Tarheel News Summer 2015 - North Carolina Chapter of HFMA

Vol 49 No. 1
Summer 2015
The North Carolina Chapter’s News Magazine
2
Contents
President’s Message
President’s Message ……………………………………………………………………………………………… 5
Welcome New & Transfer Members …………………………………………………………………… 6—8
Feature article: 501 (r) Regulations and the Provider’s Responsibility ………………… 10 –11
Welcome 2015-2016 Regional Executive ………………………………………………………………… 12
Theme for HFMA ………………………………………………………………………………………………. 13
Scholarship Funds Available ………………………………………………………………………………… 14
Feature Article: Medicare’s Mandated Orthopedic Bundle …………………………………….. 16
NCHFMA 2015-2016 Matrix ……………………………………………………………………………….. 17
Matrix Meeting: Your Matrix at Work ………………………………………………………………….. 18
Founder Points and Awards …………………………………………………………………………………. 19
NCHA Update ……………………………………………………………………………………………… 20—21
Student Member Focus ……………………………………………………………………………………….. 23
2015-2016 Corporate Sponsors …………………………………………………………………………….. 24
Upcoming Education Events ……………………………………………………………………………….. 25
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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 Chair
Lynn Lambert, CPA, FHFMA (Chair)
Jody Fleming
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]
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Chief Solutions Officer
Healthcare Business Analytics, LLC
Phone: (828) 508-4644
[email protected]
Payor/Managed Care Committee
Vice President of Sales & Marketing
NCHA Strategic Partners
Phone: (919) 677-4130
[email protected]
Eb Preuninger
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 Chair
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]
Founder Committee
Kim Coker (Chair)
Sr. Financial Analyst
Cone Health
Phone: (336) 832-8038
[email protected]
President’s MPresident’s
essage
Message
By Ken Vance, 2015-2016 NCHFMA President
I
Ken Vance
2015-2016 NCHFMA President
I recently saw a quote
that said “No one has ever
climbed Mount Everest
alone; they always go as a
Team”. That quote is so
appropriate as I begin my
quest as President of the
NCHFMA for the 2015-16
Chapter year. It is with that
as a backdrop that you will
hear from your Executive
Team in future issues of
the Tarheel News – Bill Bedsole, President-Elect; Carol Barron,
Secretary; and April York, Treasurer. It is noted that our
Chapter is blessed with many dedicated volunteers that insure
the operations of your chapter are handled timely and
accurately. You will note in this edition of the Tarheel News
messages from each of our Committee Chairs and Council
Chairs. Chapter volunteers get pulled in many directions from
their paying job, family responsibilities, and other daily
responsibilities. Therefore, we need to say Thank You to those
that allow us to be involved in HFMA: our employers, our
families, and significant others.
Healthcare is rapidly changing. My term comes when policy
makers, payers, and health systems are instituting measures to
improve outcomes while at the same time changing the
reimbursement methodology. Our state is seeing the formation
of numerous ACOs and CINs and yet we still have so much to
learn with respect to their operation and integration with the
market. This uncertainty creates great opportunity for HFMA
to be a leader in education and bringing the various “players” to
the table to find mutually acceptable solutions.
Our Chapter had a successful 2014-15 calendar year under
the leadership of Past President, Tim McElderry. Your NC
chapter received nine national awards at the annual Chapter
President’s Dinner held June 23, 2015 at the HFMA Annual
National Institute (ANI) in Orlando. HFMA awards and
recognizes chapter activities to achieve results defined by the
Davis Chapter Management System (DCMS). It is intended to
add value for members while encouraging innovation and
improvement.
NCHFMA was recognized for the following awards of
excellence and achievements:
 Bronze Award for Excellence in Membership
Growth and Retention, by exceeding the membership goal of 893 members.
 Bronze Award for Excellence in Certification, as
10% of our members are certified
 Silver Award for Excellence in Education, by
achieving 18.6 education hours per member

Helen M. Yerger Special Recognition Awards
2 Chapter awards for the member service and
member communication:
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NASBA Certification and the Value of CPE for
NCHFMA; and
Getting Social with NCHFMA
4 Multi-Chapter awards for collaboration
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Charm City Region IV Mid-Atlantic Conference
Region IV Building a Better and Stronger Region
Region IV Initiative on the Potential Tax
Implications of Sponsorship
Certification Practicum Webinar
Bill Bedsole, Ken Vance, Kim
NCHFMA 2014-2015 President
Coker, Tim McElderry at the
ANI President’s Dinner
Tim McElderry at ANI in
Florida with Melinda Hancock
and Kari Cornicelli
Thank you for your support of HFMA and more
importantly, NCHFMA. I started this message with
recognizing our volunteers and will end on a similar
note. Our Chapter is only as strong as our volunteers.
Volunteering is the ultimate expression of human
relationships – people acting on behalf of their
organizations, because of a desire to contribute and help.
As a result, volunteers tend to be highly engaged and
committed to the outcomes of their work. Your
commitment and active volunteerism with NCHFMA
will be what makes this Chapter one of the best chapters
in America.
