Copyright 2016, Healthcare Financial Management Association.
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