AAHAM Certifications Offer You Solid Steps to your ... · AAHAM National Office Staff 11240 Waples Mill Road, Suite 200, Fairfax, VA 22030 Executive Director Sharon R. Galler, CMP

Spring 2015

Is Meaningful Use Meaningful?Hidden Traps in Managed Care Hospital Contracts

The Affordable Care Act: Past, Present, and Future

Passion, Power and Personality; Looking at

What Feeds and What Impedes Each of Them

Final 501r Rule; The Impact on the Billing Process

AAHAM Certifications Offer You Solid Steps to your Professional Success:Certified Revenue Cycle Executive-I (CRCE-I)Formerly known as the Certified Patient Account Manager (CPAM) for directors and executives

Certified Revenue Cycle Executive-P (CRCE-P)Formerly known as the Certified Clinic Account Manager (CCAM) for directors and executives

Certified Revenue Cycle Professional-Institutional (CRCP-I) For mid-level managers

Certified Revenue Cycle Professional-Professional (CRCP-P) For mid-level managers

Certified Revenue Cycle Specialist-I (CRCS-I)Formerly known as the Certified Patient Account Technician (CPAT) for front-line staff

Certified Revenue Cycle Specialist-P (CRCS-P)Formerly known as the Certified Clinic Account Technician (CCAT) for front-line staff

Certified Compliance Technician (CCT) For compliance professionals

Certified Revenue Integrity Professional (CRIP) For revenue cycle professionals

American Association of HealthcareAdministrative Management

Spring 2015 1

8 Is Meaningful Use Meaningful? By Rob Borchert CRCE-I And Tim Borchert, PMP

12 Hidden Traps in Managed Care Hospital Contracts By David F. Mastan, Esquire

14 The Affordable Care Act: Past, Present, and Future By Tim Borchert, PMP, Kristen De Pena, Peter Strack

20 Passion, Power and Personality; Looking at What Feeds and What Impedes Each of Them By Dorothy A. Martin-Neville, PhD

22 Final 501r Rule; The Impact on the Billing Process By Laurie Shoaf, CRCE-I

2 Letter from the Executive Director

4 Letter from the National President

6 Washington Wire By Paul A. Miller, PLC

24 From the Desk of the Certification Director By Maria LeDoux, CAE

26 Executive Certification Corner By Erin Selin, CRCE-I, CCT

26 Specialist Certification Corner By Doris Dickey, CRCE-I

27 Professional Certification Corner By Brenda Chambers, CRCE-I,P

27 Movers & Shakers

28 From the Desk of the Membership Director By Moayad Zahralddin

32 Did You Know? By Moayad Zahralddin

33 National Calendar/The JHAM network

table of contents

features

departments12

20

8

14

AAHAM National Office Staff11240 Waples Mill Road, Suite 200, Fairfax, VA 22030

Executive Director Sharon R. Galler, CMP 703.281.4043, ext. 204 [email protected]

Membership Director Moayad Zahralddin 703.281.4043, ext. 202 [email protected]

Certification Director Maria LeDoux, CAE 703.281.4043, ext. 201 [email protected]

Finance Manager Christelle Isambo 703.281.4043, ext. 216 [email protected]

Certification Amanda Leibert Manager 703.281.4043, ext. 211 [email protected]

Manager of Danielle Burns Meetings & Events 703.281.4043, ext. 209 [email protected]

Art Direction Christopher R. Izzo & Graphic Design CRI Design 401.821.1849 [email protected]

AAHAM National Executive Officers President Victoria DiTomaso, CRCE-I System Director, CBO Lee Memorial Health System P O Box 150107 Cape Coral, FL 33915 239.242.6011 | 239.242.6005 [email protected]

Chair of the Board Christine Stottlemyer, CRCE-I Director Patient Accounting Memorial Hospital 325 S. Relmont Street York, PA 17403 717.849.5431 | 717.815.2474 [email protected]

First Vice President John Currier, CRCE-I Executive Director Revenue Cycle Management Gibson Area Hospital & Health Services 1120 N Melvin Street Gibson City, IL 60936 217.784.2613 | 217.784.5853 [email protected]

Second Vice President Lori Sickelbaugh, CRCE-I Executive Director Revenue Cycle Operations EMS Management & Consultants, Inc. 2540 Empire Dr # 100 Winston-Salem, NC 27103 336.397.3975 [email protected]

Treasurer Amy Mitchell, CRCE-I Director, Revenue Cycle Support Services University of Utah Hospital 127 South 500 East #500 Salt Lake City, UT 84120 801.587.6486 | 801.587.6675 [email protected]

Secretary Linda Patry, CRCE-I Director, Patient Financial Services Mary Washington Healthcare 2300 Fall Hill Avenue Fredericksburg, VA 22401 540.741.1591 | 866.774.9287 [email protected]

Legal Counsel Richard Lovich, Esquire Stephenson, Acquisto, & Colman 303 North Glenoaks Blvd. #700 Burbank, CA 91502 818.559.4477 | 818.559.5484 [email protected]

letter from the executive director

Sharon R. Galler

2 The Journal of Healthcare Administrative Management

Continued on page 2

Continued on page 18 ❏ Enclosed is my check. Please make payable to AAHAM.

❏ Please charge my credit card: ❍ AMEX ❍ MasterCard ❍ VISA

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Signature: ___________________________________________________________

SHIPPING INFORMATION

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Address: ______________________________________________________________

City: __________________________________ State: ________ Zip: ___________

CONTACT INFORMATION

Name: __________________________________ Phone: ___________________

Email Address: _______________________________________________________

❏ Yes, I want all 4!

❍ 4 Part Series as MP4: $350.00 Member rate

❍ 4 Part Series as MP4: $450.00 Non- member rate

❏ No, I only want the following sections: $125 per section as MP4 - Member rate $225 per section as MP4 - Non-member rate Individual Sections: Please check which section(s) you want:

❍ Part 1 Access

❍ Part 2 Billing

❍ Part 3 Credit & Collections

❍ Part 4 Accounts Receivable Management

Email, fax or mail this registration form along with your payment to:AAHAM CRCE-I/CRCE-P Study Sessions, 11240 Waples Mill Road Suite 200, Fairfax VA 22030

Fax: 703.359.7562 • Email: [email protected] • Questions? Please call 703.281.4043 x202

Company: ___________________________________________________________

Professional CertificationWebinar Series

Available Now As Downloadable MP4’s

AAHAM and top CRCE-I & CRCE-P present afour part Webinar Study program

for the AAHAM Professional Exams:

Access • Billing • Credit & Collections • Accounts Receivable Management

The entire 4 part recorded MP4 series costs $350.00.Individual parts can be purchased separately for $125.00 each.

As you have heard, our historic 11th Legislative Day was a huge success, be sure to read “The Washington Wire” column by Paul Miller and check out the great

photos in our online photo gallery. Lori Sickelbaugh, CRCE-I, 2nd Vice President; Rich Lovich, Legal Counsel and Tim Moore, Government Relations Chair joined Paul Miller and attorney Mark Brennan at a meeting with the FCC about our position on the Telephone Consumer Protection Act (TCPA) (see photo below).

A special thank you to our generous Legislative Day sponsors:

President Level PFS Group

Senator Level Illinois chapter Keystone chapter Marcam AssociatesPhiladelphia chapter Pine Tree chapter Progressive Management Systems VARO Healthcare

The next big event is our ANI. Mark your calendars for “The Wonderful World of Revenue Cycle”, October 14-16, at the gorgeous Disney Swan hotel in sunny Orlando,

Representative Level Accretive Health Florida Sunshine chapter Hawkeye chapter Maryland chapter NE Pennsylvania chapter Revenue Cycle Co-op/Wisconsin chapter SHERLOQ Solutions

Spring 2015 3

❏ Enclosed is my check. Please make payable to AAHAM.

❏ Please charge my credit card: ❍ AMEX ❍ MasterCard ❍ VISA

Card Number: ________________________________________________________

Name on Card: ___________________________________ Exp. Date: ___________

Signature: ___________________________________________________________

SHIPPING INFORMATION

Name: ______________________________________________________________

Address: ______________________________________________________________

City: __________________________________ State: ________ Zip: ___________

CONTACT INFORMATION

Name: __________________________________ Phone: ___________________

Email Address: _______________________________________________________

❏ Yes, I want all 4!

❍ 4 Part Series as MP4: $350.00 Member rate

❍ 4 Part Series as MP4: $450.00 Non- member rate

❏ No, I only want the following sections: $125 per section as MP4 - Member rate $225 per section as MP4 - Non-member rate Individual Sections: Please check which section(s) you want:

❍ Part 1 Access

❍ Part 2 Billing

❍ Part 3 Credit & Collections

❍ Part 4 Accounts Receivable Management

Email, fax or mail this registration form along with your payment to:AAHAM CRCE-I/CRCE-P Study Sessions, 11240 Waples Mill Road Suite 200, Fairfax VA 22030

Fax: 703.359.7562 • Email: [email protected] • Questions? Please call 703.281.4043 x202

Company: ___________________________________________________________

Professional CertificationWebinar Series

Available Now As Downloadable MP4’s

AAHAM and top CRCE-I & CRCE-P present afour part Webinar Study program

for the AAHAM Professional Exams:

Access • Billing • Credit & Collections • Accounts Receivable Management

The entire 4 part recorded MP4 series costs $350.00.Individual parts can be purchased separately for $125.00 each.

letter from the national president

Deadlines & Submission GuidelinesThe Journal welcomes submissions from AAHAM

members. Submission deadlines are as follows: Journal Issue Submission Deadline Summer 2015 July 24, 2015

Send submissions to:Executive Director, AAHAM

11240 Waples Mill Road, Suite 200Fairfax, VA [email protected]

n Please send a copy of your submission on a CD or flash drive, or e-mail it to: [email protected].

n Leave a one-inch margin on the top, bottom, and sides.

n Use upper- and lower-case letters as you would in typing any correspondence.

n Indent the first line of each paragraph five spaces.

n Include a cover page with the following information: Author’s name, (degrees, certifications) Place of employment Position Address Phone/Fax number AAHAM Chapter Affiliation (if any)

n Any article submitted for reprint in the Journal must be accompanied by written permission to reproduce from the original source.

n Do not use abbreviations or italics.

n All photos become the property of AAHAM, unless you specifically request that they be returned. Each picture should be accompanied by a listing of all individuals in the picture (left to right). Black and white pictures reproduce better than color.

n All articles are subject to editing by AAHAM. AAHAM reserves the right to hold articles for future Journal issues when space is limited.

n Articles referring to or endorsing specific products or services will not be considered.

The Journal is published quarterly by the American Association of Healthcare Administrative Management, 11240 Waples Mill Road, Ste. 200, Fairfax, VA 22030. Opinions expressed in this publication represent the viewpoint of each author, and do not necessarily reflect the policy of AAHAM. Advertisements do not necessarily imply sponsorship by AAHAM. Subscriptions are included with AAHAM membership. Reprints are available from the National Office in portable document format (PDF) for a $75 fee per article. Prepayment is required.

© Copyright 2015 by the American Association ofHealthcare Administrative Management.

www.aaham.org

Victoria DiTomaso, CRCE-I


Happy spring to my fellow AAHAM members!

Finally, a break in the weather, after what was a long and arduous cold winter for a lot of folks. We thoroughly enjoyed the nicer weather in Washing-

ton, DC a few weeks ago, for our 11th annual Legislative Day. It was a remarkable event, with wonderful participa-tion, great speakers and a lot of positives on our work on modernizing the TCPA, and our support of the HIP Act. All of the attendees seemed engaged and energized, and excited to part of such an important event.

