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Spring 2014

The Future of Managed Care Contracting, How Do You Measure a Winner? – Part Three

The Coming Age of Electronic Medical Records: From Paper to Electronic

Are You Blooming?

Mission Still to Be Accomplished: Enrolling America’s Uninsured

Use the Force

Setting Goals

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Spring 2014 1

8 The Future of Managed Care Contracting Data Driven Decisions – Part Three By Rob Borchert, MBA, FHFMA, CRCE-I and Tim Borchert, MBA, PMP

14 The Coming Age of Electronic Medical Records: From Paper to Electronic By Naveen Malhotra, Ph.D. and Marlieta Lassiter, CRCE-I

18 Are You Blooming? By Sheryl Roush

20 Mission Still to Be Accomplished: Enrolling America’s Uninsured By Steven Abramson and Everett Lebherz

24 Use the Force By Frank Keck

26 Setting Goals By Heather Eavers, CRCS-I-P

27 Meet a committee chair: Roger Poremsky, CRCE-I, Membership Chair

2 Letter from the Executive Director

4 Letter from the National President

6 Washington Wire By Paul A. Miller, PLC

28 From the Desk of the Certification Director By Maria LeDoux, CAE

30 CRCP Certification Corner By Brenda Chambers, CRCE-I,P

31 CRCE Certification Corner By Erin Selin, CRCE-I, CCT

31 CRCS Certification Corner By Doris Dickey, CRCE-I

32 From the Desk of the Membership Director By Moayad Zahralddin

36 Did You Know? By Moayad Zahralddin

37 National Calendar/The JHAM network

Inside front cover Salucro Healthcare Solutions www.salucro.com

14

24

8

20

table of contents

features

advertiser index

departments

AAHAM National Office Staff11240 Waples Mill Road, Suite 200, Fairfax, VA 22030

Executive Director Sharon R. Galler, CMP 703.281.4043, ext. 204 [email protected]

Membership Director Moayad Zahralddin 703.281.4043, ext. 202 [email protected]

Certification Director Maria LeDoux, CAE 703.281.4043, ext. 201 [email protected]

Finance Manager Christelle Isambo 703.281.4043, ext. 216 [email protected]

Certification Amanda Leibert Manager 703.281.4043, ext. 211 [email protected]

Manager of Danielle Burns Meetings & Events 703.281.4043, ext. 209 [email protected]

Art Direction Christopher R. Izzo & Graphic Design CRI Design 401.821.1849 [email protected]

AAHAM National Executive Officers President Victoria DiTomaso, CRCE-I System Director, CBO Lee Memorial Health System P O Box 150107 Cape Coral, FL 33915 239.242.6011 | 239.242.6005 [email protected]

Chair of the Board Christine Stottlemyer, CRCE-I Director Patient Accounting Memorial Hospital 325 S. Relmont Street York, PA 17403 717.849.5431 | 717.815.2474 [email protected]

First Vice President John Currier, CRCE-I Executive Director Revenue Cycle Management Gibson Area Hospital & Health Services 1120 N Melvin Street Gibson City, IL 60936 217.784.2613 | 217.784.5853 [email protected]

Second Vice President Lori Sickelbaugh, CRCE-I Director, Facilty Patient Access Wake Forest Baptist Medical Center Medical Center Boulevard Winston Salem, NC 27157 336.716.4053 | 336.713.4198 [email protected]

Treasurer Amy Mitchell, CRCE-I PFS, Business Services Director University of Utah Hospital 127 South 500 East #400 Salt Lake City, UT 84120 801.587.6486 | 801.587.6675 [email protected]

Secretary Linda Patry, CRCE-I Director, Patient Financial Services Mary Washington Healthcare 2300 Fall Hill Avenue Fredericksburg, VA 22401 540.741.1591 | 866.774.9287 [email protected]

Legal Counsel Richard Lovich Stephenson, Acquisto, & Colman 303 North Glenoaks Blvd. #700 Burbank, CA 91502 818.559.4477 | 818.559.5484 [email protected]

letter from the executive director

Sharon R. Galler

2 The Journal of Healthcare Administrative Management

As you have heard, our historic 10th Legislative Day was a big success, be sure to read “The Washington Wire” column by Paul Miller and check out the great photos in

our online photo gallery. A special thank you to our generous sponsors;

President Level Senator Level Representative LevelPFS Group Illinois chapter CDR Associates, LLC Keystone chapter Florida Sunshine chapter Marcam Associates Gopher chapter Philadelphia chapter Maryland chapter Pine Tree chapter Medical Bureau/ROI Pro Co Wisconsin chapter

The next big event is our ANI. Mark your calendars for “Sail into Revenue Cycle Success”, October 15-17, at the gorgeous Manchester Grand Hyatt, in scenic, San Diego, California. Plan now and add this to your budget so you can join us at this once a year educational and networking event. We know funds are tight and so we include most of your meals in our registration fee. We have sensational speakers and sessions, so you can get your CEUs and education all in one place, all at one time. You will also meet exhibitors and learn about their solutions to your at work challenges. We have many networking opportunities to help you build relationships and give you the edge in today’s competitive economy and job force.

Our education committee has put together a stellar slate of speakers in addition to two fabulous keynotes; Jack Singer, “Developing a Maintaining the Mindset of a Cham-pion”, www.askdrjack.com on Wednesday and Sheryl Roush, “How to Keep a Spar-kling Attitude Everyday”, www.sparklepresentations.com on Thursday. Plus our “man in Washington”, Paul Miller will be providing his popular closing session about the latest on what is happening in Washington. So be sure not to miss this one! The registration brochure will be in the mail and on the website in June, so be on the look-out for it.

We hope you enjoy this issue of the Journal. In addition to our regular quarterly columns, we have a fun interview with Roger Poremsky, CRCE-I, our new membership chair. We have very timely articles like part three of the future of managed care contract-ing by Rob and Tim Borchert as well as our fascinating article on the history of electronic medical records by Naveen Malhotra and Marlieta Lassiter. Be sure to read the article by Steven Abramson and Everett Lebberz on enrolling our uninsured. We have included several personal motivation articles by Frank Keck, Heather Eavers and ANI keynote, Sheryl Roush. I think you will agree, this is a great information packed spring issue.

A big AAHAM thank you to our advertisers, exhibitors and sponsors, we couldn’t do it without you!

Warm regards, Sharon

Note: A CEU is defined as a sixty (60) minute period of education

* Be Sure to Attached Supporting Documentation

Mail Completed Recertification Form and backup documentation to:

AAHAM National OfficeProfessional CEUs

11240 Waples Mill Rd #200Fairfax, VA 22030

Signature _____________________________________________________________________ Date _____________________________

Certification Designation:

First Name: Last Name: National Members ID#:

Address:

City: State: Zip:

Work Phone: Home Phone: Email:

No. of X Weight = CEUs Description:

Hours/Units Earned Date Earned:

No. of X Weight = CEUs Descritpion:






AAHAM Professional Recertification FormContinuing Education Units (CEUs)

CRCE-I/CRCE-P

Weight Activity Qualifying for Continuing Education Units (CEUs)1.0 unit Each hour proctoring a professional certification exam

1.0 unit Each hour proctoring a technical certification exam

1.0 unit Each professional exam section completed and graded by deadline

1.0 unit Each hour in attendance at an educational program or class relating to the healthcare field

1.0 unit Each hour coaching an organized technical certification review session

1.0 unit Question, answer and reference material submitted and accepted into the professional exam bank

2.0 units Each hour in attendance at an AAHAM sponsored educational program

2.0 units Authored an article published in an AAHAM Chapter publication

2.0 units Attendance at a National President’s meeting

2.0 units Director or Chapter Committee Chairperson

2.0 units Each hour coaching an organized professional certification review session

3.0 units Attendance at an AAHAM audio conference

3.0 units Authored an article published in a National AAHAM publication

3.0 units Given presentation related to AAHAM, patient accounting or healthcare administrative management (AAHAM related credit given if made at an AAHAM sponsored event or if presenter is representing AAHAM)

3.0 units Chapter Officer

4.0 units National Committee Chairperson

6.0 units Officer of National AAHAM

8.0 units Attendance at AAHAM Legislative Day

letter from the national president

Deadlines & Submission GuidelinesThe Journal welcomes submissions from AAHAM

members. Submission deadlines are as follows: Journal Issue Submission Deadline Summer 2014 July 25, 2014

Send submissions to:Executive Director, AAHAM

11240 Waples Mill Road, Suite 200Fairfax, VA [email protected]

n Please send a copy of your submission on a CD or flash drive, or e-mail it to: [email protected].

n Leave a one-inch margin on the top, bottom, and sides.

n Use upper- and lower-case letters as you would in typing any correspondence.

n Indent the first line of each paragraph five spaces.

n Include a cover page with the following information: Author’s name, (degrees, certifications) Place of employment Position Address Phone/Fax number AAHAM Chapter Affiliation (if any)

n Any article submitted for reprint in the Journal must be accompanied by written permission to reproduce from the original source.

n Do not use abbreviations or italics.

n All photos become the property of AAHAM, unless you specifically request that they be returned. Each picture should be accompanied by a listing of all individuals in the picture (left to right). Black and white pictures reproduce better than color.

n All articles are subject to editing by AAHAM. AAHAM reserves the right to hold articles for future Journal issues when space is limited.

n Articles referring to or endorsing specific products or services will not be considered.

The Journal is published quarterly by the American Association of Healthcare Administrative Management, 11240 Waples Mill Road, Ste. 200, Fairfax, VA 22030. Opinions expressed in this publication represent the viewpoint of each author, and do not necessarily reflect the policy of AAHAM. Advertisements do not necessarily imply sponsorship by AAHAM. Subscriptions are included with AAHAM membership. Reprints are available from the National Office in portable document format (PDF) for a $75 fee per article. Prepayment is required.

© Copyright 2014 by the American Association ofHealthcare Administrative Management.

www.aaham.org

Victoria DiTomaso, CRCE-I


Hard to believe that winter is finally over, and “spring has sprung”. I know for many of my AAHAM friends out there, it has been a long and brutal cold season.

We sure could not complain about the weather last week at the 10th Annual AAHAM Legislative Day. Our time on the hill was marked with gorgeous warm sunshine, beautiful spring flowers, and those famous cherry blossoms. It made moving between the various of-fice buildings an absolute joy!

It was the 10th anniversary of our event and I had the opportunity during the week to reflect back on the previous 10 years of AAHAM Legislative Days, and it has been an amazing ride. We started out fairly small, and we have all learned so much as we come back year after year. During the opening festivities we honored Linda Sheaffer, CRCE-I,P, as she prepares for her well earned retirement. We affectionately called Linda the “Godmother of Legislative Day” as it was her brainchild, and the first one took place during her tenure as national president. What she built is an amazing testament to her passion for our business and our organization.

Someone made the comment that everyone in our group seemed so animated and knowledgeable about our issue this year, and I know for a fact that we impressed the folks we met with at our Senator and House of Representative offices. It was incredibly encouraging to see they remembered us from previous years, and seemed genuinely interested in hear-ing our thoughts on modernizing the TCPA and how the 501(r) regulations are going to affect all of us. At the meetings I attended, we were actually able to tie the two together, and that certainly garnered some additional interest. This year brought record attendance, many, many first timers, and a real sense of “we can do this!” The entire experience is so gratifying to me. If you were able to join us, thank you, and I hope you enjoyed it as much as I did. If you didn’t, make sure you plan on it next year, you will not regret it.

As always, healthcare is ever changing, ever challenging. I so value the education and networking that our organization brings to all of us. Thank you for all you do every day.

I could not close without thanking Tim Moore and his Government Relations com-mittee for a job extremely well done last week, and also for the incredible hard work and organization of the event by the national office staff led by Sharon Galler.

And as always, my personal plea, remember to give back to your family, your friends, your community and your local chapters. “We make a living by what we get. We make a life by what we give.” Winston Churchill.

Sincerely,Victoria Di Tomaso, CRCE-INational President

Happy spring!

