Tuesday, December 23, 2014

Negative Consequences Abound When Nonprofits Hospitals Sue Poorest Patients

Nonprofit hospitals receive a tax-exempt status based on their work to serve the poor by addressing their medical needs. However, the medical billing practices of hospitals was recently called into question by a Consumer Financial Protection Bureau report. The report examined medical debt in this country and found that 1 in 5 consumers, or 43 million individuals, have a negative mark on their credit report from a medical debt. The debt collections practices employed by hospitals raise several concerns including releasing private medical information covered by HIPAA to outside parties not involved in treatment, unfair billing practices that disproportionately impact low-income patients, a failure to provide and educate patients on available aid, the need for aid to retroactively cover eligible medical costs, and the legality of nonprofit hospitals suing their poorest patients. 

A recent NPR story highlighted the issues that arise for low-income patients when nonprofit hospitals sue for unpaid medical bills. In addition to the aribtrarily higher prices many low-income patients are charged for medical treatment, the debts associated with their medical care negatively impact nearly every area of their lives. Medical debts reported to credit agencies lower credit scores which in turn, raises the prices for many basic needs such as car insurance, mortgages, credit cards, and loans. Additionally, some employers examine the credit report in the hiring process and a low credit score or history of medical debt may negatively impact an individual's chance to get a job because they are viewed as irresponsible or the employer feels they will not be reliable due to the medical issues insinuated in the report. 

Hospitals are turning to the courts to recover these inflated debts from their low-income patients. When the hospitals are successful they may be able to recover the debt, in addition to court costs, debt collection administration fees, and interest by garnishing the low-income individual's wages. This practice creates a cycle of poverty that is nearly impossible to escape and discourages individuals from receiving medical care. It particularly provides a disincentive for low-income individuals to receive preventative care, which would be beneficial to all parties involved. 

Reform is imperative. Hospitals and health access managers must be diligent in educating patients about aid, prudently billing, and limiting the debts that move to collection agencies. 

Resources to help those with medical debt may be found at the following websites:

Monday, December 22, 2014

CMS Proposes 3-Year Penalty Delay for Accountable Care Organizations & New ACO Model

Accountable Care Organizations (ACO) are voluntary organizations that providers may choose to participate in which are comprised of doctors, hospitals, and other health care providers. The Centers for Medicare and Medicaid (CMS) created Accountable Care Organizations with the goal of coordinating care to ensure that patients get the right care at the right time while avoiding unnecessary duplicaiton of services an preventing medical errors. Currently Medicare offers the Medicare Shared Savings Program that allows ACOs to share in the savings it achieves for the Medicare program. ACOs may also be penalized for poor performance. 

Penalty Delay
However, CMS recently proposed that health care systems experimenting with a new way of being paid by Medicare would have three extra years before they could be punished for poor performance. This three-year delay is in addition to the three-year extension currently in place, for a total of six years. The proposal can be found here. The new rule applies to both new and existing ACOs. 

While ACOs wouldn't face penalties for an additional three years, any ACO that chose to avoid penalties after the initial delay period of three years would be limited to 40-percent of the money they save Medicare. There is a 50-percent maximum cut off of savings ACOs are able to keep during the first three years. 

Track Three ACO Model
The new ACO model, known as "Track Three," allows ACOs to keep up to 75-percent of the money they save Medicare. Track Three ACOs would be responsible for 15-percent of any excess spending they cost Medicare. This is higher than the 10-percent limit to the other models of ACOs that are in place now. 

Friday, December 19, 2014

Omnibus Continues Tax Breaks for Blue Cross and Blue Shield Insurance & Ups Spending to Detect Healthcare Fraud and Abuse

The 2015 Fiscal Year Omnibus Appropriations Bill provides just over $1 trillion in discretionary spending in compliance with the Murray-Ryan budget agreement and funds the majority of the federal government through Sept. 30, 2015. 

Nongermane Riders
The New York Times reports that "Steve Ellis, vice president of Taxpayers for Common Sense, a nonprofit research group that tracks federal spending, said the bill bestowed favors on all sorts of constituencies.

“Authors of the bill and lobbyists behind these provisions know they are in there,” Mr. Ellis said. “But the public will not find out about most of them for weeks or months, if ever.” Congress supposedly forswore spending earmarks several years ago, after federal largess led to several scandals. But lawmakers can still steer money in less conspicuous ways."

One example of a nongermane rider that went into the bill without public debate provides relief to nonprofit Blue Cross and Blue Shield plans, which have special tax breaks that may have been threatened by provisions in the Affordable Care Act. While Blue Cross is not mentioned by name in the legislation, the deduction is only available to Blue Cross and Blue Shield plans. Blue Cross and Blue Shield have been lobbying Congress for a clarification since the Affordable Care Act was signed in 2010.

Fraud Prevention
The Committee on Appropriations executive summary also explains that the bill provides $1.484 billion for cap adjustment funding to prevent waste, fraud, abuse and improper payments in the Medicare, Medicaid and Social Security programs. This is a $560 million increase in funding from last year's level.