Experiences like Legislative Day consistently remind me what a great organization AAHAM is. We spend a lot of time planning, pouring over the results of our surveys, incorporating suggestions and improvements and making everything we do about you, the member.

Our certification programs have really been picking up steam. It has been so gratifying to see the new Certified Revenue Cycle Professional (CRCP) take off. This was a need that the committee and executive team identified, and through hard work and dedication, that need was filled. After our February exam, we now have 146 members holding that designa-tion! That is a remarkable number in just one year.

Our newest exam, the Certified Revenue Integrity Professional (CRIP). Is designed to fill the certification needs of the revenue integrity members was offered in February. We are so proud to say we already have 8 newly Certified Revenue Integrity Professionals (CRIP).

Our other certifications, Certified Revenue Cycle Executive (CRCE), Certified Rev-enue Cycle Specialist (CRCS) and the Certified Compliance Technician (CCT) continue to experience wonderful growth. I am so proud of our certification programs, and I am always gratified at the respect these designations have earned in our industry. AAHAM is second to none in this arena.

Thank you to all of our members that recently took the time to vote on our bylaw up-dates. This is a very important function of the Practices and Standards committee, and your right as a member to vote.

Speaking of voting, just a reminder that 2015 is an election year for AAHAM. The nomination period is open, and a new slate of officers will be elected and sworn in at the ANI in October. Please make sure you vote when you receive your ballot. The future of our organization depends on your thoughtful selection.

The ANI will be here soon and if you are like me, the budgeting process in your office has probably begun. Make sure you are putting this in your budget now to attend. It will be held at the beautiful Swan Hotel at Walt Disney World. It is going to be a wonderful, fun-filled, fabulous educational event. We are always looking at ways to keep the event fresh (remember all the Gilligans and Skippers at last year’s banquet?) and we already have some fun ideas for this year!

It has been an exciting year for AAHAM so far, and it is not even half over yet. Stay tuned for more exciting announcements coming.

Just a reminder to always give back to those in need. It was hard to see the devastation in the Midwest this week caused by the tornados. I know some of our AAHAM families were deeply affected by this tragedy. I was reminded of a favorite quote of mine… “Giving back is something that comes from the heart to me. It’s not that I do it because it is the right thing, I do it because I want to.” Henry Kravis

Happy spring!Victoria Di Tomaso, CRCE-INational President

Note: A CEU is defined as a sixty (60) minute period of education

* Be Sure to Attach Supporting Documentation

Mail Completed Recertification Form and backup documentation to:

AAHAM National OfficeProfessional CEUs

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AAHAM Professional Recertification FormContinuing Education Units (CEUs)

CRCE-I/CRCE-P

Weight Activity Qualifying for Continuing Education Units (CEUs)1.0 unit Each hour proctoring a professional certification exam

1.0 unit Each hour proctoring a technical certification exam

1.0 unit Each professional exam section completed and graded by deadline

1.0 unit Each hour in attendance at an educational program or class relating to the healthcare field

1.0 unit Each hour coaching an organized technical certification review session

1.0 unit Question, answer and reference material submitted and accepted into the professional exam bank

2.0 units Each hour in attendance at an AAHAM sponsored educational program

2.0 units Authored an article published in an AAHAM Chapter publication

2.0 units Attendance at a National President’s meeting

2.0 units Director or Chapter Committee Chairperson

2.0 units Each hour coaching an organized professional certification review session

3.0 units Attendance at an AAHAM audio conference

3.0 units Authored an article published in a National AAHAM publication

3.0 units Given presentation related to AAHAM, patient accounting or healthcare administrative management (AAHAM related credit given if made at an AAHAM sponsored event or if presenter is representing AAHAM)

3.0 units Chapter Officer

4.0 units National Committee Chairperson

6.0 units Officer of National AAHAM

8.0 units Attendance at AAHAM Legislative Day


Will the 2016 race for the White House bring us fresh new faces,

ideas, and the next generation of leaders or will we step into a time machine and go back in time with old names and faces dominat-ing the spotlight? We are still over a year away from deciding who will become the next President of the United States, but that hasn’t stopped those wanting to lay claim to that mantle from beginning to officially an-nounce their intentions.

First, we had Senator Ted Cruz (R-TX), who became the first Tea Party candidate to be elected to the U.S. Senate, officially an-nounce he was running. From the first day Senator Cruz took the oath of office, he has been the leading voice of the far right conservative wing of the Republican Par-ty. Senator Cruz is brash and has come to Washington with a “take no prisoner” atti-tude. From the moment he gave a rousing speech during the 2012 Republican Con-vention, it has been a forgone conclusion that the Senator would make a run for the White House. He recently lived up to that belief when he announced he was seeking his party’s nomination. The many questions Senator Cruz will have to answer are, can he be a viable national candidate; can he win the Republican nomination or will he simply be another flame throwing candidate that pushes the party so far right making it almost impossible for a Republican to cap-ture the White House again? You may not like Senator Cruz or his policies, but he has to be taken seriously because of the fact he is very smart and may be the best debater in the field of Republican candidates. His stage presence could be a game changer if he doesn’t stumble too much on the campaign trail and at other events.

The Republican field also includes two other sitting U.S. Senators, Senator Rand

Paul (R-KY) and Senator Marco Rubio (R-FL). Senator Paul, once an early frontrun-ner, has seemed to fade. He brings a Lib-ertarian tilt to his candidacy that resonated early, but seems to have faded as of late. He has not come across well during interviews and his official announcement didn’t get the buzz you would expect. The question for Senator Paul is can he be seen as his own man or will he be seen as more of the same type of failed candidate his father was. Sena-tor Paul has several challenges ahead. First, can he raise the money he will need in what is expected to be a very expensive primary battle for the Republican nomination? The second bigger question is, can he share a vision that resonates with the conservative wing of the party? My early bet is no.

Next is Senator Marco Rubio who is branding his candidacy as the face of the future. Senator Rubio should not be un-derestimated. He is a fresh face. He has the ability to raise money. And, he has been willing to take a stand on issues not popu-lar with the Tea Party wing of the party, like immigration. Senator Rubio also has had some stumbles. His effort to be a leading voice on immigration reform backfired. He has looked, on occasion, as a candidate in need of more experience. This has led to the comments that he is the Republican version of Barack Obama, who ran for the White House with just a year and a half of experi-ence in the Senate on his resume. Rubio is now facing those challenges and it will re-quire him to run a flawless campaign if he hopes to convince people he has more expe-rience than Barack Obama did.

Still sitting on the sidelines and expect-ed to announce shortly are Wisconsin Gov-ernor Scott Walker (R-WI), who became a conservative favorite after winning a state recall election. This recall election victory

sent the message to conservatives all across the country that he was a straight talking guy who was willing to take on tough issues, even if that meant taking on Big Labor not only in his state, but nationally. New Jersey Governor Chris Christie is also expected to jump into the race. Governor Christie has the most questions to be answered if he is going to be seen as a leading candidate for the nomination. First, we will see if the na-tion is ready for a very blunt candidate will-ing to take on voters head on and tell them what he really thinks. We will see how his recent troubles in New Jersey will play na-tionally. We will have to see if he can come out of the gate raising enough money to be competitive in this race. Also, we will have to see if his moderate views will keep conser-vatives from taking him seriously.

These are the new fresh faces in the Re-publican Party, who will all try to convince voters they are the next generation of leaders with a vision to lead the country. There will be others who may get into the race, but in my opinion, they won’t be real contenders. It is all but a given that former Governor Jeb Bush (R-FL) will jump into the race. Governor Bush is already out raising money putting him on pace to have banked $500 million by this June. That is an incredible amount for a guy who has yet to officially announce he’s running for President. Gover-nor Bush has come out the gates firing on all cylinders, which is going to make it hard for anyone to keep up. He is viewed by many in the Republican Party as too moderate. It will be interesting to see how far to the right he has to move in order to appease hard core conservatives in early primary states like Iowa and South Carolina that he is one of them and deserves their vote.

On the democratic side the choice is an

Paul A. Miller, PLC, Lobbyist

washington wire

Continued on page 7

2016 Race for the White House:The Old versus the New

Spring 2015 7

easy one, former Secretary of State, Hillary Clinton. If you asked odd makers today who will win the Presidency, the odds will be in Hillary’s favor. The problem with those odds are we have over a year to go before people head to the polls, and a lot can happen in that time. We are already hearing questions about her candidacy from those who ques-tion her rollout to those who have yet to hear a plan of how she will run or the issues she will champion. Hillary will also have to answer the question, for her party and for Republicans, why should voters trust her? She will have to try and convince voters this is 2016 and she should be judged on her ac-tions today and not of those in the 90’s or those of her husband. That is easier said than done as the attacks are already beginning to drudge up the past.

We will likely have a few more candi-dates announce, but in my opinion, I would view them as third tier candidates at best, all hoping to get lucky or more likely vie for possible cabinet posts in a Republican or Democratic administration. The one can-didate yet to announce on the Republican side, who I personally view as the wild card who could win both the Republican nomi-nation as well as the general election against Hillary, is Ohio Governor John Kaisich. Governor Kaisich offers voters a candidate who has a long and successful track record as a member of the U.S. House of Repre-sentatives and Chairman of the House Bud-get Committee, to a successful track record as Governor of Ohio, who like Governor Walker, has taken on Big Labor and won. Governor Kaisich has been willing to buck traditional Republican Party lines by accept-ing Medicaid expansion for his state. He has also been willing to talk about the need for real immigration reform. And, he has been willing to talk openly and honestly about gay marriage. All issues that have angered the far right wing of the party but have people listening. The biggest questions for Governor Kaisich are can he raise the money necessary to go the distance and can he put together the organization he will need to be competitive in early primary states. The big

plus for Governor Kaisich is that he comes from the state you need to win if you want to be the next President. He has now won state wide twice, which is a big plus for him.

What concerns people in both parties is are we taking a step backwards in 2016 if we have a Bush-Clinton match-up? Experts on both sides are concerned that a Bush-Clinton rematch of sorts will be nothing more than a campaign that drags up the past and does nothing to take us into the future. Unless there is a major shift, Hillary Clinton will be the Democratic nominee in 2016. So at least half of the ticket will be the past trying to take us into the future. The positives for Hillary are her ability to raise money, Bill Clinton’s popularity in key states (like Ohio and throughout the Midwest), and the fact that so many wom-an want to see a woman elected President. There is a large population of woman who feel slighted from her loss in 2008. This group has been organizing the moment President Barack Obama took the oath of office. All these things make her a force in 2016 and pose real problems for the Repub-licans regardless of who the candidate is.

I believe a Bush-Clinton campaign will not only go down as our most negative race in history, but it will keep people home on Election Day. I think Bush will see the same people stay home that kept Mitt Romney from winning the White House. I think the same will happen to Clinton to a lesser de-gree. I think a Bush-Clinton match-up fa-vors Hillary early. If both candidates don’t stumble I believe you will see a huge turnout from woman (and betting some Republican

woman will vote for her just because they too want to see the first woman President) and you will see an uptick in African American votes. Republicans will need to find a way to rally hard core supporters to get out and vote for Bush. The message should be easy, do you want another Clinton White House of the 90’s which produced scandal, or do you want to suck it up and finally, after eight years, get a Republican in the White House, even if his name is Bush. Part of the problem with that messaging is that even if you dis-like the Clintons, one has to be fair and say that Bill Clinton was a pretty successful Pres-ident. Only time will tell how this all plays out, but one thing is clear, the cost for this race will reach the $4 billion mark.

