Tarheel Tidbits January 2016

Tarheel Tidbits
Editor’s Note
I am pleased to bring you the latest edition of the Tarheel
Tidbits. In this issue we have a full calendar of Upcoming
Educational events at the Local and National level. We
also have a NCHA update, an important Save the Date
and more. I hope you enjoy this edition of the Tarheel
Tidbits.
- Kyle McMahan, Publications Chair
- Lisa Griffin, Publications Co-Chair
In This Issue

President’s Message

Membership Milestones

NCHA Update

Member Benefits
January 2016
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President’s Message
(from the Secretary)
By Carol R. Barron, 2015-2016 NCHFMA Secretary
Happy New Year! It’s amazing how quickly time has flown by. The holidays have come and, while we
have started a new year, our chapter year is more than half over.
As you may recall from the summer edition of the Tarheel News, our Chapter’s President, Ken Vance,
prefaced his presidential message with the expectation that you will hear from each member of the
NCHFMA Chapter’s executive team. As an officer, I am dually honored to take on this task and to serve
as your chapter’s Secretary for the 2015-2016 year.
So how did I get here? Being new to North Carolina in the late 90s, I was encouraged to join NCHFMA
because of the many educational offerings that were provided in North Carolina. It was a resource for
affordable education, while providing a venue to meet others in healthcare finance. Soon after
becoming a member of HFMA, Past-President Millie Harding encouraged me to join the Matrix so that I
could actively participate as a volunteer within the chapter. My Matrix participation allowed me to
present at HFMA events both nationally and at the chapter level while working alongside a diverse,
talented group of people. It was also through Matrix participation that I met another Past-President ,
Bob Barber, who inspired me to sit for the Certified Healthcare Financial Professional examination.
Since then I have served on multiple committees and councils. I have been the Chair of the Payer/
Managed Care Committee and the Director of the Education Council before being elected into the
officer’s positions of Treasurer and now as Secretary.
As leaders for HFMA, we have been challenged by our National Chair, Melinda Hancock, to “Go
Beyond”. When I heard this, I thought “we already do this”. We go beyond in our daily work lives as
we prepare for and react to regulatory pressures, payment reform, federal and state legislation, work/
life balance...oh, and don’t forget to improve those outcomes. However for our NCHFMA Chapter this
means we must “Go Beyond.” our traditional methods of delivering education and communication
while providing value to our members.
Our chapter is constantly searching for ways to improve upon our membership benefits including
education and providing timely communication of what is happening today in healthcare finance. Did
you know that you can now follow us on Twitter? @NCHFMA
TARHEEL TIDBITS
President’s Message
(from the Secretary)
Continued...
So how do we “Go Beyond” to make our chapter even better? How can NCHFMA become the coolest
chapter in the nation? The answer is YOU. We need you to “Go Beyond” as members. Each one of you
has a unique story and talent that can take this chapter to new heights. We are all limited with our
time and resources but even a small contribution can produce big results for our chapter. You could:
-
Write an article for the Tarheel News- …the Chapter awards a monetary prize for the best
article each year.
-
Offer to present your facility’s best practice at one of our educational events…this would earn
you free registration for the event
-
Work the registration desk at an education event...again, free registration.
-
Offer meeting space at your facility and we can bring an education session to you! …cuts down
on travel expenses.
-
Become a mentor to a new member...you will make a new friend.
These are just examples of how you can “Go Beyond” as a member of NCHFMA. You are a vital key to
our chapter’s development & success. I challenge each of you to be active, be present in your
membership and “Go Beyond”.
If you have any suggestions for our chapter in how we can “Go Beyond”, please don’t hesitate to
contact me or any other member of our board. We are always listening.
Carol Barron is a Fellow of the Healthcare Financial Management Association. She is employed by
Novant Health. Originally from Pennsylvania, she enjoys running, college football, and watching her
sons play basketball. Carol and her husband, David, live with their sons Connor and Parker in
Tobaccoville, NC.
TARHEEL TIDBITS
NCHFMA 2015-2016 Officers and Directors
President
Ken Vance
President-Elect
Bill Bedsole, FHFMA,
SVP Healthcare
Bank of America Merrill
Lynch
Phone: (704) 818-0542
Director of Programs
Debbie Hoffman
Immediate Past President
Special Projects Controller
Carolinas Healthcare
Phone: (704) 512-6439
MBA, MHA
CEO
Southern Atlantic Healthcare
Alliance
