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 Members and Friends:

It is difficult for me to believe that my term as your President is 
coming to a close.  They say that the years go by faster as we get older, but 
I didn't realize that I had become THAT old!!

I sincerely appreciate the opportunity that you have given me to 
represent this wonderful organization during this past year.  It has been a 
delight to meet many new members and guests at our quarterly workshops,
and I have enjoyed working with many of our "old-timers" as well.  WMCA is 
fortunate to have so many dedicated professionals supporting its mission.

I am so proud of this fine organization.  WMCA was very valuable to me 
when I first came to this state 12 years ago in providing me with educational
and networking opportunities, so I have always felt a strong desire to 
do my part in bringing similar assistance to others through participation 
on the Board.  However, as I have often said, I know that I get back far 
more than I give.

I would like to thank the entire WMCA Board of Directors for their hard
work and loyalty to the organization.  I feel truly blessed to have had 
the chance to work with each of those individuals, and equally blessed to 
call them my friends.

I am grateful for the chance to have served as your President, and I 
look forward to many more years of participation with the Wisconsin Medical
Credit Association.

My best to all of you,
Deborah JB Gustafson
President



Documentation and Ambulatory Payment Classifications
By Gail Meidinger, RN, Consultant/Manager

Since the implementation of the Ambulatory Payment Classifications 
(APC) in August 2000, hospitals have struggled with the challenges of billing 
their outpatient services under the new system.  This article is a reminder 
of the impact of physician practices on reimbursement under APCs.

Before the implementation of APCs, hospitals were typically reimbursed 
for outpatient services on a cost to charge ratio.  Now, it is the accurate
reporting of CPT coding which dictates Medicare's outpatient 
reimbursement.

The Office of Inspector General's (OIG) Compliance Program for 
Hospitals states, "Accurate coding depends upon the quality and completeness of 
the physician's documentation."  The importance of documentation is not new 
to physicians/practitioners, in part because of Medicare's prepayment and
post-payment  auditing efforts, yet with APCs, accurate documentation
becomes even more critical.

Proper documentation for the excision of a lesion illustrates the significant
difference in reimbursement for hospital outpatient  services. CPT code
11444 (Excision, other benign lesion 3.1 cm to 4.0 cm) has an APC payment
of more than $300.  While the reimbursement for the lesion excision with a
diameter over 4.0 cm (CPT code 11446) is reimbursed at more that $600. 
This is only one example of the detail that is required by physicians in order
to ensure accurate reimbursement for their professional service and the
hospital's technical component of a surgical procedure.

Under APCs there are a number of surgical procedures that Medicare will
only pay when done as an inpatient.  If a procedure included in the  list is
performed in the outpatient setting, the physician will be reimbursed for
his service while the hospital receives no reimbursement for the  procedure.
We strongly encourage physicians/practitioners to review the "Inpatient
Only" list with the facilities where they have privileges.

Physicians/practitioners should be aware that hospitals are no longer
separately reimbursed by Medicare for observation stays.  It is not our
intent, and should not be the intent of a hospital to encourage
physicians/practitioners to admit all patients to an acute stay.  
However, we do encourage the review of their admitting practices
to determine if there are occasions when it is appropriate to admit a
patient for an inpatient stay. One example is a patient who presents with
chest pain. These patients are typically admitted to an observation bed, while 
their status may meet inpatient criteria.  We recommend that
physicians/practitioners familiarize themselves with the criteria for  an
inpatient stay  A hospital's Utilization Review Department or Case 
Manager should be able to provide direction.

We have provided only a few examples of the impact of physician/practitioner
documentation practices under APCs.  We  encourage physicians/practitioners
to maintain an open dialogue with hospital staff during this time of APC
implementation.  Participation in APC and documentation /coding
training is highly recommended.

Gail Meidinger, RN, is a certified professional coder and a health care
manager with our Fargo health care office.  Gail has more than 22 years
experience in hospital and clinic settings, plus seven years experience
with a Medicare carrier and third-party payer.  Gail can be reached via
e-mail at gmeidinger@eidebailly.com or at 701.239.8629.


A Self-Exam for Managers
To learn if your management approach is on target or if you need to 
adjust your aim, ask:

•Your boss:  Am I focusing my staff's efforts on issues you deem
important?  Do you see problems in my department that I don't see?  
Have you noticed anything about my management style that I should change?  
What can I do to better support your efforts?

•Your employees:  What else can I do to help you do your job?  Does my
management style impede you in doing your job?  If so, what can I do to
correct the problem?  In what ways can I better use your skills and
abilities?  Do you see any problems I need to take care of?

