Tuesday, October 14, 2014
The Affordable Care Act (ACA), as we are all well aware, has been rolled out and operational. There has been over 8 million people that signed up for the coverage through the different Marketplaces throughout the country. The end result, or the plan, is to provide affordable care to individuals and to reduce the overall count of uninsured that some say is over 40 million people currently in the United States. Moreover, the ACA is also trying to bring high quality, affordable coverage to all individuals, regardless of their gender or pre-existing conditions that may be present in an individual’s health history.
CMS provides individuals and businesses with tools to educate everyone that is purchasing healthcare and is making sure that 80 cents out of every dollar generated in premiums goes to the healthcare that you receive. There are checks and balances here, in that, if health insurance companies do not spend 80 cents for every premium dollar, you get a refund. In 2012 the average refund was around $100.00 per family.
When we look at health insurance rates we sometimes wonder why they are so high or where do we find posted rates that one can compare. Now the ACA has provided the consumers with a layer of protection when it comes to rate increases. Insurance companies in every state must follow the rule that if they increase any rate over 10% they must publicly justify this change in premium.
There are also administrative measures being taken to protect the individuals who may get ill or make a mistake on their application. Also, there are no more denials for pre-existing conditions. But one of the more appealing things that came out of the ACA, at least in my opinion, was that young adults can stay on their parent’s plans until the age of 26.
All of this sounds good, but there also needs to be an administrative change, and this has been addressed as well. The Donut Hole has been shrunk for individuals and this will save the average beneficiary money with regards to their pharmacy spending. Maybe our elderly will someday not have to worry about the decision, do I buy my medicine or do I buy food. Some other items of interest, and maybe of great interest, is that CMS is fighting fraud at a much higher level and they are trying to strengthen the Medicare Trust Fund. This fund supports so many programs, and without it, there will be many people impacted throughout the country.
Overall, the goal of our health system is access, cost and quality. This is a step in the right direction and with everyone’s help maybe we can continue to make positive changes in our healthcare system.
Contributed by Kevin Harrington, Faculty Member
Monday, September 29, 2014
National Assisted Living Week is celebrated every September. This year, the theme was “The Magic of Music.” Numerous assisted living communities across the country participated and celebrated in various ways.
For those who have observed long term care for the past 20-30 years, you may have noticed this trend: nursing home residents of today were on hospital medical/surgical units 20 years ago, and those in assisted living today were in nursing homes 20 years ago. This shift has resulted in adjustments for the nursing home and assisted living professions.
Factor in the aging of the consumer-oriented Baby Boomer generation. These folks are accustomed to being able to buy whatever they want, whenever they want, wherever they want. They are far more likely to seek a second opinion and make their own clinical decisions than previous generations were. Their microwave mentality values instant results. They want choices and options; they don’t accept “no” for an answer. They want convenience, even if they have to pay a little bit more. They may ask why they have to move locations and change lifestyles in order to access care; why can’t the care come to them? As they enter long-term care systems, they still want these expectations to be met.
These trends are leading to the creation of many new models of senior living. Licensed facilities that rely upon government funding (Medicare/Medicaid) are remaining stagnant in population, while other senior living arrangements are growing. Baby Boomers want to have medical care available, even if it’s not needed routinely. Senior living communities now often have medical services available on campus. Social workers may be available for some degree of case management. Concierge services may meet other needs. These seniors may want a condo-style home with a spa, a golf course, and other amenities on the property, with a nurse available in case they sprain an ankle playing tennis.
As new models of senior living are developing, stay tuned to see how Saint Joseph’s College is keeping up with new trends. A degree program specializing in Senior Living Leadership is under development. We are planning to remain on the cutting edge of leadership in aging services!
Posted by Twila Weiszbrod at 8:45 AM
Monday, September 08, 2014
Saint Joseph’s College Online would like to congratulate Constance Noble for successfully completing a Bachelor of Science in Radiologic Science Administration degree (May 2014) and for having an excerpt from her Senior Seminar (Course: RS 412) paper published in the National Professional Journal of the American Society of Radiologic Technology (ASRT).
Connie's paper is on “Service Quality in Mammography” and is published in the September/October issue of Radiologic Technology. Please join me in congratulating Connie on her accomplishments. If you’d like to read her article online and are a member of the ASRT, please visit their website at
This is an amazing example of our our programs provide a quality education and result in benefits to the entire industry! We are proud of your work Connie!
Posted by Twila Weiszbrod at 3:29 PM
Friday, August 08, 2014
Often times a healthcare administrator will be questioned, or be the one questioning:
What will we get paid from Medicare if we start doing a certain procedure/ provide a particular service?