Phone: (919) 350-2004
Corporate Director, Business
Development and Sales
Novant Health
Phone: (336) 277-1133
Senior Director, Patient
Finance
Novant Health
Phone: (336) 277-1355
[email protected]
[email protected]
Director of Membership
Ariana Zibilich, CHFP
Director of
Chapter Services
Elaine Peeler, MBA, BHCM,
BBA, CHCA, CPC, CPC-H
Compliance Officer
EMS Management
Phone: (336) 3967-3791
[email protected]
Treasurer
April York
FACHE
[email protected]
[email protected]
Secretary
Carol Barron, FHFMA,
Principal
Triage Consulting Group
Phone: (404) 574-6400
[email protected]
Manager, Revenue Cycle Quality
Assurance
Novant Health
Phone: (704) 616-0954
[email protected]
Tim McElderry
[email protected]
Director of
Management Practices
Craig Wade, FHFMA
Director of Education
Lisa Morgan, CPA
Director of
Publications
Kyle McMahan
Director, Patient Account
Services
UNC Hospitals
Phone: (919) 843-0512
[email protected]
Reimbursement Project
Manager
Carolinas Healthcare
Phone: (704) 512-6444
Lisa.i.Morgan@
carolinashealthcare.org
Senior Analyst
KPMG
Phone: (704) 957-8267
[email protected]
NCHFMA 2015-2016 Committee Roster
Hospital Services
Kimberly Gore (Chair)
Patient Financial Services Director
Columbus Regional Healthcare
Phone: (910) 640-4060
[email protected]
Physician Services Committee
Sponsorship Committee
Lynn Lambert, CPA, FHFMA (Chair)
Jody Fleming (Chair)
Managing Consultant
Lambert Healthcare Consulting
[email protected]
Larry Trout (Co-Chair)
Compliance Committee
Kevin Leder, CPA (Chair)
Manager
CliftonLarsonAllen, LLP
Phone: (704) 998-5248
[email protected]
Information Management
Tim Lea (Chair)
Chairman & CEO
Healthcare Systems Consulting, Inc.
Phone: (919) 295-2965
[email protected]
Chief Solutions Officer
Healthcare Business Analytics, LLC
Phone: (828) 508-4644
[email protected]
Payor/Managed Care Committee
Vice President of NCHA Strategic Partners
NCHA Strategic Partners
Phone: (919) 677-4130
[email protected]
Eb Preuninger (Chair)
Managing Partner
AP Associates
Phone: (828) 296-1408
[email protected]
Assistant Treasurer
Manager
DixonHughesGoodman, LLP
Phone: (704) 644-4805
cassandra/[email protected]
Phone: (843) 655-1499
[email protected]
AVP Patient Financial Services
Carolinas Healthcare System
Phone: (704) 984-4398
[email protected]
Chris Johnson, FHFMA (Chair)
Vice President Revenue Cycle Mgmt
Carolinas Healthcare System
Phone: (704) 512-7083
[email protected]
Technology Committee
Cassandra Fahey (Chair)
Sherry Keck (Co-Chair)
Certification Committee
Yerger Committee
Scholarship Committee
Bunnie Overby (Chair)
Director Revenue Integrity
Cone Health
Phone: (336) 663-4002)
[email protected]
Lynwood White, CPA, FHFMA
Publications Council
Lisa Griffin, FHFMA (Co-Chair)
Manager, CON/Strategic Planning
Novant Health
Phone: (704) 384-3462
[email protected]
Founders Committee
Kim Coker (Chair)
Sr. Financial Analyst
Cone Health
Phone: (336) 832-8038
[email protected]
Welcome New Members
Name
Title
Company
Reed Burger
Assistant Director, Finance and Administration
Wake Forest Baptist Medical Center
Rick Wells
President
SolutionWells
Douglas Webb
Senior Director of Business Development
Intermedix
Debbie Carthen
Patient Account Manager
Duke University Medical Center
Ketki Green
Revenue Manager
Duke University Medical Center
Judy Heath
Business Operations Manager
Orthopedics East & Sports Medicine
Mike Smith
Certified Public Accountant
Jerry Harrington
Senior Financial Analyst
Pankaj Kumar
UNC Hospitals
Wake Forest Baptist Medical Center
Elizabeth Forrestal
Professor Emerita
Andrew Dutcher
Senior Internal Auditor
UNC Healthcare
Derek Robinson
Senior Manager
Deloitte Consulting LLP
James Jansen
Manager, Insurance Services
Chesapeake Regional Health
Weston Cranford
Financial Analyst
Ensemble Health Partners
Katherine Rinehardt
Board of Directors
Community Health Center of Union County
Vincent Dunnegan
Accounts Receivable Manager
Duke University Health Systems
Phillip Bell
Carmen Watley
Prism Healthcare
Welcome Transfer Members
Name
Title
Company
Praveen Mekala
Chief Financial Officer/ VP
Southeast Alaska Regional Health
Michelle Johnson
Director of Operations
ClaimAssist
John Melton
Chief of Staff (COO)
Womack Army Medical Center– Fort Bragg
Amanda Johnson
Senior Accountant
NASH UNC Healthcare Systems
TARHEEL TIDBITS
Upcoming Educational Events:
National and Local
National Educational Events/ Webinars:
February 2
Understanding Today’s Payor Climate and Provider-Sponsored Health
Plans
February 4
Bridging the Clinical and Financial Divide for a New Era of Healthcare
February 9
Kick Healthcare Analytics Up a Notch: A New Recipe for Success
February 11
Provider Organizations Share Insights that Mitigate Financial Risk Caused
by Burgeoning Patient Responsibility Debt
February 23
Using Chronic Care Management Programs to Improve Clinical and
Financial Health in a Value-Based Era
February 24
Why HFMA’s Certified Healthcare Financial Professional (CHFP)
Certification is Right for You
February 25
The Latest Outlook and Trends on the Not-For-Profit Healthcare Sector