A significant portion of those funds, $672 million, are dedicated to the Health Care Fraud and Abuse Control program at the Centers for Medicare and Medicaid Services. That amount more than doubles the level enacted in fiscal year 2014. 
One reason for the increase is that preventing fraud creates a significant savings for the government. The latest data shows that for every $1 spent on fraud and abuse control, $8.10 is recovered by the Department of Treasury. That recovery ration is the highest three-year average return on investment in the entire 17-year history of the Health Care Fraud and Abuse Control program.

Further Information
For a more comprehensive discussion of nongermane riders passed in the Omnibus see this New York Times article, "In Final Spending Bill, Salty Food and Belching Cows are Winners." The Senate Committee on Appropriations executive summary of the bill can be found here.

Wednesday, December 17, 2014

CMS State Innovation Models Grants Awarded

The HHS announced Tuesday that a significant portion of the $665 million in available grants was awarded to health IT programs.The District of Columbia, 28 states, and three territories received grant money to fund local experiments in improving health care. The money is the second round of grants coming from CMS's State Innovation Models initiative. A breakdown of the awarded grants can be found at the initiative website

Politico reports that the selected health IT projects largely focus on improving data in electronic health records and systems. Part of the $100 million New York will receive will go toward better health IT, "including greatly enhanced capacities to exchange clinical data and an all-payer database." Overall, the state is looking to create a stronger, more integrated primary care workforce and delivery system. Colorado will receive up to $65 million over four years to integrate physical and behavioral health care in primary care and community mental health center. Part of the money will expand IT efforts including telehealth. The money will also assist in integrating public health, behavioral health and primary care sectors. Data analytics is a factor in the plans for Michigan and Iowa.

Friday, December 12, 2014

CMS Boosts Coverage for Telehealth

The Centers for Medicare & Medicaid Services released new rules that significantly broaden coverage for chronic care telehealth services.The rulemaking changes are inside the 1,185-page document detailing Medicare payments to physicians and other providers. The new rules also include seven new covered procedure codes for telehealth, including annual wellness visits, psychotherapy services, and prolonged services at physicians' offices.

Health Leaders Media reports, "The American Telemedicine Association, which had sought the expanded coverage for five years, notes that among the rules are provisions that will pay for remote chronic care management using the new current procedural terminology (CPT) code 99490, with a monthly unadjusted, non-facility fee of $42.60.

"For us, it was more important to begin to specifically address chronic care," says Gary Capistrant, senior director of public policy at ATA. "The combination of the chronic care management code and being able to use it in conjunction with monitoring of those chronic conditions is a big step forward and a very substantial change for Medicare." Capistrant says the new rules also represent an acknowledgement by CMS that reimbursing for chronic care could prove to be cost effective.

"It's an important policy move. Whether it is sufficient, time will tell, but it is certainly a step in the right direction and an important initiative," he says. "There has been a lot of focus on primary care, even with the Medicare population. That may be the 80% of the people but it is only 20% of the problem. There's an increasing emphasis on looking at the 80% of the problem that is 20% of the people, and that is chronic and specialty care. They understand that the government is spending a huge amount for chronic care conditions and that there is a value managing those to reduce the overall expenditures."

Explore NAHAM AccessKeys

Coming in Mid-January:  NAHAM AccessKeys®
NAHAM is excited to announce the unveiling of a project more than two years in the making. Click here to read more about the NAHAM AccessKeys®.  Be sure to also register for the webinar taking place on January 14, 2015 at 2:00 pm. This webinar  will describe the creation of AccessKeys® and provide information about how to implement it in your facility.  

Be sure to renew your membership before January 1, 2015. AccessKeys® will be available to members only! 

Wednesday, November 26, 2014

NAHAM Webinar: Servant Leadership, Dec. 9th

Join Jeff Brossard, BSHA, CHAM,  for a presentation that will dig into the differences between management styles, with particular emphasis on servant leadership. 

Discover how servant leadership and mentoring, both co-workers and other leaders, can be an effective tool for generating high performing organizations. 

This webinar will include time for participant discussion, providing you with an opportunity to learn best practices. 

Tuesday, Dec. 9 at 2 p.m. EST

NAHAM members: FREE
Non-Members: $35  

All participants will receive 1 NAHAM contact hour. 

Register today!

Monday, November 24, 2014

Net Neutrality Impacts Healthcare IT

Modern Healthcare's  Darius Tahir explains why healthcare providers should be paying attention to net neutrality in the following article:

The techie term “net neutrality” likely isn't in the daily lexicon used by most senior healthcare executives. But it should be, and soon, argue those in healthcare technology who have been following the topic.

The wireless telecommunications industry's trade group, CTIA, for example, has been circulating a letter to healthcare organizations, asking their support to oppose regulation that would ensure continued net neutrality. But others argue healthcare benefits from net neutrality and should be lobbying for its continuance via a new Federal Communications Commission mandate.

Net neutrality means everyone sending data is treated the same by carriers like Verizon and others; no one can pay or be charged more for faster transmission speeds and none can be barred from sending data. The tool that net neutrality advocates want to use—Title II of the FCC’s authorization act—would essentially make internet traffic into a public utility.

The FCC is expected to rule either by year-end or early next year.

The debate on net neutrality has intensified as the amount of data being transmitted in videos and other usages has increased, leading some to argue that too much traffic is crossing a too-small network, slowing down performance.