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Welcome New Members
NCHFMA proudly welcomes the following new members:
6
Welcome New Members
7
Welcome Transfer Members
NCHFMA proudly welcomes the following members who transferred
to the chapter:
8
Feature Article
501(r) Regulations and the Provider’s Responsibility
by Kimberly Gore, Patient Financial Services Director, Columbus Regional Healthcare System
Craig R. Brondyke, Director, PricewaterhouseCoopers LLP
Amy Bibby, Partner, DHG Healthcare
Bill Howard, Senior VP, FirstPoint Collection Resources, Inc.
T
The Affordable Care Act has had a tremendous impact
on healthcare as we know it, and continues to do so. It is
re-shaping healthcare not only for the patient, but also for
hospitals and how business is directed.
The 501(r) Regulations are a result of what the
Affordable Care Act has prompted for tax exempt hospitals,
and with it comes many responsibilities to the provider
including: a community health needs assessments, financial
assistance policies, billing and collections, and limits on
charges. These key components have potential implications
to provider reimbursement.
Community Health Needs Assessment
In order to fulfill the requirements regarding the
Community Health Needs Assessment (CHNA), hospitals
are now required to conduct an assessment every three years
in an effort to identify and address the needs of the
community. These needs are defined by the region and
population served by the hospital. Once all is determined,
the CHNA then should be documented and reported to the
community and be available if requested. The hospital
must also complete and publish an Implementation Strategy
outlining the plan and approach that the hospital is taking
to address the needs identified.
Financial Assistance Policies and Procedures
The standards of a hospital’s financial assistance policy
(FAP) are greatly impacted by the 501(r) Regulations. There
must be an established written policy in place, and that
policy must include certain stipulations, such as clearly
stated eligibility requirements, a description of how a
patient applies for financial assistance, etc. Communication
regarding the policy should also be posted and publicized in
areas within the hospital, as well announced in the
community. Just as with the CHNA, a hard copy of the
financial assistance policy must be available if requested by
anyone.
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Limits on Charges
A key concept of the 501(r) Regulations relates to how
much a hospital facility can charge a financial assistance
eligible individual for emergency and other medically
necessary care. If an individual has applied for and met the
qualifications of financial assistance, per the policy, the
hospital cannot charge that patient more than the amounts
generally billed (AGB) to individuals who have insurance
covering such care. Hospitals should carefully consider the
qualifications for charity care per the financial assistance
policy as they will have a direct impact on the hospital’s
overall charity care percentage, collection efforts, and
financial results.
Billing and Collections
The Billing and Collections Policy should describe the
hospital’s policy of obtaining payment from a patient before
any extraordinary collection actions (ECAs) are taken.
Examples of an ECA would be reporting the debt to a credit
agency or initiating legal actions such as a court judgment of
lien or garnishment. The process must also ensure the
hospital has made reasonable efforts to determine if a
patient is eligible for financial assistance, before engaging
ECAs, and include timeframes in which the hospital will
begin any ECA engagement. As it relates to the hospital’s
use of collection agency vendors, while the referral of an
account to an agency is not considered an ECA the hospital
needs to make a legally binding written agreement with
their agencies that the agency will follow 501(r) regulations
including that the agency will refrain from initiating an
ECA for at least 120-days from the first post-discharge
billing statement. If at the end of the 120-day period no
application has been submitted the hospital may initiate an
ECA after they give the patient a 30-day written notice and
during this time make a reasonable effort to orally notify
patients about the hospital’s FAP.
Therefore, hospitals and their agencies must be sensitive to
the account activity between Day-1 and 240:
Days 1-120
No ECA can be taken.
Days 121-240 Assuming the patient has been given
proper notice that ECA can occur the agency can
take ECA but may have to stop or reverse them,
including a refund of money collected from the
patient, if it is dis covered that the patient is
FAP eligible or that an application is received
for financial assistance or that a previously
submitted application was incomplete.
Provider Reimbursement
The policies and processes established in the financial
assistance policy and billing and collection policies can have
an impact on a provider’s reimbursement. The provider is
not only responsible for creating policies and procedures to
comply with 501(r) Regulations, but also understanding the
reimbursement implications. These implications could
include foregone revenue related to changes in billing
collections policy’s as well as impacts on Medicare and
Medicaid reimbursement including uncompensated care
DSH payments, state DSH pools, and meaningful use
payments.
The details summarized above are just a few of the
mandates within 501(r) Regulations. The responsibilities of
tax exempt hospitals prompted from the regulations are
quite tedious and comprehensive.
At the NCHFMA 2015 Summer/Fall Institute,
'Go Beyond', HFMA members will host a panel of your
peers, consultants and receivable management vendors to
lead an open discussion on this subject. This session will be
held on Monday, October 12th at 10:15 in the Winchester
Room.
WE NEED YOUR HELP!
Please submit questions on your challenges or come
willing to share the success stories of your organization.
Questions for the panel can be emailed in advance to Bill
Howard, [email protected].
Implications of Noncompliance
Failing to meet one or more of the requirements of
section 501(r) may result in revocation of 501(c)(3) status.
Revocation would be based on the hospital’s history of prior
501(r) failures, the significance of the failure, and other
factors indicating the hospital’s efforts made towards
implementing the Regulations and corrective actions taken.
