Palmetto State News south carolina chapter

Serving healthcare financial management professionals statewide since 1953

www.schfma.org

Winter 2012 facebook.com/SCHFMA

HFMA

Healthcare Financial Management Association

HFMA-South Carolina Chapter CRCA Graduates and CHFP and FHFMA National Certification Recognition Honors during the 2012 CRCA Graduation and Annual Awards Luncheon January 13, 2012

Palmetto State News

Officers, Board & Committee Chairs ’11-12’ President Ronnie Hyatt Bon Secours St. Francis Hlth Systems [email protected]

Editor: Jay Rickman, Jr. 111 Lancewood Road Columbia, South Carolina 29210 803-217-3831 • Fax 803-798-4966 Email: [email protected] Please contact Jay with any updates to data contained within this publication. Palmetto State News is the official publication of the South Carolina Chapter of the Healthcare Financial Management Association. Opinions expressed here are those of the author and do not reflect the views of the HFMA or the South Carolina chapter. © 2011-2012 South Carolina Chapter, Healthcare Financial Management Association. All rights reserved. For a copy of the publications policy and guidelines, send a letter or email to the Editor at the address above.

President-Elect Diane Story Roper St. Francis [email protected] Secretary Jude Crowell Washington and West [email protected] Treasurer Greg Taylor Dixon Hughes, PLLC [email protected] Immediate Past President Ken Scheller Palmetto Health [email protected] Chapter Board of Directors Jimmy Joye Datatrac Receivables Recovery Group [email protected] Jeff White Beaufort Memorial Hospital [email protected]

Ray High MedAssets [email protected]

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Include links to company websites and e-mail addresses [email protected]

Estelle Welte MDS [email protected] Tommy Cockrell SC Hospital Association [email protected] Committee Chairs Advisory Committee Ken Scheller, Chair Budget/Finance Barney Osborne, Chair Communications Jay Rickman, Jr., Chair Corporate Sponsorship Ray High, Chair CRCA Brian Walker, Chair Dixie 2015 Greg Taylor, Chair

Debra Wolfe Contract Callers, Inc. [email protected]

New Advertising Prices!

Brian Walker Lexington Medical Center

Barney Osborne SC Hospital Association [email protected] Woody Turner Lexington Medical Center [email protected] Christy Powers NBSC [email protected]

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Education/Programs Alice Childs, Chair Founders Contact Jude Crowell, Chair Information Systems Michael Bowe, Chair Membership Christy Powers, Chair Membership Directory Diane Story, Chair Nominating Ray High, Chair Professional Excellence/Certification Steve Lutfy, Chair Special Awards Debbie Hunt, Chair Strategic Planning Ken Scheller, Chair

2011/2012 Corporate Sponsors Presidents Club BlueCross BlueShield of South Carolina • www.southcarolinablues.com

Gold CB & T, a division of Synovus Bank • www.apsolutions-cbt.com

MED A/Rx • www.medarx.com

Draffin & Tucker, LLP • www.draffin-tucker.com

PricewaterhouseCoopers, LLP • www.us.pwc.com

Hollis Cobb Association • www.holliscobb.com

Silver Abbott Immunology • www.abbott.com

Firstsource Solutions USA, LLC • www.firstsource.com

Bank of America Merrill Lynch • www.bankofamerica.com

MedAssets • www.medassets.com

Bottom Line Systems, Inc. • www.onlinebls.com

Meridian Leasing • www.onlinemeridian.com

Chamberlin Edmonds • www.chamberlineedmonds.com

The SSI Group • www.thessigoup.com

Deco, LLC • www.decorm.com

Bronze Advanced Patient Advocacy LLC • www.apallc.com

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AMCOL SYSTEMS • www.amcolsystems.com

