Even though the calendar says it's still winter, the weather feels like spring. This was the first year mild weather caused the cancellation of the popular Birkebeiner cross-country ski race in Hayward. I am looking forward to spring and hope winter is almost over. I'm ready for golf, baseball, and barbecues.

WMCA had a great turnout for the February Joint meeting with WAHAM in Neenah. The agenda was exceptional and we know the registration and collection process is a team effort. Call me if you missed it because I have a few extra handouts from Lori Zindl, Catherine Mode Eastham, and Maria Fuentes.

I want to thank Bob Gulig, HFMA Representative and Deb Gustafson for their diligent work in organizing the WMCA-HFMA Joint Workshop, which will be held in March, at the Regency Suites in Green Bay. It will be a great opportunity to network with your peers and gain valuable information on the current topics including APCs and HIPPA.

Again, a reminder that there is still time to get on the ballot for the WMCA Board election this spring. I encourage anyone who is interested to get involved and call a Board Member for details.

Medicare will be the topic for the May Quarterly Workshop. It will be held at the Holiday Inn Express in Black River Falls on May 12th. Plan to attend.

Mark your calendar and make plans early to attend our Annual Institute August 9, 10, and 11, 2000. It will be at the Fox Hills Golf Resort and Conference Center in Mishicot. Look for more information at our upcoming meetings.

Jackie Lippe

WMCA President

February 1, 2000

Jackie Lippe

St. Joseph's Community Hospital

551 South Silverbrook Drive

West Bend, WI 53095

Dear Jackie,

I am writing to inform you that it is truly with much regret that I will no longer be serving you in the role of Medicare Customer Service Manager for United Government Services, LLC. I am continuing to pursue my career in health care management, but not with UGS. This decision was a very difficult one, in large part due to the many friendships and professional relationships I have been fortunate to develop over the years.

Together, we have faced many challenges and I want to express my sincere appreciation for all of your support, assistance, and genuine professionalism you have shown. I am truly grateful for the privilege of knowing and working with you and your organization. I hope that one day our paths will cross again. In the meantime, I wish you continued success in all of your endeavors. Since I do not have everyone's USPS or email addresses, please feel free to share my note of thanks and appreciation to other members of your organization and anyone else you deem appropriate.

Respectfully Yours,

John R. Bartell

jb_roland@mindspring.com

6 Ways To Build A Top Staff

To build a staff into a team that does the best possible job for the organization:

Be Friendly to staff members but don't treat them like close personal friends. They want you to be the boss, and they want to be employees. It works better that way.

Tell them everything. And expect them to tell you the same. Shared knowledge builds loyalty and trust.

Practice Pulitzer Prize plagiarism: Steal only from the best. If you need help, reach out to your professional community. Someone, somewhere, somehow will know how to help you.

Invest heavily in loyalty. If staff members know that you're always loyal to them, they'll give you the same in return.

Realize that fairness - not cleanliness - is next to godliness.

Never be too busy to laugh. Nothing gets people through a crisis like a good laugh and a manager who's willing to enjoy it with them.

Source: Gene H. Cheetah writing in Association Source, Florida Society of Association Executives, 1211 Semoran Blvd., Casselberry, FL 32707.

state of Wisconsin

Share your experiences! A wedding? A significant Anniversary?

A Birthday? A job change? An unusual vacation? A new baby? An unusual experience? A promotion? Commentary!

Are any of these events going on in your life or of anyone we know?

Call Bud Brauer at (414) 964-6040

E-mail: feenix@execpc.com

Where has Dave Melville gone? I do not know where he is, but I do know where is not. Dave left Collections Unlimited, Inc. after just eight months. Rumor has it he has left the collection business.

Rae Ann Danner will be retiring from Watertown Memorial Hospital after just 33 years. For many years, Rae Ann was the always pleasant smiling face at the WMCA registration table. She was a WMCA board member for many years . Rae Ann will leave the hospital on June 30, 2000.