Telehealth and electronic record data exchange are the two primary areas of healthcare that would suffer were internet service providers allowed to charge higher prices for faster transmission speeds, say those who back net neutrality.

“I don't think people realize how much net neutrality can affect health services,” said Mark Gaynor, an associate professor of health management and policy at St. Louis University and a long-time advocate for net neutrality.

President Barack Obama earlier this month put the spotlight on the issue when he called on the FCC to “implement the strongest possible rules to protect net neutrality.”

But he muddied the debate when it comes to healthcare by saying the rule, “can have clear, monitored exceptions for reasonable network management and for specialized services such as dedicated, mission-critical networks serving a hospital.”

But many critics of a net neutrality rule believe that allowing internet service providers to charge for a “fast lane” or “paid prioritization” would be helpful for innovation. Such pricing would allow data from paying content providers to move more quickly to consumers. Currently, they argue, many networks slow at peak times when everyone wants to view Netflix videos or use other heavy bandwidth applications, like online gaming.

Charging those users more allows for more efficient usage of limited bandwidth, and provides an incentive to internet service providers to build more network infrastructure, which would accommodate more usage down the road. That position is partially supported by a July 2014 draft paper produced by two FCC officials, which use a model to show that overall market efficiency is improved if broadband providers are allowed to charge for fast lanes.

Billionaire internet entrepreneur Mark Cuban argued, in a post on his personal blog, that this debate has particular relevance to healthcare.

Hypothetically, he said, an emergency surgeon might want to access an internet application for a surgery—and finds that she can't get enough bandwidth for the service to work because “TV and movie services … swamp bandwidth.”

A net neutrality rule, he suggested, encourages that situation for two reasons: because it prevents the investment that would make a bigger network for everyone; and because it prevents high-priority data from jumping to the front of the line.

Cuban also doesn't believe Obama's exception for hospitals—which might put it at the front of the queue—would do much good, writing, “First in line in a traffic jam is still slow and buffering.”

Also opposing neutrality, Verizon has argued in a letter (PDF) to the FCC, that classifying internet traffic under Title II is not legally permissible, and an attempt to do so would invite legal challenges.

The push-and-pull over net neutrality has left the FCC's decision uncertain. The Washington Post reported on Nov. 11 that FCC chair Tom Wheeler had rejected Obama's call to reclassify internet traffic to Title II and he was looking to “split the baby” between internet service provider and net neutrality advocate concerns.

Most opponents of formal net neutrality believe that classifying internet traffic under Title II would result in onerous new requirements for internet providers, as the section was designed for older types of networked communication.

Jot Carpenter, the vice president of government affairs for CTIA, said in an interview that the rules would slow new innovations for wireless providers. The exception proposed by Obama, he said, would introduce confusion for the providers.

In those instances, he said, they would have to approach the FCC and see whether their intended idea—whether a formal partnership with a content provider or an economic arrangement—fell under the hospital exception. Carpenter derided that as the “Mother, may I?” approach to governance, which he argued is bad for innovation.

It's also unclear what might fall under the exception, Kerry McDermott, the vice president of public policy and communications for the Center for Medical Interoperability and a former FCC official said. Which hospital data would apply? Would other healthcare data apply?

Because of that perspective, Carpenter and CTIA have been circulating a letter to healthcare groups arguing that proposed reclassification would increase regulatory uncertainty for mobile health, which they argue is too young to withstand the shock.

While Carpenter declined to name which stakeholder groups had been contacted, a draft copy of the letter obtained by Modern Healthcare includes comments from the Healthcare Information and Management Systems Society. It's not possible to attribute specific comments on the letter to the organization. As of press time, HIMSS had not responded to inquiries regarding the letter. And Carpenter wouldn't discuss when the letter would be officially released, or with which signatories.

But Gaynor and others are anxious about the negative effects of allowing providers to charge higher prices to content providers.

“I don't want to see small companies that are trying to innovate be locked out by bigger companies that have more money and can pay for faster service,” Gaynor said.

Carpenter rejects that argument. “I don't know that there's any evidence to suggest that these startups would be prevented from reaching their customers or gaining critical mass in the marketplace or gaining notice. Paid placement isn't always an evil,” he said, citing Google's early history as an example.

And facing a toll might also hurt efforts to encourage interoperability, Gaynor continued. The healthcare system is hoping to encourage more data sharing, often through Health Information Exchanges. A charge for faster service provides a disincentive to sharing overall, and in particular hurts HIEs – which are non-profit and often struggle to find the proper business model under current conditions.

Innovation might be hurt in another way, Gaynor and his co-authors argued in a July 2013 paper in the Journal of the American Medical Informatics Association. Some internet service providers own or are closely associated with healthcare services; Verizon, for example, has a virtual visits telehealth service, as well as an Apple HealthKit competitor called Converged Health Management. If internet service providers are allowed to discriminate between content providers, they might favor their own, Gaynor writes.

That argument also attacks the FCC officials’ paper, which assumes that broadband internet service providers are not vertically integrated with a content provider.

Steve Kraus, a partner at venture capitalist firm Bessemer Venture Partners, agrees with Gaynor’s argument. “The whole premise of telemedicine would fall down,” he said, if startups suffer lagged performance.