NCO Group, Inc. • www.ncogroup.com

Avadyne Health • www.avadynehealth.com

Paragon Revenue Group • www.paragonrevenuegroup.com

CAB Collection Agency • www.cabrmc.com

Receivables Management Corporation • www.rmccollect.com

Dixon Hughes Goodman LLP • www.dhgllp.com

Receivable Solutions, Inc. • www.receivables-solutions.com

Laddaga-Garrett, P.A. • www.sehealthlaw.com

RGL Associates • www.rglassociates.com

LarsonAllen LLP • www.larsonallen.com

Security Collection Agency • www.abs-sca.com

Letter Logic, Inc. • www.letterlogic.com

South Carolina Hospital Association • www.scha.org

Medical Data Systems • www.meddatsys.com

The Outsource Group • www.theoutsourcegroup.com

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The 2011-2012 South Carolina HFMA Corporate Sponsorship Applications are now open! The chapter truly appreciates the generous support from all of our corporate sponsors. Contact Ray High at [email protected] for more information on becoming a SC HFMA Corporate Sponsor 3

A Message from the Chapter President….. I want to wish you all a “Happy New Year”, and trust you are having a nice and prosperous year so far! As we move forward into 2012, I am “turning the corner” on my year as President of HFMA-SC Chapter, and I want to thank all of our Members, Vendors and Sponsors for the support you have shown me! My year would not be any form of success without your loyal contributions and support of me, and of our great Chapter. HFMA-SC Chapter just held its Annual CRCA Graduation and Annual Chapter Awards Luncheon on January 13th in Columbia. It was a great success, with approximately 100 total attendees! The Program started with two great educational topics from Diane Paschal, Director of Corporate Compliance at SCHA, and Tim Larkins, Director of Patient Financial Services for Greenville Hospital System. After that, the CRCA graduates Ronnie Hyatt were recognized, then those who have received Certified status, as well as those who attained Fellow status this Chapter year. The Chapter recognized our Sponsors, without whom the HFMA-SC Chapter could not hold functions such as this Awards Program. Additionally, the annual Chapter Awards portion of the Program took place, with many being recognized for their accomplishments, including YERGER Award winners, and other significant recipient achievements. Thanks to all who participated and facilitated this event, and congratulations again to all CRCA graduates, newly-Certified and Fellow Members, and all award winners of the Chapter! As you know, “The Dixie” is upon us in February, and any of us who can attend this should do so! We need to support our host Chapter in Georgia, just as they (and other Region V Chapters) supported us in Charleston the last time it was there in 2010! Also, as the New Year moves forward, it certainly won’t be long until the AI will be upon us! Myrtle Beach “awaits us” once more, and Estelle Welte and others have been working hard to make this event a great success! Lots of work goes into making this meeting so memorable, and we hope to have record attendance! As you know, the theme for National HFMA and all Chapters is “Believe to Achieve”. With a great list of Officers continuing to work hard with me, and an outstanding roster of Board and Committee Chairs and volunteers, I continue to Believe we will Achieve much during this Chapter year. We still have strong challenges ahead of us, with lofty goals set forth in our Chapter Balanced Scorecard, but I know we and our Membership will meet those challenges. Also, I am looking forward to the results of the Membership Survey, due out soon! Again, I am very proud to be serving as your President for this Chapter Year, and will always work for you as a Member, Vendor and/or Sponsor of our great Chapter! It is still is an honor - and a privilege - to serve as your President!

Ronnie Hyatt

The word “tip” stands for “to ensure promptness.” So when should you give it? Upfront, of course. Sophisticated people don’t take chances on poor service. They ensure good service. -Jim Rohn Leading Business Authority on Success 4