From the rumor mill, Al Gomez has left his patient accounting position at All Saints in Racine . Mark Braatz, Patient Financial Services Director at Wausau Hospital, has moved on as well.

It's time again for one of those "where has the time gone?" articles. I suppose it's my age. But it does seem that Medicare just came on the scene, not 35 years ago. It is difficult to accept that many of you reading this never knew a time when there was no Medicare (nor cable TV, VCRs, or microwaves for that matter). And much more recently weren't many of you just yesterday concerning yourselves about the Y2K problems that were going to shut down everything from heart lung machines to toilets and everything in between? I know that many of you spent New Year' s Eve at your workplace waiting for something, anything, to happen. (I didn't...but you knew that!) But like Medicare, healthcare survived Y2K as well.

Another reference point for me is that 2000 marks my fifth year of writing this column. And since the column has people as its focus (or tries to), let's visit a few names of persons who have come and gone or switched places. Hopefully the names may trigger a personal memory, fond or otherwise. There are few of us around now who remember Lou Johnson of National Account Systems, Marty Gross of Credit Service Inter national, or Jack Wild of Collection Managers Service. Not only have the people left the scene, but their companies as well. A look at the past presidents' list invokes many memories. Names like Paul Luke, Paul Peach and Jim Davis, the only two-term president, remind me of the great Annual Meetings at the Holiday Inn in Stevens Point, back in the mid-70's. Whatever happened to Don (I'm thinking of a city) Nipper, who with Ernie Jackel, brought their own special brand of enthusiasm to their era. And Joan Kennedy, the first female WMCA president elected in 1983.

I will end this trip down memory lane for now. I hope it brings a pleasant thought or two to mind. If it triggers some story or anecdote from your WMCA past, write me, fax me or email me so that we can share it with everyone.

We convince ourselves that life will be better after we get married, have a baby, then another. Then we are frustrated that the kids aren't old enough and we'll be more content when they are. After that we're frustrated that we have teenagers to deal with. We will certainly be happy when they are out of that stage. We tell ourselves that our life will be complete when our spouse gets his or her act together, when we get a nicer car, when we are able to go on a nice vacation, when we retire. The truth is, there's no better time to be happy than right now. If not now, when? Your life is always filled with challenges. It's best to admit this to yourself and decide to be happy anyway. One of my favorite quotes comes from Alfred D . Souza. He said, " For a long time it had seemed to me that life was about to begin - real life. But there was always some obstacle in the way; some thing to be gotten through first; some unfinished business; time still to be served; a debt to be paid. Then life would begin." At last it dawned on me that these obstacles were my life. This perspective has helped me to see that there is no way to happiness. Happiness is the way! So treasure every moment that you have . And treasure it more because you shared it with someone special, special enough to spend your time with and remember that time waits for no one. So stop waiting until you finish school, until you go back to school, until you lose ten pounds, until you gain ten pounds, until you have kids, until your kids leave the house, until you start work, until you retire, until you get married, until you get divorced, until Friday night, until Sunday morning, until you get a new car or home, until your car or home is paid off, until Spring, until Summer, until Fall, until Winter, until the first or the fifteenth, until your song comes on, until your ship comes in, until you've had a drink, until you've sobered up, until you die...to decide that there is no better time than right now to be happy.

Happiness is a journey, not a destination. Work like you don't need money. Love like you've never been hurt, and dance like no one's watching.

Author Unknown

"Every new beginning comes for some other beginning's end." When I first heard the song with those lyrics, I marveled how a pop lyric with the main purpose of rhyming to a beat could so easily epitomize the process of letting go of the past and, at the same time, anticipating the future.

Isn't it interesting that out of the thousands who work in the collection industry each day, not one of us has had the same beginning and none of us will share the path that will take us to that beginning's end? Yes, we all share a place in this industry. Yes, each day we invest our time thoughts and energy into making successes. Yet none of us have had the same experiences and none of us anticipate the same future possibilities.