Spring 2014 5

❏ Enclosed is my check. Please make payable to AAHAM.

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Email, fax or mail this registration form along with your payment to:AAHAM CRCE-I/CRCE-P Study Session CD ROMs,11240 Waples Mill Road Suite 200, Fairfax VA 22030

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This past April, AAHAM celebrated its 10th Anniversary of Legislative Day. I

want to applaud AAHAM on this milestone, not just for undertaking such an event, but for really turning it into a true member value proposition. Most people might say going to Washington for ten years is no big deal. In part, they’d be right because most national groups host “fly-ins” where they bring their members to Washington to discuss their key industry issues. What sets AAHAM apart is the growth of its advocacy program and the success it has had. Most groups may host legislative summits, but not all do them af-fectively. This is what separates AAHAM from the rest. AAHAM has a very effective agenda and program that has produced re-sults on some key issues facing the industry.

AAHAM started with a vision, the leadership knew that to continue to offer its members real value, they needed to add advocacy to its core competencies and mem-ber value propositions. I can still remember that phone call with AAHAM’s Executive Director Sharon Galler, and then President, Linda Sheaffer and the Executive Board. I can remember hanging up the phone think-ing, this group gets it. From the moment the group discussed advocacy and what it wanted to achieve, to today, you will see a group of leaders who get the value of be-ing in Washington and being the voice for your profession. It hasn’t always been easy, but when your leadership team continues to buy into the program, you can understand how contagious the feeling becomes. This year AAHAM also marks the largest group of attendees and the amount of sponsor dol-lars raised. I share this information with you because sponsors aren’t simply willing to throw money at events today if they don’t see value. AAHAM has some tremendous business partners who have seen the value

and importance of this event. This is a key group that needs to be thanked for all their support of the association and its efforts on Capitol Hill over the past ten years.

Linda Shaffer had the vision, but she has not been alone in making advocacy a prior-ity within AAHAM. I have had the pleasure to serve under AAHAM Presidents Linda Sheaffer, Steve Markesich, Robert DeBiase, Laurie Shoaf, Chris Stottlemyer and now Victoria Di Tomaso. I mention these folks by name because they have and continue to lead the way for the profession, which in my opinion, has separated AAHAM from the other groups in the industry. Each year I leave Legislative Day with a big smile on my face. Not because of anything I did, but be-cause when you talk to AAHAM members and watch them in their meetings, you see not only a passion, but a true understanding of what it takes to be successful in Wash-ington. In most associations, this is half the battle. You can organize an event for your members that might be a great vacation spot or you can organize events like Legislative Day that require real work and participa-tion. I am convinced AAHAM’s continued success after ten years is due in large part to the work requirements they place on their members once they come to Washington.

In any business or association, you mea-sure success by accomplishments. I can tell you AAHAM has had significant success on key industry issues over the past ten years and why celebrating AAHAM’s success in this article is important. When AAHAM first started Legislative Day, our focus was on the Medicare RAC Audits, which are in place to-day with changes the association pushed ag-gressively for. We then moved onto Admin-istrative Simplification, which if you look at the Affordable Care Act (ACA) you will see language AAHAM pursued and got. Today

we have the Telephone Consumer Protection Act (TCPA), which prohibits you from us-ing innovative technologies like autodialers to call a patients cell phone, even if that is the number they provide you on admissions forms. Still a work in progress, but I am con-fident AAHAM can win this battle too.

The TCPA seems like a simple issue and one that most people would agree probably needs to be modernized, but once you fac-tor in the politics of this issue you quickly see how complicated making these changes really is. It has been a tough road thus far and one I still hear people saying you will never get the changes you’re advocating for. I was in a meeting last month and a lawyer commented how changes would never be made to the TCPA. I am looking forward to the article where I get to say I told you we’d do it!

This year AAHAM hit Capitol Hill with the goal of continuing to educate mem-bers of Congress and their staff on what the TCPA is and why changes are needed. This year was more critical than in the past, in that we continue to see more and more lawsuits filed against hospitals for viola-tions to the TCPA. We continue to see the number of homes without a landline con-tinue to grow. To date over 40% of homes no longer have a landline, which means it becomes almost impossible to communicate with patients today without changes to the TCPA. The biggest issue we face is with the requirements of the Affordable Care Act, which state hospitals are required to stay in touch with patients upon discharge from the hospital. This requirement is becom-ing a costly unintended consequence for hospitals. Because hospitals cannot use au-todialer technology to help in this process means hospitals are spending more having

Paul A. Miller, PLC, Lobbyist

washington wire

Continued on page 7

One Voice, One Mission

Spring 2014 7

staff call patients once discharged. This is not only a huge administrative cost to the hospital, but a less effective way to keep pa-tients informed. You would think that when a patient comes in for a procedure and they provide the best contact number on a form or verbally, that you should be able to reach them at this number. Today and due to an outdated TCPA, it’s not that simple.

AAHAM members and leadership have spent many hours writing letters, meeting with their elected officials, meeting with the Federal Communications Commission, and working with other groups who share the same concerns. I can honestly say these ef-forts are paying off. You have to remember that change in Washington does not happen overnight and with our government now more famous for its inaction than action, one can understand the hurdles we face. Even with these hurdles we are chipping away and moving this issue forward. Since Legislative Day, we have had several offices come forward and indicate they may be will-ing to introduce legislation that would fix this problem. We have had even more of-

fices willing to send a letter directly to the FCC urging them to start a rule making that would make these changes. We have also discussed filing our own petition with the FCC urging them to make these changes. A lot of inside baseball goes into the above, but an effort I can say we are having real suc-cess on. You have to realize that on average it takes ten years for legislation to become law (not all, but a typical issue like this one). I’m not saying it will take us ten years, because I don’t believe it will. We still have a lot of work to be done, but we are definitely mov-ing in the right direction. In fact, you now have the FCC weighing in on this issue.

In a recent blog post, FCC Commis-sioner Michael O’Reilly stated “the TCPA is supposed to protect consumers from un-wanted commercial robocalls, texts, or faxes. The FCC must hold bad actors accountable when they violate this law. But the FCC should also follow through on the pending TCPA petitions to make sure that good ac-tors and innovators are not needlessly sub-jected to enforcement actions or lawsuits, which could discourage them from offering new consumer-friendly communications services.” We agree with Commissioner

O’Reilly and hope the FCC does in fact take this issue up this year.

There is another big reason Congress should change the TCPA. Changes to the TCPA would generate new revenue for the U.S. Treasury. In fact, in his last three bud-get requests, President Obama has asked for similar changes. AAHAM wants the changes to help more effectively communicate with patients and the President wants it to go af-ter those who have failed to pay their taxes. This has been a selling point Congress is tak-ing a look at.

As you can see, we have had and still have; hurdles in our way, but you can also see what a commitment AAHAM has made for the profession in tackling this issue. We are having success and I fully expect to re-port back later this year even more success if not victory. This success is only possible when you have an organization committed to the needs of its members. AAHAM is an organization fighting for you. AAHAM may not be the biggest national association in Washington, but it does have a loud and effective voice that is unified and getting the results you want and need to do your job.

One voice one mission, that’s AAHAM!

washington wire

continued from page 6

2813142


By Rob Borchert, MBA, FHFMA, CRCE-I, President

Best Practice Associatesand

Tim Borchert, MBA, PMPDeputy DirectorAltarum Institute

Since the writing of part two, “How Do You Measure A Winner?”, we have seen

numerous articles and attended a number of presentations on the evolving managed care market and future reimbursement possibili-ties. Awareness is happening in our industry and we hope that our articles are contrib-uting to understanding the labyrinth that is Managed Care contracting. If you provide high quality healthcare to patients, we be-lieve that you should get paid properly for it. As “quality and outcome” become more intertwined with reimbursement require-ments, the monitoring of appropriate data becomes critical. For example, if your pa-tients have a higher acuity and require more intense care and these patients have an im-

proved outcome above a national norm, then we believe you should get reimbursed more. Data can help you reach these ele-ments of reimbursement.

The Merriman-Webster’s dictionary de-fines data as, “factual information (as mea-surements or statistics) used as a basis for reasoning, discussion, or calculation.” We also like to use the acronym DATA as Doc-ument All Things Accurately! Yes, good data is to document all things accurately and, just as important, is that the data must be timely, appropriate, meaningful and mea-sureable. Data can certainly be collected but if it doesn’t provide information leading to a conclusion of some sort, it is just num-bers. Data provides the most valid informa-tion against previously defined information. Many of us are used to data driven infor-mation by which we measure performance. Some examples are:• GDRO(GrossDaysRevenueOutstand-

ing) – the measurement of how long it takes to collect one dollar of accounts re-ceivable

• NetDays RevenueOutstanding – same

measurement but deducting projected contractuals, etc. where possible striving to give the same outcome of collections

• DNFB (DischargedNot Final Billed) –the measurement of the discharged pa-tient charges that are on hold awaiting information to complete the claim for billing

For these measurements to be worth-while, the data elements must be accurate. This means that all services rendered to pa-tients during their inpatient or outpatient status must be identified, documented and entered into the computer system for charg-ing purposes. Effective health data aggrega-tion are built with a solid foundation from the physician-patient encounter through the Electronic Health Record (EHR) and a cen-tral repository for these records that allows tools to access the data to monitor, analyze, document, and report clinical quality and fi-nancial results. As one can see, data is vital to the successful running of any operation and if it is incorrect, stability and business man-agement is questioned. The same can be said

Managed Care

Continued on page 10

Contracting,The Future of

How do You Measure a Winner? – Part Three

Exhibit 1: Managed Care Reimbursement Summary by Year/Quarter/MonthHospital ABC and Five Managed Care Payors

AllowEd to BillEd RAtio CollECtEd to BillEd RAtio Period Red white Blue Green Yellow Red white Blue Green Yellow total 74.2% 44.3% 35.4% 35.6% 37.2% 65.5% 33.0% 27.5% 26.8% 29.1%By Year2012 74.3% 45.8% 35.3% 32.2% 37.2% 66.1% 36.3% 27.6% 25.4% 30.9%2013 74.1% 43.3% 35.5% 37.5% 37.2% 65.2% 30.7% 27.4% 27.7% 28.1%

Winter 2014 9


about our topic, Managed Care contracts.It is difficult to verify that payers are

paying correctly. This requires monitoring contracts with physician services, clinical, and multiple departments in your hospital; each possibly having its own unique policies and payment structures. Additionally, you have to manage invalid denials, underpay-ments, and delayed payments. Many Hos-pital Information Systems alone are unable to correct these problems because they are

not designed to identify or track contract payment errors at the level required, more specifically managing the complex terms in contracts, such as high-cost care-outs, mul-tiple surgery reductions, ambulatory surgi-cal center (ASC) groups, modifier multipli-ers, site-of-service payment adjustments, code edits, stop-loss provisions and the ever-constant government and private payment rule changes.

We laid out the various historic reim-bursement models in Part One of this article. In Part Two, we presented some possibilities

for future reimbursement models. In this final Part, we want to present to you some of the basics of sound managed care con-tracting measurements. This data presented throughout comes from various contract analysis examples that have highlighted risk areas, positive areas of reimbursement and definite areas for immediate further study. It should be noted that all of the names of hos-pitals, physician groups and managed care companies are fictitious; but the data is true.