Government Affairs By David Sudduth, FHFMA The General Assembly returned to work on January 10th for the second year of its two-year session and was immediately faced with several difficult decisions. One bright spot is that the Board of Economic Advisors estimates that tax collections this year will exceed budget by $900 million. While Governor Haley advocates using the projected surplus for tax relief and debt repayment, many in the Legislature would like to see a portion of the funds used to restore the $1.7 billion cut to department budgets since 2008. Some form of compromise will most likely be the result. With all 170 House and Senate members up for re-election in November, expect only “meat and potato” issues to get much attention. The most likely items of interest include tax reform, government restructuring, and the state retirement system. These issues are important to both legislators and the public because they involve money…both revenue enhancements and expense reductions. Both of which should help improve the state budget situation. Tax reform is a major priority for Governor Haley in terms of phasing out the corporate income tax and simplifying the individual income tax. But her most pressing priority is the establishment of a Department of Administration. This would be a cabinet-level agency and replace in large part the antiquated Budget & Control Board. The primary responsibility of the Budget & Control Board is to manage state government when the legislature is not in session. SC is the only state in the nation with such a governing board. The bill to make such a change passed the House last year and now sits in the Senate. And if our state retirement system was a patient, it would be in ICU receiving around-the-clock care. The system currently has a $17 billion unfunded pension liability that must be addressed. The most pressing piece of legislation facing healthcare providers this session could be S.999 – the bill filed by Senator Harvey Peeler to abolish the CON statute. The bill as filed would remove all requirements to justify need by providers and simply make the approval process for adding or expanding services a function of licensure. Please keep an eye on this bill as it currently sits in the Senate Medical Affairs Committee. And, as always, take time to communicate regularly with your legislators. Education and advocacy are critical to the long-term success or our organizations and the communities we serve. David is Administrative Director of Finance and Government Affairs at Bon Secours St. Francis Health System. He can be reached at 864-282-4912 or [email protected].

Table of Contents Award Winners. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Chapter Officers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2011-2012 Corporate Sponsors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 A Message from the Chapter President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Government Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Certified Revenue Cycle Associate (CRCA) News and Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8 You Just Can’t Clone Yourself...Effective Communication and Optimization Across the Revenue Cycle. . . . . . . . . . . . . . . . . . . . 9-10 Upcoming SCHFMA Events. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 HFMA Region 5 Fall President’s Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Presumptive Charity-Care Scoring: How Timing and Methodology Make All the Difference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-18 HFMA Region V Fall Presidents’ Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-22 Ernst & Young’s Report on Impact of Bad Debt Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Welcome to the Following New Members to HFMA SC Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Map Awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 From CFO to CEO: Transitioning to the Top Spot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-29

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BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

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Certified Revenue Cycle Associate (CRCA) News and Notes South Carolina is one of just a few states that has developed a state specific and affordable educational and credentialing program for revenue cycle personnel - the Certified Revenue Cycle Associate Program. Its purpose is to both educate as well as to recognize those who have demonstrated an accepted proficiency in the revenue cycle field. Achieving the CRCA certification is a prestigious honor. When you register for the program, you will receive a CD of the CRCA Training Manual and Study Guide (nearly 300 pages packed full of information that you can use on your job), be eligible to attend a one-day workshop, receive a DVD of the workshop, and of course eligible to take the CRCA exam.

Patient Access: Effective Pre-Admission Program, Important Forms, Successful Admissions Processes, In-house Monitoring Processes, Discharge Processing, Courtesy Discharge Processes Customer Service: AIDET Process for Patient Access, Handling Patient Complaints, Listening Skills Medicare: Medicare Eligibility/Coverage; Services Not Covered as OP Observation, Medicare Advantage Plans, Medicare as Secondary Payer, Shadow Bills, Timely Filing guidelines, Hospital Transfer Impact on Reimbursement, Leave of Absence, When an IP Admission Can be Changed to Outpatient; Appeals, Critical Access Hospitals, SNF Consolidated Billing

Don't let this wonderful opportunity for growth and achievement pass you by!

Other Programs: S.C. Vocational Rehab; Medically Indigent Assistance Program, State Office of Victim Assistance, Workers Compensation, CHAMPVA

"I have spent 19 of the last 24 years working in the healthcare field, and I still found the CRCA program to be an extremely helpful resource in understanding the “big picture” of how the Revenue Cycle works as a whole; including reimbursement from government and large managed care payers. It is so easy to get lost in our own bubbles within our own departments, but this program gave me a greater understanding of how my job affects, and is affected by, other areas within the hospital system. The certification exam is well worth the effort…!