What is common, though, and what allows associations like ACA and your state units to exist is the human element. And as humans we each bring attitude. Attitude - positive or negative - is the foundation that allows us to improve or weaken our personal and professional realities when we assess those endings and plan for the beginnings.

The credit and collection industry is growing and changing rapidly, and you are part of it. You will have new beginnings and expectations. You will either succeed, or you won't. But success doesn't always mean that you made the most money, that it all went as

planned, or that you located the elusive consumer. Failures can be success - with the right attitude.

How would you rate your professional attitude? What is your feeling when you assess your past and anticipate your future? Remember, it is unrealistic, perhaps even phony, to have a positive attitude on the job at all times. But overall, how would you evaluate your out look?

Take the accompanying quiz and see where you rank. Once you've assessed your attitude and have an idea of what your outlook is as you embark on this new year, don't fret if it's less than what you hoped. Re member, this is the year 2000. Those three zeros that follow the "2 " can be symbolic. 2000 brings a physical, as well as a psychological, chance to start again. Zero is truly the start.

Over the next four weeks, embark on an awareness of your attitude and how it can, and does, shape your experiences. Next month's column will focus on suggestions that can help you improve and maintain your attitude.

What Advisory Opinion No. 99-13 Means To You

The Office of Inspector General (OIG) in consultation with the Department of Justice (DOJ) has recently issued Advisory Opinion No. 99-13 regarding the policy of providing discounted laboratory and pathology services to physicians. The conclusion of the opinion is that the offering of discounts for laboratory and pathology services to physicians "might constitute prohibited remuneration under the anti-kickback statute."

Although Advisory Opinions are limited in scope to the specific arrangement described in the request, they assist providers and their legal counsel in their understanding of the interpretation and applicability of certain statues relating to the Medicare and state health care programs. These opinions provide additional guidance regarding the application of the anti-kickback statute and safe harbor provisions, as well as other OIG health care fraud and abuse sanctions. The focus of the opinions is to help clarify what constitutes prohibited remuneration or inducements to reduce or limit services to beneficiaries.

This Advisory Opinion addresses a professional corporation (Company A) with three shareholders who are specialists in pathology and employ five pathologists and 14 technicians. They provide pathology services (including clinical and anatomic pathology services) to five hospitals, as well as to the patients of physicians in private practice.

Company A has several billing methodologies depending upon the payer. For federal health care program patients, it bills its charges to the governmental payer and bills the patient for any applicable co-payments or deductibles.

For non-federal health care program patients, referring physicians have two payment options. One option is to bill its charges directly to the applicable third-party payer, and bill the patients for any co payments or deductibles. The alternative is to bill the physicians for the pathology services and accept that payment as payment in full. The physicians then bill the third-party payers and patients for the purchased pathology services. This options is commonly referred to as "account billing."

Under its account billing arrangements, Company A has traditionally offered physicians a discount of its usual charges which reflects the cost savings it realizes. The corporation generates a single monthly statement to the referring physicians who is required to pay on a prompt basis. Company A maintains this billing arrangement saves time and expense because the claims are not submitted to a wide range of payers with differing billing criteria and they are not responsible for determining and collecting applicable co-payments and deductibles owed by the patients.

In addition, there is a better collection rate under account billing and most physicians refer virtually all of their patients to Company A, whether the patients' specimens are covered under the account billing arrangement or are directly billed to the federal health care programs.

In this request Company A proposed to offer its account billing customers discounts that are greater than its cost savings, to match the prices of its competitors. Some of the discounted charges would be below the actual cost of providing the pathology or laboratory services.

In addition, the profit margin for the non-federal health care program business under this arrangement would be less than the profit margin on the services that it bills directly to federal health care programs. The discount would not be conditioned upon the physicians sending Company A their federal health care program business.