The amount of money it now takes to run for the Presidency is staggering. It is the biggest reason so many other talented candi-dates are sitting on the sidelines. We are see-ing it on the congressional level as well. You can win without raising billions, as Repre-sentative Dave Brat from Virginia can attest. He is the candidate who came from nowhere to beat former Majority Leader Eric Cantor. Brat only had him and two other campaign staff and very limited financial resources and took out a giant. Virginia’s 7th congressio-nal district is not the whole United States, which makes what he did in Virginia a ma-jor uphill challenge on a national level.

So as you prepare for 2016 I can only tell you to buckle up and get ready for an-other very bumpy political ride. n

Mr. Miller can be reached [email protected]

washington wire

continued from page 6


By Rob Borchert CRCE-IPresident of Best Practice Associates, LLC

member of the Virginia chapterAnd Tim Borchert, PMP

Deputy Director, Business Advisory ServicesAltarum, member of the Virginia chapter

Do you all remember all of the excite-ment when the announcement about

obtaining an “electronic health record” was released? Do you remember the dollar val-ues of “reimbursement” that was announced once the electronic health record (EHR) reached certain stages in development? Oh, what a consultant’s dream to help hospitals and physicians choose the right system for their facility or practice! Oh, what a great revenue stream for the numerous companies who sold EHRs or were even in the develop-ment of one! What a boon!

Along with this great announcement, but not emphasized, was the focus that physicians and those documenting into the EHR, were supposed to utilize the new tool to enhance their documentation and make the picture of the patient’s condition and medical care more expandable. What did happen was that physicians complained about the length of time associated with the completion of the medical record during the “face-to-face” meeting with the patient. Other things that occurred during the initial year of the EHR were:• the expansion of existing single point

systems to multi-point systems without much testing

• the introduction of “vaporware” compa-

nies who would sell their system and then develop the system at the client site

• the quick growth of some established companies to the point that they would hire young people right out of college, train them in one specific functional area of their system and then send them to cli-ents for implementation

• consultants who strived to implement sys-tems that they had little to no knowledge of its various functions

With all of this activity, it became fairly apparent the real focus of obtaining and implementing an EHR system was the fi-nancial reward the government would pay at certain stages of implementation. But not the true purpose of increased documenta-tion for better medical care and the interop-erability of utilizing this medical informa-tion to offer enhanced care to the patient.

Where are you in all of this? It may be too late for some of us but it would be nice if everyone could evaluate how meaningful is the use of the data in our medical records. The first thing I remember is that many of the EHRs were “re-implemented” because the first time around, the outcome was not very good. Many of the “selling points” of the initial system did not work or were not user friendly; many of the dictionaries were standard with no advanced language to im-prove medical record information; many of the information hints that were supposed to increase the physician’s documentation were not helpful or not used by physicians because it wasn’t the way they would say it or it sounded ‘dangerous’ as documentation.

The reality point that a large number of already implemented systems had to be re-placed or re-implemented told us the focus was financial and “patient-centered.” Today, I think we have learned our lesson and have begun to turn the tide. There are two areas we need to now focus on to truly maximize meaningful use; physician documentation and interoperability. Both are very tough tasks and each has their own set of problems.

Physician Documentation This is still the biggest complaint about

physicians and among physicians. “Every-one wants more!” says one doctor; “The doctor will yell at me if I ask him for more information” says either a nurse or a medical record coder; “Denied, not enough infor-mation” says the insurance specialist; “Poor documentation is effecting our case mix and reimbursement” says the chief financial of-ficer. We could go on and on but you get the point. Physician documentation is and has always been the key to successful patient care as well as the appropriate reimburse-ment. This is why physicians and other pro-viders are always ‘in question’ when it comes to documentation.

When discussing documentation with physicians and providers, it is best to rec-ognize their knowledge base and their per-sonal commitment to their patients. Under the new coding system, ICD-10 (Inter-national Classification of Diseases – 10th edition), we are very much aware of the new level of detail that is expected regard-ing patient care. This will be somewhat dif-

Is Meaningful Use

Meaningful?

Continued on page 10

Spring 2015 9



ficult for many physicians since they have the knowledge and keep it in their head but don’t document it. Some of the best ways to enhance their ability to document the completeness of the patient’s condition is to have some “experiential patient sessions” with the physicians of the same specialty. You can take some actual patients, redact their name and other information, or make up some patients with the typical language and conditions you usually see from that specialty area. Have one physician read the documentation as primary care physician and then ask if anything happened to the primary care physician, would any of the other physicians be able to immediately take over the care? Ask for comments regarding further description of the patient’s condition and what other descriptions could be added to the medical record to make it more com-plete. If you think this is may be a good ap-proach to further address the improvement of clinical documentation, then you should adopt this method and have the “clinical documentation improvement” team work with you for more focused sessions.

Physicians have a way of respecting data. They want data and respect it also. Therefore, this method also becomes valu-able when dealing with claims that are re-duced in payment or denied completely. Without mentioning the particular physi-cian, this method can be extremely benefi-cial especially when, at the end of the ses-sion, you present the data representing the dollar value of these denials against the total dollars of revenue from that area. We have found that when the physicians understand the level of documentation associated with these types of claims, they can add sugges-tions to either the electronic EHR to help with documentation or with other creative methods to help other physicians in their specialty. This has proven successful on more than one occasion. This is also a great way to gently express the incredible detail

that ICD-10 wants. The more specific the documentation, the more specific the as-signment of a code can be.

This level of specification regarding the assignment of an ICD code becomes even more important as the new APR-DRGs (All Patient Refined-Diagnosis Related Groups) are adopted by Medicare and other third par-ty insurance carriers. If you read the article in the last issue, you will know that APR-DRGs have stratified each DRG into four classifica-tions: minor, moderate, major or extreme. These are the codes that express the severity of the disease and the risk of mortality for that disease. As can be expected, each clas-sification has its own set of weights in the “grouper” and that the higher the classifica-tion, the greater the weight. The greater the weight, the larger the payment. Therefore, the depth of the documentation should bring about more specific assignment of medical record codes. The more specific and complete the codes are, the more likely the final assign-ment of the DRG will be above the moder-ate classification. The only way to make any profit from these APR-DRGs is to have the assignment classified above moderate.

InteroperabilityInteroperability has always been a topic

that people really don’t talk discuss comfort-ably. The electronic health record within a facility or practice can work well as an in-teroperable system. The internal IT staff of a facility or practice can usually “make it work” and have the availability of the EHR open to many work stations. Even a large health system, if they chose the right EHR system, can have as a very productive asset in sharing a patient’s medical history and cur-rent condition.

Interoperability is still a problem in most communities. The interoperability of the EHR across all systems through the HL7 protocols has not been accomplished. There is no significant focus on this aspect of the electronic medical record since entity rev-enue is still the major draw. Interoperability

would need to be written, tested, cleared and then approved for another system to have the information from a patient. This is the goal of interoperability. We are still working on it and, I am confident, that we will get there someday. Meanwhile, we need to con-tinue on enhancing both of the vital pieces to an electronic medical record; detailed documentation and system interoperability.

If your physicians, whether at a facil-ity or for a practice, can access and utilize the EHR from outside of the physical build-ing, like from home or other location with a security code, then right steps are being taken toward accessibility and communica-tion. Let me end with two quick personal experiences. The first experience is with my primary care physician who I have been see-ing for a number of years. He is in a multi-specialty practice and during one visit, we talked about a certain test you should have done at a certain age. We agreed to have me referred to another member in his practice and as I was leaving, he told me he just sent this specialist my medical record and history so I do not have to repeat all of my health background. This is internal communica-tion. The second experience is with the same physician but the test that I needed was from a specialty that was not in his practice. He said that he would send my medical record over again. Well, I made my appointment and upon arriving, there was no medical re-cord. I asked the specialist if he received my information and he said no. He then had to call my physician and they faxed my infor-mation over. No interoperability here.

So let us do what we can, work with our physicians to obtain the highest level of documentation specialty for each patient and have the information technology people continue to work on making medical record systems interoperable. n

Rob Borchert can be reached at 315.345.5208 or [email protected] Borchert can be reached at 703.328.3953 or [email protected]

With highly informative session tracks, AAHAM’s 2015 ANI promises real-world solutions you can put into use immediately at your facility.Mark you calendar now and put the ANI in your budget. Join us in wonderful Walt Disney World, Orlando Florida and get ready to enter “The Wonderful World of Revenue Cycle.”

October 14-16, 2015October 14-16, 2015Walt Disney World Swan Hotel

Orlando, Florida

2015 AAHAM ANI2015 AAHAM ANI


By David F. Mastan, EsquireStephenson, Acquisto & Colman

Negotiating managed care contracts can be a win/win experience for both

providers and payors. Relationships can be developed and strengthened, patient satis-faction can be enhanced, and the result can be lucrative, beneficial and efficient for all parties involved.

However, at the core of the matter the interests of the providers and the payors dif-fer substantially. When negotiating the man-aged care agreements, each side brings to the table different fundamental wants, needs and desires. The bottom line is providers want to be fairly paid for their services and payors want to limit their economic outlay. Typically from the provider side, reimburse-ment rates often tend to be the primary if not the sole focus of the contract. However, focus on rates is a myopic approach which leads to providers overlooking other crucial aspects of the contract language that could detrimentally effect ultimate reimbursement.

Boilerplate TrapsMost, if not all, hospital services con-

tracts are presented in template form with certain provisions that are essentially non-negotiable. These provisions often provide time limits for providers (and rarely for payors) to perform certain acts or risk waiv-ing the ability to contest the reimbursement level of the claim. Time limits for appeals, at multiple levels, specific address instructions for different types of appeals, meet and con-

fer requirements as preconditions to arbitra-tion or litigation, all can serve as traps for the unwary provider leading to a significant decrease in recoverable compensation.

Artificial Deadline TrapsThe most egregious type of deadline is

one that significantly reduces the amount of time a provider has to formally pursue an underpayment or denial. In most states, the statute of limitations for breach of a written contract is at least four years from the breach. This means a provider has up to that time period to bring an action to force proper payment. However, hospital services contracts often significantly reduce this limitation period, some to as short as six months. Looking at this objectively, why would you agree to limit the amount of time you have to pursue your rights when the law says you have a much longer period? As un-fair as these truncated limitations periods appear to be, if you were to argue to a judge how inequitable it is to cut short a provider’s rights, the usual response is “you agreed to it.” Thus, the advantageous rate negotiated by a provider can evaporate if the denials are not prosecuted according the strict limita-tions in the contract.

Doomsday TrapsThe negative impact of these types of

limitations can be one of degree depending upon the specific language in the contract. If a contract states “all appeals must be filed within 30 days of denial” the provider who files on day 31, one day late, may still have an argument available at arbitration or trial that being one day late is not prejudicial to the

payor, that medically necessary services were provided to the payor’s insured after all, that the 30 day time limit is an artificial technical-ity and that overall fairness and equity should control. Oftentimes, that is an effective argu-ment. However, if we change the contractual language slightly this argument is eliminat-ed. If the contract states “all appeals must be filed within 30 days of denial, and if not filed within that time period, provider shall be forever foreclosed from pursuing additional payment and the decision of the payor will be final” then recovery becomes more problem-atic. The presence of this “doomsday” lan-guage indicates an agreement by the provider to be bound by what would otherwise be an unrealistic and harsh result.

