THE VOICE
The VOICE is a technical magazine for health care accounts receivable
managers and is the official publication for the Wisconsin Medical Credit
Association. It is published bi-monthly since 1964.
Dear WMCA Members and Friends:
What is it about our February Joint Meeting with WAHAM that seems toattract weather disasters? In response to a very strong agenda, we had one of the largest registrations for a Quarterly Meeting in a long time. Unfortunately, many of you were "stuck" at home because of ice, snow, or your children's school closings! We had a great turn-out despite the storm, and we trust that everyone made it home safely. (Perhaps we should consider conducting the February workshop in Florida!)
We are counting on a warm, sunny day for our next Quarterly Workshop on May 11th in Wausau. Mark that date on your calendar, and watch for registration information in your mailboxes. You should also begin planning for your attendance at our Annual Institute on August 8, 9, and 10 at the Pioneer Inn in Oshkosh.
It's that time of year again when we begin to prepare for the election of new Board Members. We will have two Director positions to fill this year, and I would like to encourage everyone to seriously consider running. I won't promise that no time and energy is required to be a member of the Board, but I will promise that anyone who participates in this capacity will receive far more than they give. Please feel free to call me or any other Board Member if you have any questions, or if you would like to be a candidate.
Take Care!
Deborah Gustafson
President
Board of Directors Highlights
The Board of Directors meeting for the Wisconsin Medical Credit Association was held February 9, 2001 at the Paper Valley Hotel in Appleton, Wisconsin.Call to order
The meeting was called to order by Deborah Gustafson at 5:10 P.M.Approval of minutes
A motion was made by Lynn Johnson to approve the December 2000 minutes.
Jennifer Tarantino seconded, motion was carried.Business Managers Report
Financial Report
The financial reports for December 2000 and January 2001 was presented by Steve Baseley.Membership
No new members to reportOld Business
Regarding the Associate members and vendor sponsorship, Deborah Gustafson sent out a letter to all Associate members inviting them to sponsor a workshop. In exchange for a financial contribution WMCA will recognize their organization in written materials at the workshop. To the Associate members that inquired she sent out a second mailing explaining the three contribution levels and advertising for each.Jenifer Tarantino motioned to approve. Lynn Johnson seconded, motion carried.
Quarterly Workshops - Jennifer Tarantino reported for the March joint HFMA she has John Zorbini (New thoughts about Management), Joan Bulton (HIPPA), and John Bartel (APC's)
Annual Institute - Jennifer has confirmed AHC to do a program. She will ask them to focus on 3rd Party Insurance Follow-up. Other subjects of interest include: collection workshop/payment plans, Legislative speaker with regards to the State of Healthcare in Wisconsin, and possible VonBriesen Purtell.
Wednesday, Aug. 8, 2001 - WMCA Board meeting, Registration and Vendor Fair
Thursday, Aug. 9, 2001 - Full day of speakers
Friday, Aug 10, 2001 - 1/2 day of speakers and golfJulie Smith made a motion to adjourn at 6:30 P.M. Marlene Reimer seconded motion, motion carried.
Respectfully submitted by
Julie Smith, WMCA SecretaryCompliance Update: HIPAA -
The Final Ruling on Privacy Regulations
By JoNell Moore, RN, Consultant/Sr. ManagerOn December 20, 2000, the long awaited final privacy regulations under the Health Insurance portability and Accountability Act (HIPAA) of 1996 were released. While the proposed rules applied to health information that is or has been in electronic form, the final rules extend coverage to also include paper records and oral communications. The new standards apply to all consumers whether they are privately insured, uninsured or are covered under Medicare or Medicaid. As required by HIPAA, the final regulation covers health care providers, health plans and health care clearing houses. The final regulation does not regulate life insurers or worker's compensation programs, but Congress is expected to include them in future action. The privacy regulation will be enforced by the HHS Office for Civil Rights and will come into effect in two years.
Currently all health information is protected by various state laws. This final national regulation will require providers to establish policies and put into practice specific processes to remain in compliance. Stronger state laws (like those covering mental health, HIV infections and AIDS information) continue to apply.
