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THIRD QUARTER | JANUARY 2017PEAKS & plains
HFMA COLORADO CHAPTER
INSIDE THIS ISSUE
PRESIDENT’S MESSAGE CHERYL CURRY p. 1
MEMBER SPOTLIGHT TED SIROTTA p. 15
WOMEN IN LEADERSHIP EVENT RECAP p. 5
UNDERSTANDING MANAGED CARE LESSOR OF PROVISIONS p. 7
EARLY CAREERIST: IT’S TIME FOR YOUR MILLENIAL INTERVIEW p. 20
CHA UPDATE p. 25
QUALITIES OF MENTORS & MENTEES p. 23
SUPPORT OUR ANNUAL SPONSORS! p. 27
2016: A YEAR IN PICTURES PHOTO GALLERY p. 22
PAGE | 1
plainsPEAKS3rd QUARTER 2016-2017 | JANUARY&
PRESIDENT’S MESSAGECheryl Curry HFMA Colorado Chapter President 2016-2017
Happy New Year!
I hope you had a joyous Holiday and are feeling refreshed and ready to THRIVE as we work together to apply the best practices we continue to learn about healthcare finance through our association with HFMA.
The beginning of a new year is a typical time to reflect on goals, which could include personal and professional development. I encourage you to check out information on our CO HFMA website regarding certification, and consider becoming certified as an HFMA Certified Healthcare Financial Professional (CHFP). The CHFP certification provides the broad range of business and financial skills essential for succeeding in today’s healthcare environment. We have provided personal contact information on our website if you would like to probe this further and discuss the benefits of being certified with an HFMA representative.
The next few months will be packed with education and networking opportunities. In addition to FREE monthly webinars, please save the date and register to attend as many of the following events as you are able:
■ January 15-18, 2017 – Western Region Symposium (Planet Hollywood, Las Vegas, NV)
■ January 24, 2017 – Annual Legislative Reception (Uni-versity Club, Denver, CO)
■ February 16-17, 2017 – Compliance Conference (Denver Marriott South at Park Meadows)
■ March 20-21, 2017 – Revenue Summit (Children’s Hos-pital, Aurora, CO)
■ April 19-21, 2017 – Annual Conference (Doubletree DTC, Greenwood Village, CO)
Please keep an eye out for the weekly emails from Colorado HFMA with more information on each of these events, including the award-winning social and networking that is always a highlight of each conference!
In October, 2016 you should have received a membership survey from HFMA National, requesting your feedback on HFMA and specifically our Colorado Chapter of HFMA. I look forward to reviewing those survey results and suggestions in late January, and I will provide a summary in our next Newsletter with the strengths and opportunities you have identified.
Take care, and go THRIVE!
Cheryl Curry
Scott I. Raberge, Senior Vice President Marketing & Sales970.352.5000 • 800.864.4391 extension [email protected]
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COVER PHOTO CONTEST
Have a beautiful picture of our state? It could be featured on the cover of our next issue of PEAKS & p la ins ! Submit your h igh resolution photo to Jessica Griffith at [email protected]. The featured photo will win a $10 Starbucks giftcard! Make sure you let us know where the photo was taken. You will receive a photo credit. Help us showcase our beautiful state!!
■ January 15-18, 2017 Region 10 & 11 Symposium, Las Vegas, NV
■ January 24, 2017 Legislative Reception, University Club, Denver, CO
■ February 16-17, 2017 Compliance Conference, Marriott Park Meadows, Lone Tree, CO
■ MARCH 20-21, 2017 Revenue Summit, Children’s Hospital Colorado, Aurora, CO
■ APRIL 19-21, 2017 Annual Conference, DoubleTree DTC, Greenwood Village, CO
■ MAY 2, 2017 Connecting the Dots: Reinvention at Every Stage, A Women in Leadership and Early Careerist joint event. Mile High Station, Denver, CO
UPCOMING EVENTSCHECK OUT OUR UPCOMING EVENTS! FIND MORE DETAILS AND WAYS
TO REGISTER AT WWW.HFMA-CO.ORG.