Payor Limitation TrapsWhat about the payor’s limitations?

Often these harsh results are visited more often upon the provider, and the actions of the payors often are not artificially limited. One significant area of concern should be limits on the ability of the payor to seek re-imbursement for overpayments. Most hos-pital services contracts are silent as to time periods within which notice of, and actual take backs, can occur. So while providers stand to lose the ability to recover on legiti-mate claims if they do not meet time limi-tations, payors have the luxury of the full time periods allowed by law to pursue their issues. To level the playing field, providers should negotiate the same type of limits on the payor’s ability to act as are imposed upon the provider.

Hidden Traps in

Managed CareHospital Contracts


Spring 2015 13

Other Document TrapsAnother area of focus should be upon

the incorporation of “other documents” into the contract. The four corners of the contract should, for all intents and pur-poses, contain each and every agreed term entered into by the parties. There are occa-sions, however, when another document is referenced and incorporated and the parties agree to be bound by that collateral or an-cillary document. Often times the ancillary document referenced is innocuous. How-ever, that is not always the case. The most egregious example can be commonly found in most managed care contracts; that being where the parties actually agree to incorpo-rate the payor’s operations manual into the contract, and agree to be bound by the pro-visions of that operations manual.

The payor’s operations manual can change from year to year or month to month and it can change at the sole discretion of the payor with no effective input whatsoever from the provider. The changes made can be highly advantageous to the payor, and the provider does not get to contribute, com-

ment, negotiate or in any way formulate the changes and amendments. Often the only available provider remedy when a payor makes changes to its operations manual is to terminate the contract. That is generally not economically viable for the provider and thus more burdensome provisions are put into place to reduce ultimate compensation.

For example, look at the definition of and concept of “medical necessity.” In most managed care agreements, the definition of what constitutes “medical necessity” is set forth in the contract itself, and the language is usually negotiated to be fair and meaning-ful to all parties concerned. Yet, in the pro-cedures manual, a document not negotiated by the parties, the payor often states that the “final determination” of what actually constitutes “medical necessity” in any given claim rests solely with the payor. Therefore, if the payor denies or reduces a provider’s re-imbursement based upon “no medical neces-sity” the provider still has the right to appeal. However, the payor need merely cite to the provider manual and invoke the “final deter-mination” language. Case closed. There is no recourse. Upon learning this fact the provid-er may be outraged, but the truth is that the

provider agreed to allow this to occur.

Be Aware of the Hidden TrapsThe take away is that managed care con-

tracts can be very productive and profitable. Relationships between payers and providers can be forged and strengthened. Gener-ally the result is that the patients themselves win because a better quality of medical care becomes more accessible to many more people. However, as outlined above when negotiating the managed care agreement, the provider must be acutely aware of all contract provisions and not allow the lure of favorable reimbursement rates to distract from the hazards of unanticipated terms. Doomsday language in a contract can carry significant financial repercussions. Allowing binding ancillary or collateral documents to be incorporated into a contract can be dangerous especially when the sole control of content of those documents rests in the hands of the payor.

Please keep these hidden traps in mind when negotiating contracts. n

Mr. Mastan can be reached at 818.559.4477 or [email protected]



By Tim Borchert, PMPDeputy Director, Business

Advisory Services, Altarum, member of the Virginia chapter

Kristen De PenaConsultant, Business

Advisory Services, AltarumPeter Strack

Senior Advisor, Business Advisory Services, Altarum

Staying current of The Affordable Care Act (ACA) requires constant vigilance

and continuous learning even as we cel-ebrate the fifth anniversary of the law. As-pects of the law affect the past, present and the future in ways that we already know, in news ways we’re still learning, and in many ways we can’t anticipate. Things to keep in mind as you explore the depths of the ACA are the origins of the law, how it affects us today, and where it’s headed tomorrow.

The most immediate goals of the ACA were to increase accessibility to affordable health insurance options, and to control rapidly growing healthcare costs. To achieve these goals, the law employs a mixture of mandates, subsidies, tax credits, and penal-ties to increase coverage of the uninsured, spur healthcare innovation, and provide for new payment models to reward quality of care and improved healthcare outcomes. A secondary goal, and one that is now tak-

ing shape, is improving healthcare delivery through payment and delivery reforms.

Healthcare, Then Between 2008 and 2013, the market

was fraught with healthcare woes; national health spending increased from $2.2 tril-lion in 2007, to $2.4 trillion in 2008.1 By 2018, national health spending was expect-ed to reach a whopping $4.4 trillion, and comprise just over one-fifth (20.3 percent) of the Gross Domestic Product (GDP).2 In addition to rising costs, the number of uninsured or underinsured Americans was also rising. On the cusp of the passage of the ACA, over 41 million people were still with-out coverage.3 These two factors drove one of the largest healthcare overhauls in history: the ACA.

Healthcare, NowThe ACA passage was the first step to-

wards increasing access to and coverage of millions the “un” and “under” insured Amer-icans that contributed to the rapidly increas-ing costs of health coverage. A number of provisions in the ACA provide for increased availability of health insurance options: • Insurers can no longer deny consumers

coverage based on a pre-existing condition;• Insurers can no longer charge women

more for coverage;• Children/young adults can remain on

their parents’ insurance until they’re 26 years old;

• Most plans include free preventive ser-vices and comprehensive coverage guar-antees; and

• Consumers can apply for Advance Pre-mium Tax Credits (APTC) and Cost-

Sharing Reduction (CSR) subsidies.

Still, healthcare costs are rising. The national medical bill may be back to grow-ing faster than GDP. After five years of his-torically slow growth, new data shows U.S. healthcare spending accelerated significantly in 2014. In fact, health spending increased by 5% last year, compared to 3.6% in 2013.4

If confirmed by the final tally, healthcare spending in 2014 would mark the biggest jump since before the recession.

One way to attempt to control these rising costs is improving healthcare delivery. To continue to slow the growth of healthcare spending, the ACA provides for healthcare delivery provisions that mandate healthcare delivery reforms meant to simultaneously decrease healthcare costs, and increase qual-ity of care.

As the range of benefits continues to increase, as well as the availability of access to care, there exists a renewed focus on more efficient, cost-effective, delivery of care. Looking forward, the drivers of these im-provements include:

Better Care: Improving customer ser-vice and satisfaction by identifying and managing needs and expectations;

Healthy People/Healthy Communi-ties: Improving the health of the U.S. popu-lation by supporting proven interventions to address behavioral, social, and environ-mental determinants of health in addition to delivering higher-quality care;

Affordable Care: Reducing the cost of quality healthcare for individuals, families, employers, and government by making pro-cesses more lean, efficient, and standardized,


Past, Present, and Future

ACA AT A GLANCEThings to keep in mind as you explore the depths of the ACA are the origins of the law, how it affects us today, and where

it’s headed tomorrow.

The Affordable Care Act:

Spring 2015 15


and by incorporating resource stewardship in all decision-making; and

Sharing Information: More effectively generate, capture, and transfer knowledge and improve internal and external commu-nications.

Together, these drivers focus on “pa-tient-centered care,” an increasingly influen-tial healthcare term that includes better care initiatives and affordable care initiatives. To ensure that newly insured individuals and their families are receiving the quality of care they deserve, at a price they can afford, re-quires focused attention on simultaneously improving quality processes and decreasing costs. To affect this goal, many providers are focusing on payment reform and delivery reform, including reducing harm caused in the delivery of care; ensuring that each person and family are engaged as partners in their care; promoting effective communi-cation and coordination of care; promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease; working with communities to promote wide use of best practices to enable healthy living; and making quality care more affordable for in-dividuals, families, employers, and govern-ments by developing and spreading new healthcare delivery models.5

Of note, delivery reforms will likely occur regardless of the successes of any of the payment reform initiatives; these are the drivers of patient-centered care, which will increase costs to providers if they do not suc-cessfully pilot and implement proper pay-ment reforms.

Healthcare, Looking ForwardIn addition to the payment and deliv-

ery reform vehicles, three major issues will shape healthcare moving forward.

#1 EnrollmentEnrollment numbers will have an enor-

mous impact on how successful the ACA is in 2015 and beyond. Of the roughly 11 mil-lion people who enrolled in state or federal Marketplaces in 2015, about 4.2 million were auto-renewals or renewals, indicating that roughly half of all 2015 enrollees kept their 2014 Marketplace insurance plan.6

The Congressional Budget Office (CBO) estimated in April, 2014 that Mar-ketplace enrollment would hit 15 million in 2015; significantly higher than the 11 mil-lion actually enrolled.7 These expectations were mitigated in November 2014, when HHS indicated that CBO’s initial assump-tions inflated the number of enrollees; the actual target being somewhere between 9.0 and 9.9 million enrollees, nearly 4 million less than the CBO projected.8

For small businesses, the enrollment numbers are a mystery, despite delaying implementation until November 15, 2014. SHOP coverage is available to employers with 50 or less full time equivalent (FTEs) employees, and will expand to cover em-ployers with 100 or less FTEs in 2016. In exchange for signing up, employers qualify for tax credits that lower their share of em-ployee premiums.

#2 Disappearing SubsidiesSworn in on January 6, 2015, the 114th

Congress marked a drastic shift in the make-up of the legislative branch. For the first time since 2007, Republicans control both the House and the Senate during the last two years of the Obama Administration. What does that mean for healthcare? Perhaps in-dicative is H.R.132, Obamacare Repeal Act, introduced in the House the very day of their swearing in. The purpose? The law repeals ACA, effective as of their enactment, and restores provisions of law amended by the Act. Although it sounds ominous, the House has voted well over 50 times to repeal the bill, and it wasn’t a surprise to anyone that it passed with flying colors in the House in early February of this year.

The main difference this year, as op-posed to the past seven years and 50-some-thing other attempts, is the Republican Senate majority may decide to call up the bill, a move the Democrat-controlled Sen-ate refused to do prior to the 2014 elections. While there is a slim possibility that the Sen-ate will hear and pass the bill, Presidential veto is almost a certainty, meaning that a clean repeal is highly unlikely. Still, it marks a significant presence of lawmakers and con-stituents that want to repeal the law, and end the subsidies.

Perhaps more threatening is the health-care case the Supreme Court of the United States (SCOTUS) heard in March. SCO-TUS announced in December, 2014 that it will hear arguments in King v. Burwell, a case that turns on the interpretation of one of the most influential healthcare laws passed in the United States, the Patient Protection and Affordable Care Act (ACA). Specifically, SCOTUS will decide whether the Internal Revenue Service may permis-sibly promulgate regulations to extend tax-credit subsidies to coverage purchased through exchanges established by the fed-eral government under Section 1321 of the Patient Protection and Affordable Care Act.

This is a big deal…theoretically

If the IRS final rule is invalidated, and tax credits are no longer available in the states that have (or had) federal exchanges, more than half of the 7.3 million people



HEALTH DELIVERY & PAYMENT REFORMS TO CONTROL COST

• Bundled Payments for Care Initiative• Accountable Care Organizations

(ACOs)• Evidence-based practices • Narrow networks • Hospital Value-Based Purchasing

Program

FEBRUARY 2015 OPEN ENROLLMENT STATS

• 11.4 million were enrolled in Market-place coverage

• $268 was the average monthly tax credit

• 87% Marketplace consumers qualified for tax credits

• 25% increase in issuers competing for business in the 2015 Marketplace, as compared to last year.

Spring 2015 17

who purchased ACA compliant insurance plans and received subsidies are no longer entitled to them.