from Standard & Poor’s
Local Educational Events:
March 13-15, 2016
August 28-31, 2016
November 13-15, 2016
NCHFMA Winter Institute
Pinehurst, NC
NCHFMA Summer Institute
Kingston Plantation– Myrtle Beach, SC
Region IV Mid-Atlantic Institute
Omni Grove Park Inn - Asheville, NC
Save the Date: 2016 NCHFMA
Annual Meeting
Come and join us for a “Night at the Oscars”!
We are very excited for our upcoming Annual meeting. We have lots of fun, education and networking in
store. We have heard our members and the Program Committee has done a wonderful job identifying
speakers to fulfill these request.
Some of our education events include; a CEO Panel discussion, TCPA, The Exchange, ANDI and Ethics, to
name a few. Come and take time to spend with colleagues networking around the bonfire or at “The
Night of the Oscar.” While it is at night, we are having a nontraditional dinner style, fun awards, and
member made movie trailers and dancing with the DJ, Butch Barnes.
You don’t want to miss making memories and continuing your personal growth. We will see you there!
TARHEEL TIDBITS
NC Membership Milestones!
By Ariana Zibilich – NCHFMA Membership Chair
Webster defines a milestone as “an important event”. I would certainly argue that hitting 10 or more
years with HFMA marks a milestone worthy of celebrating. In 2016, over 50% of our NC chapter
members (461 of our 831 members) will be celebrating at least 10 years or longer as part of the
nations leading professional membership organization for financial management executives and
leaders. That is significant! We look forward to celebrating with those of you who will be attending our
annual meeting in Pinehurst as part of our Night at the Oscars!
Years as a HFMA Member
# of NCHFMA Members
Zero to Nine Years
370
Ten to Nineteen Years
233
Twenty to Twenty Nine Years
141
Thirty to Thirty Nine Years
70
Forty to Forty Nice Years
13
Fifty to Fifty Nice Years
2
Sixty or More Years!
2
TOTAL NCHFMA MEMBERSHIP
831
Please join me in thanking and congratulating the following NCHFMA members for their commitment to our professional organization. The organization is only as strong as it members and I would
say we are a very strong chapter when I look at its makeup. Scrolling through the lists below, I am
struck by the number of past presidents, board members, matrix members, and others who have
contributed to our chapter over the years in various ways!
Sixty Years or More
Fifty to Fifty-Nine Years
Bill Moffitt
Jeff Steinert
James Bennington
Bill Fuller
Forty to Forty-Nine Years
Roger Kishman
Bob Newton
Lyn White
Oren Wyatt
Marian Safriet
Thomas Poccia
Bill Gutekunst
Belinda Tilley
Garry Karsner
Carrie Wadlinger
Dempsey Craig
Mike Stevenson
Don Whittington
TARHEEL TIDBITS
Thirty to Thirty-Nine Years
Jon Graham
Christopher Taylor
Roy Smith
Ken Boggs
Tim Pollard
Phil Geissinger
Bill Boatwright
Ron Petterson
Eb Preuninger
Fred Zodda
Woody Hathaway
Tim McElderry
Pat Hawkins
Ruth Anne Bland
Jim Leis
Ed Ollie
Sam Rose
Charles Ayscue
John Cook
Joseph Calcutt
Rex Street
Gladys Mills
David Boone
Marie Hawkins
Keith Hullender
Jim Hutchinson
Greg Klein
Philip Harewood
Larry Miller
Deborah Whittington
Joel Mercer
Charles Acker
Greg Gombar
Matt Pracht
John Congelli
George Kimbro
Dave Conradt
Dennis Coffey
Bill Bedsole
Alan House
Don Trippel
Ronnie Cook
Skip Austin
Lynn Lambert
Phil Manz
David Pyland
Roger Stroud
Carol Hoxie
Bunnie Overby
Daniel Wiens
Mike Caudle
Bill Melvin
Mark Cantrell
Betty Hurley
Glenn Martin
Sherry Jensen
Timothy Owens
Lucinda Crawford
Frank Jones
Randy Medlin
Kevin May
Don Brelsford
Millie Harding
Debbie O'Neill
George Pink
Michael Simms
Jim Bross
Angela Deans
Paul Amantea
Steve Marshall
Twenty to Twenty-Nine Years
Mary Bartlett
Linda Darden
Leslie Robinson
Steve Duncan
Donna Allen Reddy
Robert Fritts
Tracy Wagner
Carol Hale
Dan Nichols
Linda Roberson
Becky Craig
Joanne Gibson
Shari Reese
Patrick Easterling
Mary Ann Rouse
Karen Boone
Paul Harnett
Glenn Wolfe
Joseph Richardson
Darrell Pare
Anne McGeorge
Gaynelle Patterson
Bryan Hawkins
Skip Marsh
Sabrina Olsen
Mark Keener
Rodney Goodall
Martin Daniel
Michael Brown
Paul McDowell
Sherry Keck
Lee Lynch
Theresa Parker
Jim Chatman
Wanda Pell
Bob Nelson
TARHEEL TIDBITS
Peyton Howell
Carl Ferebee
Paula Greeno
Mark Hiller
Christopher Ellington
Calvin Marshall
Dudley Harrington
Lynn DeJaco
Jeffrey Jones
Dan Elmer
Kent Thompson
David Paugh
Valerie Russell
Melissa Packer
Cindy Robinson
Roger Spivey
David Hughes
Brylan Gann
Steven Williamson
Larry Hill
Rhonda Silver
Dave Belkoski
Karen Zurek
Lisa Griffin
Allen Squires
John Franklin
Beth Ward
Teresa Strom
Harry Corey
Robert Kulesher
Alan Wordsworth
David Kitzmiller
Danny Squires
David Yon
Bill Glidewell
Kathy Wood
Dave Kilmer
Chris Johnson
Brad Vass
Scott Krewson
Buck Wiggins
John Price
Cynthia Polshak
Josef Penner
Gary Massey
Renie Henslee
Gerald Heinzman
Susan Shovlin
Cheryl Burleson-Davis
Steve Stang
Eileen Caviness
Paul Juras
Richard Roycroft
Jana Clark
Donald McNeill
James McDonnell