However, Company A has assumed that the physicians receiving discounts will send virtually all of their patients to Company A for pathology and laboratory services. Company A stated that it would lose both the account billing business and the federal health care program business of those clients if it does not match the discounts of its competitors.

The OIG and DOJ concluded in their findings that the physicians were in a position to direct a significant amount of federal health care pro gram business to Company A that is not covered by the account billing component of the proposed arrangement. Secondly, both parties have obvious motives for agreeing to trade business as the physicians have the opportunity to make a larger profit on the non-federal health care program business, and Company A is able to secure profitable federal health care program business in a highly competitive market. Thirdly, Company A has stated that it is likely that physicians who have account billing arrangements with Company A will refer federal health care program business to them as a matter of practical convenience.

In light of this Advisory Opinion, all providers should have their health care legal counsel review any existing or proposed arrangements to ensure compliance with the anti-kickback statute and the safe harbor provisions, as well as other OIG health care fraud and abuse sanctions.

Build Up Your Market Share With Excellent Customer Service

By: Ashley Grayson, Zimmerman Communications published in Customer Service Revolution, January 2000

Patient satisfaction is an issue that everyone in healthcare is certainly aware of, yet it's many times an area to improve. These problems arise when it comes to satisfying patients - especially when it means satisfying so many. After all, if a patient isn't happy or satisfied with the services they received, they will simply choose to never return. Competition is necessary to better your hospital and make it one people race back to - thus building up the market when they are in need of healthcare. That's a hard thing for some providers to realize since a patient's satisfaction is a low priority for them. Their objective is merely to help cure them or save their life at any expense. The doctor could have the "go somewhere else" attitude if a patient tells them they're not happy with the services they received.

However, some things are just out of your control. What can you do to satisfy a customer who doesn't think they should have to pay for their visit to the emergency room because the doctor didn't cure them? What if the patient left without being seen by a provider, is now being charged an evaluation visit and doesn't want to pay? These are issues where it may be tough to soothe a patient,yet they are issues that hospitals these days must face.

Insurance companies force patients to go to certain doctors and certain hospitals and the patients are frustrated be cause they feel trapped. Obviously, no healthcare provider deliberately sets out to upset the patient/customer, but it does happen. In this type of industry, the provider is not able to issue free coupons for their next visit or give rebates on certain procedures. So, special services sometimes have to be practiced in dealing with these issues.

Studies have shown that patients' dissatisfaction comes

about most often not with the clinical aspects of

their visits, but from financially-related matters such as a lack of understanding of their insurance coverage or how the hospital bills for services.

This is a key to why a patient acts the way they do - they don't understand things or feel like they've been unfairly treated. Realize that anger or frustration is caused and directly related to other actions. Courtesy of staff, responsiveness, helpfulness, willingness to listen, convenience of appointments, and ability of staff to help are all areas important to the patient.

Zimmerman & Associates, the healthcare consulting group, has performed patient satisfaction analyses for clients, and the following are typically the main complaints: • Indifference to Patients • Patients Displeased with Waiting Times • Opportunity for Improved Written Communication • Billing/Collection Staff Receive Mixed Results

Because healthcare is a service-oriented business, an organization's level of service can have a major impact on the overall satisfaction level of its customers. It is imperative that you monitor patient satisfaction to keep patients coming back to utilize your medical center. Also, you want satisfied patients to recommend your organization to others. A high degree of dissatisfaction may manifest itself in less market share.

So what are the key factors in customer satisfaction? We think patients have made their opinion clear. We broke their responses down into three categories:

• Compassionate, friendly and committed staff with excellent communication skills.

The most unique characteristic of any healthcare institution is its team of professionals - physicians, nurses and non medical staff. The quality of care they provide, as well as their ability to work together, will create the long-lasting impressions of customer service in the patient's mind. Unfortunately, this is no small feat. Healthcare professionals are under great stress at many facilities. Most are ill equipped to handle the additional pressures of shrinking resources, aging facilities, and uptight co-workers. The foundation of any customer service improvement program appears to be a compassionate, upbeat, committed, and motivated staff trained in human relations.