Expectations are that those currently covered would drop coverage and avoid the tax penalty, leaving more uninsured and fewer individuals in the exchange which, in turn, could increase costs for those who retain coverage, resulting in significant in-creases in insurance rates.

According a recent RAND study,9 pre-miums would increase as much as 43% and enrollment would drop as much as 68%, resulting in more than 11 million Ameri-cans losing their health coverage. Based on a Kaiser Foundation10 analysis of Congressio-nal Budget Office estimates of Marketplace enrollment, 13 million Americans could be denied financial assistance to help pay insur-ance premiums for plans purchased in the ACA’s federally operated insurance exchang-es in 2016. It is possible that a decision from SCOTUS would cause many states to create their own exchanges to protect their citizens. As many as eleven states, Arkansas, Delaware, Illinois, Iowa, Maine, Missis-sippi, New Hampshire, New Mexico, North Carolina, Pennsylvania, and Virginia, would set up their own exchanges if necessary.

We prediction the SCOTUS will up-hold the IRS rule and find some creative solution to save the ACA from itself and spare the Court from political attacks and reputational harm.

#3 New Models of Care and Associated Reimbursement Mechanisms

As healthcare markets continue increas-ing the range of benefits available to consum-ers, access to efficient, cost-effective, quality delivery of care is becoming a priority. En-

suring that newly insured individuals and their families receive the quality of care they deserve, at a price they can afford, requires focused attention on simultaneously improv-ing quality processes and decreasing costs.

The ACA lays a foundation for increas-ing the use of bundled payments to bridge the risk gap between fee-for-service (FFS) and capitation payment models. In January 2013, Centers for Medicaid and Medicare (CMS) announced the first participants in the Bundled Payment for Care Initiative (BPCI), which was designed to produce higher quality and more coordinated care at a lower cost, by transferring financial risk to providers and grouping facility and physi-cian reimbursements into a single payment for an episode of care.11 The traditional FFS approach, by which providers and hospitals are individually reimbursed for their ser-vices, often results in fragmented care with minimal coordination across providers and healthcare settings. Ideally, with bundled payments, providers become responsible for validating the appropriateness of a payment, and must use proper financial accounting techniques to allocate each payment to a billed charge.

The shift away from FFS also encour-ages lower-cost services and the increasing use of telehealth. Looking ahead, telemedi-cine will most assuredly be a large part of the future of efficient healthcare management in America, evidenced in a report from Foley & Lardner, LLP: • 9 out of 10 providers are moving forward

with telemedicine projects, distance-based care programs, and 84% say that mean-ingful telehealth services will be central to the success of their organization;

• 64% already offer remote patient moni-toring services;

• 54% already offer store and forward tech-nology.

• 52% offer real-time interaction capabili-ties;

• 41% said they do not get reimbursed at all for telemedicine; and

• 21% claimed they get lower rates from managed care for telemedicine compared to in-person care.12

Despite underwhelming reimburse-ment rates for telemedicine, hospitals, phy-sicians, and patients recognize the promise of using information technologies to pro-vide clinical healthcare at a distance. It helps eliminate geographic barriers and can im-prove access to medical services that would often not be consistently available in rural communities.

Closely tied to offering patient-focused medicine and convenient alternatives, are new incentive-based payments that require providers to report quality measures and costs to determine value-based, or high-quality, payments. ACA is shifting the na-tional health-care system from one based on sickness and disease, to one focused on prevention and wellness. These FFS alter-natives affect provider rate-setting and rate capture activities nationwide, and include value-based purchasing, bundled payments, Accountable Care Organizations (ACOs), Patient-Centered Medical Homes (PCMH), and incentive-based quality payments. His-torically, reasonable charges13 relied heavily on external data pricing sources from CMS and commercial claims databases; now, more than billable charges, reimbursement requires quality and cost data.

Identifying and understanding these models within the scope of the ACA is daunting. New ventures and arrangements constantly evolve across the enterprise based on geographic regions and costs associated with delivering medical care, administering pharmaceuticals, and rendering supplies. In certain markets where value-based models are more prominent, FFS payments no lon-ger suffice as the singular benchmark for de-termining market rate pricing comparisons.

As the prevalence of bundled and packaged services continues to expand, it

King v. Burwell—what’s on the line?

More than half of the individuals who purchased Marketplace coverage will lose their subsidies, resulting in a 43% hike in rates, and a 68% drop in

enrollment.


Daunting Payment ReformsIdentifying and understanding payment and delivery models within the scope of the ACA is daunting. New ventures and arrangements constantly evolve across the

health enterprises.



becomes even more important to ensure charge structures and charge capture activi-ties are optimized. In a major paradigm shift for private sector providers, ACA is also us-ing Population Health Management to drive reimbursement for Integrated Care Systems. Population Health Management has to do with the organization and management of the healthcare delivery system in a manner that makes it arguably more clinically effec-tive, more cost effective, and safer.

For example, integrated care system reimbursement relies on rigorous popula-

tion health management decision support, and private sector providers use population health management solutions to integrate patient data from disparate sources, using it for proactive application of strategies and interventions to defined groups of individu-als, across the continuum of care, in an ef-fort to improve the health of the of those individuals at the lowest necessary cost.

As SCOTUS stews over King v. Bur-well, newly-elected governors will embrace policy and state-based market strategies for improving quality, and reducing the cost of healthcare using value-driven modes. The drivers of healthcare cost growth are com-

plex and the effects multifaceted; no single driver is responsible for the nation’s high and rising healthcare costs. Likewise, no sin-gle policy solution will adequately meet this challenge. Only by continuing to innovate and evolve, can we keep up with the fast-paced healthcare world post ACA. n

Tim Borchert can be reached at [email protected] De Pena can be reached at [email protected] Strack can be reached at [email protected]


1 National Health Expenditure Projections, Forecast Summary, Centers for Medicare & Medicaid Servic-es, Office of the Actuary. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthEx-pendData/downloads/proj2008.pdf.

2 National Health Expenditure Projections, Forecast Summary, Centers for Medicare & Medicaid Servic-es, Office of the Actuary. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthEx-pendData/downloads/proj2008.pdf.

3 “Key Facts about the Uninsured Population.” The Henry J. Kaiser Family Foundation. Published October 14, 2014. Available at: http://kff.org/unin-sured/fact-sheet/key-facts-about-the-uninsured-population/.

4 Charles Roehrig, “Health Sector Trend Report, March 2015—Expanded Report Coverage All of 2014.” Altarum Institute Center for Sustain-able Health Spending. Available at: http://altarum.org/sites/default/files/uploaded-publication-files/

Altarum%20RWJF%20Trend%20Report%20March%202015%20FINAL_0.pdf.

5 U.S. Department of Health and Human Services, National Quality Strategy: Overview. Available at: http://www.ahrq.gov/workingforquality/nqs/over-view.htm.

6 U.S. Department of Health and Human Ser-vices, Press Release, March 10, 2015. Available at: http://www.hhs.gov/news/press/2015pres/03/20150310a.html.

7 Congressional Budget Office, Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014. Available at: http://www.cbo.gov/sites/default/files/45231-ACA_Estimates.pdf.

8 Congressional Budget Office, Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014. Available at: http://www.cbo.gov/sites/default/files/45231-ACA_Estimates.pdf

9 Christine Eibner, Eric. Saltzman, Assessing Alter-native Modifications to the Affordable Care Act, Im-pact on Individual Market Premiums and Insurance Coverage, Santa Monica, CA, RAND Corporation, 2014

10 How Many Americans Could Lose Subsidies If the Supreme Court Rules for the Plaintiffs in King vs. Burwell?, Henry J. Kaiser Family Foundation, Nov. 2014.

11 U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Bundled Payments for Care Improvement (BPCI) Initiative: General Information. January 13, 2013. Available at: http://innovation.cms.gov/initiatives/bundled-payments/.

12 Nathaniel Lacktman, Lawrence Vernaglia, 2014 Telemedicine Survey Executive Summary, Foley & Lardner, LLP, http://www.foley.com/2014-telemedi-cine-survey-executive-summary/, Nov. 2014.

13 Healthcare.gov: https://www.healthcare.gov/glos-sary/UCR-usual-customary-and-reasonable/.

Florida. Plan now to join us at this once a year educational and networking event. We have sensational speakers and sessions for you to get your CEUs and education all in one place, all at one time, at an afford-able price. Learn about solutions to your work challenges in our exhibit hall with over 80 exhibiting companies. We also have many networking opportunities to help you build relationships and give you the edge in today’s competitive economy and job force.

Our education committee has put to-gether a world of speakers in addition to two fabulous keynotes. Keynote speaker, Chris Blackmore, www.chrisblackmore.com will be speaking on Wednesday af-

ternoon about the “The Positive Patient Experience.” He is Disney trained and his session features the core of Disney’s guest excellence and quality approach to ser-vice focused for Healthcare professionals. Thursday morning’s keynote is Christie Ward, www.christieward.com, on “Af-fecting Positive Change: Create a Work-place that Works for Everyone.” Plus our “man in Washington”, Paul Miller will be providing his popular closing session about the latest on what is happening in Washington and the 2016 elections. Reg-istration information will be in the mail and on the website in June, please be on the lookout for it. Be sure not to miss this year’s ANI!

We hope you enjoy this issue of the Journal. Our cover article on “Meaningful

Use” by Rob and Tim Borchert is interest-ing and “meaningful.” David Mastan’s ar-ticle on hospital contracts, Laurie Shoaf ’s article on the 501r rule and the group article about the Affordable Care Act up-date are all very informative and timely. Dr. Martin-Neville’s message about pas-sion and personality is inspiring, so I hope you will agree, this is a great information packed spring issue.

A big AAHAM thank you to our advertisers, exhibitors and sponsors, we couldn’t do it without you. Look for us (and Like Us) on Facebook and LinkedIn, and don’t forget to check out my blog. Happy spring y’all!

Warm regards,Sharon


Spring 2015 19

CRCS–I - Certified Revenue Cycle Specialist – Institutional

CRCS–P - Certified Revenue Cycle Specialist – Professional

AAHAM certifications can give you a powerful competitive advantage with employers. Certifications demonstrate that you have mastered the common body of knowledge for your profession. AAHAM Study Manuals will help assist you in preparing for AAHAM certification programs. These manuals are the gateway to studying for and passing these exams. The manuals include review questions and study tips.

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By Dorothy A. Martin-Neville, PhDPresident/Founder of

Dorothy A. Martin-Neville, LLC

To understand what feeds and impedes passion, power and personality, you

must begin by claiming your passion, feel-ing your power and creating a personality you love, one that radiates your soul’s es-sence, the truth of who you really are.