PAGE | 4
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ANCHORAGE | DALLAS | DENVERDETROIT | INDIANAPOLIS | LOUISVILLEMILWAUKEE | PHILADELPHIA | RALEIGH
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PAGE | 5
plainsPEAKS3rd QUARTER 2016-2017 | JANUARY&
2016: A YEAR IN PICTURESclick here to view the online gallery
Proud Sponsors of the2017 HFMA Annual ConferenceDRIVE TO THRIVEApril 19 - 21, 2017
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PAGE | 6
Connecting the DotsReinvention at Every Stage
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Save the Date
May 2, 2017Mile High Station
Conveniently located off I-25 and Colfax at 2027 Old West Colfax, Denver, CO
Event Highlights:
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Registration opens February 1st
Limited Sponsorships Available
A collaborative event hosted by HFMA Colorado Women in Leadership, Early Careerists & Mentorship
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PAGE | 7
Beginning in October 2015, the Colorado HFMA Chapter brought Women in Leadership (WIL) to our membership. Our goal was to provide leadership training and networking opportunities for the women of healthcare, finance and business in Colorado. We have made great progress in the past year.
Our most recent event, held on October 27th, provided more than 100 attendees all of that and much more! It was our largest event to date. We welcomed our guests to the locally owned and operated Balistreri Vineyards in Denver Colorado. It was a beautiful venue with a fantastic staff to assist us. Upon arrival, everyone enjoyed an hour of networking, an amazing variety of appetizers, and as an added bonus, we all had the opportunity to sample a wide range of wine offerings from the vineyard.
Our program featured Alexandra Ross and Diane Brennan, the authors of BackPocket Coach. They delivered a very powerful message about communicate styles and shared four strategies to “Ignite your Confidence and Reclaim Your Power!” The program created provided several opportunities for table groups to work together and share ideas. Collaboration was abundant and many teams had the opportunity to reconnect with team members or build new relationships.
The evening ended with a fantastic dinner, purse giveaways and delicious desserts.
As Women in Leadership, we wanted to find a way to give back to the community as well. WIL partnered with Dress for Success and held a handbag and clothing drive during our event. The committee was blown away by the generosity shown by our attendees. Thank you to each and every one who contributed! Because of your donations, women who aspire to Thrive in their future careers, will have the necessary clothing and accessories to wow at their next interview! We are so grateful.
Our amazing programs would not be possible without the generous and faithful support of our Platinum Sponsor Hall Render Killian Heath & Lyman. We are so appreciative of your firms contribution, team member support and belief if the WIL mission. This program was also made possible by Pinnacle Healthcare Consulting. Thank you for providing our giveaways and sending several of our attendees home with fantastic new purses.
If you are still wondering what WIL is all about, you will have 2 more opportunities this Spring to see what we are up to. If you are interested in annual sponsorship or event sponsorship, please contact Tammy Rivera or Cally Christensen for more information. We are gaining a lot of momentum, and our reach is expanding – we hope you will join us in 2017! Stay tuned for event details coming your way very soon.
Tammy Rivera, WIL Committee Chair
HFMA WOMEN IN LEADERSHIP FALL EVENT
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plainsPEAKS3rd QUARTER 2016-2017 | JANUARY&
Hospitals sometimes enter into managed care agreements that contain “lessor of ” provisions. In this type of arrangement, the payer agrees to pay and the provider agrees to accept the lessor of either the contracted rate or the billed charges. If a charge for a particular coded service is too low, you’ll receive less of a payment than you would have if you’d used an agreed upon rate. We refer to these as the lessor of “loss”. By understanding the scope and detail of these losses, providers can develop strategies to limit them. The analysis of losses is usually split into two categories: Outpatient and Inpatient.
Outpatient
Lessor of may be applied in the outpatient two different ways: at the service level (most common) and at the claim charge level. In the service level calculation every service’s charge is compared to the contract rate, which is driven by the contracted HCPCS. In the example below, the chest x-ray, single view (CPT 71010), has a contract rate of $100.
If the provider bills a charge of $80 where there is a service level lessor of term, the payment1 will be based on the lessor of the charge of $80, and the rate of $100. In this instance there will be a lessor of loss of $20. In the claim level calculation, the results are different. The charge for the x-ray is under the contracted rate, but the CBC (CPT 85025) has charge of $45, which exceeds the contract rate of $24 by $21. If the total charges of $125 are compared to the total payment rate of $124, there is no lessor of loss.