Health care providers and plans will be held directly accountable for the inappropriate use or disclosure of health information. The privacy regulation establishes some very real penalties for noncompliance. Penalties will be higher for actions designed to generate monetary gain. For noncriminal violations of the privacy standards there are civil monetary penalties of $100 per violation up to $25,000 per year, per standard. Criminal penalties of $50,000 and one year in prison will be imposed for violations that are done knowingly for obtaining or disclosing protected health information. Penalties of $100,000 and five years in prison will be imposed for obtaining or disclosing protected health information under "false pretenses." Penalties of $250,000 and 10 years in prison will be imposed for obtaining protected health information with the intent to sell, transfer or use for commercial advantage, personal gain or malicious harm.
Some of the specific points include:
* Providers and insurance companies will be required to rewrite contracts with business partners - including attorneys, auditors, and consultants to ensure they adhere to the privacy rules. Providers will be responsible for the partners' violations only if they knew about them.
* Patients will have the right to inspect and copy their medical records, as well as request amendments and corrections to their records.
* Providers will have to get written permission from patients before information for routine matters, such as billing and treatment, can be shared with others. The final rule requires providers to obtain patient consent for routine disclosure of health records in addition to requiring special patient authorization for non-routine disclosures. The earlier rules had proposed allowing these routine disclosures without advance consent for purposes of treatment, payment and health care operations. However, many providers continue to believe consent for these purposes should be obtained in advance and this requirement was included in the final version of the rule.
* Health care providers and plans will be required to tell patients about how their information is being used and who it is being disclosed to. The policies will need to include defining who has access to protected information, how it will be used within the entity and when the information would or would not be disclosed to others.
* Health care providers and plans will be required to restrict the amount of information used or disclosed to the "minimum necessary" to achieve the purpose of the use or disclosure. The minimum necessary requirement would mean reviewing, forwarding or printing out only those fields and records relevant to the user's need for information. This provision does not apply to the transfer of medical records for purposes of treatment, since physicians, specialists and other providers need access to the full record to provide quality care. The final rule gives providers full discretion in determining what personal health information to include when sending patients' medical records to other providers for treatment purposes.
* An individual's health information can only be used for health purposes under the final rule. Companies that sponsor health plans will not be able to access the personal health information held by the plan for employment-related purposes without authorization from the patient. Health information cannot be used for hiring, firing or determining promotions without patient consent. Specific patient consent must be sought and granted for release of information to financial institutions determining mortgages and other loans or selling mailing lists to interested parties such as life insurers. Patient information can be used or disclosed by a health plan, provider or clearinghouse only for purposes of health care treatment, payment and operations.
* Providers will need to ensure there are policies established that provide for informed and voluntary consent. Providers are not allowed to "condition treatment on a patient's agreement to disclose health information." Authorizations are to be written in plain language and, if patients are unable to understand what the authorization is stating, it is important that the individual knows what his rights are prior to signing the authorization. An individual may revoke an authorization at any time. Once the provider has received the revocation of the authorization, the entity must immediately cease disclosing the information.
* Patients have the right to complain to a covered provider or health plan, or to the Secretary, about violations of the provisions of this rule or the policies and procedures of the covered entity.
* Providers that have multiple business partners (i.e., contractors, lawyers, auditors, consultants, third-party administrators, employer groups, health care clearinghouses, data processing firms, billing firms) must ensure that when they perform an activity or function on behalf of the organization they adhere to the organizations' established policies and procedures regarding the review and release of health care-related data. If a business partner receives protected health information it is only to perform the functions as outlined in the contract between the organization and the contractor.
The final rule permits disclosure of health care information for:
* Oversight of the health care system, including quality assurance activities
* Public health
* Research
* Judicial and administrative proceedings
* Limited law enforcement activities
* Emergency circumstances
* Identification of the body of a deceased person, or the cause of death
* Facility patient directories
* Activities related to national defense and security
Health care providers need to begin addressing the privacy elements in the near future to ensure compliance within the two-year time frame.