Rose Cook
Tim Lea
Joe Hall
Craig Wade
Sidney Stern
Toni Hatch
John Grissom
Leslie Gura
Greg Holsinger
Brent Shive
Carl Armato
Keith Moore
Richard Marvin
John Sweeney
Sharon Roseberry Long
Ronald Costanzo
Laurie Shoaf
Todd Butts
Michael Coffey
Jim Panton
Dean Swindle
Kathy Rhyne
Stuart Smith
Chris Batson
Anthony Moore
Jay Stock
Mike Snyder
Linda Walker
John Miller
Sarah Goodman
Barbara Mohr
Rhonda Miller
Kathy Barger
Beverly Flynn
Galen Ezzell
Leroy Oakley
Thomas Johnson
Keith Bray
David Catoe
Ty Carson
Karen Stevens
Russell Early
Glenn Wagner
Earl McCandless
Scott Lieberenz
Margene Holak
Michael Fabrizius
Doug Rowe
Geoffrey Miller
Ten to Nineteen Years
Keven Carroll
Frank Chatman
Richelle Fleischer
Donna Holt
Judy Booth
David Motsinger
Al Hooks
Lou Ann Day
Rob DeLoach
Debbie Gray
J.P. McLaurin
Mark Miller
Pattie Moore-Boyette
Ed Gasparovic
Kimberly Crews
Michael Polito
Glen Hubbard
Fred Hargett
Rebecca Langdon-Galbreat
Kevin Williams
Neil Wlodyka
Michael Duke
Sarah Mayo
Michelle Mitten
Susan Phelps
Rodney Ball
Eric Bauer
Amy Crews
John Settlemyer
Michael Bollinger
Michael Howe
Trent Messick
Marybeth Nagle
Shelly Forward
Taff Kraatz
Sarah Frye
Mary Jane Jankowski
Meredith Miller
Kent Spear
Lawrence Brooks
Chris Fraley
Kyra Hippensteel
Joe Molis
Michael Rauchwarg
Jeff Casey
Stanley Hester
Bill Greene
Geoffrey Gardner
Chris Uthe
Rick Owen
Elizabeth Strickland
Robert Weathers
Jack Dennis
Debra O'Neill
Jody Fleming
Robert Willis
Carl Gryczynski
Kevin Randall
Tom Carlin
Kim Coker
James Ramsey
Hugh Bray
Shelly Miller
Jeff Wakefield
Brett Liverman
Lynn Lowrie
Patricia Moll
Lacy Reeder
Lynn Thrower
Derek White
Neil Dorr
Jeff LeGay
Carol Barron
Mark Relyea
Bob Wilson
Jim Allen
Veda Williams
Clara Caldwell
Andrew Barrow
Anita Turner
Lorie Collins
Vickie Monteith
Jason Bromley
Krista Lutz
Don Hale
Sabrina Hedglin
Gary Kennedy
Mike Lazar
Trey Sturtevant
Michelle Durner
Mark Hoffman
Brian Short
Billy Tatum
Kirsten Royster
April York
Jamey Stoner
Marcie Terry
Karen Stepp
Bill Hayes
Steve Burr
Lynda Norris
Stephanie Sessoms
Michael Brady
Dan May
Anita Bennett
Jonathan Hoy
Barry McKee
Deborah Graziano
Polly Doroshenko
Mike Kennedy
Angela Sanford
Chris White
Wendi Barber
Allen Clayton
Chris Reyes
Beth Alford
Tyler Miller
Hewitt Fulton
Erich Koch
Donna McClung
Fabian Stone
Craig Wise
Renay Walker
Nancy Lane
Travis Justice
William Kauder
Tom Laymon
Kimberly Griffin
Ryan Hunsucker
Karin Mendenhall Mabe
Deborah Sackie
Chad Polk
Loretta Long
Shannon Gore
Craig Pergrem
Kristi Sutton
Tim O'Connor
Carl Biber
Mike Daiken
Curt Shaw
Christopher Townsend
Debbie Hoffman
Elaine Peeler
Lori Robinson
Elisabeth Barksdale
Malinda Gallup
Kim Hull
Katie Davis
Erick Hawkins
Donna Parsons
Lauren Elmore
Steven Cherok
Camey Thomason
Tim Alba
Kelly Baker
Ken Vance
Rob Murr
Richard Westbay
Maria Jayoussi
Russ Armistead
Joseph Baker
Gerald Swiacki
Jason Pullar
David Hinson
John Lynch
Penney Burlingame
Sharon Clayton
Mory Lowe
Yates Lackey
Jason Nelms
Richard Weeks
Kevin Leder
Sandra Wood
David Morton
Melissa Masterton
Kim Ray
Michele Cash
Bob Lagesse
Liz Farrow
Christine Sibley
Leslie Bard
Sandy Ray
Robin Shepard
Mark Moyer
Karen Biegler
Darin Spencer
Stephen Rinaldi
Kenneth Miles
Michael Rabb
Eliana Owens
Andrea Hickling
Jennifer Arcudi
Erin Bartley
Karen Travers
Pam Thompson
Tony Mary
Heather Flickinger
Joseph Kahn
Vivan Thomas
Michael Trumbore
Russell Salton
Leigh Anne Pope
Kristin Reiter
Beth Bell
Cheryl Pardue
Mike McDonald
Mitch Valentine
Rodney Williams
Christopher Frederick
Lisa Walter
Myra Fields
Susan Gristchuk
Angela Gardner
Cindy Arnold
Sarah Wilson
Jeff Neisen
Scott Williams
Ariana Zibilich
Rita Antonelli
Sharon Thompson
Scott Mitchell
Michael Whalen
Keith Williams
Laura Rackley
Barry Wald
Sean Angert
Lynda Keith
Traci Swaim
Sarah Broome
Josh Steedley
Sunny Sain
Jack Justice
Richard Bovard
For those who have been part of HFMA for less than 10 years, please know your membership and
dedication to our chapter is crucial for the future of HFMA! We welcome your involvement in the
MATRIX and hope that you continue to find the education and networking opportunities to be
valuable to both your personal and professional development!
TARHEEL TIDBITS
Member Benefits: Promoting the Value of
HFMA
By: Ariana Zibilich – NCHFMA Membership Chair and Kyle McMahan – Publications Director
Have you been meaning to encourage a colleague, client, or vendor to join HFMA but just haven’t
gotten around to having that conversation? Need some additional information to help with that
conversation? Want to be awarded for your efforts? Read on…….
Invite your peers, your staff, and your colleagues to join you and you could be eligible for a number
of prizes such as $25, $100, or $150 Visa Prepaid Cards or the Apple Watch Sport!
In addition to these incentives offered by national, our NC chapter will be offering an iPad Mini to
our member who recruits the most members between now and April 31, 2016.
*Don’t forget to have your new member add your name as their sponsor to be eligible.*