Inpatient
What if the rate is based on a case rate such as MS-DRG? If the sum of the charges is less than the payment rate for the MS-DRG or other case rate, then the payment is based on the charge. There may be an additional term that modifies the payment for a short stay or patient discharge status. In those instances the payment rate may be a portion of the full case rate. When we observe the charges as less than the case rate, it is often due to a shorter hospital stay than expected.
UNDERSTANDING MANAGED CARE LESSOR OF PROVISIONSby Seth Avery, AppRev President and CEO
10
Case rate lessor of analysis
When working with hospitals that perceive that they have a inpatient lessor of issue we perform a detailed analysis.
1. Identify all payers that have case rates and the corresponding rates
2. Select inpatient account data for patients who have been discharged and have a payer identified as having a lessor of provision.
3. Data elements should include: ■ Payer ■ Account number (or reference number) ■ Charges at the revenue code summary level ■ DRG or case rate indicator ■ Length of stay ■ Discharge status ■ ICD-10 Diagnosis and procedure codes
We compare the charge totals to the corresponding rates to identify those that are paid using the lessor of term or the case rates. When attempting to get to the bottom of inpatient lessor of issues, you will generally find that only a handful of discharges are driving the numbers. It’s the opposite of the 80/20 rule: typically you will find that a relatively small number of short stays experience larger
differences between the charges and the contracted rate.
To help understand some or root causes we add the Geometric Mean Length of Stay (GMLOS) from the Centers for Medicare and Medicaid Services (CMS) Inpatient Prospective Payment System Final Rule, Table 52.
By assuming there is a relationship between the length of stay and the expected charges we can identify the cases where we would expect the charges to be low and the opportunity to recover the difference to also be low. Coding and documentation issues often underlie the lessor of loss. We have found accounts where coding errors have led to higher level DRG assignment, thus the length of stay on the paid DRG and the case rate was higher than the result would be with accurate coding. When the length of stay for a discharge to home is at 20-30% of the GMLOS, this is typically not an issue of undercharging.
Another wrinkle in this analysis is the impact of carve outs, so named because this separate payment rate is “carved out” of the case rate. Carve outs are terms in which devices, implants or high cost drugs are typically paid based on a percentage of the hospital charge. To understand the impact of the carve out the analyst must understand how the charge for carve is used on the overall payment calculation.
UNDERSTANDING MANAGED CARE (continued)
PAGE | 11
UNDERSTANDING MANAGED CARE (continued)
Please note the impact of carve outs in the following examples:
EXAMPLE 1
Case Rate $80,000Charges (excluding device) $70,000Device Charge $20,000Total Charges $90,000
In the example above, the device is reimbursed at 60% of the device charge. In this case the payer identified the device charge by totaling the charges in the revenue code 0278. There are two possible calculations for the total payment; case rate and lessor of rate.
EXAMPLE 2
Case Rate $80,000Device $12,000Total Payment $92,000
In this payment calculation, the payer has used the total charges to satisfy the lessor of calculation and added the carve out payment.
EXAMPLE 3
Lessor of Rate $70,000Device $12,000Total Payment $82,000
In the second payment calculation the payer has excluded the charges paid under the device carve out from the lessor of calculation. As you can see, it is very important to understand how the payer actually calculates this term.
PRICING IMPLICATIONS
A provider’s overall rate increase is typically limited by their managed care agreements, usually expressed as a gross charge increase. Many providers may simply perform an “across the board” price increase by raising all of their prices by a set percentage equally. While this may have a minor impact on lessor of loss, it does not target specific components for increases.
A more sophisticated approach would be to identify line items that are suffering lessor of losses and raise those prices by more than the overall increase. It is then usually necessary to offset those increases with other line item decreases so that the overall gross increase conforms to the contracted increase. An actual decrease in net revenue can be an unintended consequence of this approach.
EXAMPLE:
Assuming that we have a payer cap on our overall price increase of 5%, we had a lessor of loss because the charge was $20 below the contract rate above.
Let’s say the payer quantity for this service for the year was 100 - the lessor of loss would then be $2,000. To eliminate this loss the price would need to be increased by $20 for each one of $2,000 in gross charges. So far, so good: We have a 100% return on our price increase, but…we have other payers with their own terms and quantitates.