•Your customers or clients-internal and external:  Are we providing 
what you need when you need it?  How can we work together to make sure you  
get the quality products and service you need?  Does my staff cause you any
problems?  If so, what can we do to correct those situations?  Do we 
need to do anything to improve our service to you?

•Your colleagues:  How can we work together to solve problems we  share?
Have I supported your efforts enough?  If not, what more should I do?  
Do you see any ways for our staffs to cooperate so we both get better returns?

•Yourself:  How am I doing?

Source:  The High-Valued Manager:  Developing the Core Competencies 
Your Organization Demands, by Florence M. Stone and Randi T. Sachs, AMACOM, 
135 W. 50th St., New York, NY 10020.



The Scope of Healthcare Collections
*  According to ACA's 2000 Top Collection Market Survey, the average
recovery rate for hospital collections is 6.5 percent, and for clinics 
it's 7.6 percent.

•Between October 1999 and September 2000, U.S. hospitals' total
uncollectible income averaged 5.7 percent of  total revenue.  Charity 
care accounted for 1.6 percent while bad debt made up the other 4.1 percent,
according to Modern Healthcare.

•Thirty-two states have statutes limiting, restricting or otherwise
forbidding medical providers and hospitals from billing consumers who 
are enrollees or subscribers of an HMO.

•According to researchers at the Harvard School of Public Health in
Boston, approximately 20 percent of insured adults reported a time in 
the past year when they did not have enough money to pay for medical bills,
prescription drugs or other healthcare needs.  Researchers also found 
that approximately 20 percent of insured adults in the low to moderate 
income groups had been contacted by a collection agency about unpaid medical 
bills in the past year.

•Nearly 50 percent of Americans who filed for bankruptcy protection 
in 1999 cited medical bills and inability to cope with the financial
consequences of illness of injury as a factor in their financial 
troubles, according to the Washington Post.

Reprinted with permission of
American Collectors
Association, Inc. "Collector"



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. Cheatham writing in Association Source, Florida Society 
of Association Executives, 1211 Semoran Blvd., Casselberry, FL 32707.



Privacy Rule Still the Center of  Debate
The long and winding road of the first federal attempts to protect
individually identifiable health information has become even more 
twisted in the last several months.

On April 7, exactly one week before the privacy regulations mandated by 
the Health Insurance Portability and Accountability Act (HIPPA) were to go 
into effect, the New York Times reported that Bush administration officials
found that the standards, drafted by the Clinton administration, "were
fundamentally flawed and needed to be changed before they could take
effect."  The healthcare industry rejoiced that months of lobbying 
about the cost and burden of the regulations had proven effective.  Privacy 
and consumer advocates decried the harm that would be done to public 
privacy without the new rules.  Within a few days, the tables were to turn.

On April 12, only two days before the planned April 14 implementation 
date, Health and Human Services (HHS) Secretary Tommy Thompson released a
statement acknowledging that the rules  still needed work, but that
"President Bush wants strong patient privacy protections put in place 
now. Therefore, we will immediately begin the process of implementing the
patient privacy rule that will give patients greater access to their  own
medical records and more control over how their personal information is used."

And so, on April 14, with a swirl of controversy, the long awaited and 
long debated privacy rule took effect. But the discussion has not ended.  As
Thompson noted in the April 12 statement, the HHS still has the 
authority to "tinker" with the regulations, even after they have gone into 
effect: "We will keep these comments (submitted during the public commentary
period) in mind as we continue to make sure patients receive the 
highest quality care and begin the process of issuing guidelines on how this 
rule should be implemented.  The guidelines will allow us to clarify some of 
the confusion regarding the impact this rule might have on healthcare 
delivery and access.  And we will consider any necessary modifications that will
ensure the quality of care does not suffer inadvertently from this  rule."

And so, the debate continues.  On May 1 the American Hospital 
Association (AHA), which had fiercely opposed the rules as too complex and too
expensive to implement and monitor, released an advocacy-oriented 
report based on research it commissioned Price Waterhouse Coopers to perform.  
The report detailed the paperwork burdens on healthcare providers related 
to regulatory compliance (of which the privacy regulations are only a 
small part).  the report implied that each new regulation passed by the 
federal, state or local governments takes healthcare professionals'  time away 
from direct patient care.

Also on May 1, U.S. House Majority Leader Dick Armey (R-Texas) 
announced his intention to send a letter to HHS Secretary Thompson asking
him to reconsider aspects of the privacy regulations.  Armey contends that the
regulations are too complicated to meet the goal of protecting sensitive health data.
According to media reports, Armey wrote: "Americans deserve to know their
privacy is being protected and not threatened by their own\ government."