Validate your skills and knowledge
Enhance your credibility in the industry
Support your professional development
Demonstrate a high level of commitment to the field





Conferences: ANI
NC Specific opportunities: 2 Institutes a Year
NC Brings the Education to you: Medicare Bootcamps
Countless Webinars National Offers
Resources: Access to blogs, newsletters, HFM
$AVE
New Members: join or reinstate your HFMA membership by January 31, 2016 and your prorated
price is $167. Membership will be good through May 31, 2016 or extend your membership through
May 31, 2017 for $482.
And keep in mind all members can take advantage of reduced member registration fees for both
local and national conferences. In addition, NC Chapter New Members are eligible for a $100
discount off your first conference registration fee. Email Ariana @ [email protected]
for additional information.
TARHEEL TIDBITS
Education
With over four different certification program options available, there is likely one that fits your
level and skill set!
Certifications
Becoming certified distinguishes you as a leader and high-level professional in the healthcare
finance industry and allows you to:
Networking
With an HFMA membership, you gain immediate access to the largest network of healthcare
finance professionals. You can join forums and bounce questions off peers and industry experts or
enter into forum wide discussion on topics that relate to your area of expertise.
NCHA Update
By: Jeff Weegar
NC Legislature Passes Session Law
2015-245: Medicaid Transformation and Reorganization
Details of the legislation can be found in Session
Law 2015-245.
CMS Issues Outpatient Prospective Payment
System (OPPS) and Ambulatory Surgical Center
The NC Legislature passed House Bill 372, which will (ASC) Proposed Rule for FY 2016
transition the current Medicaid fee-for-services
On November 13, 2015 the calendar year 2016
system to full capitation.
final payment rule for Medicare Outpatient
Prospective Payment System (OPPS) was published
Major proposals include:
in the Federal Register. The final rule includes