He argued that the net neutrality debate is particularly relevant to healthcare: first, patients and providers often need speed in making care; and second, because the data being moved in healthcare – like medical records, genomics, and video – is often so large.

Kraus's colleagues agree, and are worried about the large telecommunications firms potentially giving themselves an unfair advantage, noting that both Verizon and AT&T have been investing heavily in healthcare.

Virtual visits firm American Well also feels strongly about net neutrality. In an interview, the firm's senior vice president of consumer markets, Mike Putnam, said that he believes paid prioritization would decrease healthcare access and cause the firm to pass on costs to the consumer.

Seth Ginsburg, the president of non-profit Global Healthy Living Foundation, has been advocating for net neutrality in Capitol Hill—and actually retained a lobbyist to do so, the only purely healthcare entity registered in the Senate's lobbying database to list net neutrality as an interest.

Ginsburg’s organization, which helps patients with conditions like rheumatoid arthritis, believes that paying tolls for faster service would harm its relationship with patients. The organization is a nonprofit, and can’t afford to pay a toll; and yet it also communicates time-sensitive information, concerning drug safety for example, to its patients. Allowing a fast lane would put the organization in a bind.

Ginsburg is contemplating complementing his firm's lobbying efforts by adding the voices of his patients, who he said are in all 50 states. He has seen a lack of healthcare interest in the political half of the debate. He suspects it's due to the other large healthcare IT issues on the docket, like meaningful use and the ICD-10 code switch.

Thursday, November 20, 2014

CMS Names Niall Brennan First Chief Data Officer

The Centers for Medicare & Medicaid Services (CMS) today announced the formation of the Office of Enterprise Data and Analytics (OEDA) which will be led by Niall Brennan, the agency’s first Chief Data Officer (CDO), and tasked with overseeing improvements in data collection and dissemination as the agency strives to be more transparent. OEDA will help CMS better harness its vast data resources to guide decision-making and develop frameworks promoting appropriate external access to and use of data to drive higher quality, patient-centered care at a lower cost.

CMS collects a wealth of data that is critical to decision making for the agency and other stakeholders in the nation’s health care system. CMS generates data administering the Medicare, Medicaid and CHIP programs. In addition, new responsibilities, including stewardship of the EHR Incentive Programs, more expansive quality measurement programs, and the establishment of the Health Insurance Marketplaces, have expanded the scope of data that CMS collects. As CMS works to shift the focus from volume of services to better health outcomes for patients, coordinating care, and spending dollars more wisely, the need for CMS to analyze data across its multiple programs and provide greater access to this data, whether in granular or aggregate form, will only intensify.

“It’s clear how much data transparency will help the country improve outcomes, control costs and aid consumer decision making,” said CMS Principal Deputy Administrator Andy Slavitt. “This appointment signals to the industry that there is no turning back from the health care data agenda. Niall Brennan will help make sure CMS leads the way.”

The creation of this new post and the data and analytics office  builds on the steps CMS has taken in recent years to better harness its data resources both internally and externally. CMS is now routinely analyzing claims data in real time and applying predictive analytics to proactively identify fraud and abuse and track key metrics such as hospital readmissions. Accountable Care Organizations and State Medicaid agencies receive monthly near real-time feeds of Medicare data to support care coordination. CMS has launched the Virtual Research Data Center to facilitate lower cost access to CMS data for researchers and federal grantees. CMS has also released numerous public use datasets; the most notable releases to date include the release of data on hospital charges and physician utilization in 2013 and 2014.

“Our commitment to transparency is matched by our commitment to keeping personal information safeguarded. We can't expect to advance health outcomes unless we also ensure that our policies and practices around data privacy are leading the way,” said Slavitt. “We look forward to building on the success of recent releases, providing a clearer picture of the health care delivery system.”

Wednesday, November 19, 2014


Politico reports that health IT company Iatric Systems, Inc. has announced its integration with Apple Health to pull patient data into HealthKit and present it from inpatient, ambulatory and patient-generated sources. The "EHR-neutral" approach will link data from records, physician practices and other health IT software, according to an announcement from Iatric. Iatric envisions that patients will help hospitals with meaningful use requirements--especially view, download and transmit.

Two hospitals are currently using Iatric for integration with Apple Health - Michigan's Memorial Healthcare and King's Daughters Medical Center in Mississippi. "We envision our patients using Apple Health easily because for many, the iPhone is already a main part of their lives, said Frank Fear, CIO at Memorial Healthcare, in the announcement. "We could have integrated Apple Health within a portal from our EHR vendor or ambulatory system vendor, but data from disparate systems sits in silos. Iatric Systems was a natural fit because their portal integrates across all of our systems, giving us one tool for capturing and sending data to patients, and eventually, receiving data back from them."

For more information visit Politico here

Tuesday, November 4, 2014

Politico Reports: ONC Releases Meaningful Use Stage 2 Attestation Rates

Attestation rates for Stage 2 of meaningful use remained low at the end of September, according to data released ahead of today's Health IT Policy Committee meeting. The figures, contained as footnotes in an ONC data analytics update, show that 4,656 doctors and other eligible providers and 258 hospitals had attested to Stage 2. This is an increase over the end of August but still only a rounding error out of 480,000-plus eligible providers and hospitals. The low figures reflect problems that electronic health records vendors and providers have had achieving Stage 2. 