The Regulations also institute an intermediary step to
revocation which results in taxing of the noncompliant
facility (i.e. applying corporate tax rates to the organization’s
taxable income). The Regulation does include a materiality
concept stating that if a hospital facility has only a ‘minor
omission or error’, the hospital can make corrective action
with no taxation or revocation. Multiple omissions or
errors are considered in the aggregate and ultimately the
IRS will determine the deficiency (or deficiencies) to be
‘minor’ based on the facts and circumstances.
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Welcome our 2015-2016 Regional Executive
By Tom Henderson, 2015-2016 Region IV Regional Executive
W
When I began my HFMA journey 11 years ago, I had never even heard of the
title Regional Executive. And now, I proudly represent that title for Region IV of
HFMA. Serving on the membership committee in the Virginia-DC chapter seems
a lifetime ago. Eventually, that role steered me through the ranks and I found
myself serving as Chapter President. Before I knew it, I was a Regional Executive.
There are so many HFMA friends that have supported me and shared this journey
with me. I can’t thank them enough. I am looking forward to serving Region IV,
its chapter presidents and their members during 2015-2016.
Tom Henderson
2015-2016 Regional Executive
Virginia/DC HFMA Chapter
As my term begins, I want to thank all of the chapter leaders for their hard
work and dedication to HFMA. The 5 chapters that make up Region IV (NC,
MD, KY, VA/DC, and WV) are well respected in the ranks of HFMA. Our
Region IV chapters continue to excel in all Chapter Balanced Scorecard criteria
and lead the way with new initiatives designed to improve Education, Networking,
Sponsorship and Certification.
Sadly, Membership within our region is in decline….mostly on the provider
side. This seems to be a typical pattern in other regions across the country also.
There are many reasons for this. Consolidation and budget cuts seem to be the
primary reasons, though. However, we can’t let this devalue HFMA. There are
plenty of our peers that need the benefits of HFMA. Let’s identify them together.
Let’s find new ways to bring them into HFMA. Let’s find new ways to engage
providers in HFMA. If you are a provider and you have ideas as to how to build
provider membership, please contact your chapter president or me. The average
age of members within Region IV is over 50 years. A national initiative is taking
place now to recruit and engage young careerists (millennials) in HFMA. If you
have ideas on this and wish to help, please contact your chapter president or me.
We understand the value of HFMA, so let’s share that passion with others.
I want to encourage all members to get involved. Clearly, your benefits of
HFMA will be equivalent to the energy you put into it. Personally speaking,
HFMA has helped me grow as a leader and has provided lifelong friendships. My
involvement has also afforded me the opportunity to help improve my chapter and
be a part of something special. There are many ways that you can assist your
chapter. Any amount of time that you can commit is valued by your chapter.
Volunteering for HFMA is fun as well! Please consider volunteering for your
chapter.
Thank you for being a member of HFMA. Thank you to our providers for
supporting our efforts to improve Education and Programs. Thank you to our
corporate sponsors and vendors for their financial support. Without your
commitment to our chapters, we would not be able to do the things we do. Our
industry is ever changing. HFMA is invaluable to those on the frontlines of
Healthcare Financial Management. I wish everyone in Region IV a great
2015-2016 HFMA year! As always, please let me know how I can be of service.
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2015-2016 Theme for HFMA
Go Beyond
By: Chair—Melinda S. Hancock, FHFMA, CPA
I
In the past, American health care was built on the fee-forservice payment system. Today, we know that system does not
promote the high-value care that patients and other care
purchasers demand and that providers want to deliver. We
are going through a long transition to transformation—a
transition that will require us to go beyond our current
payment system which is increasingly being phased out.
Finance leaders today must go beyond the ways of the past to
succeed in the new era of health care.
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In a time when key industry stakeholders are realigning at
an unprecedented pace, finance leaders should go beyond
old assumptions about traditional roles and responsibilities
and collaborate with others to meet industry challenges
together.
In a time when pressures to resolve longstanding industry
problems are mounting, finance leaders are challenged
not only to meet but to go beyond expectations and deliver
results that will set the bar ever higher for all of us.
In a time when emerging care and payment models offer
vast untapped potential, finance leaders should go beyond
traditional mindsets to identify and seize the opportunities
that abound during times of change.
During this time, HFMA is also challenged to go beyond
well established and proven methods of the past of
learning, communications, membership composition and
educational offerings.
When we commit to embracing change, our
achievements—and the healthcare system that we are
shaping—will go beyond our expectations.
We are all going through a long transition and
transformation—a transition that will require all of us to
go beyond. And through your service as a volunteer
leader, I am confident that together we will accomplish
great things for our industry and our communities. You
already go beyond through your HFMA service and
leadership in these dynamic times and you set a lasting
example of what this theme means in actions, much
more than words can express.
I want to remind you how much your efforts are
appreciated. On behalf of the HFMA National Board of
Directors, I want to express our gratitude, thank you for
going beyond and I look forward to working with you
throughout the coming year.
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Scholarship Funds Available!!!
The William “Bill” Moffitt NCHFMA Scholarship
Did you know scholarship funds are available for
students or NCHFMA members? In honor of one of the
founding members of the NC HFMA chapter, Mr. J.
William “Bill” Moffitt, a scholarship program was
established and named in his honor. In the years since our
Chapter was founded, Bill has been a strong support of
higher education, with an interest in promoting the field
of healthcare financial management. The scholarship
reflects the commitment of the chapter to promote
excellence in the field of healthcare financial management
by providing financial support to those currently enrolled
in an eligible field of study.