The NC Department of Health and Human Services
annual updates to the Medicare fee-for-service
(DHHS) will submit an 1115 waiver and State Plan
outpatient payment rates as well as well as
amendments to the Centers for Medicare and
finalized regulations that implement new policies.
Medicaid Services (CMS) by June 1, 2016;


The State will be contracting with Prepaid Health
Plans (PHPs) who must hold a PHP license from the
NC Department of Insurance;
The State will contract with three commercial
Insurance plans that will assume risk for Medicaid
recipients across the State, and up to ten providerled entities (PLEs) that will assume risk for Medicaid
recipients in predetermined regions as defined by
DHHS;
Major proposals include:

An overall final rate update of -.60%, which reflects
a market-basket (MB) update of 2.4 percent, -.7
percent for ACA-mandated MB reductions, -.27
percent for budget neutrality adjustments, and -2%
inflation adjustment for excess packaged payments
for laboratory tests.

Renumbering of APCs in order to better group
clinical families;

Implementation of 10 new Comprehensive
Ambulatory Payment Classifications (C-APCs) that
bundle all payments for certain device-dependent
procedures;

Contracts will cover all services except dental
services and those currently covered by behavioral
health management entities (LME/MCOs).

Contracts shall cover all Medicaid recipients except
those whose only service received is the payment of

Medicare premiums with Medicaid funds (dual
eligible);

Expansion of the list of services to be packaged into
APCs as opposed to separately paid;
For IPPS, revision of the “Two-Midnight Rule” for
reasonable expectation requirement and use of
Quality Improvement Organizations (QIOs) as the
first line of auditing.

A minimum medical loss ratio of 88 percent for
healthcare services;

DHHS is directed to attempt to preserve existing
levels of funding generated from Medicaid-specific
The full final rule can be found in the Federal
funding streams, such as assessments, to the extent
Register available on the CMS website.
that the levels of funding may be preserved.

The development of the new Division of Health
Benefits that will operate the new Medicaid program at the Department of Health and Human
Services. The current Division of Medical Assistance
will be eliminated and remaining operations will be
moved to the Division of Health Benefits within 12
months after PHP contracts begin.
TARHEEL TIDBITS
NCHA Update
Continued...
CMS Issues Proposed Bundled
Payment Program for Hip and Knee
Replacements
On November 16, 2015, CMS released its final rule
for the Medicare Comprehensive Care for Joint
Replacement (CJR) model. The program will be
effective for discharges occurring on or after April
1, 2016 in the 67 designated Metropolitan
Statistical Areas (MSAs), unless otherwise noted.
Under the CJR model, the hospital in which the
joint replacement occurs would assume financial
risk for quality and costs of the episode of care
through 90 days after discharge.