Examples of this data as a measure-



Bill Charge All PAYoRS Allowed-to- Collected-to-type Claims Billed(3) Allowed(4) (Paid) Billed Ratio Billed Ratio

360,354 $369,397,407 $219,159,046 $185,047,477 59.3% 50.1%

Institutional 1,700 $80,210,055 $47,056,266 $44,948,399 58.7% 56.0%Professional 4,528 2,813,074 834,283 686,324 29.7% 24.4%Unknown 3 22,253 16,357 15,707 73.5% 70.6%All 6,231 $83,045,381 $47,906,907 $45,650,430 57.7% 55.0%

Institutional 265,903 $263,751,961 $163,958,023 $134,624,935 62.2% 51.0%Professional 77,327 22,000,489 6,870,733 4,540,104 31.2% 20.6%Unknown 10,874 593,070 419,380 229,302 70.7% 38.7%All 354,104 $286,345,520 $171,248,136 $139,394,341 59.8% 48.7%

Exhibit 2: Patient Reimbursement Total

type Red white Blue Green Yellow Red white Blue Green Yellow

74.2% 44.3% 35.4% 35.6% 37.2% 65.5% 33.0% 27.5% 26.8% 29.1%

I/P Institutional 74.8% 22.5% 26.6% 25.4% 40.3% 73.1% 18.4% 23.9% 22.3% 34.0%Professional n/a 30.4% 34.7% 23.4% 28.0% n/a 23.0% 31.4% 18.7% 23.5%Unknown 73.5% n/a n/a n/a n/a 70.6% n/a n/a n/a n/aAll 74.8% 23.3% 27.4% 25.2% 39.8% 73.1% 18.9% 24.6% 21.9% 33.6%O/PInstitutional 74.0% 52.1% 37.1% 42.4% 36.0% 63.1% 39.2% 28.4% 31.6% 26.6%Professional 70.8% 33.6% 38.6% 21.7% 32.0% 69.2% 21.0% 26.5% 14.6% 22.1%Unknown 75.1% 59.6% 49.7% 30.2% n/a 40.5% 28.6% 35.7% 17.4% n/a All 74.0% 48.9% 37.3% 37.8% 35.3% 63.0% 36.1% 28.1% 27.9% 25.8%ERInstitutional 78.0% 53.4% 33.0% 44.0% n/a 60.4% 36.3% 29.7% 0.7% n/aProfessional n/a 28.2% 33.0% n/a n/a n/a 28.2% 23.6% n/a n/a Unknown 78.0% n/a 38.3% 44.0% 22.4% 43.7% n/a 32.6% 35.2% 22.4%All 78.0% 50.4% 35.2% 44.0% 22.4% 52.1% 35.3% 29.6% 18.0% 22.4%

Exhibit 3: Reimbursement by MCCBill Charge

Spring 2014 11


Red white Blue Green YellowHospital ABC 73.6% 40.8% 31.7% 26.1% n/aPhysician’s Office ONE 72.6% 47.8% 39.9% 26.7% n/aPhysician’s Office TWO 75.5% 45.0% 41.3% 23.7% n/aUrgent Care Center 74.8% 44.9% 46.0% 31.3% n/aAmbulatory Care Center 74.9% 44.3% 36.9% 22.5% n/aAll 73.6% 41.5% 32.4% 26.2% n/a

Exhibit 4: Site Reimbursement

Exhibit 5: Revenue by Bed Station

Red white Blue Green YellowTOTAL 74.2% 44.3% 35.4% 35.6% 37.2%General Medical Care 74.3% 25.9% 25.5% 23.1% 39.2%Surgical Care 76.4% 15.9% 27.1% 21.8% 31.2%Obstetrics 74.2% 17.9% 33.6% 24.0% 11.9%Rehabilitation Medicine 78.0% 42.0% 24.0% 96.3% 100.0%Psychiatric Care 78.1% 80.8% 25.1% 78.1% 66.5%Neurology 77.9% 16.1% 21.4% 43.0% 32.8%All 74.8% 23.3% 27.4% 25.2% 39.8%

Red white Blue Green YellowTotal 74.2% 44.3% 35.4% 35.6% 37.2%Preferred Provider Organization 74.0% 43.7% 37.7% 35.8% 34.6%(PPO)Point Of Service 76.9% 45.1% 34.6% 36.5% 34.7%Health Maintenance Organiz 76.6% 42.5% 31.4% 32.8% 51.8%Medicare A 78.0% 42.7% 47.1% 40.2% n/aMedicare Secondary (No B Exc) 67.8% 50.2% 33.6% 19.6% 30.7%ASO 78.1% 48.0% 37.7% 11.2% 30.8%Medicare Secondary (B Exc) 71.8% 64.5% 20.3% 36.7% 37.4%Comprehensive Major Medical 76.9% 53.5% 35.9% 33.5% 52.0%Percent of Charge n/a 55.0% 31.1% 91.4% n/aMedicare Supplemental 43.8% 50.9% 38.1% 18.2% 18.0%Prepaid Group Practice Plan 78.0% 49.0% 33.4% 36.8% 37.6%HSA 78.0% 47.8% n/a 6.3% 57.2%

Exhibit 6: Revenue by Product Type

ment for management to closely review can be found in the exhibits at the end of this article. The names of these exhibits are the following:1. Managed Care Company reimbursement

percentages2. Total Patient reimbursement by managed

care companies3. Patient reimbursement by managed care

companies4. Site reimbursement by managed care

companies5. Paid Revenue by Bed Station by managed

care companies6. DRG Managed Care Company compara-

tives to Medicare7. CPT Managed Care Company compara-

tives to Medicare8. Overall Summary of claims/bills/collec-

tions by managed care company

The first step towards monitoring man-aged care contract payment performance is identification of key payor relations metrics. Targeted analytics can assist management with identifying a variety of pertinent mea-sures such as: payor mix trends, collection trends, deductible triggers, variance expla-nation, and market analysis. Such capabili-ties enhance the business office’s ability to account for managed care contract behavior (collections), and assist the Managed Care management and staff in targeting specific contracts for intervention. Data should pro-vide for several tiers of drill down capabili-ties for better understanding the managed care contract markets and their penetration. Focusing on key metrics can help iden-tify managed care contract behavior which demonstrates significant deviation from baselines. Conducting “Allowed-to-Billed” (AtB) analysis will allow the hospital or phy-sician practice to provide better predictors of potential reimbursement levels, as compared to a traditional Collections-to-Billed (CtB) analysis. CtB does not provide accurate pro-jections as it is difficult to identify precise reimbursement, without having an under-standing of the various deductible amounts in many of the contracts today. Variance and

root cause analysis identify and isolate pay-ers necessitating investigation or trending. Moreover, greater aggregation and comfort with routinely available data builds familiar-ity for process control and allows for pro-active efforts in addressing and resolving managed care contract issues. Prevention of managed care contract issues yields greater revenue cycle efficiency and productivity, contributing to reduced costs and increase revenue.

Managed Care management activities should be supported by timely communica-tion from other departments. Access Man-agement, Medical Management, Patient Fi-nancial Services, affiliated physician offices, etc. data regarding contracts and their com-ponents should be communicated promptly, and through established channels to ensure timely processing and enhance the context of third party payor performance.



Activities that Validate Third Party Payer Compliance

Validating third party Payer (TPP) pay-ment compliance should be a priority for your Managed Care Contracting Depart-ment. This process begins with obtaining paid claims data for targeted payers. This data should come from payers aligned with your markets in order to establish payment

trends by service type (inpatient/outpa-tient). Understanding market data is criti-cal to establishing baselines for comparison. You should also gather other benchmarks (e.g., Medicare). Any discrepancies discov-ered during validation should be commu-nicated through appropriate channels and escalated to the Third Party Payer. To effec-tively analyze data, here are specific activities that you should engage in:• Analyze historicalVistA data - Establish

regular data push routines that rank and

trend allowable-to-billed (AtB) ratios by TPP on a monthly basis using the 835 feedback from payers. Note that this is different than a Collections-to-Billed (CtB) ratio, as the AtB ratios would allow for further drill down into specific reim-bursement variance by CPT code, DRG assignment, Non-Covered Services, etc. These ratios support the analysis of payer contracts as well as billing activity to as-sure alignment of both aspects of the pro-


dRGs % of Medicare dRG Red white Blue Green Yellow 470 Major joint replacement or reattachment 680.7% 89.1% 219.7% 138.1% 1677.0% of lower extremity w/o MCC 313 Chest pain 563.7% 194.9% 212.5% 165.1% 180.6% 392 Esophagitis, gastroent & misc 529.4% 197.1% 148.1% 59.3% 226.5% digest disorders w/o MCC 247 Perc cardiovasc proc w drug-eluting 855.5% 74.6% 139.3% 73.3% 411.5% stent w/o MCC 885 Psychoses 349.9% 48.7% 131.9% 322.9% 1509.9% 603 Cellulitis w/o MCC 405.1% 157.1% na 326.8% 138.9% 310 Cardiac arrhythmia & 755.2% 170.5% 332.1% 159.3% na conduction disorders w/o CC/MCC 312 Syncope & collapse 443.0% 160.6% 120.9% na 175.5% 303 Atherosclerosis w/o MCC 714.3% 154.1% 212.4% 147.0% na 683 Renal failure w CC 460.7% 177.9% 96.8% 152.4% na 309 Cardiac arrhythmia & conduction disorders w CC 909.9% 265.2% na 36.3% na 194 Simple pneumonia & pleurisy w CC 522.4% 44.0% na na 733.4% 395 Other digestive system diagnoses w/o CC/MCC 510.0% 64.7% 272.5% 61.4% na 292 Heart failure & shock w CC 530.5% 444.3% 226.0% 138.9% 251.5% 694 Urinary stones w/o esw lithotripsy w/o MCC 565.3% 125.2% na 110.9% 101.8% 192 Chronic obstructive pulmonary disease w/o CC/MCC 374.2% 372.8% na 134.1% 162.2% 743 Uterine & adnexa proc for 480.3% na 174.9% 120.3% na non-malignancy w/o CC/MCC 690 Kidney & urinary tract infections w/o MCC 460.6% 207.2% 221.7% na na 641 Misc Disorders of Nutrition, Metabolism, 446.5% 63.5% 194.5% 100.7% na Fluids/Electrolytes w/o MCC 897 `Alcohol/drug abuse or dependence 365.5% na 18.4% 264.1% na w/o rehabilitation therapy w/o MCC 195 Simple pneumonia & pleurisy w/o CC/MCC 737.3% na na na 52.2% 881 Depressive neuroses 847.6% na 19.1% na na 176 Pulmonary embolism w/o MCC 199.2% na 197.9% na na 440 Disorders of pancreas except 366.8% 98.6% na na na malignancy w/o CC/MCC 343 Appendectomy w/o complicated na 46.0% na na na Total for Top 25 DRGs 552.4% 159.3% 182.1% 164.4% 509.6%

Exhibit 6: Top 25 DRG Revenue as % of Medicare


Spring 2014 13

cess;• Analyze 835 data – by insurance plan and product,

review monthly collections of 835 remittance data to gauge true impact of payment history and trending. This data would also allow for detection of under-payments and over-payments by the type of service(s) rendered;

• Routinely evaluate existing contracts between payersand your organization - Contracts should be reviewed using both quantitative techniques (analyzing rates and trends) and qualitative methods (reviewing lan-guage terms and conditions) to evaluate acceptability. Staff should be trained with the knowledge and tools to review agreement language and identify unfavorable terminology such as: carve outs, reduced timely filing, silent Preferred Provider Organizations (PPOs), ambig-uous medical necessity, all products and networks clause, and benefit penalties. Contract reviews should be struc-tured and collaborative. Pertinent stakeholders (e.g., General Counsel) should have clearly defined roles and responsibilities, and review results should be standard-ized and stored in a central location for efficient access;

Establish Third Party Insurance Enterprise Payment Com-pliance Accountability Management System (PCAMS) - Implementing a structured approach to payment valida-tion will enable your organization to identify real-time payment errors for overpayments, underpayments, and no-payment. Reviews should be established on a regular basis, and adhere to a standard methodology to ensure consistency across the enterprise. It is important that payment validation occur for all payers – and not just the TPPs with contracts in place. Payments and deni-als from those TPPs with contracts should be analyzed against the established rates and terms, while payments from TPPs without contracts should be validated against billed charges.

In summary, leveraging data is critical to evaluating and managing the balance between clinical and financial information to support effective Managed Care Contract-ing. The use of dashboards to monitor key measures en-ables your organization to identify clinical and financial outliers and react quickly to potential risks. Additionally, best practices that incorporate quality outcomes and cost-effectiveness must be based on credible, holistic data. Data driven analysis also improves preparation for audits, afford-ing CFO’s the knowledge of exactly how well their hospi-tals are performing against its contracts and how its ven-dors are performing to their agreements. Effective contract management helps insure that you are meeting compliance with your contracts, which helps maintain your reputation as a preferred business partner to your vendors.

