The VOICE
October 1999

It is an honor to be your new WMCA president, and I look forward to an exciting year working with and for all of you. AsWMCAbeginsits38th year, we are approaching the end of a decade and the beginning a new millennium. As we face the challenges of a new century, we need to work together and develop a greater tolerance for the constant changes in health care. There is little chance a lull will come along any time soon even if the Y2K meetings end.

Thank you to Steve Marg for an excellent job providing leadership to our organization and for his hard work as president this last year. A special thanks to outgoing board members, Jenny

Glaja and Sue York. Jenny served as past president and Sue as secretary. I look forward to working with this year's board of directors and staff We are fortunate to havethesetalentedindividualswillingtogiveoftheirtimeandleadourorganization. Finally, I want to acknowledge and thank our associate members for their invaluable support.

As vice president of WMCA, Deb Gustafson is chairing both the Annual Committee and the Quarterly Workshops Committee. The committee is busy planning and developing the educational programs for this year. Medicare is scheduled to be on the agenda at our December meeting in Madison. The next quarterly meeting is October 8 at the Country Inn in Waukesha with an excellent agenda that includes APCs and HIRSP.

In closing, let's work together on the challenges and never forget the difference we all can make every day. Together we can make 1999/2000 a great year!

Jackie Lippe

President, WMCA

Overdue Medical Bills Present Unique Set of Problems, Concerns Says Hospital Executive

By: Janet Ortegon, Lakeshore Inc staff

Scott Buckley has heard them all. Director of patient business services at St. Nicholas Hospital in Sheboygan, Buckley man ages the department that puts together patients' bills and statements. And over the years, he's fielded every he's fielded every question and heard every excuse for why people can't pay their medical bills.

Instead of demanding payment or immediately turning the account over to a collection agency, Buckley and his staff listen to the stories.

"We quite often, before sending accounts to collection agency, (try) to find out why the bills are not paid," Buckley said. "When we find out there is a valid reason, we try to work with people. We try to view debtors in a compassion ate way. We many times offer them charity without them even knowing they're being considered because we know it's a hardship case."

"That's been the philosophy of the sister's all along, "he said.

The sisters are the Hospital Sisters Health System, the net work of 13 Catholic hospitals in Wisconsin and Illinois of which St. Nicholas is a part.

Buckley said that there is no hard and fast rule dictating how a delinquent bill is to be handled and every case is judged on its own merits.

In general, however, the hospital sends the bill to the patient's insurance company first, if there is one, and the patient gets no statements until the insurance has settled up its part of the bill.

After that, the patient usually gets a letter from the hospital explaining what the remainder of the bill is, and then the patient gets monthly statements.

If no payment is forthcoming, the patient continues to get statements, with added notes warning the patient that the bill is past due or that they run the risk of being turned over for collection.

"We generally give people 60 days or more before we even get into talking about agency referral, " Buckley said. "Most times (we wait) more than 60 days. If the person is in touch with us (or) lets us know they're in difficulty," the hospital will work out a payment plan with the patient.

"We've got people who have been paying on bills for more than 10 years," Buckley said. "They were big (bills) when they started."

Collecting overdue medical bills is a different issue than collecting on debts for retail goods or other services, Buckley said.

"Our product is intangible and nobody wants it," he said. "When people leave they can't hold it in their hand. They don't feel that much better, especially when they get the bill and say 'Oh my gosh, look what the is costs.' We can't threaten to repossess."

Buckley said at least part of the problem is that many patients don't understand their insurance coverage.

"Because of that they do look for the insurance company to pay more than they're obligated to," he said. "With PPOs, HMOs, special contracts, it's very difficult for people to understand why they can't go where they traditionally have gone.

 

 

state of Wisconsin

Share your experiences!
A wedding?
A significant Anniversary
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) 964-6000 or fax Bud at (414) 964-6040

Congratulations!
Once again, congratulations go out to Linda Krish as the newly appointed Director of Patient Ac counts at Froedtert Memorial Luthern Hospital. Linda had originally accepted the position of Manager of Patient Ac counts at Froedtert. She has since been promoted to the Director position. Best wishes again are due Linda.