Most of us have lost touch with our passion, our power and our true personality because we have been taught that our value, worth and goodness are intrinsically tied in to what we do and how we serve:• In our relationships• In our work• With our children• Within our volunteer organizations

We weren’t really called to be present in our lives. Since our lives really haven’t been about us, we didn’t really need to be there. Our souls, the essence of who we are hasn’t been necessary, only our ability to serve and to love the other joyfully, whoever the other is or was. If you review your life journey to this point, has it been about the others in your life, the others you have consented to serve? Were you really there as a defined entity or as the role you play? Spouse? Parent? Child? Friend? In going along with that be-lief system have you noticed how absolutely depleted and energetically drained you get when you give far beyond what you want to

give? This is what happens when you are not getting fed. When you have lost touch with the passion that feeds you all the way down to your soul. Think about when you feel passion; don’t you have infinite amounts of energy? Don’t you have clarity, vision, creativity and drive? It is amazing what a difference having our passion makes in our lives, emotionally, spiritually, and physically. Now going back to having lost touch with it, have you noticed how little every-thing you do is appreciated even if it is noticed? Have you noticed that you have taught the people in your life to take, and yet resent them for doing it so well? And blame them for doing it? It is because when you believe that you are loved or valued be-cause of what you do or give, you can never do or give enough, because you can never be loved enough. It becomes a vicious cycle in which everyone loses. The folks in your life don’t get a chance to learn to give and you never learn to receive. When this is your life, you are just sur-viving; you are not living and certainly are not thriving. If you are going to discover your passion, claim your power and create a personality you love, you need to begin by finding out who you truly are, without the job description. If I were to ask you to de-scribe yourself, how many of you would say mother/father, husband/wife, lawyer, coach, etc.? If I were to describe me to you, I would say I am a passionate, highly spiritual woman with a lot of drive, joy, and longing, willing to take risks to get where I need and

want to go, and someone who has already taken a million of those risks and I am only half done! If you ask, I will also tell you that I am a mom, a nana, a psychotherapist, an author, an international speaker, a healer, and a woman who is well traveled. Can you see the difference?

To describe who you truly are, first ask yourself:• What is your soul longing for?• What defines you?• What feeds you?• What dreams do you possess, for your

present and your future? • What one dream are you saving for? • Who are you?• What success (for you) makes you feel

proud and powerful? How often does that happen?

• What have you achieved that makes you say “I did it!!!”?

• What makes you feel passionate? Alive? Whole?

If you begin to bring the newly discov-ered you into your life, you will find not only is there far more reciprocal behavior going on in your relationships, you will see that those who love you are actually getting to know who you are. You will feel seen, loved, and not at all depleted since you will have permission to stop when you are tired not exhausted and to say no without feeling unloving or neglectful and wounding. You will have you, and so will they. You can fall in love with you, and so can they!

Looking at What Feeds and What Impedes Each of Them

Passion, Powerand Personality;

Passion, Power and Personality; Looking at What Feeds and What Impedes Each of ThemBy Dorothy A. Martin-Neville, PhD,


Spring 2015 21

From that point, you can identify and experience your passion, claim your personal power to make your life whatever you want it to be. You can clearly see your personality

isn’t at all who you are. It is just something you have created to be loved or safe, to guide you in social interactions in a way that helps define you to the public while making you feel happy with whom you have chosen to be. This this will be a reflection of the es-

sence of your soul, not your ability to buy love through excessive service. n

Dr. Martin-Neville can be reached at 860.543.5629 and [email protected]



By Laurie Shoaf, CRCE-IContent Manager, CCI,

member of the Carolina chapter

By now we have all heard about, or read information on, the new 501r provi-

sions that impact all not for profit hospitals. Whether we like it or not, the 501r regula-tion is here to stay. These new regulations directly impact the way hospitals must man-age self-pay receivables.

The 501r final rule, published on De-cember 31, 2014, outlined several key mod-ifications including patient notification of a hospital’s Financial Assistance Policy (FAP), notification of Extraordinary Collection Ac-tions (ECAs), and Presumptive Eligibility. The modifications address how a patient is notified about the FAP from the time they are present for medical services and as they continue through the billing process, when and how a patient is to be notified prior to initiating an ECA and the proper steps to manage presumptive eligibility. For general clarification, the final 501r regulations state that hospital facilities may not engage in ECAs against an individual before making reasonable efforts to determine whether the individual is FAP eligible.

Although the substance of the rule did not dramatically change, there are key dif-ferences that must be addressed within your internal policies and procedures to comply with the final rule.

At Time of Patient ServiceNow covered as part of the measure to

“widely publish the FAP”, a hospital must “offer” the patient a plain language sum-

mary of the FAP as part of the intake or discharge process. The language specifically states “offer” rather than “provide” as it is understood that not all patients will want a plain language summary of the FAP. The regulation allows the hospital to include the “offer” process within the intake/discharge flow where it best meets the hospital’s needs.

Elimination of FAP Plain Language Summary in Billing StatementsIn the proposed rule, each billing state-

ment was required to include a plain lan-guage summary of the FAP. However, in the final rule that is no longer the case.

Now instead of including the plain language summary of the FAP, all that is required, is a conspicuous written notice on the statement that advises the recipi-ent about the availability of financial assis-tance under the hospital’s FAP. It needs to include the telephone number of the office or department that can provide information about the FAP. This notice should also in-clude information about the FAP applica-tion process and the web address where cop-ies of the FAP documents may be obtained.

Written Notice about Potential Extraordinary Collection Actions

(ECAs)The final rule requires hospitals to pro-

vide at least one written notice that informs patients about the intended ECA the hospi-tal (or other authorized party) may take if they do not submit a FAP application or pay the amount due by the date (specified in the notice) that is no earlier than the last day of the 120 day period.

The written notice must be provided at

least 30 days before the deadline specified in the notice. This notice must include a plain language summary of the FAP.

Oral Notification about Potential ECAs

In addition to providing a written no-tice at least 30 days before the deadline for initiating ECAs, hospitals are also required to make a reasonable effort to orally notify an individual about the FAP and how the individual may obtain assistance with the FAP application process at least 30 days be-fore the initiation of ECAs.

By allowing hospital facilities to target their oral notifications to those individuals against whom they actually intend to engage in ECAs, the final regulations are intended to respond to the concern that the oral no-tification rule in the 2012 proposed regula-tions was too burdensome. This change is meant to greatly reduce the oral notifica-tions that hospital facilities must make.

Presumptive EligibilityThe final regulations state that, in addi-

tion to presumptively determining that an individual is eligible for the most generous assistance available under it’s FAP, a hospital may also presumptively determine that an individual is eligible for less than the most generous assistance available under the FAP based on information other than that pro-vided by the individual or based on a prior FAP eligibility determination.

However, when the amount of assistance is less than the most generous amount, it only constitutes reasonable efforts to determine FAP eligibility if three conditions are met:


The Impact on the Billing Process

Final 501r Rule

Spring 2015 23

1. Hospital must notify the individual regard-ing the basis for presumptive eligibility de-termination and how they may apply for more generous assistance under the FAP

2. Hospital must give the individual a rea-sonable period of time to apply for more generous assistance before initiating ECAs to obtain the discounted amount owed for the care

3. Hospital must process any complete FAP application by the end of the application

period or, if later, by the end of a given reasonable time period

The important distinctions outlined above and addressed in the final rule should be closely reviewed and incorporated into a hospital’s current policies and procedures.

501r should be taken seriously as these obligations have been added to the same section of the Internal Revenue Code that establishes the tax-exempt status of hospitals under (501(c) (3). Because of this, hospitals are encouraged to work closely with their

legal counsel and tax advisors to establish FAPs and billing and collection policies to assure the policies are 501r compliant. Now is the time to start the 501r implementation process if you haven’t already taken steps to do so. Hospitals must comply with the final regulations by the start of the tax year that begins on or after December 2015. For most hospitals, that means by January 1 or July 1, 2016. n

Ms. Shoaf can be reached at 336.761.1524 x 1250 or [email protected]



from the desk of the certification director

Maria LeDoux, CAE

2015 AAHAM Certification Calendar

May 11-22, 2015 Certification exam period

June 1, 2015 Registration deadline for

August 2015 exams

August 10-21, 2015 Certification exam period

September 1, 2015 Registration deadline for November 2015 exams

November 9-20, 2015 Certification exam period

December 1, 2015 Registration deadline for February 2016 exams

You too, could be on your way to earning an AAHAM certification. Take advan-

tage of the exclusive AAHAM study materi-als available and be on your way to becom-ing a part of this elite group of professionals in your field.

We held our first Certified Revenue Integrity Professional (CRIP) exams in Feb-ruary. We are happy to congratulate all of the inaugural Certified Revenue Integrity Professionals:

Illinois #9 Renee Duncan, CRIP Mary Farmer, CRIP

Inland Empire #10 Shelby Cathey, CRIP Montine Moser, CRIP

Maryland #13 Elizabeth Wilson, CRIP

Pine Tree/Maine #22 Vickie Heath, CRIP

Virginia #27 Brenda Chambers, CRIP Debra Hartley, CRIP

We want to congratulate those who earned their CRCE certification, in Febru-ary 2015. Congratulations to all of them:

Hawthorn #8 Judy Zemke, CRCE-P

Maryland #13 Patricio Zuniga, CRCE-I

Philadelphia #29 Kathleen Ochal, CRCE-I

Chennai #49 Janarthanan P., CRCE-P Gregory Rozario, CRCE-I

Congratulations to those who earned their CRCP certification in February 2015. Congratulations to all of them:

Florida Sunshine #03 Tonya Emerson, CRCP-I

Charlene Feilner, CRCP-I Ann Noriega, CRCP-P Dina Santoro, CRCP-P

Gopher #06 Tricia Hanevik, CRCP-P

Inland Empire #10 Cathy Mulloy, CRCP-I

Keystone #11 Terry Balcavage, CRCP-I John Romines, CRCP-I

Maryland #13 Lawrence Evans, CRCP-I Denise Hansbrough, CRCP-P Luminita Pacurar, CRCP-I

New Jersey #16 Pamela Bates, CRCP-I Veronica Gorden-Chinsoon, CRCP-I Dorothy Grassi, CRCP-I Beatrice Holmes, CRCP-I Joanne Mackay, CRCP-I Frances Uche, CRCP-I Rhonda Welcer, CRCP-I

Rocky Mountain #21 Aaron Knutson, CRCP-P

Pinetree/Maine #22 Tammy Lee Adams Roscia, CRCP-I Barbara Keezer, CRCP-I

Virginia #27 Holly Bradley-Carter, CRCP-I Beth Horn, CRCP-I Marcia Parrish, CRCP-I Debra Reese, CRCP-I

Philadelphia #29 Margaret Gagliardi, CRCP-I Erik Lewis, CRCP-P

Bluebonnet #40 Stephen Rogers, CRCP-I

Indiana #42 Sammye McClelland, CRCP-I

Michigan #55 Natalie Lemke, CRCP-P Mindi Sirk, CRCP-P


CRCE, CRCP, CRIP, CRCS and CCTContinuing Education Units

Spring 2015 25

from the desk of the certification director continued from page 24

We have made some adjustments to the way the CRCP and CRIP CEU cycle runs. They will now be on a two year cycle from the date it was earned. Anyone who earned the CRCP and CRIP designations in 2014 will be due to recertify two years from their earned date. They will need to earn and re-port the full 30 CEUs (at least 15 from AA-HAM related events) for their two year cycle. Please remember that all CEUs need to be reported by using the correct CEU reporting form, available as a PDF, on the recertifica-tion page of the AAHAM website. There are no changes to the CRCE CEU cycle.

CRCE CEUsWe are a little more than half way

through this CEU reporting period (1/1/2014-12/31/2015), please make sure to check your CEU status, and be sure to earn the required CEUs and report them to the National office by 1/31/2016. This two year reporting cycle began on January 1, 2014, and will run through December 31, 2015. Make sure you submit your pa-perwork for the required number of CEUs to maintain your AAHAM CRCE Certifica-tion.

Verify all of your eligible education

time has been submitted to the National office. Check your online activity to make certain you have received credit for all quali-fied education hours. To do this, click here: CRCE Certified Revenue Cycle Executive .This will open a separate CEU page where you must login with your last name and member ID. A summary of your activity will appear at the top of the page followed by a breakdown of your CEU activity. Your member ID# is printed on your member-ship card.