CPT Red White Blue Green Yellow99214 206.2% 146.6% 104.5% 134.9% 90.9%99213 208.5% 146.5% 102.5% 103.9% 95.5%99283 524.1% 374.2% 263.5% 270.3% 271.2%90471 567.8% 689.7% 270.4% 346.7% 256.3%88305 1165.3% 742.0% 521.9% 645.8% 545.8%99212 209.9% 146.5% 101.6% 84.5% 90.8%99284 571.0% 406.1% 288.4% 280.9% 276.2%20610 707.3% 365.7% 223.3% 420.6% 202.8%71020 583.1% 404.9% 276.7% 331.6% 226.9%96372 568.2% 401.8% 267.1% 373.5% 248.3%92012 202.5% 145.7% 102.5% 139.2% 88.1%99211 224.1% 158.7% 109.5% 175.0% 91.6%92014 208.1% 147.0% 102.5% 130.2% 92.5%99202 205.7% 144.2% 101.1% 153.3% 92.5%73630 591.3% 494.1% 289.6% 362.5% 238.1%97110 293.4% 199.8% 180.9% 186.5% 136.5%73030 592.3% 416.9% 280.2% 367.1% 233.9%92557 307.9% 214.6% 155.4% 192.0% 129.9%90853 463.8% 132.2% 333.8% 280.3% 183.1%99203 209.5% 145.7% 100.2% 133.1% 100.4%92250 423.6% 287.9% 194.7% 244.6% 167.0%97001 166.7% 131.2% 89.8% 100.3% 83.2%99201 220.0% 157.3% 111.2% 178.2% 100.0%90472 601.3% na 301.3% 337.9% 269.0%97140 222.2% 134.0% 150.8% 114.7% 81.8%Total for Top CPTs 304.9% 203.9% 146.8% 264.6% 163.3%

Exhibit 7: Top 25 CPT Revenue as a % of MedicareSummary by Top 25 Outpatient CPTs as a % of Medicare

Payors Claims Billed Coll %Red 164,182 $203M $132M 65.0%White 75,162 60M 20M 33.3%Blue 53,142 43M 12M 27.9%Green 42,702 38M 10M 26.3%Yellow 10,731 10M 3M 30.0%

Exhibit 8: Summary Comparison


Mr. Rob Borchert can be reached at 315.345.5208 Mr. Tim Borchert can be reached at 703.328.3953


PaperElectronicBy Naveen Malhotra, Ph.D.

Professor of Management & Finance, Eckerd College

and Marlieta Lassiter, CRCE-I

Compliance Auditor, Baycare Health System, member and 2nd Vice President of

the Florida Sunshine chapter

Medical records, first developed in the fifth century, have remained virtu-

ally unchanged until the explosion of new technology in the mid 1960’s. The National Space and Aeronautics Administration’s de-velopment of computerized patient record (CPR) brought life to the electronic medical record (EMR) industry. Preventable deaths due to medical errors drew the attention of public and healthcare professionals to the need for increased patient safety and im-proved quality measures in medicine. With healthcare costs compromising 16-17% of the U.S. Gross Domestic Product, Congress passed legislation to financially support pro-viders to adopt electronic medical record (EMR). As a result, future efforts will focus on the sharing of information among all healthcare stakeholders. Across the world, governments, technology companies, and care providers are collaborating efforts to make the EMR a reality.

The first known medical record was developed by Hippocrates, who envisioned two goals: a medical record should accurate-ly reflect the course of disease; and it should indicate the probable cause of disease. Dur-ing the Roman Empire several saints opened facilities to care for the orphans, sick or

crippled. Some of those names remain with us today, St. Helena, St. Basil, and St. Je-rome. Arabic invasions and comingling of cultures created a culmination of new ideas for human preservation and treatment. The Arabs were responsible for the establishment of pharmacy and chemistry as sciences. (Ly-ons, 1987).

During the 18th and 19th centuries a trend began to render care to acutely ill and etchings and paintings became the first medical records. The medical record today is a comprehensive health record, often main-tained in electronic format. Older medical personnel are struggling with the new tech-nology their younger counterparts use with ease. Electronic medical records are reshap-ing healthcare systems. It is a quiet revolu-tion that the patient doesn’t always relate to his or her care experience. World health organizations have created the foundation to improve quality and longevity of life few non-medical personnel understand.

Adoption of EMRThe introduction of the Medicare pro-

gram created a massive repository of benefi-ciary records, large processing centers, the need for electronic records, claim process-ing, and storage of beneficiary health infor-mation. The cost to store and subsequently retrieve past paper medical data became quite significant. Often, past medical re-cords were stored offsite and lack of imme-diately available data led to a delay in patient care and services.

The Kennedy administration awarded grants to private corporations to develop computer applications to manage patient

care. Engineers spent many years analyzing the operational flow of data at a pilot hospi-tal. Academic medical centers (AMCs) were among the pioneers in adopting automated health records. These early EMR projects included:• CompositeHealthCareSystem(CHCS),

the Department of Defense’s clinical care patient record system used worldwide

• De-CentralizedHospitalComputerPro-gram (DHCP), developed by the Veter-an’s Administration

In the 1990’s, the terminology changed for healthcare records from computerized patient record (CPR) to electronic medical record (EMR), and began to incorporate outpatient and ambulatory records. With the explosion of large scale communication networks, personal computers and servers, the private sector has emerged with new ways to serve the medical community.

The World Health Organization’s (WHO) began promoting healthcare policy around the world and directing interna-tional healthcare funds to disadvantaged populations and disease outbreaks. The International Classification for Diseases (ICD) program began a system to track dis-eases of the world. Following this healthcare tracking procedures the American Medical Association developed the Current Proce-dural Terminology (CPT) system in 1966 to describe surgery procedures in a numeric system similar to ICD-CM. This coding system expanded to all care categories. Addi-tional coding systems were developed to de-scribe healthcare procedures, medicines, and

to


From

The Coming Age of Electronic Medical Records:

Spring 2014 15


skilled diagnostic care. These coding systems make the medical EMR a viable analytic tool for care tracking and healthcare reim-bursement models. In addition, the codes provide medical statistics, and help track patient EMR between healthcare providers. An additional part of the Electronic Health Record or EMR was the development of the Uniform Billing system. Without auto-mated claim processing the reimbursement model could not work electronically. The Health Insurance Portability Accountability Act of 1996 (HIPAA) mandated Electronic Data Interchange (EDI) to allow for uni-form electronic billing.

Patient Safety ImperativeUntil the mid-1960’s, a patient’s medi-

cal record contained the medical and treat-ment history of the patient as a paper re-cord. There are, however, many documented disadvantages to a paper chart, such as, misplacement of key medical information, incomplete records, and expensive mainte-nance. Other common issues include the time wasted gathering a patient’s medical history, illegible handwriting, resulting in incorrect tests and studies being ordered, and thus incorrect medications being ad-ministered to the patient. In addition, cer-tain laboratory tests and diagnostic study re-sults, such as blood gases, radiology results, electrocardiogram and electroencephalo-grams results are stored in various repository systems that may or may not feed data to the patient’s legal medical record. By the time the paper copy of the valuable information is printed and placed with the paper medical record, critical medical decisions impacting patient care and safety could be based on in-complete medical history and/or data.

Physician practices and outpatient clin-ics were early adopters of the EMR. A study published by the Institute of Medicine in 1999, titled “To Err is Human”, detailing medical errors galvanized the public and health professionals in all clinical care set-tings. According to this report, up to 98,000 individuals die each year in U.S. hospitals from preventable mistakes. “Before then,

providers, healthcare organizations, and policymakers lacked the understanding and incentives to generate the changes in culture, systems, training, and technology to improve safety” (Wachter, 2004). The report highlighted, among other issues, the potential for communication problems be-tween members of the healthcare team. As the tools of medicine became more power-ful and technologically sophisticated, highly specialized teams were needed to deliver care. Often these teams included more than a dozen physicians, nurses, respiratory ther-apists, pharmacists and others contributing to deliver patient care in the shortest time and most cost efficient manner. Yet, prior to the American Recovery and Reinvest-ment Act of 2009, just 17% of physicians’ offices and 12% of hospitals has chosen to implement some kind of electronic medical records system.

Incentives to Allow Adoption The U. S. Government has pledged to

invest in new technology to promote elec-tronic medical records to reduce errors, bring down costs, ensure privacy and save lives. The 2009 Recovery Act sets aside more than $20 billion as federal incentive payments for doctors and hospitals adopting electronic medical records and demonstrating ways that can improve quality, safety and effec-tiveness of care. The National Coordinator for Health Information Technology projects that 74% of hospitals are investing in health exchange services” (Goldman, 2011). To support quality patient care, improve safety, and to qualify for the incentive payments, the EMR must be standardized and struc-tured in uniform ways so that, providers can demonstrate “meaningful use” objectives. The implementation of the electronic record must include:• Structuredtemplatesforphysiciandocu-

mentation• Electronic resulting of labs, radiology

studies and pharmacy medication dis-pensing and documentation of adminis-tration

• Acentralizeddatarepository• Clinicaldecisionrulesandalerts• Evidence based templates for computer-

ized physician order entry

The main goal of the Healthcare and Management Systems Society (HIMSS) is to improve patient safety and quality of care. It is expected that by the year 2014, 75% of all healthcare information technology systems will be utilizing optimized safety and quality improvement tools. The electronic medical record is expected to become a longitudinal electronic record of patient health informa-tion generated by one or more encounters in any care delivery setting. HIMSS states “as EMRs automate they have the ability to generate a complete record of a clinical pa-tient encounter as well as supporting other care-related activities directly or indirectly via interface, including evidence-based deci-sion support, quality management, and out-comes reporting.” The Centers for Medicare and Medicaid Services in conjunction with the U.S. National Institutes of Health have begun offering additional EMR Incentives. They require Demonstrated Meaningful Use program and treatment of Medicare and Medicaid patients mix.

EMR Cost/ Benefit PayoffPractitioners delivering services to pa-

tients understand the need for electronic management of knowledge and discipline for collecting and organizing data. Align-ment of information technology with the strategic business decisions of a medical facility are now viewed as a necessary cost of doing business. Earlier, nobody wanted to pay for information exchange, but now there is general acceptance to exchange in-formation and coordinate care because the business rationale demands it (Goldman, 2011). Various Stakeholders, including pa-tients, families, healthcare providers, em-ployers, insurance payers, including the gov-ernment, recognize the increased efficiency and effectiveness of an EMR, and realize the competitive advantage associated with it.

A recent American Hospital Associa-tion survey found that the median annual capital investment on Information Technol-ogy was over $700,000 and represented 15



Spring 2014 17

percent of all capital expenses. Those entities with more advanced systems, the implemen-tation of the EMR across the entire network cost upwards of a $1billion.

Barriers to AdoptionIn the hospital environment, one of the

greatest deterrents to adoption of an elec-tronic record is the lack of interface with other existing systems that collect and report patient care data. Vishwanath & Scamura, (2007) identified core barriers to be stan-dardization and inoperability in addition to technical and cost/benefit issues. Other ob-stacles include reluctance by some patients to believe that electronic medical records are more secure than paper records. Nonethe-less, it appears that the push to encourage EMR use is here to stay. Eligible profession-als who have not already adopted EMRs should begin to take advantage of the finan-cial incentives (Millsaps & Gotleib, 2011). HIPAA mandates security and privacy of protected health data as well as improved efficiency and effectiveness of the nation’s health care system by encouraging the wide-spread use of electronic data interchange. EMR systems provide enormous potential to share, analyze and present data in ways that were never possible before. These ben-efits will not be reached until the system designers understand how clinicians work and think. Most of the technical people working in design have training based in the financial world and are trying to use para-digms that do not sufficiently enhance clini-cian efficiency. As the systems improve the ability to draw data from multiple sources and present it to the clinicians in new ways the benefits can be exponential. However there is also the risks that poorly designed systems will impose unnecessary burdens on clinicians, degrade their performance and distract them from patient care.