• Professional and high-quality services, provided efficiently, at hours convenient to modern work schedules.

In our consulting practice, we have repeatedly identified the cause of "extended wait time" as inefficient scheduling of procedures and ineffective admission procedures. Emergency rooms and other waiting rooms are all too often 'clogged' with patients seeking non-urgent healthcare, because they can't access services during conventional schedules. Many hospitals have far too many patient processes that take patients from one waiting area to another with unnecessary long delays in each. Extended wait times can be fixed, and have been, at many healthcare facilities. If the patient (the customer) wants service during times at which providers currently do not provide them, providers should consider changing their schedule.

• Adequate information, provided in a timely fashion, In understandable terms.

Patients want an explanation of procedures and medications. They want a bill they can understand and someone to explain the charges to them. Patients want healthcare providers to take the time to talk to them, listen to their concerns, and then provide them with information they can understand. These needs are too often not being met by providers today.

Reacting To Difficult Types

When dealing with people, be ready to react to the actions of different personalities. Some examples:

• Dealing with the aggressor, who is intimidating, hostile and loves to

threaten.

What to do: Listen to everything the person has to say. Avoid arguments and be formal, calling the person by name. Be concise and clear with your reactions.

• Dealing with the underminer, who takes pride in criticism and is

sarcastic and devious.

What to do: Focus on the issues and don't acknowledge sarcasm. Don't overreact.

• Dealing with the unresponsive person, who is difficult to talk to and

never reveals his or her ideas.

What to do: Ask open-ended questions and learn to be silent waiting for the person to say something. Be patient and friendly.

• Dealing with the egotist, who knows it all and feels and acts superior.

What to do: Make sure you know the facts. Agree when possible and ask questions and listen. Disagree only when you know you're right.

Source: Business Marketing Reference Manual, by Tom Lapham, 160 Farmington Ave., Briston, CT06010.

Planning...

by Joan Carr

Joan Carr is President of J. Carr, Ltd. health coverage & reimbursements specialist. SheholdsanMBAandhas~Oyearsinboththeclinicalandfinancialaspectsofhealth care. She is a national member of the Medical Group Management Association and a member of the Wisconsin Medical Credit Association. You can phone Joan at 414- 764- 7743 or fax 414- 764-6708.

How long does it take you to create a clean claim? (a clean claim is one without technical or informational errors on it)

You gather information: • From patient • From physician • From insurance company • From medical records (diagnoses, etc.)

You translate this information into "claim language" through the use of: • Occurrence, value, condition codes • Revenue codes • Procedure codes (CPT, ICD, HCPCS) • Modifier codes • Technical specs required by the insurer • Provider numbers

You then ensure all information is placed in appropriate places ON the claim form. (Remember this is the leading cause of technical errors AND you really want to avoid these - no direct appeal rights.) Putting a code in the wrong Form Locator on the UB could change the meaning of the code, and therefore change the meaning of your claim.

HOWLONGDIDTHATTAKEYOU?????????????

Once you have determined how long it takes you to create a clean claim, determine how many clean claims you can create in a workweek.

In a workweek, you generally have 40 hours (make adjustments as necessary, i.e. you only work 37.5 hours). During these work hours, carve out time allotted to other tasks

(meetings, copying, patient education, error correction,

claim submission if using EMC or doing paper claims, etc.)

Now that you know how much time you have and how much time it takes for each claim, you can determine how many clean claims you can create in the week.

If you need to increase the number of claims you create in a week. you only have 2 ways of doing it: decrease the time it takes you to do a claim or increase the work hours you have to do claims.