Sometimes we know what our business model is focused on, but do we really know how to build a solid proforma to direct the efforts of our staff and financial resources to be successful in targeting what will truly benefit our facility?
There are so many acronyms such as RBRVS, PPS, IPPS, CPT, IRF PPS, GPCI, HOPPS, IPF PPS, ASC, MS-DRG, SNF PPS, HCPCS, and DRG just to name a few. But there is one acronym that can be very helpful from CMS. Oh, another acronym! The Centers for Medicare and Medicaid Services (CMS) is a repository of information that can help just about any practice, group practice, Ambulatory Surgical Center (ASC), or other healthcare organization to breakdown the reimbursement for any service or procedure to help identify the appropriate reimbursement from CMS.
This tool is called the Searchable Medicare Physician Fee Schedule (MPFS).
It has over 10,000 services listed and each is broken down by all elements of reimbursement including pricing, payment policies, and Resource Based Relative Value Scale. This tool allows healthcare professionals to find out the Medicare payment for any code that is part of the MPFS database. It will identify the payment for those providers that are a “Participating Provider” under CMS. Moreover, it will identify for those providers that are “Nonparticipating” what the limiting charge is for a particular code. This will put a ceiling on the charge for a code that the provider cannot exceed when billing Medicare and this will also limit the out-of-pocket expense for a beneficiary.
Overall, the MPFS is an excellent tool to see if Healthcare Common Procedure Coding System (HCPCS) codes are affected by the place in which the services are performed and if there are any modifiers that are available.
The payment procedure is that there are many codes available for reimbursement. CMS will reimburse 80% of the allowed charges for an approved code and the patient will be responsible for the remaining 20% (plus any annual deductible that may be due). There are reductions that are identified in the MPFS that include a 16% reduction of the MPFS rate for an assistant surgeon. There are other reductions such as nurse practitioners (NP), physician assistants (PA), and clinical nurse specialists are paid 85% of the allowed rate and clinical social workers are paid 75% of the allowed rate from Medicare.
The MPFS will take the user through several steps to identify the appropriate codes, locality, and reimbursement. To start the search you click on the “Physician Fee Schedule Search” or the “Start Search” button. You will need to accept the terms and conditions of using the Current Procedural Terminology, Fourth Edition (CPT©).
Then you will need to select:
- · The year
- · The type of Information that you are looking to search
- · The pricing information
- · Payment policy indicators
- · RVU
- · Geographic Practice Cost Index (GPCI)
- · Specific Locality (each area has a unique locality code, like Metropolitan Philadelphia Pennsylvania is 12502)
- · All Carriers or specific MACs
· Then you can enter the HCPCS code that you are looking for and if you want specific modifiers or “All”
· Click Submit
The MPFS tool will help the healthcare administrator and their staff to better forecast revenues based on actual reimbursement. Moreover, having the ability to find out all payment rules and requirements will allow for a successful and compliant billing process for the new or existing service that your facility provides.
To locate the searchable Medicare Physician Fee Schedule you can go to http://www.cms.gov/apps/physician-fee-schedule/overview.aspx
-Kevin Harrington, MSHA, RHIA, CHP
Posted by Twila Weiszbrod at 11:45 AM
Monday, August 04, 2014
Wednesday, July 23, 2014
The faculty members that teach in the health administration programs at Saint Joseph's College met on campus on July 11th. We discussed ways to enhance our courses and the programs in general! What an amazing group of dedicated teachers! No wonder our program is excellent!
Posted by Twila Weiszbrod at 9:53 AM
Wednesday, July 02, 2014
Just a reminder!!!!!
Warm weather draws people outside to participate in summer activities for a greater duration throughout the day. Skin exposure to the sun has benefits, as well as risks. The health benefits from limited exposure to the sun are vitamin D production, it helps to support the immune system, strengthens teeth, decreases symptoms of asthma, etc.
However, unprotected, over-exposure to the sun can result in the development of skin cancer or melanoma. This condition is curable, if treated in the early stages of development. As skin cancer grows on the skin, there are early warning signs to help identify melanoma.
The ABCD rule is used by health professionals.
A = asymmetrical (irregular in shape)
B = bigger in size
C = color change (color variation – tan, drown and dark brown)
D = diameter (larger than ¼ “)
After self-examination, if you find a mole or skin growth in question, please seek medical attention. Have fun in the sun, but stay protected.
Posted by Twila Weiszbrod at 12:56 PM
Thursday, June 12, 2014
Long-Term Care Administration is receiving a facelift! In early June, the National Association of Long Term Care Administrator Boards (NAB) held its annual meeting in Louisville, Kentucky. The results of a Professional Practice Analysis, the culmination of 18 months of study, were revealed.