X-Ray A B C D E FPayer Rates $100 $40 $100 $70 $80 $60Quantity 100 300 50 150 100 250Gross Revenue $8,000 $24,000 $4,000 $12,000 $8,000 $15,000Lessor of? Y N Y Y Y NNet Revenue $8,000 $12,000 $4,000 $10,500 $8,000 $15,000Lessor of loss $2,000 $1,000
Total Quantity 950Total lessor of loss $3,000Total Gross $76,000Total Net $57,500
To eliminate the lessor of loss for payer A and C, the price for the service would need to be increased by $20 (or 25%). Unfortunately, this increases the rate for all payers. We can’t just increase the rate by the $3,000 to equal the total lessor of loss. Doing so would result in a $19,000 (950 X $20) increase! We will then have exceeded our gross charge increase cap by $15,200 ($76,000 x 0.05 = $3,800).
To make this work we need to decrease prices in other areas by $15,200 to break even. In doing so, we may inadvertently impact another service with a lessor of term.
To further complicate things, some payers pay as a percentage of charges (POC). When we lower prices where there are POC volumes, we have a similar impact to lessor of loss. We will experience a POC loss for each dollar of decrease multiplied by the quantity of the payer for the service.
So how do we make this analysis manageable? We calculate the price sensitivity for each service by using the payment term for each specific quantity of service and patient type. This eliminates the problems associated with across the board price increases, such as payer increases, exceeding gross charge increase cap and taking on POC losses.
UNDERSTANDING MANAGED CARE (continued)
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plainsPEAKS &UNDERSTANDING MANAGED CARE (continued)
In Conclusion
Because of the many moving parts associated with lessor of reduction, hospitals should approach the issue with caution. Additional complications not addressed in this paper include outpatient grouper hierarchy, outpatient case rates, grouped services and others.
The impact of this issue also tends to change from state to state. Payers in some states may tend to have more percent of charge and fewer lessor or terms. We also encourage hospitals to adopt technology or processes to detect “hidden” lessor of, much as they would with a silent PPO discount. With planning, intent and attention to detail, hospitals can develop strategies to reduce lessor of losses.
About the Author
Seth Avery has over 25 years of experience as a healthcare executive, serving as auditor, consultant, Administrator and Chief Financial Officer (CFO). Mr. Avery has served as the CFO for a major teaching hospital in Texas and as the Executive Director of a leading New Jersey Medical School. He has worked at government, for-profit, and not-for-profit health care providers, as well as at a Big 6 organization.
Seth has been certified by the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) and is a past member of the National Advisory Board for the AAPC. Seth has a B.S. from Campbell University, an M.A. in Economics from the University of New Mexico and a Juris Doctor from Texas Wesleyan University. Seth is also a 14 year veteran of the U.S. Military, serving both as a member of 5th Special Forces Group and as a Medical Service Corps officer.
He is a frequent speaker at Healthcare Financial Management Association conferences and presents webinars providing education on various healthcare finance topics.
1. For this analysis the term “payment” is used to represent the total amount due to the provider or otherwise known as the “allowable”. The allowable is the combination of the payer payment and the patient responsibility.
2. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2016-IPPS-Final- Rule-Home-Page-Items/FY2016-IPPS-Final-Rule-Tables.html
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PAGE | 16
MEMBER SPOTLIGHT
TED SIROTTASenior Vice President of Finance and CFO | Vail Valley Medical Center
I know how far and what it is like to move from Vermont to Colorado. But to move from California to Vermont and then to Vail, Colorado - very few have experienced that. Add to that attending high school with THE John Elway and it is highly likely that only Ted Sirotta, Senior Vice President of Finance and CFO of Vail Valley Medical Center (VVMC) can make that claim.
Ted explained the move back toward Los Angeles from Northwest Medical Center in Vermont as just that, a move back closer to his California roots. With the move, Ted brought his great success and vision to VVMC. His trail of success extends more than 5,000 miles and will likely not end without making a significant impact on VVMC.
VVMC covers about 55,000 patients in Eagle County and can increase during ski weekends by another 50,000 people. With a dozen primary care physicians and a 58-bed community
hospital, VVMC serves organizations such as Colorado Mountain Medicine, Steadman Clinic (Orthopaedic), and Vail Summit Ortho.