To decrease claim time look at your current work process and make it more efficient: • Group tasks (copying & mail out once a day) • Coordinate info with admitting (meet once a day to get

info) • Develop a check-list for yourself to gather all info before

you put the claim together (Reduces interruption - most

frequent cause of errors) • Have reference tools at hand (Hosp. Manual, UB-92 Editor, Medical Dictionary, etc.) • Establish a " Quiet Time " schedule to reduce interruptions • Anything else in your work process that needs " tweaking "

To increase the number of hours in your week for claim creation. look at the "Carve-out" time and the reasons for the carve outs: • Group task (if you cover for someone during their lunch,

plan tasks - like copying or alphabetizing your filing

which could be interrupted easily - also a great time to

review updates and info from insurers) • Schedule claim creation during YOUR peak time (i.e. 9-12

noon vs. 1-4 pm) your peak time is when you are at you

best (and make the least ## of errors) • Plan ahead for contingencies (unscheduled meetings,

etc.) and the end of the week (things usually slow down a

little). • If you feel overwhelmed, take a moment or two to regroup

rather than let frustration build.

Last but certainly not least, enlist the help of your management. Even though it is said that management is crazy or out of touch ( and being management I am here to assure you that sometime we can be exactly that - after all, we are only human) There is not a management person in healthcare that would refuse a request from a biller that went like this: "I need your help. My goal is to submit error free claims 100% of the time, but I need to get a handle on my work process in these areas (list specifics). I also request the right to set "quiet time" and have no interruptions - unless there is a fire in the building. My focus is to provide to this organization and the patient, the best service I can. I would also enjoy sharing my ideas with others in the department so we can all benefit. Support from you tells me that you are committed to my success as well as the success of all in the department, that you do care, and that you are aware of how difficult this job can be."

I do not know of any management that could say "no" to that. Focus on the work process and problem solving makes the situation win-win for everyone.

Clinton Proposes New Anti-Fraud Measures

2001 Budget Includes Funding For Fraud Fight

Proposed provisions in President Clinton's 2001 budget will continue the administration's war on Medicare fraud. According to a statement for Clinton on the not-yet-re leased budget, the budget includes a proposal to place federal agents in the offices of health insurance companies and other contractors that process Medicare bills. Clinton is also seeking funds to finance new technologies to track false claims filed by healthcare providers.

According to the Office of the Inspector General's (OIG) semiannual report, fraud and abuse investigations during fiscal year 1999 resulted in payments to the government totaling $407.7 million.

• OlG audits identified $252.5 million in overpayments during 1999.

• Between April 1999 and September, OIG recouped more than $160 million through civil monetary penalties and False Claims Act civil settlements related to Medicare and Medicaid.

• OIG collected $1.7 million in civil monetary penalties from hospitals and physicians involved in "patient dumping" violations.

• Reviews of reimbursements to physicians at teaching hospitals

resulted in the recovery of $75.1 million.

• $15 million was recovered from hospitals involved in pneumonia upcoding investigations.

• $71 million was reimbursed by hospitals that submitted claims for non-physician outpatient services which had already been included with inpatient payments.

• $53.5 in settlements were received from laboratories for improper or excessive claims.

Clinton is also urging Congress to give Medicare the power to broaden the pool of private sector companies eligible to provide program services and process claims.

In additional Medicare news, the Health Care Financing Administration (HCFA) announced in January an initiative to ensure that Medicare does not pay healthcare claims that are the responsibility of private insurance companies. The initiative is expected to help Medicare increase the $3 billion annual savings by ensuring that private insurance companies are paying their share of Medicare beneficiaries' health-care bills.

Sources: ww.washin~tonpost.com (1/24/2000) & AHA News, December 13, 1999. Reprinted with permission of State Collection Service, Inc. Madison, WI "Pulse"

20 Work Days/Month Average

7.5 Hours/Work day

150 Work Hours/Month

• Your average ## of IP Bills/Month 200

• Your average ## of OP Bills/Month 100

• 50% of job time dedicated to billing 75 hrs.

(no meetings or other duties)

• Time allotted to bill each patient 15 min.

If you don't have enough time to do it right, when will you have the time to do it over?