HIPAA: Privacy Rule, PHI & Disclosure, Security, Electronic Transactions & Code Sets, NPI, American Recovery and Reinvestment Act of 2009 Compliance: OIG Work Plan, Difference between Fraud & Abuse; Federal False Claim Act, EMTALA UB04/1500: UB04; Present on Admission Indicators; Value Codes, Condition Codes, Occurrence Codes; Codes for MSP; UB04 Field Descriptions; 1500 Field Descriptions

-Sophia Lawson, CRCA (2011) The CRCA designation is hard-earned and recognizes an individual's advanced understanding of the Revenue Cycle. The exam covers:

Medicaid: Medicaid Managed Care Organizations; Medical Homes Network; Dual Eligibility coverage; Medicaid Third Party Liability; Medicaid Coverage; Medicaid Reimbursement; Medicaid Administrative Days; Swing Bed Hospitals

Blue Cross: FEP, PPC, and BC State benefits and precertification requirements; the Blue Card Program; Coordination of Benefit Rules; BC Third Party Administrators; BC Case Management; Identifying BC Medicare Advantage members

Credit and Collection: Truth In Lending Act; Fair Credit Reporting Act; Fair Credit Billing Act; Fair Debt Collections Practices Act; Fair and Accurate Credit Transactions Act

ERISA: Qualifying events under ERISA; How to protect your hospital under ERISA TRICARE: TRICARE eligibility/coverage/cost share; Outpatient Prospective Payment System under APC’s; Claim Submission Guidelines, Skilled Nursing PPS Billing Tips

Coding: CPT and HCPCS Codes, ICD 9 and ICD 10 changes Reimbursement: DRG's, Specific Services/Fee Schedules, APC's; Cost, Quality, and Value

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2011 - 2012 Certification Exam

2012 - 2013 Certification Exam

It has been another successful year for the Certified Revenue Cycle Associate (CRCA) program. The chapter has awarded certification to twenty-three (23) individuals, who through commitment, hard-work, and perseverance have successfully taken and passed the rigorous certification examination.

Efforts are well underway in preparing for this year's exam. The CRCA Program will provide an education session to anyone who may be interested in signing up for this year's exam. The session is FREE, and all interested in the exam are encouraged to attend.

Congratulations 2011 CRCA Graduates! April Lewis, Brian Earnest, Christine James, Dale Burgess, Dana Dove, Felicia Lesane, Jeremy Faulkenburg, Jessica Parkins, Judy Jones, Katherine Taylor, Koshina CampbellLegette, Lesandra Langley, Lynn Hollifield, Rebecca Miller, Sarah Lemmonds, Shannon Oakley, Sherrie Egloff, Sierra ButlerSondra Townsend, Sophia Lawson, Summer Quaethem, Tamara Arndt, Tara Gibson

For additional information on this program, including Key Dates, please see our website at www.schfma.org, and select the CRCA Option.

A special thank you to all of the CRCA Program volunteers for your time and efforts this past year!

“Whenever you see a successful business, someone once made a courageous decision.” Peter F. Drucker Author, Scholar, Business Management Theorist

HFMA, South Carolina Chapter Our Vision: The South Carolina Chapter of the Healthcare Financial Management Association will continue to be the leading professional resource for individuals seeking excellence in the area of financial management of integrated health systems and other healthcare organizations.

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You Just Can’t Clone Yourself...Effective Communication and Optimization Across the Revenue Cycle. frequently, minor adjustments that are outside the contractual amount are just lumped in with the contractual write-off because they aren’t that significant. Start adding those up and the numbers might really surprise you.

If you could clone yourself and handle every task across your revenue cycle, chances are that you could take each of the four questions below and answer them with absolute confidence… 1. Does your entire organization agree on the definitions of these terms: Revenue Cycle, Denial, Workflow?

Workflow. What is it? Does it mean taking a piece of paper from one desk to another? Well, that’s part of it. But the key to workflow is making sure that we accomplish all of the steps we need to ensure reimbursement, that we do so in a timely manner, and that we learn from mistakes and redundancies so we can improve the process in the future. Once you begin considering how you work from your new definition of workflow, you immediately move from a reactive mode to a proactive one…and the impact of that move can be very significant indeed.