Congratulations too to newly elected WMCA President Jackie Lippe, the board, and the Annual Institute Committee for the quality program presented at the Landmark. And in keeping with the topic of Friday's speaker - stress - I thought this next piece may be appropriate:

I read of a man who stood to speak
At the funeral of a friend.
He referred to the dates on her tombstone
From the beginning to the end.
He noted that first came her date of birth
And spoke the following date with tears,
But he said what mattered most of all
Was the dash between those years (1900-1970).

For that dash represents all the time
That she spent alive on earth
And now only those who loved her
Know what that little line is worth.
For it matters not how much we own
The cars ... the house ... the cash
What matters is how we live and love
Add how we spend our dash.

So think about this long and hard...
Are there things you'd like to change?
For you never know how much time is left,
That can still be rearranged.
If we could just slow down enough
To consider what's true and real,
And always try to understand
The way other people feel.

And be less quick to anger,
And show appreciation more
And love the people in our lives
Like we've never loved before.
If we treat each other with respect,
And more often wear a smile,
Remembering that this special dash might only last a little while.

So when your eulogy's being read
With your life's actions to rehash...
Would you be proud of the things they say
About how you spent your dash?

(Author unknown)

Entertainment
Life's Lessons found on the Internet...

Age 6 - I've learned that I like my teacher because she cries when we sing "Silent Night."
Age 7 - I've learned that you can't hide a piece of broccoli in a glass of milk.
Age 9 - I've learned that when I wave to people in the country they stop what they are doing and wave back.
Age 13 - I've learned that just when I get my room the way I like it, Mom makes me clean it up.
Age 14 - I've learned that if you want to cheer yourself up, you should try cheering someone else up.
Age 15 - I've learned that although it's hard to admit it, I'm secretly glad my parents are strict with me.
Age 24 - I've learned that silent company is often more healing than words of advice.
Age 26 - I've learned that brushing my child's hair is one of life's great pleasures.
Age 29 - I've learned that wherever I go, the world's worst drivers have followed me there.
Age 39 - I've learned that if someone says something unkind about me, I must live so that no one will believe it.
Age 41 - I've learned that there are people who love you dearly but just don't know how to show it.
Age 44 - I've learned that you can make someone's day by simply sending them a little card.
Age 46 - I've learned that the greater a person's sense of guilt, the greater his need to cast blame on others.
Age 47 - I've learned that children and grandparents are natural allies.
Age 49 - I've learned that singing "Amazing Grace" can lift my spirits for hours.
Age 50 - I've learned that motel mattresses are better on the side away from the phone.
Age 51 - I've learned that you can tell a lot about a man by the way he handles these three things: a rainy day, lost luggage, and tangled Christmas tree lights.
Age 52 - I've learned that keeping a vegetable garden is worth a medicine cabinet full of pills.
Age 53 - I've learned that regardless of your relationship with your parents, you miss them terribly after they die.
Age 58 - I've learned that making a living is not the same thing as making a life.
Age 61 - I've learned that if you want to do something positive for your children, try to improve your marriage.
Age 63 - I've learned that life sometimes gives you a second chance.
Age 64 - I've learned that you shouldn't go through life with a catcher's mitt on both hands. You need to be able to throw something back.
Age 65 - I've learned that if you pursue happiness, it will elude you. But if you focus on your family, the needs of others, work, meeting new people, and doing the very best you can, happiness will find you.
Age 66 - I've learned that whenever I decide something with kindness, I usually make the right decision.
Age 72 - I've learned that everyone can use a prayer.
Age 73 - I've learned that it pays to believe in miracles ... and to tell the truth, I've seen several.
Age 82 - I've learned that even when I have pains, I don't have to be one.
Age 85-I'velearnedthateverydayyoushouldreachoutandtouchsomeone. People love that human touch - holding hands, a warm hug, or just a friendly pat on the back.
Age 92 - I've learned that I still have a lot to learn.