Activities to focus on include:
* Beginning training of staff and physicians on the elements of the privacy regulations.
* Ensuring staff understands the importance of this regulation along with the consequences of noncompliance.
* Beginning to inform the public on how they can access their medical record information.
* Beginning to inform the public about what your organization is doing to safeguard their medical record information.
* Establishing procedures that staff can follow regarding the release of medical information.
* Providing examples to your staff on what an allowable disclosure of information should include.
* Determining if your records system is able to selectively provide the minimum amount of information needed.
* Including in your compliance plan a regularly scheduled audit of your entity's adherence to the privacy regulation.
* Establishing a system where individuals can report suspected breaches of confidentiality to administration.
* Analyzing which relationships are business partner relationships, which are not but require safeguards and which are covered by provider policies. Beginning the process to obtain a "chain-of-trust" agreement with each partner and ensuring all vendors have privacy and confidentiality policies in place and requesting to see them.
* Designating a "privacy officer" among the staff to monitor or ensure appropriate safeguards are in place to protect health information.
With the finalization of the privacy regulations, health care providers and plans need to establish privacy-conscious business practices. Compliance to these regulations will require a team approach involving the services of many different disciplines.
JoNell Moore is a health care consultant/senior manager in our Fargoffice. She has 24 years experience in the health care industry. JoNell specializes in training providers regarding Medicare and other third-party payers and providing assistance with reimbursement and documentation needs, billing procedures and corporate compliance programs. JoNell can be reached at 701. 239. 8690 or through e-mail at jmoore@eidebailly.com.
Reprinted with permission of Eide Bailly, 406 Main Avenue, Suite 3000, P.O. Box 2545, Fargo, ND 58108.
701-239-8500 "The Medical Monitor"Sharing Appraisal Burdens
Shifting some of the performance appraisal burden to employees could help you deliver more timely and insightful employee evaluations. How to do it:* Notify employees two weeks before their review date that you expect them to prepare for the meeting by completing a self-evaluation. Note: In some cases, you might want to give employees more than two weeks to do this.
* Require that employees describe their job; list their duties and responsibilities; evaluate their impact on their work unit; note where they need improvement; list specific, measurable achievements and propose concrete goals for next year.
The payoffs:
* You can spend more time as a mentor and coach because you need less time to collect and assemble information you need for reviews.
* Giving employees more say in the performance review provides you with vital employee feedback and encourages acceptance of review results.
Source: Management Review, 135 W. 50th St., New York, NY 10020.
Trainers List Top 10 Qualities of Great Leaders
What makes a great leader? Trainers - many of whom are responsible for training future leaders - listed their top 10 characteristics for a leader to either have or develop. They are, in declining order:* Vision
* Communication skills
* Empowering skills
* Strategic planning skills
* Being a good listener
* Integrity
* Problem solving skills
* High standards
* Team development
* CompetenceAccording to the recent survey by the American Society for Training and Development, six out of 10 companies believe that leadership development is a "high" to "very high" priority.
The survey, administered to a self-selected panel of Fortune 500 companies and private companies, showed that the type of leadership development most frequently offered is managing change, followed by quality.Reprinted with permission of American Collectors Association, "Collector"
Avoid This Word When Dealing With Employees
If you eliminate the word "but" from your memos, e-mail, phone conversations, and dealings with employees, you'll strengthen your ability to persuade others. Why? Any time you use the word "but," what you're really saying is that you disagree with that person. For Example, if you say, "I agree with you, but let me say this ..." employees will wonder if you really agree with them or not. The solution? Always replace "but" with "and." In the above example, you would say: "I agree with you , and let me say this..." Replacing "but" with "and" eliminates all contradiction from your message, and makes what you say more powerful.
Creditor + Collection Agencies = Collection Success
By John Beglinger, State Collection Of Service, Inc.
Madison, WI, 608-661-3000Agency management is not simply a matter of handing over accounts and saying "collect it!" It starts with a better understanding of the agency's business philosophy, today's changing environment, and client fit. By taking an active role in agency management, the creditor can make a difference in agency performance and collection results.