CMS relaxed the rules on reporting Stage 2 attestation earlier in the year, and provider groups have been pressing to reduce the one-year reporting period to 90 days in 2015. We have a feeling that a GOP-controlled Congress may try to do something about this.

ONC's analysis of the Sept. 30 attestation data showed disappointing levels of accomplishment in meeting some of the most important categories of Stage 2. For example, 87 percent of eligible providers who attested to Stage 2 received exclusions from showing they could electronically send summaries of care. Of those who did not receive exclusions, only 18 percent were able to send electronic summaries 80 percent of the time or more. A total of 55 percent were able to file summaries electronically 30 percent or less of the time. Scores for the "view, download or transmit" category, a measure of physicians' capacity to share data with patients, were even worse. Although 65 percent of the attesters' patients had online access to records, only 10 percent of these providers were able to get patients to download their records more than half the time.

A similarly small percentage sent patient reminders on a regular basis. In its analysis of hospitals, ONC found that only 10 percent got out electronic care summaries to patients more than half the time, and less than 15 percent were able to get more than 20 percent of their patients to view, download or transmit their records. However, as ONC pointed out, the figures represented a somewhat improved picture from analyses it did over the summer.

Many individuals are concerned about the privacy of their medical records, but that doesn't keep most of them from giving information to health care providers, according to survey results to be released at the meeting. In a survey of more than 2,000 people conducted in 2012-13 for ONC, 75 percent were "very or somewhat concerned" about the privacy of information in EHRs. But only eight percent said those concerns would cause them to withhold information from health care providers.

Wednesday, October 29, 2014

Free Interactive Webinar: Ebola in the U.S. & the Role of Patient Access

Ebola in the U.S. & the Role of Patient Access 
Tuesday, November 4, 2014 at Noon EST

With the ongoing national news coverage surrounding the Ebola virus, your facility's leadership team may be implementing new screening protocols, and asking you to provide them with an immediate plan of action. What do you do? Where do you start?

Join NAHAM for this interactive webinar and explore how other organizations and facilities are tackling basic plan development in crisis situations, including ebola. 

Areas of discussion will include: 
Complying with CDC requirements
Integrating with infection control areas
Alleviating employee anxiety with targeted communication tips and tricks
Recommendations on quickly implementing your plan

This webinar will include time for participant discussion, providing you with an opportunity to learn best practices and examine the challenges in implementing a plan. If you have any specific questions you would like answered, please email us. 

This webinar is free of charge for all participants. Register now, and learn what you need to know to keep your facility up to speed on the Ebola virus.

Stacy Calvaruso
Assistant Vice President, Patient Access, Ochsner Health System
Stacy is a Healthcare A/R Executive with over 24 years of progressive experience in both private and public sectors. Prior to joining Ochsner Health System, Stacy was the key developer/owner/operator of an organization that evolved from a small PFS A/R consulting and interim staffing organization, to a large national service center in the Urgent Care industry. Stacy’s current role with Ochsner includes managing over 600 FTEs dedicated to front line Patient Access service. She has held board positions for HFMA, NAHAM, UCBCA, as well as a Community Hospital in Louisiana.

Brenda Sauer
Director, Patient Access, New York Presbyterian Hospital
Brenda Sauer, RN, MA, CHAM, FHAM is Director of Patient Access at New York Presbyterian Hospital, Weill Cornell Medical Center in New York City, NY. She has held several board positions in NAHAM on both the local and national level; she is currently the Immediate Past President of NAHAM. Recently, she was named a Fellow in Healthcare Access Management. She has spoken on several topics including: Health Care Reform, patient privacy, disaster preparedness, patient throughput initiatives, and leadership for various organizations on the local, regional, and national level.

Join Webinar TODAY at 2pm EST: Enhancing the Revenue Cycle Experience for Patients

Enhancing the Revenue Cycle Experience for Patients 
October 29, 2014

Webinar Information: TODAY
2:00 pm – 3:00 pm Eastern
NAHAM Contact Hours: 1
Register Now 

Join NAHAM for a special patient experience webinar focused on front-end strategies to improve the revenue cycle experience for patients. Industry thought leaders from Texas Health Resources will review strategic initiatives for patient access leaders to further engage patients in their care experience – beginning before they enter the hospital’s front door. The session will present key strategies and related outcomes in patient satisfaction, staff performance and upfront patient collections. 

Patricia Consolver, CHAM
Senior Director, Patient Access Services
Texas Health Resources Scott Phillips, CHAM
Senior Director, Patient Access Services
Texas Health Resources

Register now and learn how to reduce registration times, increase point-of-service collections, and increase patient satisfaction! NAHAM members will enjoy free access to this live webinar, just one of the perks of NAHAM membership. For all non-members, the cost to attend this webinar is $35.

Join NAHAM Webinar: Developing Patient Access Leaders for Tomorrow

Developing Patient Access Leaders for Tomorrow 
November 11, 2014

Join NAHAM for our monthly webinar and hear a detailed account of how WellSpan Health’s Patient Access Department instituted an internal leadership development program to prepare for growth and succession in their rapidly growing Access departments. From conception and development to the inaugural program and its evolution over time, experience a detailed dissection of the various elements of the program, aimed at cultivating our leaders for tomorrow.