Future ImplicationsEMR’s are application environments

composed of the clinical data repositories, clinical decision support, controlled medi-cal vocabulary, order entry, computerized

provider order entry, pharmacy, and clinical documentation applications. This environ-ment supports the patient’s electronic medi-cal record across inpatient and outpatient environments, and is used by healthcare practitioners to document, monitor, and manage health care delivery within a care de-livery organization (CDO). The data in the EMR is the legal record of what happened to the patient during their encounter at the CDO. Leveraging technology such as the Continuity of Care document allows the pa-tient and healthcare providers access to med-ical information that spans episodes of care.

The goals of Hippocrates are still ap-propriate. The medical record should not only reflect the course and cause of the dis-ease, but electronic medical records systems should also provide additional functionality. Interactive alerts to clinicians when order-ing tests, studies and medications can re-duce medical errors. Interactive flow sheets, capturing up to the minute monitoring of blood pressures and heart rates can reduce delays in treatment. Continuing the goal to make processes digital and connected, and delivering these capabilities to the health-care organizations will further improve the quality, safety and efficiency of health care.

Currently, most clinicians and hos-pitals are at “the end of the beginning” of electronic medical record implementation. As the systems mature clinical users become involved in the design and implementation. These improvements will allow data collec-tion to become a by-product of the pro-cess-administration of medication which, in turn, can be integrated with billing, in-

ventory, and the electronic medication ad-ministration record. The goal of supporting a robust exchange of information among stakeholders in the medical community seems to be on track.

Massive mainframe integrated com-puter systems, PC tablets, hand held PC’s, and mobile smart phone applications are all creating additional layers of EMR in-formation. Networking technology and in-frastructures are changing rapidly to adapt additional data pathways. Today, there are over 40,000 medical applications available for smart-phone downloads and tablets; the U.S. Food and Drug Administration regu-lates the mobile device industry along with other government agencies, and the sheer volume of device applications is creating a backlog. The technology revolution has changed healthcare systems across the world and our lives in ways we may not even com-prehend. The EMR is a reality embraced by government hospitals, healthcare providers, patients, and families. Today, patients can have a prescription printed in the doctor’s office, receive a condensed printed copy of medical record for travel purposes, load health information on their smart phone, and access their medical records on the in-ternet. Patient access to the electronic health record / EMR is creating a new level and dimension to healthcare. Yesterday’s science fiction is certainly a partial reality today. n

Ms. Lassiter can be reached at [email protected] and Dr. Malhotra can be reached at [email protected]


By Sheryl Roush, President/CEOSparkle Presentations, Inc.

With the constant changes going on in healthcare, policies, legislation,

mergers, doing more with less, extra work, tighter deadlines, how is your mental state? What is your revenue cycle attitude? Are you shriveling or blooming?

That mental state, our attitude makes the major difference in handling our daily chal-lenges, short-term and long-term situations. It’s not the event, but how we handle it!

I greatly appreciate the services AA-HAM members provide. My father passed away the first week in January. I had been his primary caregiver, coordinating hospital visits, Hospice care, then writing his obitu-ary, the celebration of life services program and making the arrangements, not to men-

tion tending his huge organic garden in San Diego. Now, with my mother’s Stage 3 lung cancer diagnosis recently, I am now handling her needs plus all of the estate, too. Address-ing our own mortality is never easy and es-pecially that of losing our cherished parents. Sure, there are tougher days than others emotionally, and stronger days than others. Attitude is a choice. And there’s five types of attitudes from which we can “choose.”Optimist: The Can-Do attitude; let’s make

things happenPragmatist: More realistic and practical. (A

safe balance for most professionals today.)Pessimist: Looks for what could go wrong. Negativist: Focused only the bad, and cre-

ates it to happen (even unknowingly). Also known as the “Gloom n’ Doom-er” or “Debbie Downer”, and tend to be chronic complainers.

Apathetic: Has already given up, and may

have an “it’s no use” or “victim” attitude.The good news is you can “upgrade”

to a positive outlook anytime! We can also add a third alternative to the mix. Instead of things being only good or bad, there is also neutral’, where “it just is.” This option is helping me handle the rapid changes in my personal life, which also affects my profes-sional life. And just like you, we need to be able to do our jobs; provide stellar service, touch lives in significant ways and keep our balance (or sanity) through it all.

A great lesson I learned from my Dad, we’ll all “expire” someday, just like the buds on the rose bush. It’s how we “bloom” and spread the joy to others while we’re here. I hope you choose to bloom! n

Hear Sheryl Roush at the Thursday keynote session at the ANI. For more information, visit www.SherylRoush.com

Are YouBlooming?


Spring 2014 19

With highly informative session tracks, AAHAM’s 2014 ANI promises real-world solutions you can put into use immediately at your facility.

Mark you calendar now and put the ANI in your budget. Join us in beautiful San Diego, California and get ready to “Sail into Revenue Cycle Success.”

October 15-17, 2014October 15-17, 2014Manchester Grand Hyatt, San Diego, California

2014 AAHAM ANI2014 AAHAM ANI


By Steven AbramsonMarketing Manager, ChapCare

and Everett Lebherz

Vice President, PointCare

With one out of every three uninsured Americans, approximately 13 to 16

million people, Medicaid-eligible and still able to enroll in programs past the ACA Open Enrollment deadline, smart providers know the enrollment effort is far from over. For hospitals and Federally Qualified Health Centers (FQHC’s), not leaving patients un-insured and federal dollars on the table is an advantageous move. For the approximate 3,000 FQHC’s on the front line for ACA enrollments, it’s clear that these centers (as well as hospital emergency departments) will need to continue to provide care for the underserved population, whether insured or not, after the ACA deadline. It’s also clear that this population utilizes the lion’s share of the country’s urgent and non-urgent care services.

This article explores optimal strategies for those providers who have been chal-lenged in their ability to sign patients up for insurance. These strategies include the need to consider how the technology marketplace has met the challenge by providing a num-ber of software products that can vastly im-prove hard-to-capture data from this often transient population. Beyond technology, one strategy that will be discussed is the incorporation of enrollment operations in both the admissions process, as well as part of community outreach.

The Process of Screening & Enrollment

In addition to the many glitches, delays, and general confusion surrounding the ACA enrollment process, many hospital ERs and community clinics have struggled with the added burden of not just treating patients but also qualifying them for coverage. The task of data gathering and tracking simply adds to the overall enrollment challenge. A number of providers have been able to em-brace this new responsibility and take advan-tage of the federal economic incentives, as well as new enrollment technologies.

One success story is that of the Com-munity Health Alliance of Pasadena (Chap-Care). ChapCare is based on a five-clinic system, which utilizes enrollment technolo-gy to get patients screened and enrolled. The organization provides more than 58,000 medical, dental, and behavioral health vis-its annually. With a goal to enroll 20% of those uninsured but Medicaid-eligible in the communities it serves, ChapCare has been relying on taking portable technology out into the community to qualify and en-roll the local population.

During Open Enrollment, ChapCare’s staff screened thousands in its San Gabriel Valley community for insurance eligibility by using a cloud based software known as PointCarePA. The software’s tool, which in-cludes a 90-second, five-step questionnaire about basic patient household and personal information, gave ChapCare staff the ability to screen uninsured patients for every avail-able state, county, and federal health cover-age program and centralize all of the data that was being collected. Screenings cre-

ated a unique patient record and provided a list of coverage programs personalized to the patient’s situation. From there, staff was able to initiate, manage, and complete the patient’s coverage enrollment. Meanwhile, ChapCare Managers were able to track the screening data across multiple sites and events through a user-friendly reporting dashboard and ensure process consistency and that goals were being met.

The enrollment statistics and positive community feedback generated by Chap-Care’s outreach efforts have been eye-open-ing. Through community events, along with a walk-in-friendly enrollment retail shop in downtown Pasadena, ChapCare consistent-ly screened and enrolled an average of 300 people per month. The organization held 11 outreach events, screening 458 patients and producing a remarkable 81% insurance conversion rate. ChapCare also used the tool at point-of-care at their enrollment shop, where they have enrolled 1,212 patients.

In addition to the mobile screening software, ChapCare collected and stored verification documents and status informa-tion on a HIPAA-compliant, cloud-based environment, which was accessible from any device with internet access. This helped to create efficiency throughout its 5 locations and various enrollment events.

The most valuable element of many of the software programs that have stepped up to the plate to assist providers with meet-ing ACA challenges is the ability to simplify what can often be a chaotic process. Simple changes, such as being able to replace a manual Excel-based screening process that

Mission Still to Be Accomplished:

America’sUninsured

Enrolling


Spring 2014 21



relies heavily on staff’s personal knowledge of coverage programs with a tool that screens patients in 90-seconds and always presents up-to-date coverage information, can posi-tively shift providers’ focus to enrollment follow-up and patient retention.

In ChapCare’s San Gabriel Valley health care market, it is estimated that more than 250,000 people are eligible for Medic-aid programs. With this large of a popula-tion, it is necessary to generate time-saving, efficient programs with easy-to-use technol-ogy. It is highly unlikely that traditional outreach methods can stand alone in ensur-ing coverage for this large of a population; from a cost and administrative standpoint, it would simply take up too much time and too many staff members. With that in mind, another strategy to consider is consumer-driven health coverage identification, where community members can go online, screen themselves for coverage, and be assured with confidence that a reliable provider who has their best interests at heart will follow-up to assist with enrollment. ChapCare, along with a five Los Angeles based health plans and community centers, have created a cen-tralized database to allow for just that.

Community Outreach & Operation Strategies

With the idea that it’s easier to go to the public when they are healthy than try to extract data from them when they are sick, ChapCare assigned clinic workers to go out into the streets daily with laptops and tab-lets. Armed with the previously mentioned portable screening technology, ChapCare workers attended community events, in-cluding concerts, PTA meetings, and soccer games, to educate and screen potential pa-tients. Additionally, the team invested in a portable printer to provide instant access to hard copy materials needed to enroll.

Another value in this kind of proactive approach is that patients are more willing to come to the clinic before a problem becomes acute when they know they have coverage.

Operationally, additional strategies that providers may consider to ensure better communication with these at-risk popula-tions are:1. Expanding community-based and

highly-localized enrollment events, such as health fairs, booths at local events, and coordination with local employers,

2. Using technology to provide outreach teams and navigators with tools to aid

people in the field before they come into a clinic or hospital,

3. Ensuring consistent follow-up and tracking of patients to show when they enroll and when to provide additional assistance,

4. Utilizing technology that records out-reach efforts and provides reports for necessary tracking and grant evalua-tions and reporting,

5. And partnering with health plans and other organizations to work together on outreach and technology efforts.Open enrollment for each state’s Ex-

change has closed, but Medicaid-eligibility and enrollment is available all year around. Now is the time for providers to implement new strategies and make use of available technology to create consistent screening and enrollment processes to aid the sizable Medicaid-eligible population. Drawing on what proved successful during this first ACA Open Enrollment, providers have the abil-ity to not only improve the lives of patients in their community, but also increase their own financial stability. n

Mr. Abramson can be reached at [email protected] and Mr. Lebherz can be reached at [email protected]

CRCS–I - Certified Revenue Cycle Specialist – Institutional

CRCS–P - Certified Revenue Cycle Specialist – Professional

AAHAM certifications can give you a powerful competitive advantage with employers. Certifications demonstrate that you have mastered the common body of knowledge for your profession. AAHAM Study Manuals will help assist you in preparing for AAHAM certification programs. These manuals are the gateway to studying for and passing these exams. The manuals include review questions and study tips.

Log on to www.aaham.org for more information and to order your Exam Study Manual today!


By Frank KeckCertified Speaking ProfessionalPresident of Excellerant, Inc.

We were introduced to the concept of “the force” in the Star Wars movies.