 

For Wisconsin Residents Only
You know you're from Wisconsin when: Every sweatshirt you own is either red and white, or green and gold. Cheese is an important staple in your diet. You know how to pronounce "brat. ' You know how to polka. You went to a wedding reception in a bowling alley. You own at least one cheese head. Sunday afternoons are sacred for Packer games. You thought everyone drank from "bubblers." You went to a local tavern on Friday night for a Fish Fry. You have experienced snowstorms in April. You have had school closed due to wind chills and frostbite warnings. You get choked up when you hear the University Marching Bank play "On Wisconsin." You have partied at Summerfest, Fiesta Italiana, Germanfest, Irishfest or all of the above. You have gone out of your way to eat ice cream at Gilles or Kopps.

Get Well Soon
Best wishes for a speedy recovery to Rae Ann Danner, Watertown Memorial Hospital who is recovering from recent major surgery, and to Chuck Worgull, Account Recovery Service, who has also undergone recent surgery.

Warning - Y2K Will Delay Payments
By: David Zimmerman, Chief Executive Officer Zimmerman & Associates

In spite of all of the rhetoric of how well organizations are prepared for Y2K compliance, providers will spend the early part of the year 2000 with serious cash flow problems. Payments will be delayed big time.

Think about it. Consider the millions of potential snags and possibilities that could cause payment delays. Regardless of all of the compliance testing by providers themselves, there lies the strong possibility of not getting millions of charges and bills anywhere near 100 percent correct for payment.

About half of the health care provider organizations responding to a federal government survey say their information systems already are year 2000 compliant. But fewer than half of the 5,000 hospitals, nursing homes, home health agencies, durable medical equipment vendors and physicians' offices who were sent surveys took the time to fill one out. More than 90 percent of responding hospitals and at least 70 percent of other responding providers say their systems will be year 2000 compliant by December 31. Still, provider organizations have a long way to go toward full compliance, say officials of the Department of Health and Human Services' Office of Inspector General, which conducted the survey from December 1998 through February 1999.

However, even if providers do a great job of converting their bills to the year 2000, what do you think are the odds the thousands of payers will pay without a hitch come the days (and maybe months) after the stroke of midnight on December 31?

You want to lay money on Medicare being able to cross over Y2K without somewhat of a glitch?

The U.S. Department of Health and Human Services is one of many federal agencies that failed to meet a March 31 deadline for having mission-critical systems year 2000 compliant. Of the critical claims processing and reimbursement systems that Medicare fiscal intermediaries and carriers operate, 70 percent are year 2000 compliant.

How about Medicaid with its variety of already fouled-up payment systems and zillions of possibilities for screw ups? Think they will slide through Y2K without a scratch? Anyone who has dealt with Medicaid through the years knows better.

The nation's 51 Medicaid programs are seriously behind in year 2000 compliance efforts, and many aren't giving federal officials status updates, according to a report from the U.S. Office of Management and Budget.

And how about HMO's and the rest of the managed care world? They can't pay claims within a decent time frame now. Come Y2K and you will think a 60-day turnaround in payment from your

HMO is outstanding. Delays will become long and common for HMO's in 2000. You can also throw the thousands of other payers into that same bucket - more or less.

And since many providers don't bill the patient until insurance pays, delays in patient-pay will become exaggerated. Higher bad debt will surely follow. Profits will take a beating. CFO's will get heat.

Add to the Y2K payments delays the shrinking Medicare margins, and you have the potential for serious cash flow problems in 2000.

Assuming I just might be right about serious Y2K payment delays, what should you do? The obvious is to build up as much cash reserve between now and then as possible. That means either your revenue goes up considerably and/or your expenses go down - both or some kind of combination for most providers is highly remote. You could also forget the reserve building approach and either borrow the cash needed to build reserves or obtain an extended line of credit from your bank or some other national bank.

However, healthcare providers who are de pending on a larger-than-usual line or credit incaseY2Kcausespaymentproblemsmaybe disappointed.

The USA Today recently reported banks are starting to tighten credit standards on loans to organizations that seem to be lagging in the fight to fix the Year 2000 computer bug, banking regulators say.

The aim: to limit losses in case the bug disrupts business and makes it harder for organizations to repay their loans. Some banks are asking organizations to put up more collateral to back their loans. Others are refusing to add to credit lines until they're satisfied the organizations are ready to tackle the Y2K bug.