The webinar will: 

Describe how WellSpan Health's rapid growth drove the need for an internal leadership development program, and how that program was implemented and molded.

Detail the various elements of the leadership development program, including what worked, what didn't and what has changed over time.

Discuss the challenges and successes of the leadership development program, including lessons learned, success stories, facilitation, participation, and relevance.

Register now and learn how to reduce registration times, increase point-of-service collections, and increase patient satisfaction! NAHAM members will enjoy free access to this live webinar, just one of the perks of NAHAM membership. For all non-members, the cost to attend this webinar is $35.

Date: November 11, 2014
Time: 2:00 pm – 3:00 pm EST
Presented by: Lisa Woods, Manager of Access Operations, WellSpan Health
NAHAM Contact Hours: 1
Register Here 

Wednesday, August 6, 2014

ICD-10 Transition Date Finalized for October 2015

The Centers for Medicare and Medicaid Services announced last week that the final deadline to comply with the ICD-10 implementation requirement is October 1, 2015. The tenth edition of the International Classification of Diseases is widely viewed as a significant change in the way claims that are submitted to Medicare and private insurance payers are classified. 

These changes enable providers to coordinate patients care over distance and time, improve the accuracy of patient records with more detailed patient history coding, and reduce fraudulent claims. CMS also believes that the ICD-10's granular classifications will improve the data and analytics related to public health research, surveillance, and reporting. The more specific classifications found in ICD-10 represent, in part, the evolution of diagnosis and the modern developments in medicine and medical technology used to treat patients. 

CMS released an online resource designed to help providers in small practices make a timely transition to ICD-10. The "Road to 10" is an online resource available here. The  Road to 10 breaks allows providers to select a profile based on their expertise that is specifically tailored to each speciality's common codes, clinical documentation procedures, and clinical scenarios. Additionally, the Road to 10 gives users the opportunity to create an ICD implementation action plan specifically suited to the needs of their small practices. 

Friday, July 25, 2014

NAHAM Requests Addition of Health Access Positions to Department of Labor's Standard Occupational Classification

The NAHAM Special Projects Committee recently submitted a request to the Department of Labor asking that the Standard Occupational Classification include health access managers and coordinators as distinct occupational classifications. NAHAM's Special Projects Committee worked hard to compile information on duties and responsibilities that are uniform across the health access field.

Politico reported on this letter in the "Morning Health" newsletter. Find their report below:


Seventeen health IT industry groups signed a letter to the Department of Labor this week requesting a new Standard Occupational Classification for the position of Health Informatics Practitioner. Presently, the classifications for health care lack codes associated with health informatics occupations. Due to lack of an official code, colleges and universities find it difficult to develop new academic programs, students in health informatics can't apply for federal aid, and health informatics practitioners can't fill in their correct occupational data on the U.S. Census, according to industry leaders. The HITECH Act of 2009 designated $118 million for workforce development, the letter points out, but new codes have not been created for all those jobs yet. "Collecting reliable and valid data for the health informatics occupation can be completed through the multiple discipline-specific professional associations and societies, but would be significantly improved with a [Standard Occupational Classification]," the groups write in the letter. Currently, they say, "there is a lack of appropriate career representation, both from work performed and a required education perspective." The letter writers include the Alliance of Nursing Informatics, the American Health Information Management Association, the American Medical Informatics Association and the College of Healthcare Information Management Executives, and various university, federal and state health informatics departments.

Monday, June 23, 2014

Medicare Expected to Release Final List of Hospitals Assessed with Penalties under Hospital-Acquired Condition Reduction Program in October

The Affordable Care Act established  three mandatory pay-for-performance programs. The three programs are the Hospital Readmissions Reduction Program, the Hospital Value-Based Purchasing Program, and the Hospital-Acquired Condition Reduction Program. Since the law was enacted hospitals have been scrambling to meet the requirements of all three programs to avoid the possible loss of 5.4 percent of Medicare payments if maximum penalties are assessed.

The Department of Health and Human Services estimates that one out of every eight patients suffered a potentially avoidable complication during a hospital stay in 2012. The Hospital-Acquired Condition Reduction Program was created as part of an effort to improve patient safety, create a financial incentive to improve care, and hold hospitals responsible for their negligence and dangerous conditions. 

Medicare will begin penalizing hospitals that have the highest rates of patients that acquire new infections or injuries during their hospital stay in October.  The preliminary list of approximately 750 hospitals Medicare expects to penalize was encompasses nearly a quarter of the nation's hospitals and is available here. Hospitals with the worst rates for hospital-acquired injuries and illnesses will lose 1 percent of every Medicare payment for the next year. 

Friday, June 13, 2014

Can't Miss NAHAM Webinar on Improvements to Patient Access Departments Through Automation, June 26th

NAHAM presents the "Building a More Efficient Patient Access Department Through Automation" webinar, free to NAHAM members on June 26, 2014, from 2:00-3:00 p.m. This webinar will be presented by Patrick Kelley, Dedicated Advisor at The Advisory Board Company, and Alexander Guambana, Senior Director at The Advisory Board Company.