In these movies, the force was an invisible element that could see the unseen and know things that mere mortals could not know. Here are some ways of using the force to be more clairvoyant. Clairvoyant means gain-ing clarity beyond the normal range of vi-sion. In short, using the “force.”

Imagine being able to read your em-ployees minds to get a better understand-ing of what is going on with them and how you can help them move forward. Imagine spending less time and effort to truly under-stand these people, who at times seem like they are from another galaxy, far, far away.

The first part of being clairvoyant is to put yourself aside. You see, humans have this natural tendency to view things through our own filters, which include our own emotions, perspectives, and many other things. Focus on the other person. Who are they? What drives them? Why do they make those decisions? What is it that is important to them? How do they filter things? What emotions are they feeling right now? What is it that they want? How can you help them to get there?

Two of my favorite quotes are: “You can get anything you want in

life by helping other people get what they want.”

Zig Ziglar And “If two people agree on every-

thing, one of them isn’t necessary”William Wrigley

I love Zig’s quote because I have found it to be true. When you help other people achieve what they want in life, they work much harder to help you achieve what you want. People help those who help them. Take that approach. Help them get what they want. You will be amazed at how much initiative they will then take to help you get what you want. Be sincere; fakery will be detrimental and very painful to you both.

To do this, you have to know what they want. Then, show them how doing what you need them to do, will help them to get what they want. A woman once taught me this valuable lesson. On a regular basis, she would say, “Frank, it’s not about you.” After hearing this for the umpteenth time, I finally asked her, “so who is it about?” Her answer, “me.” While her delivery was a little painful, her point was certainly one worth repeating. If you want to be prosperous in what you do, it must be about the other person.

Let’s keep this simple; in order to serve more people, you must be able to see things from their perspective.

Your perspective is determined by what your priorities are at that moment. If you know what is important to someone, you can better communicate with him or her, by switching from your hat to that person’s hat. Make it about them. Let them know how your suggestion will help them reach their goals and aspirations and their current pri-orities.

In order to put on their hat, you need to know which hat they are wearing. Keep in mind; this is only the tip of the iceberg. There are four basic hats: the Social, the Driver, the Lover, and the Thinker. Each hat has different perspectives, different priori-ties, and is useful in different situations. The hat rack is designed to help you select the

right hat for the right occasion, so you can always make it about the other person and you both become more prosperous. Get out there and practice switching your hats!

The second quote tells me that most people are going to disagree and that’s a good thing. Don’t expect them to see things from your perspective. Make an effort to see things from their perspective. You might be surprised what you learn about them, and about the subject you are talking about.

In order to know this information, an-swer these questions:1. What is important to them?2. What is most important to them?3. What is not important to them?4. What do they want? (A want is some-

thing that will most likely make your life better. If you don’t have it, your life will still be good.)

5. What do they need? (A need is some-thing you must have to be fulfilled.)

6. What do they desire? (A desire is some-thing you dream about, a very strong wish.)

7. Where are they coming from?8. How did they arrive at their point of

view?9. What things or people have influenced

them in the past?10. How can I help them to fulfill #4, 5 or

6?

When you know someone to the point that you understand the person, then, and only then, can you truly persuade that per-son to open their mind to change. Only then do you have a chance to convert him/her to your perspective.

Use theForce



What do you need to understand your employees better? Why don’t you under-stand them now? Is it skill (or lack of ) or is

it will? Do you not know how to understand them or do you not want to make the effort?

People are simple, not easy, just simple. First make the effort to understand them then to be understood yourself. With un-derstanding comes conversion!

Remember, it’s not about you. It’s about them, make it so. n

Mr. Keck can be reached at 816.399.5325 and [email protected]

Spring 2014 25


By Heather Eavers, CRCS-I, PReimbursement Analyst/Charge

Master Specialist, Augusta Health, member of the Virginia chapter

Working hard without setting goals can leave you feeling like a wheel

spinning to nowhere. Goal setting allows you to motivate yourself and decide what you are going to achieve. Your goals can ei-ther be long term goals or short term goals. Either will allow you to focus and organize yourself to make the best of yourself.

First, create a big picture of what you want to accomplish and then set smaller

target goals that will help you achieve this. When setting goals be realistic and specific. This will ensure you are able to stick to your plan. Allow yourself time to achieve your goal. Not all goals can be accomplished overnight. Commit to your goal and don’t get discouraged along the way. If you have more than one goal, be sure to prioritize your goals so that you don’t end up feeling overwhelmed. However, do set deadlines for your goals. This will give you something to work towards.

Even the accomplishment of a minor goal is cause for celebration. Don’t get hung-up with thoughts about all you still have to do. Then move on to the next milestone. A

useful way of making goals more powerful is to use the SMART mnemonic. SMART stands for:S – Specific (or Significant).M – Measurable (or Meaningful).A – Attainable (or Action-Oriented).R – Relevant (or Rewarding).T – Time-bound (or Trackable).

You can be successful in 2014, just set a goal!

“People with goals succeed because they know where they are going” Earl Nightin-gale. n

Ms. Evers can be reached at 540.332.4632 and [email protected]

SettingGoals

Spring 2014 27

Q: How long have you been a national member?

A: 18 years

Q: How did you get where you are today professionally?

A: Honestly it was by accident. My en-trance into healthcare was not planned but has certainly turned into a very en-joyable and rewarding career. I stared as a hospital credit manager almost thirty years ago. Along the way, I was very for-tunate to work in billing, patient access, information systems and finance. This provided me with invaluable experi-ence to piece together the revenue cycle process. Most of all I have worked with some very talented people who have been great mentors.

Q: What made you decide to become certi-fied?

A: Becoming a certified member was an easy decision. I knew I wanted to excel in the industry and achieving the status of CRCE-I (formerly CPAM) was a great way to achieve peer recognition. Certi-fication acts as a great measuring stick that everyone can look to as a level of knowledge and experience. I encourage everyone who is not certified to pick the level of certification that best fits their current skills and take the test. Trust me; you will be better for having done so.

Q: What advice do you have for members that want to move up in their current healthcare careers?

A: Learn as much as you can about what you do and what affects what you do. So, if you are in charge of billing, collec-tions or the entire accounts receivable, learn more about those departments and processes that have an impact on your performance. Interact with those other

department directors and managers be-cause what they do plays an important role in your ultimate success. Most of all, work well with people and manage and understand your data well.

Q: What is your spouse’s name and occupa-tion?

A: Denise is a surgical scheduler for a group of eye doctors

Q: What are your children(s) names, ages and occupations?

A: Madison is 15 years old and a high school freshman and Evan is 12 years old and is a middle school 7th grader

Q: What was the last book you read? A: I am very much an old fashion newspa-

per reader and I love the Sunday New York Times. History and current events are enjoyable for me.

Q: What is your favorite movie? A: The Godfather

Q: What is your indulgence? A: I love cakes and baked goods. Hence my

portly profile.

Q: What was your first job? A: I was a paperboy when I was 11. My

first job with tax deductions was an after school job at J C Penney.

Q: What did you have for breakfast today? A: Whole grain toast with peanut butter

Q: Where did you spend your last vacation? A: As a family we love to travel. Our last

vacation was to Atlantis (Nassau, Baha-mas) which we have been to a number of times.

Q: What do you never leave home without

when you travel? A: I am a firm believer you can always buy

what you need when you get there. Go-ing on a trip I can be packed in five minutes. Really, how much do you need when you are going to the islands?

Q: I still can’t quite get the hang of....where has all the time gone?

A: You know life moves so quickly and I feel I am missing out on so much. Guess you can’t do it all but it would be fun trying.

Q: What is your favorite way to celebrate after you’ve completed a demanding project?

A: Small celebrations are good. I can be happy doing a variety of things but mostly it is just an inner feeling that something went well, or we were suc-cessful.

Q: Name something about you that most people don’t know.

A: We’re not releasing any secrets here. Maybe most don’t know I love being out on the ocean in my boat. Very peaceful and relaxing.

Q: What do you know now that you wish you’d known when you were younger?

A: That list is far too long but in short “keep your friends close and your en-emies closer”. There are not too many true friends. Cherish those who are truly friends.

Q: The world would be a better place if only....

A: We didn’t lose sight of our core values. The simple things in life are really the best. It’s not that complicated. n

meet a committee chair

Roger Poremsky, CRCE-IMembership Chair


We are pleased to announce that any-one who held a CPAM/CCAM has

now received a new certificate representing their new designations, CRCE-I (Certified Revenue Cycle Executive-Institutional) or CRCE-P (Certified Revenue Cycle Exec-utive-Professional). New pins were also mailed reflecting the new designations. Expiration dates were added to the certifi-cates, however, after some feedback, it has been decided when the certificates are reis-sued at the end of this certification cycle,

December 31, 2015; they will not have an expiration date printed on them. Anyone who held a valid CPAT/CCAT received a new certificate representing their new desig-nations, CRCS-I (Certified Revenue Cycle Specialist-Institutional) or CRCS-P (Certi-fied Revenue Cycle Specialist-Professional).

We had fourteen members earn their CRCP (Certified Revenue Cycle Profes-sional) designation during the first offering of this new exam, in February 2014. We now officially have twelve CRCP-I and two new CRCP-P certificants. We are sure we will add many more to this list as the year goes on. May exams are taking place as this article is being written.

CCT Renewal using CEUsBeginning June 1, 2014, you now have

the option to retain your Certified Com-pliance Technician (CCT) certification by meeting a CEU and membership require-ment. Originally, the CCT Certification required a retake every three years. The Executive Committee and the Certifica-tion Committee have determined this is no longer necessary if continued education and membership requirements are met.

In order to qualify for recertification, you must:1. Be a national member in good standing2. Submit 20 hours of continuing education

units (CEUs) during a three year period (Half of those credits must be AAHAM sponsored events)

If you are dual certified; CCT and CRCE/CRCP/CRCS; The CEUs you sub-mit for those certifications may also be used toward your CCT CEUs.

We have a few CCTs that will be expir-ing after June 1, 2014. If you are able to sub-

mit your 20 CEUs for recertification prior to your expiration date, you will be eligible for this new program. If not, you will need to retest.

In order to qualify to use this program, you must become a national member within the year of your earned certification date. We will be waiving that requirement for anyone with a 2015 or 2016 expire date; they will need to join as a national member by December 31, 2014.

Just as a reminder, we now offer all of our certification exams four times a year; February, May, August and November. Au-gust is the next exam period; the deadline to sign up is June 2, 2014.

from the desk of the certification director

Maria LeDoux, CAE

New AAHAM Designations

2014 AAHAM Certification Calendar

June 2, 2014Registration deadline for August certification exams

August 11-22, 2014Certification exam period

September 2, 2014Registration deadline for

November certification exams

November 10-21, 2014Certification exam period

December 1, 2014Registration deadline for

February 2015 exams

Welcome new CRCPs:Lisa Bressett, CRCP-I, Mid York chapter

Roberta Collins, CRCP-P, Gopher chapter

Dolores Dunn, CRCP-I, Connecticut chapter

Debra Ferguson, CRCP-I, Maryland chapter

Rosie Hartmann, CRCP-I, Inland Empire chapter

Joshua Johnson, CRCP-I, Illinois chapter

Kristin Kane, CRCP-I, New Jersey chapter

Susan Klokis, CRCP-I, Keystone chapter

Deb Myers, CRCP-P, Pinetree chapter

Dawn Savenelli, CRCP-I, Connecticut chapter

Kelly Tressler, CRCP-I, Keystone chapter

Frank Trillas, CRCP-I, Florida Sunshine chapter

Katy Vos, CRCP-I, Gopher chapter

Ozzie Walker, CRCP-I, Maryland chapter

Spring 2014 29

CRCE CEUsThe new two year reporting cycle began

on January 1, 2014 and will run through December 31, 2015. Make sure you submit your paperwork for the required number of CEUs to maintain your AAHAM CRCE certification.

CRCE certificants are required to earn 40 CEUs over the 2 year period (20 of those must come from AAHAM sponsored events). AAHAM national membership must also be maintained in order to keep your CRCE designation.