The HHS is currently working on clarifications and guidelines to help 
the healthcare industry understand some of the more confusing or complex
aspects of the regulation.  This guidance document is expected to be
completed by late spring or early summer.

Reprinted with permission of State Collection Service (Pulse 6/2001)

Turning Negative Feedback From
Business Office Into Positive Results
Author:  Tom Hajny

The game doesn't change.  The business office bunches up all the 
billing rejections caused (or thought to be caused) by registration staff.
Dutifully, you dole out the sheets to the "offender".  The "offender"
dutifully gets annoyed at the business office (or you) for pointing out 
all the errors and not recognizing all the things that went "right".

This is negative feedback at its best - or worst.  It sets up tension
between business office staff while whittling away at the self-esteem 
of the registration staff.

It's Time For A Change
No one wants to do a less than quality job.  It is basic human nature 
to be respected by your peer group, your supervisor, and "external" parties 
(i.e. business office staff, nursing personnel, physicians).  It is the
responsibility of Patient Access management to mentor staff to become
proficient and to ensure they are recognized for their excellence.

A recognition system needs to be established which identifies those top
performers who achieve accuracy rates in excess of the targets.  While
errors are reviewed with individual staff members it is achieved under 
the constructive umbrella of training.  Was the error committed due to a 
lack of understanding of insurance, or of the policy and procedure 
statement, or of a continuing problem with typographical errors?  If so, then some
re-training is necessary.  However, if the error was an obvious one (or 
a legitimate one) then it does nothing but de-motivate the employee.  Do 
we not all find it irritating to have the one error in 100 pointed out to 
us. What about the 99 accurate registrations?

It is time to reward the person who had 99 accurate registrations.

The System
The actual audit system to identify high achievers is simple.  Select a
"random" sample of registrations for each registrar for a particular 
time period.  Review the registration to identify any missing or inaccurate 
data that caused a billing error.

However, to achieve the quality standards and to identify "required" 
and "accurate" data elements, the business office needs to become an active
player.  It is no longer appropriate (or effective) to send the 300 
page manual from each payer to the patient access manager with the note 
"...deal with it."  Any registration  effectiveness program needs to be broken 
down by specific payer requirements and business office staff are the 
experts. Business office staff specialized in specific payers must create audit
checklists specific to those payers.  These checklists have a dual
purpose-as the standards for the audit tool but also as a reference aid 
to be used by staff at the point-of-registration.

The Audit
The audit will need to review the actual registration prior to any
corrections by business office staff.  This may involve capturing the 
"face sheet" or insuring the audits occur for registrations prior to their
scheduled bill date.

Do not lay the responsibility for the audit on the desk of the 
director, manager, or supervisors-peer review is the most effective approach.  
The best way to learn is to teach.  A person who has the responsibility for
judging another person's work will want to make sure of their own  knowledge.

Take 20 registrations for each staff member.  Make sure the reviewer 
has the proper reference material and knows supervisory staff is available 
to answer any questions.  When the reviewer is finished, a supervisor 
should review their assessment and discuss items in need of interpretation.  
An agreement as to the "score" needs to be reached.

The Targets
There are two targets-one for the department and the other for the
individual.  For the individual, to achieve the highest ranking, and 
you will want to establish a near perfect score-one significant error out 
of the 20 registrations.  The department target, however, should be based 
on a progression.  What is your registration accuracy today?  If it is 70
percent, then you will want to encourage an ever-improving percentage
rather than "demanding" 98 percent accuracy within two weeks.  Set your
department targets aggressive enough to ensure a rapid quality 
improvement but within reach to allow for a few celebrations along the way.

Rewards and Recognition
The reward is the recognition.  However, it might also be nice to 
reward individuals who meet the target with small, inexpensive gifts (i.e. 
theater tickets).  For those individuals who demonstrate proficiency over time, 
a certification of excellence is an idea you might consider.

As the department improves and meets its goals, this is a time to 
recognize the entire staff and re-invigorate the group through showing where they
were, where they are, and where they are going.   It is important to 
find a time where all (or most) of staff will come together and celebrate 
their success and to recognize that improvement is possible and the audit 
process is a recognition system and not an "I-gotcha" system.

Communication Is Critical

For the positive feedback system to be successful staff must understand
what it is and why it is beneficial to them.  The benefits must be laid out:

•Recognizes Individual Performance
•Constructive Educational Process
•Peer Review System
•Understandable and Achievable Goals
•Makes Business Office Accountable with
   Education Resources
•Able to Communicate Patient Access Excellence
   to Administration, Clinical Departments and
   Physician Community

Successes must be communicated.  The individual needs to be recognized
within the group as something special.  The group must be recognized 
and respected by the "outside" world - administration, clinical personnel 
and physicians.  Communicate successes through your hospital's newsletter 
or department newsletter (make sure those you want to inform get a copy on
their desk), department meetings, and even formal presentations.