Regulators want banks to take a tougher stance on business loans to organizations that have lagged in efforts to fix the computer glitch because they don 't want the banks to lose too much money.

But, assume you can borrow and have to. It's not cheap money. You can count on paying a higher rate of interest than quoted today. And if your receivables are in bad shape, you are going to pay a higher rate. You could be looking at a rate well over 10 percent for the money you may need to get over the Y2K hump.

Then again, you could also look to your own receivables as a source to build up reserves. If you could somehow turn your receivables around considerably faster than you are now, you could have more available cash.

To do that, you may consider outsourcing some or all of your accounts to an outside firm to accelerate cash from accounts receivable. However, that would be somewhat costly. too The going rate now is somewhere between 8 to 12 percent. but that's a rate on what the outsourcing firm collects, not on total accounts receivable dollars. That adds to your cost. Then outsourcing receivables of any magnitude requires rather complicated system issues. Considering any additional computer complications this year may be suicidal. So maybe outsourcing is out of the question. Probably is.

Finally, you could do something yourself, within your own organization to improve the turnaround of receivables - something with your own staff - that would accelerate cash to enable you to build more reserves to get past the inevitable cash delays from Y2K.

Whatever you do to prepare for cash flow problems in Y2K, count on serious payment delays. It's bound to happen in spite of all the Pollyanna rhetoric.

AUTHOR, David Zimmerman is chairman and CEO of his own health care receivables consulting group, Zimmerman & Associates, for the past thirteen years in Milwaukee, Wisconsin. He is also the author of ten diverse books including his most recent effort, Unleash the Potential, Unlocking the Mystery of Motivation.

A popular lecturer known nationwide, Mr. Zimmerman is quoted regularly in a wide variety of newsletters and national trade magazines and has been interviewed numerous times on television and radio.

National Patient Account Management (PAM) Day • October 18, 1999
Hospital and medical business offices will celebrate this special occasion with awareness and recognition activities for patient accounts staff. Patient accounts personnel play a vital role in the delivery of high-quality health care and deserve special recognition and appreciation for their efforts. PAM Day offers an opportunity to increase awareness of the importance of patient account management and to recognize staff for their accomplishments.

 

Board Of Director Meeting Highlights
The Board of Directors meeting for the Wisconsin Medical Credit Association was held Wednesday August 17, 1999 at the Landmark Resort in Egg Harbor, Wisconsin. The meeting was called to order at 1:15 p.m. by Steve Marg. A motion was made by Lynn Johnson to approve the May 1999 minutes. The motion was seconded by Martha Henes, motion carried.

FINANCIAL REPORT
Steve Basely presented the financial reports for May 1999, June 1999, and July 1999.

MEMBERSHIP
Membership has decreased by 13 primarily due to mergers and acquisitions. WMCA received an application from EBIX. EBIX is a billing service that operates out of Greendale,Wisconsin. A motion was made by Cindy Lichter to approve the new member, Martha Henes seconded the motion. Motion was carried.

BOARD COMMITTEE ASSIGNMENTS
Board committee assignments were established and disbursed by Jackie Lippe. Assignments were made for the following committees:

1. Annual Institute
2. Quarterly Meetings/Workshops
3. Nominating
4. Ad Hoc/Scheduling
5. Accounts Receivable/Audit/Surveys
6. Membership/Registration
7. By-Laws
8. Voice Advertising/Job Placement

Meeting sites and dates have been finalized for 1999-2000. A WMCA calendar indicating dates and location of the meetings were disbursed. A correction to the calendar was identified. Dates of the meetings are listed below:
1. October 8, 1999
2. December 10,1999
3. February 11, 2000
4. March 10, 2000
5. May 12, 2000
6. August 9,10,&11, 2000

COMMITTEE REPORT
Deborah Gustafson reported that a representative from HIRSP is ontheagendafortheOctober8, 1999WMCAmeetinginWaukesha. Deborah is considering various alternatives for a speaker on Ambulatory Payment Classifications (APC's). It is anticipated that a speaker from United Government Services will be scheduled for the December 10, 1999 meeting.