You can find out how many CEUs we have recorded for you by going to The AA-HAM website and clicking the re-certific-aiton under the certification tab. Click on the link and then enter your last name and AAHAM Member ID# (it’s printed on your membership card).

CRCP CEUsThe two year reporting cycle began on

January 1, 2014 and will run through De-cember 31, 2015. Make sure you submit your paperwork for the required number of CEUs to maintain your AAHAM CRCP certification. CRCP certificants are required to earn 30 CEUs over the 2 year period (15 of those must come from AAHAM spon-sored events). AAHAM national member-ship must also be maintained in order to keep your CRCP designation.

You can find out how many CEUs we have recorded for you by going to The AA-HAM website and clicking the re-certific-aiton under the certification tab. Click on the link and then enter your last name and AAHAM Member ID# (it’s printed on your membership card).

CRCS CEUsCRCS examinees can maintain their

certification with CEUs by joining as a na-tional member of AAHAM rather than re-testing every three years. They also have the

option of testing every three years for those that opt not to join AAHAM at the Nation-al level. National members are required to earn 30 CEUs in the 3 year period (15 of those must come from AAHAM sponsored events) and maintain national membership in order to keep their technical certification.

You can find out how many CEUs we have recorded for you by going to www.aaham.org and clicking the re-certificaiton under the certification tab. You will need to enter your last name and AAHAM Member ID# (it’s printed on your membership card).

The recertification contact for all cer-tifications is Amanda Leibert, Certification Manager, [email protected]. You can download a CEU reporting form from the AAHAM website. Submit your CEUs by mailing the completed form to:

AAHAM CEUs11240 Waples Mill Rd Suite 200Fairfax, VA 22030 n

from the desk of the certification director

Continuing Education Units

CRCE–I Certified Revenue Cycle Executive – Institutional

CRCE–P Certified Revenue Cycle Executive – Professional

Certification opens the door to the possibility of career advancement. Earning an AAHAM certification demonstrates that you have mastered the common body of knowledge for your profession. Sitting for these exams requires commitment and dedication. The CRCE–I,P Exam Study Manual will help assist you in preparing for the CRCE–I,P Exams.

Written by AAHAM, for AAHAM’s own certifica-tion programs ensures that this manual is thegateway to studying for and passing these professional exams. Included in the manual are chapter review questions and study tips. Log on to www.aaham.org for more information and to order your Exam Study Manual today!


I knew when I was asked to take on the chair position for the new Certified Rev-

enue Cycle Professional (CRCP) that I must be ready for challenges that lay ahead. Be-cause the CRCP is the newest level of cer-tification that AAHAM offers to healthcare professionals and members, it is imperative we provide the very best in education and training materials. AAHAM wants everyone to be successful in their career paths and we want to help you strive to get there.

I am excited to announce that during our last certification exam period, we had a 42% pass rate and 14 individuals successful-ly passed the inaugural CRCP exam! What a wonderful stepping stone to take in one’s career and AAHAM is pleased we are able to

offer that very important step as part of our certification program.

So what has the CRCP committee been up to lately? Well, here are just some of the items we have tackled:• The committee reviewed sections of the

Certified Revenue Integrity Professional (CRIP) manual for edits and formatting. We plan on launching the exam at this year’s ANI.

• Wecontinuetoholdmonthlycommitteemeetings so that we can stay on top of the certification program and to ensure that we continue the forward direction that we are heading in

• Thecommitteeispresentlyintheprocessof developing additional CRIP test ques-

tions based on sections of the manual • A review of the CRIPmanual was per-

formed and the committee has deter-mined that the following four sections will encompass the exam:

1. Overall Review of Charge Capture2. Ancillary Services3. Surgical Services and Procedures4. Recurring Outpatients and Clinical

Services• We will be distributing information on

the CRCP and CRIP certifications on so-cial media sites (be sure to “like us” and “follow us” on Facebook, so you can get the latest updates.

• Certification articles have been writtenfor several chapter newsletters (let me know if you’d like one for your chapter too)

• Respondedtoemailsfromindividualsin-terested in the various types of certifica-tion exams

• Wecontinuetoblogaboutallthecertifi-cations that AAHAM has to offer.

During this next quarter, our goal is to develop the CRIP exam in our exam soft-ware. This is a time consuming process as each question needs to be placed in the vari-ous sections that have been created. Then the questions have to be placed in the test-ing application process.

I would like to take a moment to thank my wonderful committee and national staff; they are all very active and helpful in every aspect of the CRCP certification level.

Should you have any questions related to the CRCP exam, or the new CRIP exam coming in February 2015, don’t hesitate to contact me. I can be reached at [email protected]. n

CRCP certification corner

Brenda Chambers, CRCE-I,PTechnical Certification Chair

Certified Revenue Cycle Professional

Spring 2014 31

CRCE certification corner

Becoming a Certified Revenue Cycle Ex-ecutive (CRCE) through AAHAM can

provide many opportunities for growth in your professional career. Those opportuni-ties may include:• Promotion• Increasedwages• Recognitionofyourrevenuecycleknowl-

edge• Competitiveedgeonyourresumeandin

future job prospects

With the changes implemented in Oc-tober of 2013 to AAHAM’s certification

program, there are additional options and opportunities for a wider range of indi-viduals within the healthcare revenue cycle realm.

The CRCE certification is focused on assisting executive leaders in developing and demonstrating healthcare operational knowledge and critical thinking manage-ment skills. As each of you are aware, critical thinking skills are crucial in today’s health-care environment because of the constantly changing government regulations and payer requirements. Additionally, these skills are essential to ensure increased cash flow, com-

pliant claim billing, complete and accurate registration, and compliant and effective collection practices.

The CRCE certification exam is com-plex, but there are many tools available to help. Links to these tools can be found online under the right navigation headings ‘Order Study Materials Online’ or ‘Print-able Study Materials Form’ at http://www.aaham.org/Certification/CRCE.aspx.

There are many out there willing to help you succeed in your certification…don’t forget to reach out to us! n

Certification through AAHAM is AWESOME!

By Erin Selin, CRCE-I,CCT

CRCS certification corner

Our committee has been hard at work updating the Certified Compliance

Technician (CCT) Exam Study Manual and exam. We are also excited to roll out a new recertification policy for CCTs. Start-ing June 1, 2014, it will not be necessary to re-take the exam every three years if con-tinuing education and membership require-ments are met.

In order to qualify for recertification, you must:1. Be a national member in good standing2. Submit 20 hours of continuing education

units (CEUs) during a three year period

(half of those credits must be AAHAM sponsored events)

If you are dual certified; CCT and CRCE/CRCP/CRCS; The CEUs you sub-mit for those certifications may also be used toward your CCT CEUs.

We have a few CCTs that will be expir-ing after June 1, 2014. If you are able to sub-mit your 20 CEUs for recertification prior to your expiration date, you will be eligible for this new program. If not, you will need to retest.

In order to qualify to use this program,

you must become a national member within the year of your earned certification date. We will be waiving that requirement for anyone with a 2015 or 2016 expiration date; they will need to join as a national member by December 31, 2014.

Of course, the option to not join and re-test every three years is still available. Any questions regarding this change to your CCT certification can be directed to the Na-tional office. n

Certified Revenue Cycle Specialist

By Doris Dickey, CRCE-I


from the desk of the membership director

Welcome New Members

Moayad ZahralddinAAHAM

Membership Director

Aksarben Chapter Joan Malouf

Referred By: Ronald Pick

Carolina Chapter Valorie Culp Joann Dineen, CRCS-I Kimberly Heafner, CRCS-I Joe Karl William Okello Donna Schmidt Inez Schwarzenegger, CRCS-I Michelle Snow, CRCS-I Carolyn White

Referred By: Monique Christian, CRCE-P

Chennai ChapterMala Dhillon

Referred By: Kathi Athey

Connecticut Chapter Laurie Hart Sheila Murray, CRCS-I

Evergreen ChapterJessica Johnson

Florida Sunshine ChapterNazeera Amiruddin, CRCS-P

Santana Ashenfelter, CRCS-I Stephanie Beach, CRCS-I

Referred By: Karen Kennedy, CRCE-ISashah Damier Yamilee Derosena Lisa Dreger Judy Duba, CRCS-I Donna Fahd, CRCS-I Rick Jeronimus

Referred By: Victoria Di Tomasso, CRCE-I

Joe Karl Kathleen Lesch, CRCS-P Tonya Mallard Barbara Manning, CRCS-P Mark Mayes Danielle Nipitella, CRCS-I Darlene M. Shank, CRCS-P LaTrisha Starkes Carla Stillwell, CRCS-I

Referred By: Karen Kennedy, CRCE-INadia Vargas

Georgia Chapter Mark Mayes Nanci Watkins Gopher Chapter

Doreen Carroll, CRCS-I, PReferred By: Kathi Hoops

Tricia Hanevik Julie May

Referred By: Sandra Pawelk, CRCE-I, PDan Peterson

Referred By: Susan HoelNissa Pierre-Toussaint

Referred By: Sandra Pawelk, CRCE-I, PRebecca Thompson Catherine Weedman, CRCS-I

Hawkeye Chapter Kelly Coles Lori Iversen Kate Nagl - Referred By: Becky Venner

Hawthorn ChapterDonald Tapella

Referred By: RebeccaKinsella Jennifer White

Illinois ChapterSandra CollinsMelody Cowolrey

Referred By: Nancy VollmarNichole Grant

Thank you for maintaining your membership in AAHAM, in these competitive and challenging econom-ic times, it is more important than ever to maintain your membership. Becoming certified or maintain-

ing your current certification demonstrates your knowledge and proficiency to any potential employers. The unique networking opportunities AAHAM provides can help you gain an edge by keeping up-to-date on the most recent developments and opportunities in your area.

I would like to welcome all of our new members. Don’t forget to check out the member’s only section of the recently redesigned AAHAM website. We have valuable information there to help you both professionally and personally. Some of the information includes AAHAM’s Information Central, membership directory, Legislative Action Center, Journal archives, member’s only listserve, and archives of prior years’ ANI presen-tations and webinars. We have added many new member affinity programs from companies including UPS, Hewlett Packard, GoToMyPC, GoToMeeting, Lenovo, and Office Max, to name a few. You can also find out more in the member services brochure, which is available to be downloaded from the member’s only section of the AAHAM website. If you have any questions about these or any of our other member benefits, please feel free to contact me at [email protected].

Don’t forget! AAHAM offers scholarship opportunities for our members and children of our members. We have updated the requirements and application for 2014. You may download the application from the home page of the AAHAM website at www.aaham.org. The application deadline is May 31, 2014.