Each year the NC Chapter of the HFMA awards
$2,000 for each scholarship recipient (up to two per year)
seeking a degree in healthcare administration or healthcare
management with an interest in a career in healthcare
financial management.
The scholarship is available to chapter members,
along with those new to the healthcare profession.
Candidate qualifications are:
 Must be sponsored/recommended by a NC
Chapter member
 Must be enrolled in an appropriate institute
studying health administration, health
management, or business, and with a
demonstrated concentration and career
interest in healthcare financial management
 Must be in good academic standing
Applications for the scholarships are due by April 15
and October 15 of each year and reviewed by the
Scholarship Committee for eligibility and merit. The
application must include 500-1000 word essay by the
candidate of what led to your career goal and/or your
intended major, two letters of reference (including one
from an NCHFMA Chapter Member), and transcript
from institution of current enrollment.
Further information regarding scholarship information and application can be found on the
Chapter’s website at www.nchfma.org under the “About” menu.
The Scholarship Committee would like to request NCHFMA members encourage student
candidates you know to gather their information and submit an application.
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15
Feature Article
Medicare’s Mandated Orthopedic Bundle
Comprehensive Care for Joint Replacement (CCJR)
Keys to Success can be found in other bundle programs such as BPCI
By: Sheldon Hamburger
C
CMS has announced their intent to initiate a five-year mandated orthopedic bundle program for hospitals in certain
defined geographies. The proposed rule for this new program has been released (available here: http://www.gpo.gov/
fdsys/pkg/FR-2015-07-14/pdf/2015-17190.pdf ) and public comment is due by September 8, 2015.
The new program, known as ComprehensiveCare for JointReplacement (CCJR), would put most hospitals in 75
identified locations into the program effective, January 1, 2016. With the stated goal of saving CMS over $150M, CCJR
has been built on the experiences of previous bundle programs such as ACE (Acute Care Episode) and BPCI (Bundled
Payments for Care Improvement). CCJR is a bundle for MS-DRGs 469 and 470 and post-acute care for 90 days postdischarge.
CMS will provide historical claims data for analysis to help hospitals develop their strategy. While there is no
downside risk in the first year, hospitals will be at risk in the remaining four years of the program. The upside for
hospitals will be the reduction in total spend below a CMS
defined “target price” (based on the hospital’s historical
spend) and meeting certain quality measures. Interestingly,
these quality measures are hospital-wide, not bundle specific.
While previous CMS demonstration programs such as
ACE and BPCI have had mixed results, CMS is attempting
to integrate “lessons learned” in formulating CCJR. The
proposed rule explains both the details of the proposed
program’s operation and the rationale for various decisions.
As in previous programs, CMS will pay all providers using
the current fee-for-service model and reconcile against target
prices on an annual (not quarterly as in BPCI) basis. This
maintains cash flow and current business process.
Ultimately, this program is intended to drive savings in the post-acute experience. This will require hospitals to engage
surgeons and post-acute providers to improve outcomes while optimizing spend. The savings to CMS will be the basis of
provider upside payments.
Stay tuned – more to come!
Sheldon Hamburger serves as a Principal Consultant of The Aristone Group, a healthcare
consultancy with focus on helping healthcare enterprise organizations address emerging
trends. Sheldon can be reached at (248) 613-7166 or [email protected].
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Matrix
NCHFMA 2015-2016 Matrix
DIRECTORS
EDUCATION
COUNCIL
MEMBERSHIP
COUNCIL
PROGRAM
COUNCIL
MANAGEMENT
PRACTICES
COUNCIL
PUBLICATIONS
COUNCIL
CHAPTER
SERVICES
COUNCIL
Lisa Morgan
Ariana Zibilich
Debbie Hoffman
Craig Wade
Kyle McMahan
Elaine Peeler
Jeffrey Weegar
Danielle Andujar
Laura Branch
Teresa Gitomer
Colleen Wood
Brandon Hughes
Veda Williams
Snow Coriale-Roche
Gladys Mills
Wendi Bennett
Sarah Goodman
Van Cates
Roy Lewis
Liz Farrow
Tim Pollard
Loretta Long
Tim Owens
Ken Vance
Camey Thomason
Diana Moore
Ernie Davis
Troy Spring
Lisa Morgan
Robert Hall
Brandon Ayscue
Steve Ford
Larry Trout
Bobby Von Bremen
Deborah Brown
Chris Johnson
Ty Carson
Phil Geissinger
Sheldon Hamburger
Matthew Deets
Eric Summers
Sid Stern
April York
Kent Thompson
Kathy Entwistle
Angela Deans
Bill Hayes
Elaine Peeler
Kenya Bennett
David Kilmer
Cassandra Fahey
Sarah TeagueMckenzie
James Robinson
Carol Barron
Lisa Kellner
Lisa Griffin
Lorie Collins
Keith Bray
Christine Sibley
Anthony Poole
Michele Melchior
Sabrina Hedglin
Bobileigh Daniels
Bunnie Overby
Kevin Leder
Bobby Hamill
Bill Howard
Bill Bedsole
Rick Shrader
Travis Justice
Linda Darden
Keith Hullender
Gabe Jacobs
Kathy Wood
Kim Coker
Randy Medlin
Tim McElderry
Lyn White, CPA
Tim McElderry