The responsibilities of executives in nursing homes, assisted living, adult day care, home health care, and hospice were compared. There were far more commonalities than distinctions. In fact, 82% of the duties associated with these roles were found to be the same.
With the participation of leaders from all of these care settings, the idea has come forth for a “Health Services Executive” license. Service lines are blending; for example, nursing homes are opening hospice agencies and home health services. To prepare leaders for these roles, educational criteria for licensing will change.
Currently, nursing home administrators must take a national board exam. The make-up of this exam will change slightly. The exam will include a leadership core, those competencies that are in common across these care settings. Field-specific questions will be added to the mix.
Saint Joseph’s College is staying current with these developments to ensure that our curriculum meets these new requirements. A timetable for implementation has not yet been decided.
Philip C. DuBois, CNHA, FACHCA
Program Manager, Long Term Care Administration
Posted by Twila Weiszbrod at 7:50 AM
Tuesday, April 08, 2014
A Health Information Manager's (HIMs) role in the Revenue Cycle Management and the workflow:
The revenue cycle and the management the involvement of a Registered Health Information Management Administrator (RHIA) of the processes contained in a good plan are vital to obtaining accurate reimbursement. Every piece of healthcare information collected during the cycle contributes to the production of an error-free claim. The effective management of the revenue cycle results in efficient processes that meet the Key Performance Indicators identified for your practice and produces optimal performance in accounts receivable management. Achieving and maintaining optimal performance levels at a physician’s practice not only improves revenue but allows the practice to focus on other areas for improved profitability in this every changing healthcare delivery model.
Outcomes of working with a RHIA professional:
Once a RHIA has worked with a practice they can assist in supporting contract negotiations with commercial payers. With all the data collected in the Key Performance Indicators, the RHIA professional can help your organization work more effectively identify commercial payers with compromised margins and initiate negotiations that better align reimbursement with resources utilized. In addition, the practice will have the ability to better evaluate pricing for commercial payers, based on fee schedules from Medicare and Medicaid, and establish pricing based on desired profit to help steer the negotiation process. Moreover, market share and lives covered will assist in leveraging a better reimbursement model, but most importantly quality measures and data reporting that the RHIA professional can obtain from the system will further support the negotiations. The physician’s practice will now be able to look at such things as case mix, utilization, and outcomes during negotiations with individual commercial payers.
1. Key Performance Indicators
i. Practice Operating Margin
1. Measures financial performance of a physician entity on an accrual basis
ii. Practice Net Days in Accounts Receivable
1. Calculates the average number of days it takes to collect payment on services rendered and measures revenue cycle effectiveness and efficiency
iii. Practice Cash Collection Percentage
1. Measures revenue cycle efficiency and supports valuation of current accounts receivable and predicts income
iv. Total Physician Compensation as a Percentage of Net Revenue
1. Demonstrates ability to afford physician compensation in relation to revenue of the physician enterprise
v. Professional Services Denial Percentage
1. Tracks payer denials and impact on cash flow and trends payment and process improvement opportunity
vi. Point-of-Service (POS) Collection Rate
1. Provides opportunity to decrease collection costs, accelerate cash flow, and increase collections
vii. Total Charge Lag Days
1. Measures charge capture workflow efficiency and identifies delays in cash
viii. Percentage of Patient Schedule Occupied
1. Identifies opportunity to maximize slot utilization and improve practice productivity
As you can see, the profession has grown from a Librarian to a key player in the Revenue Cycle Management process.
Posted by Twila Weiszbrod at 2:16 PM
Tuesday, January 21, 2014
Maine ACHCA Chapter Awards
The chapter has developed its own annual awards. While the Maine chapter has been very successful in receiving national awards, the chapter awards program is designed to supplement those national awards with local recognition of individuals contributing to the chapter. They include the Outstanding Member Award, the Outstanding Business Affiliate Award and the President’s Award.
The 2013 Chapter Awards were presented at the Annual Meeting on November 1st.
· Phil DuBois, CNHA, FACHCA – Outstanding Member Award: For a truly superior and outstanding member of Maine Chapter ACHCA. Your excellent performance has set a new high standard for everyone to strive toward.
· Estellle A. Lavoie JD – Outstanding Business Affiliate: In grateful appreciation and distinguished recognition of your hard work, devotion and commitment to excellence to the Maine Chapter ACHCA.
· John R. Pratt, LFACHE, FACHCA – President’s Award: In recognition of your lifetime achievement and dedication to the Health Care Administration profession.
Our very own Phil DuBois and John Pratt were award winners! We are so glad to have them working with us!
Posted by Twila Weiszbrod at 9:27 AM