Thank you for letting me serve you, and I hope to see you all in San Diego for the ANI! Moayad Zahralddin, AAHAM Membership Director


Spring 2014 33

from the desk of the membership director

Shari Loyd, CRCS-P David M. Pareja

Referred By: Alam StaidlLorna Schindler Pat Schneider

Referred By: John McGlassonChristene Willis

Referred By: Doris Dickey, CRCE-I

Inland Empire ChapterAbbagail Bollman

Referred By: Kathy SargentNadine Middleton Margarita Munoz-Costello, CRCS-I, P, CCT

Keystone ChapterKatie Ciprietti Tiffany Diehl Christine Rowe

Maryland ChapterAlicia Brittner, CRCS-I

Referred By: Mike Motsay, CRCE-IKim Cobb-Jimenez, CRCS-I Janace Ferguson Mike Gentine Jennifer Harman Marcelle Hodges, CRCS-I Amanda Hoffman

Referred By: Samuel HarrisElizabeth Huff-Meeks Hollie Miller Ronda Potocki Rudolph Rhoades

Referred By: Martin WoodallMatthew Robison, CRCS-I

Referred By: Mike Motsay, CRCE-ILeslie Shackelford, CRCS-I Denise Stevens

Referred By: Charles Poggioli, CRCE-IMegan Wines Martin Woodall, CRCS-I

Michigan Chapter Stacey Babut Inda Iljazovic Joe Karl Carrie Nurenberg

Mid- York Chapter Michael Cook

Music City ChapterRick Jeronimus

Referred By: Victoria Di Tomasso, CRCE-I

Joe Karl

New Jersey Chapter Max Bellmann Katie Ciprietti Latanya Dunn Heather Stanisci

Referred By: John Currier, CRCE-I

Northeast PA Chapter Katie Ciprietti Patrick Coury Kathryn Sena

Philadelphia ChapterKatie Ciprietti Thomas Louden Nancy Mcpoyle

Referred By: Beth Payne, CRCE-IJennifer Ortiz, CRCS-I Terri Potter, CRCS-I

Referred By: Monica WashburnJohn Tavani, CRCS-I

Referred By: Marina Grace, CRCE-I

Pine Tree Chapter Kelly Beal Eric Bediako

Rocky Mountain Chapter Alicia Calderon Julie Gergen Tyleka Riddle Kristi Schibi

Referred By: Sarah Moore, CRCE-I

Rushmore Chapter Brenda Bad Milk, CRCS-I, P Mary Sue Big Crow, CRCS-I, P Serena Brown, CRCS-I, P April Herrick, CRCS-I Nicole Johnson, CRCS-I Barbara Linehan, CRCS-I, P Deanna Provost, CRCS-I, CRCS-P Carmen Ruiz, CRCS-P, CRCS-I

Connie Twiss, CRCS-I, P David Walford, CRCS-P

Texas Bluebonnet Chapter Mandy Bingham

Referred By: Temple BurtMichelle Gregory Jerry Lee Hubbard Yolanda Luna Suman Smith Wanda Webb Kimberly Williamson

Three Rivers Chapter Lori Engott-Spaulding

Twin States ChapterSusan Fuller

Referred By: Timothy MooreLaurie Hart

Virginia ChapterDeborah Kingston, CRCS-P Monica Warsaw-Shelton

Western Region Chapter Veronica Cabral Alfonso Camacho Mala Dhillon

Referred By: Kathi AtheyFeliciano Jiron Rose Marie Johnson, CRCS-I Richard Lovich

Referred By: George ColmanShahanshah Manzoor Ashley Marifian, CRCS-I Prashanth Raju Jane Szondy Raymond Valiente Elizabeth Velasquez, CRCS-I Debora Wilhelm Melodi Williams

Western Reserve Chapter Kathryn Schlotzer John Tolaro

Wisconsin Chapter Stephanie Williams

States Without a Chapter Shauna Barsanti


AAHAM Providing Excellence in the Business of Healthcare

Certification, Compliance, Leadership Development, Networking, Advocacy

AAHAM… Providing Excellence in the Business of HealthcareCertification • Compliance • Leadership Development • Networking • AdvocacyCutting Edge Training + Nationally Recognized Certification = Improved Performance

Application For National Membership

Name: ___________________________________________________ Title: ___________________________________________________

Employer/Organization Name: ________________________________________________________________________________________

Primary Address: _______________________________________ City: _______________________ State: __________ Zip: ____________

Phone: _____________________________ Fax: _____________________________ Local Chapter: _______________________________

E-mail Address: ______________________________ Website: _____________________________________________________________

Home Address: ___________________________ City: ______________ State: _____ Zip: _______ Home Phone: ____________________

How did you hear about AAHAM? o Colleague o Publication o Website o LinkedIn o Facebook

If referred by AAHAM member, please give name: _________________________________________________________________________

Membership Type: o National Member o Student Member

Payment OptionsFor Credit Card Payment: o AMEX o VISA o MASTERCARD

Card Number: __________________________________________ Exp: __________

Name as it appears on card: ___________________________ CVV2 Code: _______

Signature: ____________________________________________________________

Billing Address, If Different from Above: _____________________________________

____________________________________________________________________Please allow two weeks for processing after your application is received at the na-tional office. Dues are not tax deductible as a charitable contribution, but may be as a business expense.____________________________________________________________________Please note: Membership is on an individual, not institutional, basis and is non-trans-ferable.

For Check Payment:Please make checks payable to AAHAM and send application with your payment to:

AAHAM Membership11240 Waples Mill Road, Suite 200Fairfax, VA 22030AAHAM Tax ID# 23-1899873

Your Payment Total:

National Dues: $ __________

Local Dues: $ __________

Total Enclosed: $ __________

NATIONAL MEMBERSHIP - The fee to become a National member is $175. If you join anytime between July 1st and August 31st, the dues are $140 for the rest of the current year. If you join between September 1st and December 31st, the fee is $210 for the rest of the current year and all of the following year. STUDENT MEMBERSHIP - The student membership fee is $50. If you join between July 1st and August 31st, the pro-rated dues are $35, and if you join between September 1st and December 31st, dues are $65 (for 15 months of membership). To qualify for student membership you must currently be taking 6 credit hours per semester. Student members receive all the benefits of membership with the exception of voting, eligibility for professional certification, and cannot be a proxy for a chapter president at any national board meetings. Retired Membership – The retired membership fee is $50.00. To qualify for retired membership you must have been a National Member retired from healthcare. Retired mem-bers receive all the benefits of membership with the exception of voting.

Please Check the Appropriate Codes in Each Category Below

Years in Healthcare:o 0-5 o 6-10 o 11-20 o 21-25 o 25+

Certification:

o CRCE o CRCS o CRCP

o CHAM (NAHAM) o CHFP (HFMA)

o FHFMA (HFMA) o CHCS (ACA)

o Other (please list) ________________

Employer Type:o Vendor/Corporate Partner o Billing

o Collection Agency o Consulting

o Outsourcing o Software/IT

o Provider o Law Firm

o Other (please list) __________

Position:o CFO

o Consultant

o Director

o Executive Director

o Manager

o Partner, Principal, Owner

o Patient Acces Representative

o PFS Representative

o Supervisor/Coordinator

o Vice President

o Other (please list) ______________

Responsibility:o Accounting

o Administration/Operations

o Admitting/Access

o Audit

o Benefits

o Budget

o Business Development, Sales, Marketing

o Compliance

o Information Services/Technology

o Managed Care

o Medical Records

o Medicare/Medicaid

o PFS, Patient Billing & Collections

o Reimbursement

o Third Party Administration

o Other (please list) ______________

Name of Chapter Geographic Location Chapter Dues

Aksarben #01 Nebraska $0.00

Carolina #04 North & South Carolina $30.00

Chennai #49 Chennai, India $0.00

Connecticut #34 Connecticut $35.00

Evergreen #05 Washington State, West of the Mountains $30.00

Florida Sunshine #03 Florida $40.00

Georgia #33 Georgia $30.00

Gopher #06 Minnesota $40.00

Hawkeye #07 Iowa $0.00

Hawthorn #08 Missouri $45.00

Illinois #09 Illinois $25.00

Indiana #42 Indiana $25.00

Inland Empire #10 Washington State, East of the Mountains $25.00

Keystone #11 Central Pennsylvania $25.00

Maryland #13 Maryland $20.00

Michigan #55 Michigan $0.00

Mid-York #31 New York $40.00

Mountain West #14 Utah $30.00

Music City #53 Tennessee $25.00

New Jersey #16 New Jersey $35.00

Northeast PA #19 North East Pennsylvania $30.00

Philadelphia #29 Philadelphia, Pennsylvania $35.00

Pine Tree #22 Maine $25.00

Rocky Mountain #21 Colorado $20.00

Rushmore #23 North & South Dakota $0.00

Texas Bluebonnet #40 Texas $50.00

Three Rivers #37 Pittsburgh, Pennsylvania $30.00

Twin States #56 New Hampshire & Vermont $25.00

Virginia #27 Virginia $30.00

Western Region #26 Southern California $0.00

Western Reserve #18 Ohio $0.00

Wisconsin #44 Wisconsin $25.00

Local Chapters: AAHAM has 32 chapters throughout the US and India. Local chapters offer you more opportunities for education and networking. Please see the listing of local chapters below to help you decide which chapter you should belong to along with your National membership


June 7th is National Chocolate Ice Cream Day

July is National Blueberry Month

August 23rd is Natinal Ride The Wind Day

did you know?By Moayad Zahralddin

June 2014… Aquarium Month, Candy Month, Dairy Month, Fight the Filthy Fly Month, Gay Pride Month, National Accordion Awareness Month, National Adopt a Cat Month1 ......Flip a Coin Day2 ......National Bubba Day4 ......Hug Your Cat Day5 ......World Environment Day7 ......National Chocolate Ice Cream Day8 ......Best Friends Day14 ....Flag Day15 ....Nursing Assistants Day, Smile Power Day18 ....National Splurge Day20 ....National Hollerin’ Contest Day21 ....Summer Solstice23 ....National Pink Day, Take Your Dog to Work Day 25 ....National Catfish Day26 ....Forgiveness Day28 ....Insurance Awareness Day29 ....Waffle Iron Day

July 2014… National Blueberry Month, National Anti-Boredom Month, National Cell Phone Courtesy Month, National Ice Cream Month 1 ......Creative Ice Cream Flavors Day, International Joke Day2 ......I Forgot Day4 ......Independence Day (U.S.), National Country Music Day5 ......Work-a-holics Day 6 ......National Fried Chicken Day11 ....Cheer up the Lonely Day, World Population Day13 ....Fool’s Paradise Day14 ....Bastille Day20 ....Moon Day21 ....National Junk Food Day22 ....Hammock Day26 ....All or Nothing Day30 ....National Cheesecake Day31 ....Mutt’s Day

August 2014… Admit You’re Happy Month, Family Fun Month, National Eye Exam Month, Water Quality Month, National Picnic Month 2 ......Friendship Day, Sisters Day4 ......U.S. Coast Guard Day5 ......Work Like a Dog Day6 ......Wiggle Your Toes Day7 ......National Lighthouse Day9 ......Book Lover’s Day10 ....Lazy Day13 ....Left Hander’s Day14 ....National Creamsicle Day15 ....Relaxation Day16 ....National Tell a Joke Day17 ....National Thriftshop Day21 ....Senior Citizen’s Day22 ....Be an Angel Day23 ....Ride the Wind Day25 ....Kiss and Make Up Day26 ....National Dog Day26 ....Women’s Equality Day27 ....Global Forgiveness Day, Just Because Day30 ....Toasted Marshmallow Day

Spring 2014 37

national calendar

the JHAM networkMovers & Shakers

Don’t forget to give us your information for the Movers & Shakers section of The Journal. This section includes job announcements (changes or promotions), birth and death

announcements, and wedding announcements. Send your “news” to Sharon Galler at [email protected]

ChaptersPlease send us notices of your upcoming events/meetings, chapter news and

photos. We would be happy to post them for you!

Address ChangesAll address changes can be emailed to Moayad Zahralddin,

[email protected] at the National Office or you can update your information yourself on-line at www.aaham.org.

October 15-17, 2014 2014 ANI, Manchester Grand Hyatt San Diego, California

October 14-16, 2015 2015 ANI, Walt Disney World Swan and Dolphin Orlando, Florida

Follow us on

Coaching Kits

With the new AAHAM Coaching Kits, you are equipped toconduct interactive, thorough,and effective sessions to prepareparticipants for their CRCE–I,Por CRCS–I,P exam.

Each kit, packaged in a convenient binder, includes:• Detailed preparation instructions,

including a materials checklist• Overview of the adult learning

principles built into the kit• Scheduling suggestions so you

can customize your timetable• Tips and suggestions for

facilitating each portion of the coaching session

• CD with slides to guide participants through the session

• Materials and instructions for activities including laminated cards for learning games, quizzes, a crossword puzzle, and more

• Participant guide originals, so you can make copies and include as many exam-takers as you would like

• Extensive glossary of terms included in the exams

Each coach will need one copy of the CRCE–I,P or CRCS–I,P Exam Study Manual (sold separately).

Log on to www.aaham.org for more information and to order yourExam Study Manual today!

spring 2014 - american association of healthcare ... · introducing salucro healthcare solutions, a...

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