ELECTION OF OFFICERS
Jackie Lippe officially took over the WMCA President responsibilities from Steve Marg. A motion was made by Jackie Lippe to elect Jim Kluge as Secretary. The motion was seconded by Cindy Lichter, motion carried. A motion was made by Martha Henes to elect Jennifer Tarrentino as Vice President - Elect. The motion was seconded by Jackie Lippe, motion carried.

OTHER BUSINESS
WMCA Directors assembled packets for the Annual Institute following the meeting. A motion was made by Steve Marg to adjourn the meeting. The motion was seconded, and carried.

Respectfully Submitted by:
R. James Kluge, WMCA Secretary

 

Jackie Lippe is WMCA's 38^th President
Jackie Lippe from St. Joseph's Community Hospital in West Bend, began her term as President at the WMCA's Annual Institute.

Past Presidents

1962-63.....................Al Sutherland
1963-64......................Ernie Jackel
1964-65..........................Joe Koll
1965-66........................Bob Nedden
1966-67.........................Bob Meyer
1967-68......................Augie Braatz
1968-69.........................Paul Luke
1969-70........................Fred Kuolt
1970-71.......................Ken Cvikota
1971-72........................Jim Kenney
1972-73........................Paul Peach
1973-74.........................Jim Davis
1974-75.......................Bob Mertins
1975-76..................Roger Olejniczak
1976-77........................Al Keating
1977-78.........................Jim Davis
1978-79........................Jim Warner
1979-80.....................Ted Slowinski
1980-81...................Dennis Schommer
1981 -82.......................Don Nipper
1982-83......................Ernie Jackel
1983-84......................Joan Kennedy
1984-85....................John Dellemann
1985-86......................Fred Wendorf
1986-87......................Chuck Worgull
1987-88........................Sue Becker
1988-89.....................Steve Baseley
1989-90..........................Ed Novak
1990-91.......................Pat Brandel
1991-92....................Bud Zeisberger
1992-93......................Bobbette Alo
1993-94.....................Cindy Lichter
1994-95.......................Mark Herder
1995-96......................Lynn Johnson
1996-97.......................Jenny Glaja
1997-98......................Martha Henes
1998-99........................Steve Marg

Ending a Doctor - Patient Relationship Due to a Past-Due Account
By: Glen McCluskey, ACA's Legal Counsel

ACA's Healthcare Services Program often receives questions about ending a doctor-patient relationship for lack of payment. Following are answers to some commonly asked questions about this practice.

1) Can a physician refuse further health services to a patient when that patient has filed bankruptcy or has an outstanding debt which has been sent to a collection agency?

In a life-threatening situation or where a patient requires emergency treatment, a physician has a clear responsibility to treat the patient without regard to their financial status or any disputes over their bill. Financial matters must be handled "outside of the operating room" at the proper time and place for such discussions.

Even in non-emergency situations, after a doctor-patient relationship is established, the doctor is legally obligated to provide medical care to the patient until the relationship is properly ended. The failure to pay a bill does not end the relationship because the underlying contract calls for performance of the professional obligations of the doctor for the welfare of the patient.

If the physician wants to end the relationship, the physician should send a certified letter to the patient stating that they are seeking to end the doctor-patient relationship and advising the patient to make other medical arrangements. This provides clear notification to the patient of the doctor' s intent to end the relationship. If the patient is not given reasonable notice or no other physician is available, the doctor may be liable for abandoning the patient.

Generally speaking, there is nothing in the bankruptcy code that prohibits a vendor from ceasing business with a debtor who is either insolvent or bankrupt. New credit that is extended post filing of bankruptcy is not discharged, how ever, and is fresh debt to which the debtor's bankruptcy filing does not apply.

In the case of a physician wishing to cease services, this is a question of medical ethics and the answer should be sought from either an attorney in doctor's area or the ethics unit of their medical association.

Taking all of the above into consideration, it seems unlikely that doctors would be forced to continue to work for free indefinitely, except in life-threatening situations or when no other doctor is reasonably available.

2) If a patient is set up on a payment plan to clear up previous balances, can a physician demand "upfront" payment for current visits?