Past President
Lyn White
Assistant Treasurer
Kim Gore
Belinda Tilley
John Cook
Christine Sullivan
Craig Brondyke
Jeff Joyner
Rhonda Silver
Jeff Wakefield
Fred Graessle
Craig Wade
Stacey Stachel
HOSPITAL
SERVICES
COMMITTEE
Chair – Kim Gore
PHYSICIAN
SERVICES
COMMITTEE
Chair – Lynn Lambert
Co-Chair – Larry Trout
PAYOR/MANAGED
CARE COMMITTEE
Chair – Cassandra Fahey
Co-Chair – Sherry Keck
COMPLIANCE
COMMITTEE
Chair - Kevin Leder
INFORMATION
MANAGEMENT
COMMITTEE
Malcomb Torres
Sherry Keck
Brandon Holland
Jim Privette
Ashley Sanders
Lauren Elmore
Wendy Penfield
Marc Brewer
Chair - Tim Lea
TECHNOLOGY
COMMITTEE
(Limit 6)
Note: Board Designees
Tim Lea
Mark Ellis
Carl Scarabelli
Bill Calamas
Rob DeLoach
Peyman Zand
Adam Doyle
Jeff Fuller
Jordan Miller
Chair - Eb Preuninger
Charles Acker
Linda Darden
Mike Brown
Jody Fleming
Billy Glidewell
Sarah Goodman
Windy Minor
Irene Watts
Aaron Tregoning
SPONSORSHIP
COMMITTEE
(Limit 10)
Note: Board Designees
Chair - Jody Fleming
NASBA COMMITTEE
(duties not done at Matrix)
Chair – Randy Medlin
OFFICERS
Lisa Morgan –
Education
Randy Medlin
Don McNeil, CPA
Jeff Wakefield,
CPA
Ken Vance
President
Debbie Hoffman Programs
Bill Bedsole
President-Elect
Carol Barron
Secretary
April York
Treasurer
Get Involved in Matrix!
Call or Email Ken Vance at 704-880-4887 or [email protected]
17
Matrix Meeting
Your Matrix at Work
By: Kim Coker
The Women’s Education Center at Cone Health in
Greensboro served as the host for the July 16 Matrix meeting of
councils and committees. President Ken Vance opened the
meeting and welcomed those in attendance and expressed
appreciation for participation and contribution to the chapter.
Committees met to discuss topics of interest in the industry
to our membership. After committees came to a close council
meetings took place to begin the chapter work to serve members.
The following reports were given by council leaders.
Publications Council
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Program Council
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Debbie Hoffman reported that the summer meeting agenda
was complete. The agenda will focus on topics of interest to
members to include 501(r) panel discussion, healthcare 101,
IPPS and SGR Update, revenue cycle opportunities and lessons
learned, and physician panel discussion. General sessions will
include pricing transparency, CFO roundtable and special
guest Olympic Gold Medalist Joe Jacobs.
Planning for the winter meeting is underway with agenda
topics discussed to include patient engagement, customer
service, volume to value, ACA premiums and kick-backs,
explaining bill transparency, and generational consideration
session.
Any other topics of interest please submit to Program Council.
Education Council
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Lisa Morgan reviewed the education events from the 20142015 chapter year. The chapter provided 18.6 education hours
per member.
Several workshops/webinars are planned and upcoming events
will be sent to members in the next few weeks. The chapter
will be offering free webinars, “TN trains on Tuesdays”, by
partnering with the TNHFMA chapter to help meet
educational needs. Any topics of interest please provide
feedback to Education Council.
Management Practices Council
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Craig Wade reported his council will transition to serving the
chapter with various reporting metrics to meet chapter goals.
The group reviewed various chapter performance reports to
include Davis Chapter Management System (DCMS), Chapter
Balanced Scorecard (CBSC) and Management Practices job
description.
The council is focusing on efforts of key metrics to be reported,
monitored and made available to board members and HFMA
members on a regular and timely basis. The plan is to create a
dashboard to capture the key elements.
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The council is currently seeking a new Chair as several
candidates have expressed interest. Position should be
filled by end of July upon board approval.
The theme of the next edition will be tied to summer and
the new theme for National ‘Go Beyond’. Ken reminded
the council to encourage members to write articles and
encourage others as there are monetary prizes for those
that submit best papers.
Advertising options in the Tarheel News for transition to
calendar year is a focus of the council to make payment
simpler and move to Cvent for processing payments.
The deadline for submitting articles for the Fall Newsletter
is October 15.
Membership Council
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Arianna Zibilich reported the chapter ended the 20142015 chapter year with 901 members, compared to goal of
893. The 2015-2016 goal is to maintain the 901 members.
Presently, NCHFMA has 936 members, with potential
drops as of July 15, 2015 of 240 members.
The council discussed how to diversify membership and
identify need to get more representation from payer side
and physician side.
Membership activities to be held at Summer/Fall Institute
at Myrtle Beach in October include beach networking
party, volleyball and morning walk.
Milestone recognition as members in Tarheel News.