Providers will be paid according to current
Medicare FFS rules, with retrospective reconciliation
to the episode target prices on an annual basis;

Target prices for the lower extremity joint
replacement (LEJR) DRGs will be stratified to the
episode target prices on an annual basis and
payments for all included services will be compared
to the target amount. CMS will recoup payment
amounts exceeding the target or make
reconciliation payments for amounts under the
target;

Hospitals in the 67 MSAs cannot opt out of the
program; the only hospitals excluded are CAHs and
hospitals already at risk for LEJR episodes in the
Bundled Payments for Care Improvements (BPCI)
Initiatives.

Prices/payments will include both operating and
capital amounts (the proposed rule only included
IPPS operating amounts);

For a hospital to receive a reconciliation payment,
the hospital must meet or exceed performance
thresholds on composite quality measures.
Major proposals include:

The CJR episode includes the initial inpatient stay
and all Medicare Part A and B services for 90 days
post discharge, with limited exclusions;

Episodes are triggered by an index admission to the
acute care setting that is discharged under the
MS-DRG 469 or 470;

Hospitals will be responsible for all episodes of care. Register available on the CMS website.
Physicians, post-acute providers, and conveners
cannot participate as episode initiators;
TARHEEL TIDBITS
The full final rule can be found in the Federal
NCHA Update
Continued...
CMS Issues Medicare Physician Fee Congress Passes Changes to SiteSchedule (MPFS) for Calendar Year Neutral Payment for New Provider2016
Based Hospital Outpatient
On November 16, 2015 CMS published its final rule Departments and One-Year
for calendar year 2016 with changes to the
Extension of Medicare Sequester
Medicare physician fee schedule (PFS) and other
revisions under Medicare Part B. The final rule
implements a .5 percent update to PFS payments,
as mandated by the
Medicare Access and CHIP Reauthorization Act of
2015 (MACRA).
Major proposals include:





Reimbursement of advance care planning (ACP)
services, which include the explanation and
discussion of advance directives by a physician or
other qualified health professional;
The provisions of Section 603 of the Budget
enacted site-neutral payment reductions for
Medicare services furnished in new off-campus
Expands payment for telehealth services to include provider-based hospital outpatient departments
that are not dedicated emergency departments.
prolonged services in the inpatient or observation
setting and end-stage renal disease-related services New off-campus provider-based hospital
for home dialysis;
outpatient departments are defined as departments that are not on the main campus of a
Creates two new exceptions to the prohibition on
hospital, are located more than 250 yards from the
physician self-referral, and implements a number of
main campus, and started billing for Medicare
technical changes to clarify certain regulatory
provisions and expand needed access to health care outpatient services on or after January 1, 2017.
New off-campus provider-based hospital
services;
outpatient departments will not be eligible for
Allows group practices to use the Qualified Clinical
reimbursements from CMS OPPS beginning
Data Registry reporting options currently available
January 1, 2017. Such outpatient departments
to individual eligible professionals;
would be eligible for reimbursements from other
Medicare Part B payment system, including the
For CY 2018 payments, continues placing up to 4
Medicare PFS, the ambulatory surgery center
percent of PFS payment at risk for upward or
payment system, or the clinical laboratory fee
downward adjustment under the Physician Valueschedule, as appropriate.
Based Payment Modifier (VM) and applies the CY
2018 VM to certain non-physician EPs; and