In partnership with The Advisory Board Company and Lowell General Hospital, we will be walking through a health system’s response to new industry demands by leveraging automation and efficiency gains. The Advisory Board Company will present its research on new Patient Access trends across the industry, how patient estimation is becoming a major player in healthcare, and how hospital Revenue Cycle departments are responding to new legislation in the ACA. Join us as Lowell General Hospital and The Advisory Board present their experience of implementing a culture of point-of-service estimation and the utilization of technology.

Building a More Efficient Patient Access Department Through Automation

Thursday, June 26, 2014
2:00 pm - 3:00 p.m. ET

This webinar is worth 1 contact hour.

Click here to register for the webinar. There is no cost for members!

Upon purchase, you will receive information via email about accessing the live webinar.

Wednesday, May 7, 2014

Can't Miss Event May 13th at NAHAM 40th Annual Conference: NAHAM University Session

NAHAM University

 Hot Topics Discussion & Networking Opportunity

The National Association of Health Access Management 40th Annual Educational Conference & Exposition will be held May 13-16th in Hollywood, Florida. The conference theme this year is "From Admitting to Patient Access: 40 Years of Leadership." Conference attendees will enjoy outstanding educational sessions and invaluable networking opportunities. 

One of the most interactive and informative sessions is held before the conference officially begins on Tuesday, May 13th at noon. Peter Kraus, Business Analyst at Emory Healthcare, will moderate a NAHAM University session that is a popular venue for attendees to meet and discuss hot topics in the industry. 

The event is open to patient access manager participants from both academic and non-academic healthcare facilities. The topics for the 2-hour interactive session are determined by conference registrants. Kraus expects this year's discussion to cover the ICD-10 transition, Meaningful Use implementation, electronic health records, and issues that arise in the admission process. Participants found past discussions very helpful as colleagues offered road-tested solutions to the issues facing participants' individual hospitals.

What Hot Topics are you interested in? What issues is your hospital facing in 2014? 

Let NAHAM hear your topic suggestions for the the NAHAM University 
session in the comments section!

NAHAM University
Tuesday, May 13
12:00 p.m. – 2:30 p.m.
Separate registration fee applies. Lunch is included and will be provided starting at 11:30 a.m. 

Friday, May 2, 2014

Proposed Medicare Rule Leaves Hospitals Concerned About Financial Impact

The Centers for Medicare & Medicaid proposed a rule on Wednesday that makes changes to several aspects of the  Medicare payment program. The proposals were part of a wide-ranging, 1,600-plus-page proposed rule issued by the CMS outlining Medicare payment and policy changes for hospitals in 2015. A final rule is scheduled to be published August 1. The policies would be effective October 1.

Under the proposed rule the payments for inpatient treatment at acute-care hospitals will decrease by $241 million in fiscal year 2015. The proposed rule would affect over 3,000 hospitals nationwide.  In addition, the CMS proposes increasing Medicare payments to long-term-care hospitals by 0.8% in 2015, a bump of $44 million. The change in payment methodology would affect 435 facilities. Under the proposed payment rule, hospitals that successfully participate in Medicare’s quality reporting system and meet the criteria for the meaningful use of health information technology will see a payment bump of 1.3%. However, because of the penalties meted out to the hospitals that don’t, the CMS is projecting an overall reduction in payments.

Thursday, April 24, 2014

Notice to Patients Required for Outpatient Facility Fees

The Connecticut House of Representatives responded on Wednesday to medical billing concerns patients expressed over undisclosed and unexpected facility fees by unanimously passing a bill that requires notice. Many patients expressed that the additional charges were a surprise when they received their bill. The legislation now moves to the state Senate for a vote.

The charges, often referred to as "facility fees" are charged to patients by medical offices that are owned by hospitals for outpatient care. These fees are separate from doctor fees. Facility fees range from several hundred to thousands of dollars.

The bill to require notice to patients about fees possible extra charges for outpatient care at medical offices owned by hospitals. The bill specifically requires that patients with scheduled appointments at medical offices where facility fees are charged receive notice about the fees in plain language before they receive treatments scheduled so long as the appointment is scheduled at least 10 days in advance. If the exact nature of the services or insurance coverage is unknown the patients would be provided with an estimate based on typical charges at the facility. Notice for patients receiving emergency care would need to be delivered as soon as practicable after the patient is stabilized. The bill does not impact the offices' ability to charge facility fees.

Other provisions in the bill are include requirements that the office prominently displays that the facility is connected to a hospital, what hospital the office is affiliated with, and states that the patient may be incur higher charges than if they were treated at a facility that isn't hospital-based.

Friday, April 18, 2014

Enrollment in Health Insurance Reaches Surges to 8 Million

The Obama Administration released data showing that over the last six weeks a surge of 3.8 million Americans enrolled in private healthcare plans. That notable when compared to the 4.2 million individuals that signed up in the entire first five months after enrollment when the website was plagued with IT issues that impaired enrollment. The Administration explained that young adults comprise more than a quarter of the enrollees.

During the press conference President Obama emphasized that there are 5 million more people that would be eligible for health insurance in states that chose not to expand Medicaid. Leaders in those states commented that they were concerned about costs if Congress failed to maintain full federal funding as the law requires. 