The council will continue to focus on student recruitment
at universities for 2015. Current student membership
count as of July 16 is 193. Discussions of how to engage
the students include ways to volunteer outside classes,
attendance at institutes, networking reception to learn
more about value of HFMA. The council will advertise
the Bill Moffitt Scholarship to local universities to gain
student interest in chapter and way to become involved.
At the conclusion of council reports a $50 attendance
prize was given by a random drawing from the sign-in sheet.
Congratulations to the lucky winner, Veda Williams!
Thank you for those that attended the matrix meeting and
for your involvement in the chapter. The next matrix
meeting is scheduled October 12th at the Summer/Fall
Institute in Myrtle Beach.
Founder Points
Get Involved with NCHFMA – Awards Await YOU!!!
The Founder Merit Award program was established to acknowledge volunteer contributions made by HFMA members
like YOU and thank members for their involvement!!! The core purpose is to “Recognize the Volunteer in You”. Each year
members contribute their time, efforts and talents to serve the healthcare industry, profession and our members.
Established in 1960, the Founder Merit Award Series acknowledges the contributions made by HFMA members. Points are
accumulated to reflect volunteer activity for participation in HFMA functions and leadership roles within the organization.
The Founder year runs June 1st through May 31 and is comprised of 4 Award Levels:
The William G. Follmer Bronze Award is awarded after an individual has earned 25 member points. This award is
named after William G. Follmer, who is credited with the creation of the American Association of Hospital
Accountants (AAHA) (now HFMA).
The Robert H. Reeves Silver Award is awarded to an individual who has earned 50 member points. Reeves, an
organizing member of the AAHA, was elected president of AAHA in 1956.
The Frederick T. Muncie Gold Award is presented to a member who has earned a total of 75 member points. This
award honors Frederick T. Muncie, an organizing member of the AAHA, and the first president of the
association (1947-1949).
The Founders Medal of Honor was added in 1986 and is conferred by nomination of the Chapter Board of
Directors. This prestigious award recognizes an individual who has been actively involved in HFMA for at least
three years after earning the Muncie Gold Award, has provided significant service at the chapter, regional and/or
national level in at least two of those years, and remains a member in good standing.
Do you know the ways to earn Founder Points?
 Volunteer for a chapter committee or national committee
 Write a newsletter article
 Participate as an Event Volunteer
 Mentor a new member or student
 Speak at an event or participate on a panel
As one of the largest HFMA chapters we have a number of opportunities for volunteers beginning with just a few hours of
your time. YOU are valuable to the chapter and can help the NC HFMA chapter become one of the BEST known for
quality education and networking. The time is now to get involved with NCHFMA and the chapter needs YOU!
Don’t wait another minute to get involved and start earning Founder Points. To review your Founder Points or learn
how to earn Founder Points visit www.hfma.org, login with your HFMA username and password and click on Founder
Points under My Account, Members Only section.
Founder Member Awards
The chapter is pleased to congratulate the following members on receiving Founder Awards for their volunteer efforts
with the Chapter and National. The awards were presented in March at the Annual Meeting in Pinehurst.
William G. Follmer Bronze Award
Christine Sibley, CHFP
Marcie Terry
Robert H Reeves Silver Award
Rob DeLoach
Elaine Peeler
Frederick T Muncie Gold Award
Carol Barron, FHFMA
Michael Brown, FHFMA
Jody Fleming
Paula Greeno, FHFMA
Ken Vance
April York
Congratulations and thank you for a job well done!
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NCHA Update
Submitted by Jeff Weegar
CMS Issues Inpatient Prospective
Payment System (IPPS) and LongTerm Care Hospital (LTCH)
Final Rule for FY 2016
On August 31, the Centers for Medicare & Medicaid
Services (CMS) released the inpatient prospective payment
system (IPPS) and long-term care hospital (LTCH) final rule
for 2016.
system (OPPS) and ambulatory surgical center (ASC)
proposed rule for calendar year 2016. The proposed rule
updates OPPS and ASC payment weights and rates, but also
continues to transition the OPPS from a fee for service
schedule to a prospective payment system by creating larger
payment bundles and restructuring of ambulatory payment
classification groups.
Major proposals include:

Major proposals include:
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An increase in operating payment rates paid under the
IPPS of .9 percent, which reflects a market-basket
update of 2.4 percent, -.5 percent for multi-factor
productivity adjustment, an adjustment of -.2
percentage in accordance with the ACA, and -.8 percent
for documentation and coding recoupment required by
American Taxpayer Relief Act of 2012;
Distribution of $6.4 billion in Medicare DSH payments
in FY 2016, a decrease of $1.2 billion from FY 2015
amounts;
Updates in the inpatient quality reporting program;
Update of measures in hospital value-based purchasing
program in 2018 to remove 2 measures and add a care
coordination measure. COPD will be added as a 30-day
mortality measure beginning in 2021. The amount of
base payment reduction will be 1.75 percent for FY
2016;
An update to the domain contribution of each measure
to the hospital total HAC score;
Expand the hospital readmission reduction program to
include pneumonia readmissions in FY 2017;
Establish a new LTCH site neutral payment rate
comparative to IPPS payment rates, with a 2-year
transition period
The full proposed rule can be found in the Federal Register.
