Healthcare Business Management Association - HBMA
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May - June 2012 •
Volume 17, Issue 3

HBMA – Your "ACE" in the Hole!
Message from the President
By Don Rodden, CPA, CHBME
The landing page of HBMA.org lists three foundational elements that form the core of HBMA's identity, value, and purpose: Educate – Advocate – Cooperate. Why are these three elements core and essential? What value do they bring to you, the member who we serve? Click for more

SPOTLIGHT ON! Michelle Botana
ISAM Staff Profile
Billing Editors
As an associate director, tell us a little bit about your areas of responsibility for HBMA. My main responsibility for HBMA is to support the standing committee structure. Many of my work goals are achieved within the committee structure. My responsibilities include, but are not limited to... Click for more

Pros and Cons of Using Unpaid Interns and Offering Internships
Sound Off!
Billing Editors
HBMA Members sound off on pertinent industry topics. Click for more

Strategic Planning
A Business Imperative
By Paul D. Meyer
Change leaders are typically defined as those individuals who have the capacity to envision a defined future, communicate that vision, and convince others to implement it while extinguishing short-term fires and dealing with everyday responsibilities. Strategic thinking and planning includes the progression of thoughts and ideas and the roadmap leading to future success and change. Click for more

What's Next with Healthcare Reform?
Feature Article
By Mike Farmer
The Patient Protection and Affordable Care Act (PPACA) is just over two years old now. Its future may or may not be in jeopardy, but for now it is the law. So far we have seen expanded eligibility for children on the parents' policies, a health insurance credit for employers, and a few other changes. We have also seen some parts of the bill – like the changes to 1099 reporting, W-2 reporting, and long-term care insurance – thrown out... Click for more

AMA-Led Landmark Settlement with UnitedHealth Group
AMA Perspective
Published with permission of the American Medical Association (AMA)
On February 3, 2012, a federal court judge in New York cleared the way for releasing payments from the landmark 2009 settlement that ended the historic court challenge led by the American Medical Association (AMA) against UnitedHealth Group. Nearly $200 million will be paid to settle claims from physicians for 15 years of artificially low payments from UnitedHealth for out-of-network health services... Click for more

Federal Fraud and Abuse Recoveries Exceed $2 Billion in FY 2011
Feature Article
By Bruce D. Armon, Esq.
In early February, the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) released their Health Care Fraud and Abuse Control Program Annual Report for fiscal year 2011 (the "Report"). The release of the Report coincides with the introduction of President Obama's budget proposal for fiscal year 2013. Click for more

The Essential Ingredient to Ensure an Effective EHR Implementation
Connectivity Assurance
By Mark R. Anderson, CPHIMS, FHIMSS
Software performance, responsiveness, and reliability have become major issues as healthcare organizations roll out critical clinical applications like computerized provider order entry (CPOE), outcomes measurement, clinical decision support (CDS), and Office of the National Coordinator (ONC) certified electronic health record (EHR) applications. To ensure success, healthcare management professionals must have the right management tools necessary to ensure that their network performance metrics exceed their physician clients' needs. Click for more

Website Redesign
and the Myths That May Ruin It
By Marc Oestreich
In a world of constantly evolving commerce and technology, perhaps only one truth remains constant: A website is key to establishing your brand in the world. When it comes to medical billing services, technology has been thrust on us with the electronic record mandates. We can either bend under the pressures of new technologies or take this time to embrace them. A quick glance over the world of medical billing online tells us two things... Click for more

Consumerism in Healthcare Payments
Achieving Payment Assurance
By Bill Marvin
The sweep of consumerism in healthcare has brought changes to the healthcare payments process, driving billing services to evaluate their collection tactics. While providers previously relied almost exclusively on payer payments for their revenue, patient responsibility payments are now an increasingly important provider revenue source. Billing services must increase their focus on collecting from patients. Click for more

Four Ways To Boost Social Security Benefits
Social Security
By Patrick Newcombe, CFP
Elaine Floyd of Savvy Social Security for Boomers offers these tips to boost Social Security benefits... Click for more

Let's Make More Money
Feature Story
By Lee. R. Phillips, Esq.
Now that we've established that your business needs to be run as an actual business entity (a corporation or an LLC), let's start to make more money. That sounds a little crass, but that's why you're in business. Click for more

New Opportunity for Revenue Enhancement by Automating Your Workers' Compensation Claims Submission and Attachment Processing
AMA Perspective
Published with permission of the American Medical Association (AMA)
If your billing office is like most, these common scenarios are impacting your revenue potential and probably the perception of how effective you are. Millions of dollars every year are lost due to manual, paper-based, inefficient claims processes, as well as the lack of understanding about what is required for workers' compensation claim submissions... Click for more

ICD-10
Despite the Deadline Extension, It's Still Time to Prepare
By Shelly Guffey
The Department of Health and Human Services recently announced its intent to push back the October 1, 2013 ICD-10 compliance deadline for certain health care entities. The new proposed date is October 1, 2014. Based on what the industry has learned from the transition to 5010, we all know that it is never too early to start preparing! Click for more

Dispelling Myths About ICD-10
A Payer Perspective
By Ian Bonnet
Nearly all payers have progressed with ICD-10 implementation and understand that ICD-10 impacts a large spectrum of health plan business functions and technologies. For WellPoint, one of the nation's largest health plans, this means that numerous claim processing systems, clinical and care management systems, and information management assets will be impacted along with such functions as benefit design, pricing, authorizations, clinical rules, fraud and abuse, finance, and customer service... Click for more

Medicare Consult Guidelines
Coding Corner
By Jackie Miller, RHIA, CCS-P, CPC, PCS
In 2010, the Centers for Medicare and Medicaid Services (CMS) adopted new billing guidelines for consultations. This decision was the culmination of many years of struggle by CMS to ensure accurate Medicare payment for consults. In a 2006 audit report ("Consultations in Medicare: Coding and Reimbursement"), the HHS Office of Inspector General estimated that in 2001, Medicare made overpayments of approximately $1.1 billion for consultation services... Click for more

Using Excel Tables to Manipulate Billing Data
Software Issues – Excel
By Nate Moore, CPA, MBA, CMPE
If you are still waiting to make the jump from prior versions of Excel to Excel 2007 or 2010, tables are one of the best reasons to upgrade. If you have upgraded to Excel 2007 or 2010 but aren't using tables, this article will help you get started. Click for more

CMS Delays RAC Prepayment Audit Program
Compliance Issues
By Karen Collier, JD
Recently, the Centers for Medicare and Medicaid Services (CMS) announced a new demonstration project to test Recovery Audit Contractors' (RACs') abilities to conduct prepayment review of Medicare Part A and B claims. RACs have successfully identified a wide variety of Medicare overpayments and have become one of CMS's most important post-payment audit tools. Click for more

Technical Review of Your EHR Options
EHR Issues
By Ron Sterling
In addition to the functional capabilities of any EHR options that you may be considering for your billing service, you need to verify the technical design of the EHR to ensure that not only will your clients be able to manage workflow and chart patient notes, but that their information will also be protected and managed within the EHR. Click for more

Medical Billing is a Numbers Game
From the Road
By Dave Jakielo, CHBME
Have you noticed that the medical billing industry is facing a few challenges in today's marketplace? Trying to speculate on what the billing environment will look like in a few years is anybody's guess. Click for more

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