VVMC is a 50-year-old independent, nonprofit medical center and has the reputation as the world’s most advanced mountain hospital, providing Olympic-quality orthopedics and sports medicine, leading evidence-based research, modern cancer care, and extensive cardiology capabilities.
VVMC is the 2nd largest employer in Eagle County, employing more than 850 people. As a nonprofit organization, revenues get reinvested in the community through better services, healthcare jobs, new physicians, state-of-the-art equipment, improved access, community outreach and charity care.
While care is outstanding, VVMC facilities are aging, thus inspiring a new master facility plan. The result will be revitalizing and modernizing that includes improved parking, a new Emergency Department, a new helipad tower right at the facility, improved outpatient services and more. Improvement to the inpatient facility will include the provision of an all-private bed facility.
by Brian Mitchell
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With the 2015 development of a new Cardiac Catheterization and Electrophysiology Lab, VVMC was able to recruit highly skilled cardiologists from the Denver market.
Ted’s first year at VVMC has been very active, and the future of significant changes and improvements will require substantial involvement by the new CFO. Ted’s responsibilities include Patient Billing; Finance and Accounting; Decision Support; Budgeting: Patient Access and Materials Management.
Ted plays a significant role in the development of the strategy for all of those areas and more, as well as day to day: regulations, planning, direction, market and regulatory responses. Compliance is also a part of Ted’s role at VVMC and critical to the organization overall.
Ted hails from the San Fernando Valley, outside of Los Angeles. That is where he attended High School with John Elway. He obtained his Accounting Degree from the University of Southern California. Ted is also a Certified Public Accountant.
His first job after completing his education was with the Los Angeles office of Deloitte, Haskins, and Sells (now Deloitte) for 12 years. When Ted left Deloitte, he was a Senior Manager of the Audit Group where he had audited hospitals and other health care organizations. During that time he expanded the hospital clients and became a Subject Matter Expert for Deloitte.
Ted was recruited from Deloitte to his audit client, Barlow Respiratory Hospital, as CFO and CIO. Barlow Hospital was located right around the corner from Dodger Stadium. Ted remained at that hospital for nine years, and there met his wife Monika, who was a respiratory therapist at the hospital. Ted and Monika decided that they wanted to leave the Los Angeles area, so he accepted a position at a billion dollar plus organization, Renown Healthcare in Reno, Nevada. Ted became the Corporate Controller there. The experience at Renown Healthcare was a great learning opportunity.
And then came the cross-country move to the small town of Saint Albans, Vermont, and the Northwestern Medical Center to become an award-winning CFO. When I asked Ted how that happened, he responded that “It was on a whim” because his stepfather attended the nearby University of Vermont. Ted described his time in Vermont as a “great fit” at Northwestern Medical Center (NMC). Ted was there
MEMBER SPOTLIGHT (continued)
PAGE | 18
for 9 “very enjoyable” years. Ted worked for Quorum (QHR) who managed NMC. The organization was very successful financially under Ted’s leadership. He was honored as the 2012 CFO of the year by QHR out of 150 CFO’s nationwide. Ted also led NMC to multiple years of being named by QHR as “Best Performing Financial Hospital.”
Ironically, I grew up nearby NMC and after a high school basketball injury one night; I had the privilege of being treated at NMC, then Kerbs Memorial Hospital. Kerbs later merged with Saint Albans Hospital and eventually became the highly regarded Northwestern Medical Center.
After nearly a decade of major success in Vermont, Ted and Monika decided that they wanted to move closer to California family and felt pleased about landing the position in Vail. The Sirotta’s have some family in Colorado, so it is a lot like home and very close the California roots.
When asked what are the most challenging issues in his job today, Ted responded by saying, “Trying to keep the pace and complexity of regulation change. It takes so much away from other critical operational needs”.
MEMBER SPOTLIGHT (continued)
19
I also asked Ted what his philosophy is and what inspires him regarding his position of leadership and the work that he and his team perform. He responded with, “My role is to push people out of their comfort zone to a degree while helping support them to do that. We push to get beyond status quo and get to the next level and feel good about it. I also try to be a calming force in a very challenging business for people. There is lots of stress to mitigate, and I try to play a big part in helping to do that”.