Thursday, April 10, 2014

ICD-10 Deadline Delay Slows Medical Billing Conversion

Medical billing codes are used by doctors, hospitals, and health insurance companies to track each patient procedure and ensure that the doctors are paid. The ICD-9 code has been in place since the 1970s. The ICD-9 was scheduled to be replaced with ICD-10 by October 2014. 

The conversion would add tens of thousands of unique codes to the medical billing structure, an increase to roughly 72,000 codes in ICD-10 from about 4,000 codes in ICD-9. Advocates for ICD-10 argue that the new coding system is necessary to modernize the billing code to capture the variety of medical treatments available now that did not exist in the 19070s.  Additionally, they argue that a more detailed code will allow for more precise medical research and data collection. 

Despite the benefits of moving to an ICD-10 medical billing system, the transition over the last five years has been difficult. In order for the transition to be smooth and successful all parties need to switch to the ICD-10 codes at the same time. Many smaller practices were not able to dedicate the training time and resources to complete the transition by October of this year. 

However, larger facilities, hospitals, and insurance companies with more resources were able to dedicate time and money to implementation measures and preparation. In fact, many have spent millions to train staff on the new ICD-10 billing codes. These facilities were relying on the statements by Health and Human Services representatives made as late as February 2014 that explained the October compliance date was firm. Questions remain about the implementation of ICD-10 at these facilities and whether these employees will need to be re-trained as the adjusted ICD-10 deadline nears.

Friday, April 4, 2014

Congress Passes Bill to Delay Medicare Reimbursement Cuts

On Monday evening the Senate passed and President Obama signed the Protecting Access to Medicare Act of 2014 (H.R. 4302) into law. This marks the 17th time Congress delayed the cuts to physician reimbursements established with the Sustainable Growth Rate under Medicare. The bill delays a 24% cut to the payments.

The Senate passed the bill with a 64-35 vote the evening the cuts were to go into effect at midnight. The Senate vote was preceded by the House passing the bill with a rare voice vote last week.  Both chambers moved quickly to pass this bill after it became obvious no agreement would be reached on how to pay for the permanent 'doc fix' bills.  

The Sustainable Growth Grate (SGR) was created in 1997 by Congress as a mechanism for tracking the payments with economic growth. The SGR became a problem within a few years as increases in healthcare costs substantially outpaced economic growth. This development resulted in the creation of a multi-billion dollar shortfall for the funding of Medicare payments to physicians. 

Members on both sides of the aisle and in both Chambers spoke about the need to permanently fix the SGR. However, they recognized the immediate need to prevent the delay's expiration and prioritized this temporary patch over a lengthy negotiation process to pass a  permanent fix that would result in the expiration of the SGR delay. 

Thursday, March 27, 2014

Bill to Delay ICD-10 and Sustainable Growth Rate Patch Passes House

Advocates on behalf of hospitals and practitioners were optimistic about the likelihood of a permanent 'fix' to the Sustainable Growth Rate for Medicare's physician reimbursement system. Members in both the House and the Senate introduced bills this session that would repeal the Sustainable Growth Rate in Medicare's physician payment formula. 

In a surprise development today the House passed the Protecting Access to Medicare Act of 2014, H.R. 4302, by voice vote. This bill does not provide a permanent fix, only a one year patch to the Sustainable Growth Rate. The legislation, sponsored by Rep. Pitts of Pennsylvania, did not extend a fix for the SGR to physician-owned hospitals. Insiders agree that the cost of longer term bipartisan bills with permanent fixes to SGR were tabled because the parties were not able to agree on how to pay for the costs--about $140 billion over a 10 year period.  

Many on the hill expect the Senate to move this bill to a vote tonight. Speaker Harry Reid is said to be working on a deal to bring the bill to the floor. However, Senator Wyden is said to be pushing back on passing a bill with only a short term fix. Stakeholders following SGR legislation believe that if a temporary fix is passed the Congress will feel less pressure, and efforts to pass a permanent fix this year will fade into the background. 

The Protecting Access to Medicare Act of 2014 also contains a provision to delay the ICD-10 meaningful use requirements until October 2015. CMS Administrator Marilyn Tavenner has repeatedly stated that the agency was not going to extend the ICD-10 meaningful use requirements. Many eligible practitioners and hospitals are concerned about being able to meet the deadline and have publicly appealed to the agency and Congress to extend the compliance deadline. 

Tuesday, March 18, 2014

More than 10,000 Electronic Health Records at Risk in Data Breach

Service Coordination notified nearly 14,000 Maryland residents this month that their personal medical information may have been compromised. Service Coordination is a state-licensed nonprofit organization based in Frederick, Maryland, that works with Maryland residents with intellectual and developmental disabilities. Service Coordination is one of five organizations licensed to provide services by Maryland's Developmental Disabilities Administration. To date there have been no reports of breaches from the other four licensed organizations. 

The organization learned of the security breach in October of 2013, but delayed notifying affected individuals at the request of the U.S. Justice Department. The Justice Department requested the delay to allow time for an unhindered federal investigation. The investigation resulted in the identification of the alleged hacker and the seizure of the hacker's equipment and accounts. 

To date there is no evidence that the data has been released or used for nefarious purposes. Service Coordination spokesman, Michael Baisey, explained that the breach involved a single document that contained personal information for nearly 70% of the group's 13,900 clients. Service Coordination will assist clients and families with credit report checks and identity theft protection.