Partnerships are essential to success today and in the future. A partnership that is of particular importance to those involved in the collection industry is the partnership between a creditor and a professional collection service. Selecting a third-party collection service to assist in the collection of delinquent accounts is an important business decision. Third-party collection agencies provide services that go far beyond the traditional collection services. Agencies must provide complimentary services in response to creditors needs such as early intervention programs, skip-tracing, insurance billing, payment monitoring, training, customer service, return-mail, and other business office functions.
Gone are the days when your agency acted as your vendor. Vendors do what they're told by the creditor and that's all. Business partners provide ideas and help with business problems on a continual basis. So, what are the keys to being a business partner? For one, technology, and especially the Internet. A second important factor is customer service. Today, service seems to be missing. Technology and customer service strategies must not serve self-needs, but rather those of the creditor.
The reputation and activities of your collection agency are important not only in how they handle the accounts you place with them, but also in how they reflect the image of your organization.
Selecting a professional collection service is only the beginning of this important partnership. Communication is a key element of its success. It is essential that both parties keep each other informed of the status of the accounts to guarantee that in the end, the creditors are receiving the best possible results. The ultimate goal is to have both partners working towards a common goal.
Hot jobs
Hot jobs
Fast-growing, high-paying jobs that have the largest projected growth to 2008:* Computer systems analysts, support specialist and programmers
* Registered Nurses
* Teachers
* Social Workers
* College, university faculty
* Engineering, science and computer system managers
* Police patrol officers
* Financial service agents
* Physicians
* Advertising, marketing and public relations managers
* Electrical engineers
* Legal assistants
* Writers and editors
* Artists, commercial artists
* Medical and health-service managersSource: Bureau of Labor Statistics
Allow Time To Practice
No athletic team would think of jumping into a competitive event without practicing first, yet we expect business teams to know what they're doing without having had the chance to practice. Team members need to learn how to work together.Repetition Makes Perfect
The repetition of reacting to similar situations allows teams to discover What works and what doesn't. They must gain confidence in their abilities as individuals and as a team-confidence takes time to build. Practice can take many forms: brainstorming solutions to a fictional problem; mapping a simple process; or applying training to a "safe" issue. Team leaders and facilitators should schedule practice sessions at the points where team members will be asked to use new skills. The practice sessions need not take much time, but they should not end until the team is satisfied it has mastered the required skills and is confident it can apply them to the real process/issue.Uncommon Sense, Stephen George John Wiley & Sons, 605 Third Ave., NY 10158
Here Today - Gone Tomorrow
Keep track of your debtors' whereabouts increases collection rates
By Wendy Kasten, Collection Operations Manager,
Credit Bureau Data, Inc.
Secretary/Treasurer, Wisconsin Collectors AssociationUpdating customer/patient information at the time of service is one of the most important steps you can take when extending credit. It's a low-investment, high-return process that can dramatically improve your account collections success.
When accounts become past-due or billing statements are returned to you as undeliverable, your debtors may easily fall into what we call the "skip" category -meaning they can no longer be reached by phone or mail at their last known address or place of employment. Whether the skip is intentional or not, it's difficult to collect from debtors with whom you can't communicate.
You can reduce this problem by ensuring you routinely update customers
* Current home address and telephone number,
* place of employment and telephone number,
* name of spouse and his/her employer,
* Social Security number and date of birth, and
* nearest relative's names and telephone numbers.The few seconds it takes to update your customers' records can save you considerable time and money in the future.
Reining In Rambling Speakers
To end conversations when you don't have time to listen to idle chatter:* Avoid asking open-ended questions. Instead, set limits to the chatterbox's responses by asking questions that call for specific information or a simple "yes" or "no." Bad question: "What's going on with that report you're working on?" Good question: "How do the third-quarter results compare with those of last year?"
* Ask "concluding" questions. Examples: "In a nutshell, what's the significance of that?" "To wrap up, what's the next step?"