Incorporates a star rating approach for individual
measures on Physician Compare beginning in CY
2017.
The full final rule can be found in the Federal
Register available on the CMS website.
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On November 2, 2015 the President signed into
law a two-year budget agreement to raise the
nations debt limit and set the federal budget for
two fiscal years. The bill included site-neutral
payment changes for new provider-based hospital
outpatient departments and a one-year extension
of Medicare sequester.
Selecting the Exceptional Remote Healthcare Call Center Will
Help Achieve Financial Goals
By: Michael Conklin
Healthcare organization financial managers know that their hospitals, health systems and multi-specialty
practices are often too busy for effective handling of the high volume of calls that come in throughout the
day. As a result, many have been turning to remote call centers to improve patients’ ability to connect,
whether for scheduling, information or other forms of support. This can be a wise choice for those looking
to lower costs, increase revenues, improve efficiency, ensure compliance, and improve patient
satisfaction and loyalty.
However, not all healthcare call centers are created equal. To achieve their goals, financial managers
need to select the exceptional call centers. Merely adequate call centers are those whose representatives
have healthcare experience, whose metrics ensure wait times of less than 60 seconds and 99 percent
routing accuracy, and whose robust infrastructure offers high availability, scalability and security. The
differentiator between these and exceptional healthcare call is the people.
Too many healthcare call centers are little more than a set of warm bodies following scripts. Adequate
representatives are experienced and trained on the phone system and can complete calls in a certain
amount of time; exceptional representatives also make patients feel positively connected and more
satisfied with your healthcare organization in general.
I believe there are five elements that differentiate exceptional healthcare call centers:
1. Empathy, compassion and other “soft skills.” Experience can be found on a resume; however, savvy
healthcare organizations need to interview applicants with an eye toward identifying each one’s
ability to be warm and supportive, to be calm under pressure and to connect on an emotional level.
2.
Regular, ongoing training for all representatives. Exceptional healthcare call centers are those that
insist on excellence and continual improvement across all experience levels. They listen to calls and
score how well representatives follow defined workflow, protocols and processes, as well as more
qualitative measures. They require representatives to score their own performance, which helps
motivate ownership of improvement initiatives. And they celebrate successes to encourage ongoing
progress..
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Continued...
3. A sense of connection to client organizations. The most successful healthcare call centers take
specific steps to inspire pride in their clients, turning “them” into “us.” Call center supervisors
communicate regularly with the client organizations – including in-person visits – to better understand
each practice’s demeanor and address individual preferences. Then they bring that information back
to their call center team.
4. A shared vernacular. People are more comfortable speaking with people who speak their language.
Smart healthcare call centers may use translation services, but they also employ individuals fluent in
languages that callers are likely to speak. It is important that representatives’ dialects feel familiar and
easily understood by callers.
5. A culture of mutual encouragement, respect and appreciation. An organization whose call center
representatives feel valued and important will have less people turnover and will work harder to
make callers feel that way, too.
These five components turn efficient processes into better answers to questions with more relevant
information and more effective solutions to problems for patients. This, in turn, helps healthcare
organizations to achieve their financial goals.
Michael Conklin is the Executive Director, Southeast Region, at McKesson Business Performance Services in
Alpharetta, Georgia and a member of HFMA Region 5. He can be reached at
[email protected].
**Reminder**
Deadline for the Spring Issue of the Tarheel News is April 15, 2016. Please submit all articles and news
happenings you’d like published to Kyle McMahan at [email protected] or Lisa Griffin at
[email protected] prior to that date for consideration.
TARHEEL TIDBITS
Help Wanted!
Are you knowledgeable about healthcare basics; Revenue Cycle; and/or Reimbursement? Do you enjoy
having fun? If so, NCHFMA needs your assistance. Your Chapter is looking for individuals who enjoy
teaching and training others on a part time basis. Our Chapter had great success in 2014-15 with our
Healthcare Finance Boot camp taught by Chris Johnson and Christine Sibley. However, they are only 2
people and have full time jobs! In fact, some of the on-site sessions (yes we go to our Providers) had so
much demand, we ended up scheduling 2 sessions at the same provider location. We are looking to expand the program and taking this education program to our Providers across the State of North Carolina.
If interested in learning more about this opportunity, please contact NCHFMA President, Ken Vance, at
[email protected] or by cell at 704-880-4887.
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North Carolina Healthcare Financial Management Association
2015-2016 Corporate Sponsors
Platinum Sponsors
Ensemble Health Partners
Xtend Healthcare, LLC
Gold Sponsors
AccessOne MedCard, Inc.
AccuDoc Solutions
American Health Care
Avadyne Health
CliftonLarsonAllen, LLP
Commerce Bank
MedA/Rx (A PMAB Company)
NCHA Strategic Partners
Paragon Revenue Group
ParrishShaw
The SSI Group, Inc.
Triage Consulting Group, Inc.
Valence Health
Silver Sponsors
Accelerated Claims
FISCAL Technologies
Adreima
FirstPoint Healthcare Resources
Allgood Professional Services, LLC
Patientco
Avectus Healthcare Solutions, LLC
PatientMatters, LLC.
Bank of America Merrill Lynch
PCB Collection Specialists
BDM International
Professional Recovery Consultants, Inc.
Bottom Line Systems, Inc.
RevClaims, LLC
ClearBalance
RSource, LLC
Computer Credit Inc.
Stern Recovery Services, Inc.
DixonHughesGoodman Healthcare
The ROI Companies
EOS Healthcare
TruBridge
Bronze Sponsors
Acryness, Inc.
AmCare Group, LLC
Bull City Financial Solutions
Cirius Group, Inc.
Credit Solutions, LLC
Emdeon
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EnableComp, LLC
HCFS, Inc.
MDS (Medical Data Systems, Inc.)
Medlytix, LLC
Nexsen Pruet, LLC
PARO Decision Support
Parallon
ProAssurance Companies
Resource Corporation of America
SLG, Inc.
Stanley Benefit Services, Inc.
T. Giovanis & Company, LLC