2. What can the person in charge of denial management take, right this very minute, to a meeting with the patient access manager, that will improve your revenue cycle communication and process? 3. Does everyone involved in your revenue cycle get together as frequently as they should? 4. Are you collecting everything you should? But there is only one of you, so you might want to think about how you would answer these questions, and then how others in your organization might respond.

2. What can the person in charge of denial management take, right this very minute, to a meeting with the patient access manager, that will improve your revenue cycle communication and process?

1. Does your entire organization agree on the definitions of these terms: Revenue Cycle, Denial, Workflow?

Can your PFS Director (or whomever is in charge of denial management), pull up a document on the computer, print it out, walk into a meeting with the patient access manager and say, “Last month, we had 11 denials from XYZ payer because we failed to get a preauthorization on ABC service?” If not, then you need to take a look at how your tracking your information and start putting some processes in place. Because it’s almost certain that your business office people are aware of problems in patient access, and vice-versa, but without data it’s just pointing fingers. People accuse, data informs. And it’s not just your patient access and business office teams, it’s your entire revenue cycle (once you’ve redefined it). Begin tracking where the problems, and the successes are, start communicating them, and you can begin to effect positive change.

It seems pretty simple, doesn’t it? And yet how we define these terms, and others like them, can often affect how we function and communicate within our organization. Revenue Cycle is defined differently in almost every organization, and most of the time, the definition doesn’t include everything that affects reimbursement…but it should. If it’s not included in your definition, than you might not include it in your communications and your meetings, even though it’s affecting your revenue. Many organizations don’t consider medical records as part of their revenue cycle, for example, but if medical records fails to return information in a timely manner that results in a missed appeal deadline, revenue is lost. What’s a denial? Is it a zero-pay? Is it something with a denial code? Is it an initial payer rejection? Yes, it’s all of those, and more. Any non-contractual adjustment of payment is a denial. Let’s repeat that for emphasis…ANY NON-CONTRACTUAL ADJUSTMENT OF PAYMENT IS A DENIAL. But it’s often not seen that way. Far too

3. Does everyone involved in your revenue cycle get together as frequently as they should? It’s not realistic to pull your whole team together every time there’s a problem, but what would happen if you

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created some sort of structure where everyone was able to look at the same data together on a very routine basis so everyone was on the same page and issues could be addressed quickly. There are many different approaches to this, but one effective method can be a monthly meeting where ALL revenue cycle groups are represented, a short weekly meeting that CORE revenue cycle players attend, and even a daily 5-10 minute morning huddle for revenue cycle leaders (such as PFS and PA directors) to just check in with one another and cover any hot topics that have come up. You’d be amazed at what a structure like this can do for communication.

question with a simple “Yes.” That’s because, at the end of the day, we all know there are flaws in the process, there are changing rules and regulations, there are issues of productivity and simply not having enough resources, or the right resources. Simply put, the only way to be able to answer “Yes” to this question is in the same way you can answer all the questions above with confidence – you need to clone yourself…and then you need to do every single task to the most detailed degree possible. Since that’s probably not going to happen any time soon, we need to get as close as we can…revenue cycle communication, the ability to analyze what’s happening across your organization, and some simple steps to automate and improve on your processes probably won’t allow you to say “Yes,” but the next time someone asks you that question, at least you’ll be able to say “No, but we’re getting closer every day!”

4. Are you collecting everything you should? Ultimately, all of the above discussions come down to this very simple question. I can honestly say that in the hundreds of revenue cycle leaders I’ve spent time with over the years, I’ve never had a single one just answer this

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UPCOMING SCHFMA EVENTS Region V Dixie Institute Feb.21-24 Greensboro, GA Payor Summit March 20th Embassy Suites, Columbia, SC Chapter Leadership Training Conference (LTC) March 29th Charleston, SC Annual Institute May 29-June 1 Myrtle Beach, SC ANI: The HFMA National Institute June 24-27 Las Vegas

www.schfma.org/events.htm

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