* Repeat your questions. Some babblers won't answer your questions directly. They'll hedge or drift off the topic. Just calmly repeat your question until the message gets through that you expect an answer.
Important: Don't rephrase or pose another question. Use the same wording each time you ask the question.* Use visual aids. Ask chatterers to draw a diagram or refer to a chart or graph to make a point. Draw a line on a piece of paper and ask, "Where are you on this line?" Payoff: People talk less when they're trying to express their ideas on paper.
Source: Investor's Business Daily
Payer Class Specific GDRO Analysis Can Provide an A/R
Reduction Road MapOur most recent report on best practices within the hospital revenue cycle indicated that the best performing facilities averaged 50 GDRO and 2.4 percent bad debt. For many accounts receivable managers, performance in this range seems like "mission impossible." Predictably, we hear that "it just can't be done here," "we're unique," "our payers are tougher."While it's true that overall GDRO performance is highly dependent on payer mix, our consulting team generally finds that superior performance is achievable - but improvement programs often lack the focus and prioritization required to actually make it happen.
Most "best practice" revenue cycle managers will agree that using a composite GDRO indicator does not provide sufficient focus in terms of indentifying collection opportunities. They employ a payer class specific calculation that rolls up into a composite GDRO target. This method provides not only a realistic stretch target -but also provides a road map as to how it will be achieved.
Payer class specific GDRO analysis, combined with strategic payer class specific GDRO targets is also a critical first step in establishing performance accountability. (This presumes an organization structure that is consistent with a payer A/R breakdown).
Relatively speaking, the performance variation identified below for Medicare (Target 30 GDRO; Actual 55 GDRO - A/R reduction target of $2,007,500) is more significant than the performance variation identified for Blue Cross (Target 35 GDRO; Actual 45 GDRO - A/R reduction potential of $582,500).
It is a rare situation in which an accounts receivable manager, consistently operating at 68 GDRO, would readily acknowledge the potential to reduce the receivable to 46 GDRO. Having said that, most managers, when confronted with the reality of their payer class specific GDRO immediately, see dramatic improvement potential. The calculations are relatively simple and can generally be updated monthly with the cooperation of the accounting department.
Using the Improvement Grid
Although the table presents information available in most hospital revenue cycle operations, obtaining revenue broken down by major payer class can represent a significant challenge if the information is not collected in a format that is compatible with the major payer classes defined within the accounts receivable.(In the absence of totally compatible data, a revenue percentage component estimate can be applied to total revenue to provide a preliminary analysis).
* Medicare average daily revenue of $79,750 (cell B1) is calculated by multiplying total daily revenue (cell A8) by the revenue component percentage (cell A1).
* When the open Medicare A/R (cell C1) is divided by Medicare average daily revenue (cell B1), it provides a current payer class specific GDRO of 55 days (cell D1).
* This does not compare well with a payer class specific target of 30 days (cell E1) - particularly considering the electronic nature of Medicare receivables.
* The Medicare A/R reduction target of $2 million represents about a third of the total A/R reduction target and is critical to the facility's goal.
* As a result, the potential gain would seem to justify the allocation of significant resources.
* In this example, commercial insurance represents only nominal A/R reduction potential (cell G4 - $275,000) and would not likely justify significant resource allocation. (Interestingly, many cash acceleration projects are instinctively designed to focus on commercial insurance follow-up).
* Similar analysis is done for each payer class - indentifying both a target GDRO and an A/R reduction target.
* Composite GDRO target (cell E8) is calculated by dividing total target A/R (cell F8) by total average daily revenue (cell B8).
Zimmerman Communications is a multi-media company that provides a variety of publications and services to healthcare providers. The company produces newsletters, books, audio programs, video training programs, packaged in house training programs, white papers, and special reports.
Zimmerman Communications, affiliated with Zimmerman & Associates, also provides specialized training in a variety of topics for healthcare employees. For a copy of our catalog of publications, programs and services write to P.O. Box 405, Hales Corners, WI 53130, call 888-577-7445 or fax 414-425-2035.
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