CMS Issues Outpatient
Prospective Payment System (OPPS)
and Ambulatory Surgical Center
(ASC) Proposed Rule for FY 2016
On July 1, the Centers for Medicare & Medicaid
Services (CMS) released the outpatient prospective payment
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Amending the two-midnight rules to allow certain
Medicare Part A payments for inpatient services not
spanning two midnights;
Quality Improvement Organizations (QIOs) will
complete medical review of patient status claims rather
than Medicare Administrative Contractors (MACs) or
Recovery Audit Contractors (RACs);
2.0 percent reduction to the OPPS conversion factor to
offset CMS’ overestimation of the packaged laboratory
payments under the 2014 OPPS. This proposed cut to
create a net .2 percent reduction in the OPPS; and
Adding 9 new comprehensive ambulatory payment
classifications (C-APCs) to the 25 existing C-APCs,
including a new C-APC for comprehensive observation
status.
Comments on the proposal are due by August 31. The final
rule is expected by November 1, and will take effect January
1, 2016. The full proposed rule can be found in the Federal
Register.
CMS Issues Proposed Bundled
Payment Program for Hip and Knee
Replacements
On July 9, the Centers for Medicare & Medicaid
Services (CMS) released a proposed rule that would bundle
payment to acute care hospitals for hip and knee
replacement surgery. Under the Comprehensive Care for
Joint Replacement (CCJR) 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. The model will be implemented in 75
geographic areas and would be mandatory for hospitals in
those areas.
NCHA Update
Major proposals include:

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
Testing of the CCJR model would begin on January 1,
2016 and end on December 31, 2020. The episode of
care would begin with the inpatient hospital admission
and extend to 90 days subsequent to patient discharge.
The hospital would be paid based on one of two “Major
Joint Replacement” MS-DRGs and would include all
care covered under Medicare Parts A and B;
In the first year of the program, CMS pay retrospectively and no hospital would be penalized for participation
in the CCJR model. After the completion of year 1,
services would be aggregated and would compare the
total estimated payments to the “target price,” which
would be hospital specific and regional blended
payments, minus 2 percent. A “reconciliation
payment” would be occur depending on the hospitals
performance compared to their target price;
For a hospital to receive a reconciliation payment, it
must meet or exceed performance thresholds currently
accumulated in the Hospital Quality Reporting Program
Comments can be submitted to CMS by September 8,
2015. The full proposed rule can be found in the Federal
Register.
CMS Issues Proposed Rule on
Managed Care for Medicaid and
CHIP
On June 1, 2015, CMS published a proposed rule
intended to update Medicaid and CHIP Managed Care to
better align Medicaid managed care plans with Medicare
Advantage plans and other insurance plans.
Major proposals include:
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Aligning quality improvement with HHS National
Quality Strategy and CMS Quality Strategy;
Allowing flexibility in delivery system reform efforts to
align with the triple aim
The full proposed rule can be found in the Federal Register.
The Health Resources and Services
Administration (HRSA) Issues a
Proposed Rule for 340B Drug
Pricing Program and Manufacturer
Civil Monetary Penalties
On June 17, 2015, HRSA issued a proposed rule for
340B drug pricing program and manufacturer monetary
penalties. The proposed rule clarifies many of the
definitions used to regulate the program, amends the ceiling
price for a covered outpatient drug, and clarifies civil
penalties assessed to manufacturers charging greater than
the ceiling price for a covered outpatient drug.
CMS Issues Home Health Proposed
Rule for FY 2016
On July 10, 2015, CMS published a proposed rule to
update home health payment to the home health
prospective payment system (HH PPS) with an effective date
of January 1, 2016. 2016 will be the third of a four year
transition of the rebasing adjustment to the national
standardized 60-day episode payment rate. Comments can
be submitted to CMS by September 4, 2015. The full
proposed rule can be found in the Federal Register.
Improving access to care by requiring states to establish
managed care network adequacy standards;
Standardizing actuarial standards used in the
calculation of the Medical Loss Ratio;
Aligning managed care requirements with Medicare
Advantage and other managed care plans;
Requiring managed care rates to be actuarially sound
and transparent in actuarial standards and assumptions;
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Student Member Focus
Student
e-Membership
Full-time college students,
not presently employed in
the healthcare finance
profession or one of its
specialties, are eligible for
free Student e-Membership
through National HFMA.
Crystal Miller is just one of
the many students who is
part of our chapter. Did
you know that the
NCHFMA has 193 estudents that are part of
the chapter? Did you also
know the chapter is willing
to waive the registration fee
for chapter conference
attendance to any student
member willing to write an
article about their experience, or for volunteering on
our matrix?
Student members are the
future of Healthcare
Finance and Administration and the NC Chapter
is proud to join our universities and faculty in support
of young leaders. Please
also keep in mind HFMA
membership for recent
graduates is very affordable
(savings of nearly 70% of
the standard rate)
If you are interested to
learn more please contact
one of your chapter leaders.
By: Ariana Zibilich, NCHFMA Membership Chair
Name:
Crystal Moore
College: UNC Chapel Hill
Master of Healthcare Administration Candidate (May 2016 expected graduation)
Summer Internship: Healthcar e Consulting Inter n at DHG Healthcar e in
Charlotte, NC
What prompted your interest in
pursuing a career in healthcare?