Do It Now!
You will run into obstacles.  Staff will be resistant.  You can talk
yourself blue-in-the-face about how this is a benefit to them but until
they experience the positives they will be convinced the system will be
used against them.  Staff will tell you it will form a competitive
atmosphere in the department and that is bad.  Competition is part of 
human nature, it exists whether you set up a registration effectiveness
recognition system or not.  This system is fair and understandable.  
Staff also won't like the fact that they will be reviewing the work of their
peers, they will be much more comfortable having you doing the work.

Don't let the objections stop you.  Move forward, implement.  The
objections will slow down and then stop.  When it is up and running,
registration accuracy will go up morale will be at an all-time high, 
and the respect due patient access will finally be realized.


About the Author

TOM HAJNY
Vice President Consulting
Tom Hajny, senior consultant with Zimmerman & Associates, is a
field-hardened veteran of successful clinic and hospital cash 
acceleration and performance improvement projects.  As project manager, Tom has 
helped clients nationally develop receivable strategies from pre-registration 
to final collection.

In prior lives, Tom was; director of patient financial services for a 
300 bed hospital; manager of a system's central business office (CBO); 
interim director of an Independent Physicians' Organization (IPO); financial
analyst for a Milwaukee area hospital and; an award-winning
reporter-columnist for a small town newspaper.

During his twenty-year tenure in the healthcare industry Tom has
contributed numerous articles to national and state publications 
concerning
all areas impacting clinic and hospital receivables' management.


INSTITUTE
AGENDA
WEDNESDAY, AUGUST 8, 2001

3:00 p.m. - 5:00 p.m.           Registration
6:00 p.m. - 8:00 p.m.           Vendor Faire and Social Hour

THURSDAY, AUGUST 9, 2001

7:30 a.m. - 8:15 a.m.            Late Registration and Continental Breakfast

8:15 a.m.- 8:30 a.m.            Welcome Address by Deborah Gustafson, WMCA  President

8:30 a.m. - 9:15 a.m.            "KEYNOTE SPEAKER"
        Presented by State Representative Greg Underheim,
        Chair of the Assembly Health Committee

9:15 a.m. - 9:45 a.m.            "HEALTHCARE IN WISCONSIN-AN UPDATE"
        Presented by State Senator Carol Roessler

9:45 a.m. - 10:15 a.m.            "GOVERNMENT AFFAIRS-THE IMPORTANCE OF
ADVOCACY"
        Presented by Tom Reilly, Director of Government Affairs,
        Aurora Health Care

10:15 a.m. - 10:30 a.m.            Break

10:30 a.m. - 12:00 p.m.            "SUCCESSFUL COLLECTION PRACTICES IN HEALTH
CARE TODAY"
        Presented by Bryan Cook, Collection Service Manager, State
        Collection Service Inc.

12:00 p.m. - 1:00 p.m.            Lunch

1:00 p.m. - 2:15 p.m.            "HOSPITAL REIMBURSEMENT LEGAL ISSUES WORKSHOP"
        Presented by Tracy K. Knowles, Esquire, AHC Inc.

2:15 p.m. - 2:30 p.m.           Break

2:30 p.m. - 3:30 p.m.           "HOSPITAL REIMBURSEMENT LEGAL ISSUES WORKSHOP"
        Continued

5:30 p.m. - 6:30 p.m.           SOCIAL HOUR

6:30 p.m. - 8:30 p.m.           THIRTY-NINTH ANNUAL BANQUET
        Awards and Installation of Officers

9:00 p.m. - 10:00 p.m.          Entertainment Provided by COMEDY SPORTZ

FRIDAY, AUGUST 10, 2001

8:30 a.m. - 9:00 a.m.           Continental Breakfast

9:00 a.m. - 10:15 a.m.          "CHANGE MANAGEMENT FOR MANAGERS AND OUR
EMPLOYEES"
        Presented by William J Bazan, Vice President,
        Wisconsin Health and Hospital Assoc.

10:15 a.m. - 10:30 a.m.            Break

10:30 a.m. - 12:00 p.m.            "CHANGE MANAGEMENT FOR MANAGERS AND OUR
EMPLOYEES"
        Continued

12:00 p.m.            Box Lunch

1:30 p.m.            INVALUABLE NETWORKING
        WMCA Annual Golf Outing at Westhaven Golf Club, Oshkosh

 

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