The answer here is yes. Except in life threatening situations or in an emergency, when the patient has the opportunity and ability to consult with another physician, the original physician may terminate the relationship. Therefore, a physician may refuse to extend fresh credit to a debtor whom they know to be in arrears.

This is also a question of the doctor's own business practices. If they wish to keep the current business of the patient, they must balance the value of extending new credit versus refusing to further deal with the patient, which would stifle the incentive for the patient to pay this particular bill.

Reprinted with permission of State Collection Service, Inc., Madison, Wl "Pulse"

Back to the Drawing Board...
by Joan Carr

Joan Carr is President of J. Carr, Ltd. health co1~erage & reimbursements specialist. She holds an MBA and has 20 years in both the clinical and financial aspects of healthcare. 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 414-376-9031.

Every year we have a wonderful chance for renewal at our Annual Institute, this year in Door County. If you missed it, do make plans not to miss it next year. Despite the mosquitoes (my personal score was mosquitoes - 23, Joan - 2), the information was excel lent, shopping - wonderful, entertainment - exceptional, and the 'life lesson' on Friday - certainly worth the whole trip. This renewal, hopefully, will help us get through the next year as we face new and sometimes unusual changes to healthcare - especially Medicare & Y2K.

Success in facing these depends on a solid knowledge of the basics. To that end, I want to share some claim basics with you. I call these Potential Field Conflicts (UB-92 claim form checks & balances for clean claims) . These work together to ensure consistency of information on the claim, and there fore impact whether or not your claims are "clean claims" - those where Medicare pays interest if the processing-time parameter is exceeded. Clean claims lead to timely & accurate reimbursement - essential for reimbursement.

The information in the 1st field is a potential conflict with the information in the 2nd listed field . This is how they work:

Form Locator or Field #14 is Date of Birth
and
And Form Locator or Field #67 is Diagnosis

If you enter the patient's birthday in error. as a new- born but you have a diagnosis in the adult range - you have just created a "field conflict" and your claim is no longer a "clean claim". As we near the millennium. entry of correct DOB's become critical!

Your goal in reimbursement is to ensure the front-end edits in your billing software & your claim screening (BEFORE claim submission)are effective. Use the list to work through claim submission issues so your processes can be efficient.

FIELD CONFLICTS
Field	Potential Conflicts	Notes
1	1	State & Zip Code (Provider)
13	13	State & Zip Code (Patient)
1	51	Provider Name, Address & Provider Number
4	42	Type of Bill & Revenue Codes
4	17	Admit Date & TOB
4	20	TOB & Admission Source
4	22	TOB & Patient Status
1	5	Provider Info & Tax EIN
4	6	TOB & Statement Covered Period
6	7	Statement Covers & #Cov. Days
6	8	Statement Covers & #Non-Cov. Days
7	8	Fields 7+8 Must = Field 6
7	9	Covered Days & Co-Insured Days
4	10	TOB & LRD's
4	19	TOB & Admission Type
14	67-75	DOB & Diagnoses
24	30	Condition Codes
32	35	Occurrence Codes
36	32-35	Occurrence Span
39-41	24-30	Value vs. Condition
39-41	32-35	Value vs. Occurrence
42	39-41	Value vs. Revenue Codes
42	47	Tot. Chg. Per Rev. Code
42-44	67-75	Procedure vs. Diagnosis
50	51	Provider Info vs. Payer Info
1	51	Provider Info vs. Payer Info
51	53	Provider Info vs. AOB
55	42-47	Est $$ Due vs. Rev. Totals
58	13	Patient vs. Insured Info
58	12	Patient vs. Insured Info
61	62	Either Both Or None
60	62	Info Must Be Compatible
67	68-75	Codes Not Listed Twice
67	76	Can Be Equal, But Usually Not
77	32-35	If 77, Then 32-35 Occurrence
43-44	79	If 43-44, Then Method Noted
43-44	80	If 43-44, Then Proc & Date
85	82	Mandated for Phys. Cert. On File

 

With various PPS initiatives? coding changes. and coverage guideline mandates, it is back to the drawing board - always ensuring the claims are informationally AND technically correct as well as being medically necessary. Good luck!

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