Here is a handy chart, to show you how many CEUs you need to report:

AAHAM CRCE Recertification CEU Requirements CEU Reporting Period 1/1/2014-12/31/2015

CRCE Certification Earned Number of CEUs required

Prior to January 1, 2014 40 CEUs (at least 20 must be from AAHAM Sponsored Events)

February, May August 2014 40 CEUs (at least 20 must be from AAHAM Sponsored Events)

November 2014, February, May, 2015 20 CEUs (at least 10 must be from AAHAM Sponsored Events)

All CEUs must be reported to the national office by 1/31/2016

CRCP CEUsCRCP members are required to earn 30

CEUs during their two year period (15 of those must come from AAHAM sponsored events) and maintain national membership in order to keep their certification. You can find a CRCP CEU reporting form on the AAHAM website www.aaham.org.

Verify all of your eligible education time has been submitted to the National of-fice. Check your online activity to make cer-tain you have received credit for all qualified education hours. To do this, click on CRCP Certified Revenue Cycle Professional on the website. This will open a separate CEU page where you login using your last name and member ID number that is on your mem-bership card. A summary of your activity will appear at the top of the page followed by a breakdown of your CEU activity.

CRCS and CCT CEUsCRCS examinees can maintain their

certification with CEUs by joining as a na-tional member of AAHAM rather than re-testing every three years. You also have the option of testing every three years for those that opt not to join AAHAM at the Nation-al level. National members are required to earn 30 CEUs in the 3 year period (15 of those must come from AAHAM sponsored events) and maintain national membership in order to keep your specialist certification. You can find a CRCS and CCT CEU re-porting form as well as a membership ap-plication on the AAHAM website www.aaham.org.

Verify all of your eligible education time has been submitted to the National of-fice. Check your online activity to make cer-tain you have received credit for all qualified

education hours. To do this, click on CRCS Certified Revenue Cycle Specialist or CCT Certified Compliance Technician on the website. This will open a separate CEU page where you login using your last name and member ID number that is on your mem-bership card. A summary of your activity will appear at the top of the page followed by a breakdown of your CEU activity.

The recertification contact at National AAHAM is Amanda Leibert, CEU Manager/Certification Manager [email protected]. You can download a CEU reporting form from the AAHAM website. Submit your CEUs by mailing the completed form to:AAHAM CEUsAmanda Leibert, CEU Manager/Certifica-tion Manager11240 Waples Mill Rd Suite 200Fairfax, VA 22030


executive certification corner

The AAHAM Certified Revenue Cycle Executive (CRCE) exam is offered to

National AAHAM members as an oppor-tunity for senior and executive level leaders to demonstrate their knowledge and skills of the revenue cycle industry. There are two types of Executive certifications; one fo-cused on the institutional (hospital) setting and the other focused on the professional (physician or clinic) setting.

The CRCE certification consists of an

online, proctored, eight hour exam focusing on patient access/front desk, billing, credit & collections, and revenue cycle manage-ment. The exam is comprised of multiple choice, true/false, fill in the blank, short an-swer, essay and quantitative questions.

Preparation for this exam should not be taken lightly because it has the highest level of difficulty of all the AAHAM certifi-cations. The CRCE exam combines content knowledge of the business, critical thinking,

and communication skills.Obtaining your CRCE designation

will distinguish you among your peers as a leader and one committed to advancement in your career. This certification may help assure your promotion, job advancement, or career change.

Becoming certified is a challenging yet rewarding experience. It is an investment in your career and your future. You will recog-nize the benefits for years to come.. n

By Erin Selin, CRCE-I ,CCT

AAHAM Certified Revenue Cycle Executive (CRCE)

specialist certification corner

Spring finally came, just a bit later than we all hoped. Our committee along with

the other certification committees spent the spring board meeting discussing how we could get non-certified members excited about taking certification exams. We really questioned why others might shy away from achieving certification.

We all realize there are no college cours-es that prepare our staff for healthcare regis-

tration, billing and collections. The certifi-cations AAHAM offers allow individuals the opportunity to show others their high level of expertise and professionalism. Preparing and taking an AAHAM certification exam helps examines learn and do their jobs bet-ter, turning a job into a career.

It is our position as supervisors, manag-ers and directors to assist and guide our staff in achieving certification. Our staff needs to

gain the knowledge and know they are ap-preciated and respected for what they have obtained through, trial and error, personal successes and hard work.

This spring, please take the time to identify which members of your team should prepare for certification and step up to lead them to the top of their career lad-der.. n

By Doris Dickey, CRCE-I

Happy Spring from the CRCS committee

Spring 2015 27

professional certification corner

Brenda Chambers, CRCE-I,PTechnical Certification Chair

During my many updates on certifica-tion over the years, I thought it would

be important to provide additional informa-tion on the professional certification exams. I want to share with you the importance of AAHAM’s certification and why you should consider taking it and to encourage other healthcare professionals to take it as well.

Professional Certification. What is it and what should it mean for you?

Professional certification through AA-HAM offers many avenues to become cer-tified. The certification exams offered are the CRCP-I, CRCP- P and the CRIP. The CRCP is an acronym for Certified Revenue Cycle Professional (I = Institutional/Hospi-tal; P = Professional/ Physician). This certifi-cation tests the unique skills and knowledge of those individuals in a Supervisor to Man-ager level position. It is also a great stepping

stone for a director or upper management level associate before taking the Certified Revenue Cycle Executive (CRCE) certifica-tion. The CRCP is broken down into four distinct sections of the revenue cycle; Patient Access, Billing, Credit and Collections and Revenue Cycle Management. The Certified Revenue Integrity Professional (CRIP) is the newest certification that AAHAM offers. It is broken down into four areas which in-clude, Charge Capture Overview, Ancillary Services, Surgical Services and Recurring/Clinical Services. This exam can be chal-lenging because it tests the proper way to perform revenue integrity compliance.

Both exams are online are contain 250 questions in a multiple choice format. The result of your exam is provided at the con-clusion of your exam. The exams are proc-tored to protect the integrity of the certifica-

tions we offer.Why should you become certified? Be-

cause AAHAM’s certification will give you personal satisfaction for growth, it also ben-efits your professional future in healthcare. Many healthcare organizations are looking for AAHAM certified individuals to work in their facilities because the certification des-ignates competency, compliance and a spe-cial skill set in all areas of healthcare.

Look at the many choices of certifica-tions that AAHAM offers, from front line staff to executive management and make the decision to get certified. If you are appre-hensive about doing it, sign up for an AA-HAM certification webinar or speak to your local AAHAM chapter. You will be inspired to tell everyone that you are AAHAM certi-fied! n

Brenda Chambers, CRCE-I,P, Director of Revenue Integrity at Parallon Business Solutions, Chair of the Professional Certification Committee and member of the Virginia chapter, is being honored and inducted into the Greater Fredericksburg United States Bowling Congress Hall of Fame. Congratulations Brenda!

Condolences to Darlene Clemence, Client Loyalty Manager at Financial Credit Services and member of the Florida Sunshine chapter on the loss of her dear husband, Howard. Our thoughts are with you and your family.

Condolences to Patt Lowe, Director of Business Operations at Texas Health Resource, President and member of the Texas Bluebonnet chapter on the loss of her sweet sister, Shelley. Our thoughts are with you and your family.

Lori Sickelbaugh, CRCE-I, National 2nd Vice President and member of the Carolina chapter has taken at new position with EMS Man-agement and Consultants as Executive Director, Revenue Cycle Operations. Way to go Lori! n

Movers & Shakers


from the desk of the membership director

Welcome New Members

Moayad ZahralddinAAHAM

Membership Director

Aksarben Chapter Vickie Hoffman Carla Ridenhower Carolina Chapter Vicki DeRenzis Robin Muirhead,CRCS-I

Referred by Lisa JohnsonBrittani Porter,CRCS-I Chenelle Snowden,CRCS-I

Referred by Lisa JohnsonDavid Weber,CRCS-I Tonja Westbrooks

Chennai Chapter Divya Prabakaran

Referred by Gregory Rozario, CRCE-I, P

Connecticut Chapter Robert Miller

Florida Sunshine Chapter Denise Barnes,CRCS-I

Tabitha Bombardier,CRCS-I Jeanne Bussey Jennifer Jones Adam Lackey Jeffrey Patneaude Vivian Semerdjian,CRCS-I Victoria Spino,CRCS-I

Referred by Carol Plato, CRCE-ICynthia Stevens,CRCS-P Tia West,CRCS-I Tara Williams

Georgia Chapter Melissa Smith Joy Welborn Gopher Chapter Roger Weiss

Hawkeye Chapter Julie Chase,CRCS-I

Referred by Melissa PuckAshley Eggers,CRCS-P

Referred by Melissa PuckSue Johnston,CRCS-I

Referred by Melissa PuckJenny McIntyre

Referred By Mary Jo FisherTiffany Ransom,CRCS-I

Referred by Melissa PuckJoann Salsman Jodi Summerfield

Referred by Melissa Puck

Hawthorn Chapter Allison Clark,CRCS-I Seth Erickson,CRCS-I Cheryl Koenen Kathryn Korth,CRCS-P Lisa Lynch Pamela Miller,CRCS-P Steven Miller,CRCS-I Laurie Swanson,CRCS-P


Thank you all for renewing your membership for 2015! I would like to welcome all of our new members. Don’t forget to check out the member’s only section of the

AAHAM website. There is valuable information there to help you both professionally and personally. Some of the information includes AAHAM’s Information Central, Online Membership Directory, Legislative Action Center, Journal, Member’s Only Listserve, and archives of ANI presentations and webinars. We have added many robust member affinity programs from companies including UPS, Hewlitt Packard, GoToMyPC, GoToMeeting, Lenovo, and Office Max, to name a few. You can also find out more in the Member Ser-vices Brochure, which is available to be downloaded from the member’s only section of the AAHAM Website. If you have any questions about these or any of our other member benefits, please feel free to contact me at [email protected].

Don’t forget! AAHAM offers scholarship opportunities for our members and chil-dren of our members. We have updated the requirements and application for 2015. You may download the application from the home page of the AAHAM website at www.aaham.org. The application deadline is May 31, 2015.

Thank you for letting me serve you, and I hope to see you all in Orlando for the ANI!