I first became interested in a career in
healthcare when I shadowed a Service Line
Director at UAB Health System in
Birmingham, AL. That, coupled with my
degree in business and personal experience
with Leukemia, led me to pursue a career
in healthcare administration.
What presentations were you able
to attend while at Pinehurst?
“Drinking from the Fire Hydrant” (Panel Discussion with
Nathan White, VP and CIO for
Appalachian Health Systems, Chad
Eckes, Wake Forest Baptist
Medical Center, Sulaiman
Sulaiman, Senior VP and CIO for
Mission Health)
“Don’t Land in the Sandtrap, How to
drive for success in payment”
‘(Melinda Hancock, PartnerHealthcare at Dixon Hughes
Goodman and HFMA National
Chair-Elect)
Blue Cross and Blue Shield ACO
(Tiffany Cooper, Senior Strategic
Advisor, Health Delivery
Redesign, Pamela Holt, Primary
Strategic Advisor, Healthcare
Strategy, Phillip Edwards, Primary
Strategic Advisor, Healthcare
Strategy)
Were the topics shared in the
presentations similar to what you
are hearing about in your
classroom setting?
Absolutely! It is always reassuring to
know that we as students of UNC are
learning current trends and issues that
healthcare professionals are experiencing.
What is one take away that you
walked away from Pinehurst
with?
We, meaning current and future
healthcare professionals, have a lot of
work ahead of us. It’s important to have
platforms like HFMA conferences to get
a diverse group of professionals in the
same room to discuss challenges and
potential strategic solutions. No part of
healthcare (provider, payer, government
entities, etc.) can solve the healthcare
issues alone. We need each other as
resources and teachers if we plan on
improving the American healthcare
system.
What were your initial
impressions of NCHFMA (this
does not have to be based on
your experience at Pinehurst)
and why do you feel it is
important to join a professional
organization?
Since my first interaction with
NCHFMA at UNC Chapel Hill, I have
been impressed. As a student it has been
extremely beneficial to me because I
have been able to discover different
career paths within healthcare, enhance
my knowledge of the ever-growing
glossary of healthcare acronyms as well
as learn about real life challenges
healthcare professionals face. I have used
the opportunity to shadow, network and
even find a summer internship through
members of NCHFMA! I look forward
to continuing my involvement with
NCHFMA as a professional and giving
back to future students interested in a
healthcare career.
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North Carolina Healthcare Financial Management Association
2015-2016 Corporate Sponsors
Platinum Sponsors
Xtend Healthcare, LLC
Gold Sponsors
AccessOne MedCard, Inc.
Avadyne Health
CliftonLarsonAllen, LLP
MedA/Rx (A PMAB Company)
NCHA Strategic Partners
ParrishShaw
The SSI Group, Inc.
Triage Consulting Group, Inc.
Valence Health
Silver Sponsors
Adreima
First Point Healthcare Resources
Allgood Professional Services, LLC
PatientMatters, LLC.
Avectus Healthcare Solutions, LLC
PCB Collection Specialists
Bank of America Merrill Lynch
Professional Recovery Consultants, Inc.
Bottom Line Systems, Inc.
Revclaims, LLC
ClearBalance
Stern Recovery Services, Inc.
Computer Credit Inc.
The ROI Companies
DHG Healthcare
TruBridge
Bronze Sponsors
AmCare Group, LLC
Bull City Financial Solutions
Cirius Group, Inc.
HCFS, Inc.
MDS (Medical Data Systems, Inc.)
Medlytix, LLC
Nexsen Pruet, LLC
ProAssurance Companies
Resource Corporation of America
SLG, Inc.
Stanley Benefit Services, Inc.
24
Upcoming Education Events
Chapter Conferences/Workshops
August 18, 2015
2015 Medicare Update
Greensboro, NC
October 11-13, 2015
Summer/Fall Institute
Kingston Plantation—Myrtle Beach
December 31, 2015
Accounting & Auditing Update with Ethics
Greensboro, NC
September-November 2015
Fall Certification Series
Webinar
October 21, 2015
Health Insurance Institute and Medicare Workshop
Greensboro, NC
National HFMA Webinars
Free HFMA Webinars to HFMA Members
Live webinars are free for HFMA members and $99 for non-members, unless otherwise noted.
Become a member today.
August 11, 2015
2016 Proposed Rule Changes to the Outpatient and
Ambulatory Service Center Payment Systems
September 15, 2015
Overview of MACRA Legislation: How the SGR Repeal
and New Merit-Based Incentive Payment System will
Impact Physician Payments
August 25, 2015
An Overview of Medicare’s Proposed Comprehensive Care for
Joint Replacement Model
October 7, 2015
Are Payment Threats Lurking in your Hospital?
August 26, 2015
Now Providers can Simultaneously Reduce Expenses, Improve
Operations and Increase Revenue
October 13, 2015
Medicaid Eligibility: 5 Winning Strategies in the
Healthcare Reform Era
August 27, 2015
Revealing Productivity Performance to Drive Financial
Improvements
November 3, 2015
Choosing the Right Value-Based Reimbursement Model
in an Era of Population Health Management
September 9, 2015
Aligning Physicians to Improve Reimbursement, Reduce
Denials, and Enhance Regulatory Compliance
November 19, 2015
An Update on the Latest Healthcare Legislative and
Regulatory Issues