Spring 2015 29

Illinois Chapter Huber Dawn Lori Gutierrez Pamela Kring Kimberely Smith

Referred by Nancy VollmerYvonne Thomas

Indiana Chapter Diane Bishop

Inland Empire Chapter Jennifer Bolz,CRCS-I, P Jason Coffin Shannon Kozeliski Lynnete Krebs,CRCS-I,P, CCT

Referred by Rosie Hartmann, CRCE-I, PCrystal Smith,CRCS-P, I

Keystone Chapter Eric Baines Stephanie Erwin Nancy Esterly,CRCS-I

Maryland Chapter Ashley Austin,CRCS-I Sara Bryki Rachel Christian,CRCS-I Karen Dyson John Ellis Tiffany Giles,CRCS-I Michelle Harville,CRCS-I Stacy Hromanik Darlene Rogers Mary Williams,CRCS-I Jennifer Wiseman,CRCS-I

Michigan Chapter Courtney Frost

Mid- York Chapter Sharon Casalotta Beatriz Ceballos Gaudy Rivera

Mountain West Chapter Debra Clough Jennifer Grabish

Music City Chapter James Andrews

Referred by Sean DyerHeather McGarry

Referred by Eric CurrieKenneth Stephens

New Jersey Chapter Allen Baron Madhu Kalyan Ryan Lodge Darlene Martinez Anna Martz,CRCS-I Robert Miller

Northeast PA Chapter Robyn Pintchuck

Philadelphia Chapter Donna Allen-Woolfolk,CRCS-I Nakita Forte-Robinson Corinne Robbins Arthur Williams III,CRCS-I

Pine Tree Chapter Jamie Boyd Jennifer Corneil Elizabeth Donley Becki Ellis Whitney Huntt Paula Page

Rushmore Chapter Katherine Andersen,CRCS-I

Texas Bluebonnet Chapter Lynn Arrington Sharon Davis Kimberley Doucet William Girsch Christel Johnson Cory Mecham

Referred by Chris BrazilMarta Sadowski Shelley Tijerina,CRCS-I

Twin States Chapter Shannon Keniston Lindsay Pigeon

Sonya Pinkerton,CRCS-I Shan Reil,CRCS-I Amy Sherman,CRCS-I Adam Trombly,CRCS-I

Virginia Chapter Talitha Alcaine Karen Dyson Michelle Lane,CRCS-I Judy Martin,CRCS-I Jeanette Wright,CRCS-I

Western Region Chapter Thomas Buretta Ron Deal Jacqueline King Liliya Meadows Michelle Pardo Mark D. Peters Shawna Shinault Cynthia Veliz Laveda White

Western Reserve Chapter Bree Cissell

Referred by Justine LutherCathi Dixon Deborah Frank,CRCS-I David Johnson Hillary Miller Christine Poleon Julie Purnell

Referred by Barbara Kushen

Wisconsin Chapter Dominique Liddell

States Without a Chapter Hassan Rafaa Alshehri Edward Corp Lillian Lightner Diana Murat Christina Powell Alain Sergile Catherine Smith Pamela White


AAHAM Providing Excellence in the Business of Healthcare

Certification, Compliance, Leadership Development, Networking, Advocacy

AAHAM… Providing Excellence in the Business of HealthcareCertification • Compliance • Leadership Development • Networking • AdvocacyCutting Edge Training + Nationally Recognized Certification = Improved Performance

Application For National Membership

Name: ___________________________________________________ Title: ___________________________________________________

Employer/Organization Name: ________________________________________________________________________________________

Primary Address: _______________________________________ City: _______________________ State: __________ Zip: ____________

Phone: _____________________________ Fax: _____________________________ Local Chapter: _______________________________

E-mail Address: ______________________________ Website: _____________________________________________________________

Home Address: ___________________________ City: ______________ State: _____ Zip: _______ Home Phone: ____________________

How did you hear about AAHAM? o Colleague o Publication o Website o LinkedIn o Facebook

If referred by AAHAM member, please give name: _________________________________________________________________________

Membership Type: o National Member o Student Member

Payment OptionsFor Credit Card Payment: o AMEX o VISA o MASTERCARD

Card Number: __________________________________________ Exp: __________

Name as it appears on card: ___________________________ CVV2 Code: _______

Signature: ____________________________________________________________

Billing Address, If Different from Above: _____________________________________

____________________________________________________________________Please allow two weeks for processing after your application is received at the na-tional office. Dues are not tax deductible as a charitable contribution, but may be as a business expense.____________________________________________________________________Please note: Membership is on an individual, not institutional, basis and is non-trans-ferable.

For Check Payment:Please make checks payable to AAHAM and send application with your payment to:

AAHAM Membership11240 Waples Mill Road, Suite 200Fairfax, VA 22030AAHAM Tax ID# 23-1899873

Your Payment Total:

National Dues: $ __________

Local Dues: $ __________

Total Enclosed: $ __________

NATIONAL MEMBERSHIP - The fee to become a National member is $190. If you join anytime between July 1st and August 31st, the dues are $150 for the rest of the current year. If you join between September 1st and December 31st, the fee is $230 for the rest of the current year and all of the following year.STUDENT MEMBERSHIP - The student membership fee is $50. If you join between July 1st and August 31st, the pro-rated dues are $35, and if you join between September 1st and December 31st, dues are $65 (for 15 months of membership). To qualify for student membership you must currently be taking 6 credit hours per semester. Student members receive all the benefits of membership with the exception of voting, eligibility for professional certification, and cannot be a proxy for a chapter president at any national board meetings.

Please Check the Appropriate Codes in Each Category Below

Years in Healthcare:o 0-5 o 6-10 o 11-20 o 21-25 o 25+

Certification:

o CRCE o CRCS o CRCP

o CCT o CRIP

o CHAM (NAHAM) o CHFP (HFMA)

o FHFMA (HFMA) o CHCS (ACA)

o Other (please list) ________________

Employer Type:o Vendor/Corporate Partner o Billing

o Collection Agency o Consulting

o Outsourcing o Software/IT

o Provider o Law Firm

o Other (please list) __________

Position:o CFO

o Consultant

o Director

o Executive Director

o Manager

o Partner, Principal, Owner

o Patient Acces Representative

o PFS Representative

o Supervisor/Coordinator

o Vice President

o Other (please list) ______________

Responsibility:o Accounting

o Administration/Operations

o Admitting/Access

o Audit

o Benefits

o Budget

o Business Development, Sales, Marketing

o Compliance

o Information Services/Technology

o Managed Care

o Medical Records

o Medicare/Medicaid

o PFS, Patient Billing & Collections

o Reimbursement

o Third Party Administration

o Other (please list) ______________

Name of Chapter Geographic Location Chapter Dues

Aksarben #01 Nebraska $0.00

Florida Sunshine #03 Florida $40.00

Carolina #04 North & South Carolina $30.00

Evergreen #05 Washington State, West of the Mountains $30.00

Gopher #06 Minnesota $40.00

Hawkeye #07 Iowa $0.00

Hawthorn #08 Missouri $45.00

Illinois #09 Illinois $25.00

Inland Empire #10 Washington State, East of the Mountains $25.00

Keystone #11 Central Pennsylvania $25.00

Maryland #13 Maryland $25.00

Mountain West #14 Utah $30.00

New Jersey #16 New Jersey $35.00

Western Reserve #18 Ohio $0.00

Northeast PA #19 North East Pennsylvania $30.00

Rocky Mountain #21 Colorado $20.00

Pine Tree #22 Maine $25.00

Rushmore #23 North & South Dakota $0.00

Western Region #26 Arizona and California $0.00

Virginia #27 Virginia $30.00

Philadelphia #29 Philadelphia, Pennsylvania $35.00

Mid-York #31 New York $30.00

Georgia #33 Georgia $30.00

Connecticut #34 Connecticut $35.00

Three Rivers #37 Pittsburgh, Pennsylvania $50.00

Texas Bluebonnet #40 Texas $50.00

Indiana #42 Indiana $25.00

Wisconsin #44 Wisconsin $25.00

Chennai #49 Chennai, India $0.00

Music City #53 Tennessee $25.00

Michigan #55 Michigan $0.00

Twin States #56 Vermont & New Hampshire $25.00

Local Chapters: AAHAM has 32 chapters throughout the US and India. Local chapters offer you more opportunities for education and networking. Please see the listing of local chapters below to help you decide which chapter you should belong to along with your National membership


June 21 Summer Solstice

July 30 National Cheesecake Day

August is Water Quality Month

did you know?By Moayad Zahralddin June 2015… Aquarium Month, Candy Month, Dairy Month, Fight the Filthy Fly Month,

Gay Pride Month, National Accordion Awareness Month, National Adopt a Cat Month1 ...... Flip a Coin Day2 ...... National Bubba Day4 ...... Hug Your Cat Day5 ...... World Environment Day7 ...... National Chocolate Ice Cream Day8 ...... Best Friends Day14 .... Flag Day15 .... Nursing Assistants Day, Smile Power Day18 .... National Splurge Day20 .... National Hollerin’ Contest Day21 .... Summer Solstice23 .... National Pink Day, Take Your Dog to Work Day 25 .... National Catfish Day26 .... Forgiveness Day28 .... Insurance Awareness Day29 .... Waffle Iron Day

July 2015…National Blueberry Month, National Anti-Boredom Month, National Cell Phone Courtesy Month, National Ice Cream Month 1 ...... Creative Ice Cream Flavors Day, International Joke Day2 ...... I Forgot Day4 ...... Independence Day (U.S.), National Country Music Day5 ...... Work-a-holics Day 6 ...... National Fried Chicken Day11 .... Cheer up the Lonely Day, World Population Day13 .... Fool’s Paradise Day14 .... Bastille Day20 .... Moon Day21 .... National Junk Food Day22 .... Hammock Day26 .... All or Nothing Day30 .... National Cheesecake Day31 .... Mutt’s Day

August 2015… Admit You’re Happy Month, Family Fun Month, National Eye Exam Month, Water Quality Month, National Picnic Month 2 ...... Friendship Day, Sisters Day4 ...... U.S. Coast Guard Day5 ...... Work Like a Dog Day6 ...... Wiggle Your Toes Day7 ...... National Lighthouse Day9 ...... Book Lover’s Day10 .... Lazy Day13 .... Left Hander’s Day14 .... National Creamsicle Day15 .... Relaxation Day16 .... National Tell a Joke Day17 .... National Thriftshop Day21 .... Senior Citizen’s Day22 .... Be an Angel Day23 .... Ride the Wind Day25 .... Kiss and Make Up Day26 .... National Dog Day, Women’s Equality Day27 .... Global Forgiveness Day, Just Because Day30 .... Toasted Marshmallow Day

Spring 2015 33

national calendar

the JHAM networkMovers & Shakers

Don’t forget to give us your information for the Movers & Shakers section of The Journal. This section includes job announcements (changes or promotions), birth and death

announcements, and wedding announcements. Send your “news” to Sharon Galler at [email protected]

ChaptersPlease send us notices of your upcoming events/meetings, chapter news and

photos. We would be happy to post them for you!

Address ChangesAll address changes can be emailed to Moayad Zahralddin,

[email protected] at the National Office or you can update your information yourself on-line at www.aaham.org.

October 14-16, 2015 2015 ANI, Walt Disney World Swan and Dolphin Orlando, Florida

October 5-7, 2016 2016 ANI, Caesar’s Palace Las Vegas, Nevada

October 11-13, 2017 2017 ANI, Opryland Resort Nashville, Tennessee

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Coaching Kits

With the new AAHAM Coaching Kits, you are equipped toconduct interactive, thorough,and effective sessions to prepareparticipants for their CRCE–I,Por CRCS–I,P exam.

Each kit, packaged in a convenient binder, includes:• Detailed preparation instructions,

including a materials checklist• Overview of the adult learning

principles built into the kit• Scheduling suggestions so you

can customize your timetable• Tips and suggestions for

facilitating each portion of the coaching session

• CD with slides to guide participants through the session

• Materials and instructions for activities including laminated cards for learning games, quizzes, a crossword puzzle, and more

• Participant guide originals, so you can make copies and include as many exam-takers as you would like

• Extensive glossary of terms included in the exams

Each coach will need one copy of the CRCE–I,P or CRCS–I,P Exam Study Manual (sold separately).

Log on to www.aaham.org for more information and to order yourExam Study Manual today!

Documents

AAHAM Certifications Offer You Solid Steps to your ... · AAHAM National Office Staff 11240 Waples Mill Road, Suite 200, Fairfax, VA 22030 Executive Director Sharon R. Galler, CMP