Ted has been an HFMA member his entire career and is a Certified Fellow and Advanced Member. He recently served on the CFO Panel at the Glenwood Springs Event.
Ted sees significant value in the HFMA organization because of the “Good programs and training opportunities provided and the networking at events with other groups.”
The Sirotta family includes wife Monika, daughter Alexis, a first-year student at CU Boulder and son Nathan, a Los Angeles businessman. Nathan provides digital marketing services in the entertainment business. Monika is in the process of changing careers to become a real estate professional. Ted loves the outdoors and playing softball is his passion. He also enjoys hiking, snowshoeing and other outdoor activities, while collecting sports card and coins.
Ted’s final words of wisdom for others in similar positions as his on how to be successful, “Nothing replaces hard work, keep learning technically and about compliance issues while learning how to work better with people.” That is undoubtedly sound advice from a very successful healthcare executive!
Interview conducted by:Brian Mitchell, HFMA volunteerCEO, 220 Cornerstone Business [email protected]
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MEMBER SPOTLIGHT (continued)
PAGE | 20
Winding Roads Ahead:Navigating the Complex Healthcare
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AHHHH… IT’S TIME FOR YOUR MILLENNIAL INTERVIEW! By: Dani Kimlinger, Ph.D., MHA, SPHR, SHRM-SCP
It is almost time for your 10:00 interview. You are looking for your next Financial Analyst… and the candidate is a MILLENNIAL! This position has quite a bit of turnover; in fact, we have had four turn overs in the last year. Is it the job duties? Could it be the colleagues of this position or management? How can you ensure that you are giving a realistic job preview and asking the right questions of your candidate?
When interviewing candidates, consider inviting team members who have similar or the same role as the vacancy. Ask the interviewing team members to prepare questions that would help them ensure that the candidate is a good fit for the team. Remember! Just as every organization has their own unique culture, so does each department and team. Hiring for culture, and training for skills, can support low turnover and an optimal fit for all. The team members can provide a day-to-day overview of what the role looks like, who they interact with, as well as any idiosyncratic qualities that may exist.
Although it may be tempting to ask about previous experience, skills and expertise, there are more valuable questions that can be asked to minimize a candidates’ potential inflation of self. Here are some questions to consider asking your Millennial:
1. What was most ideal about your last job? Why? What would you change? Why?
2. Can you tell me about a time that you had a conflict with a coworker? How did you handle it?
3. Describe your best and worst boss. What is your ideal relationship with a boss?
4. Describe a time that you failed. How did you know you failed? What would you have done differently?
5. Have you ever received feedback or a test score that you did not agree with? How did you handle it?
6. How did you decide to apply to this position? What do you think that you can offer? Based on what you know about this position, where do you see your limitations and/or needs for growth?
7. Can you describe the longest project that you have worked on? Describe your planning and role.
8. How do you manage stress at work? At home?
9. Describe your best and worst experience working on a team?
10. Where do you see yourself in 5 years? 10 years? Tell us how you will get there?
When considering pre-employment testing, there may be an opportunity to show the candidate what the role may entail. There are multiple ways to do this; one way would be role playing with clients or other employees about a financial request. These are just a few suggestions for hiring your next Millennial.
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QUALITIES OF MENTORS AND
MENTEES By: Adam Holderbaum
I’m sure everyone reading this article has heard the expression, “You can lead a horse to water, but you can’t make it drink.” When recently participating as a mentee in my companies own mentor/mentee program I often found myself thinking of this simple expression. As a mentee, I quickly realized that being paired with a top performer in my organization was just half the battle in making this relationship successful on both ends. A mentee must approach this relationship with an open mind and be committed to learning. It is very easy for a mentee to take a passive approach and not act on the advice of the mentor and therefore, not see the success of the relationship. Along with being committed to learning, a mentee must actively communicate with the mentor to share goals, ideas, struggles and successes. Communication is an essential piece of the equation for the mentee as it provides the mentor with feedback on how to guide future learning opportunities. Lastly, the mentee should always show appreciation for the guidance given by their mentor and be respectful of their time.
Working with a mentee with the above qualities makes the relationship for a mentor much easier to navigate, but there are still qualities a mentor must possess in order to help the mentee reach their goals. A quality mentor is enthusiastic to share his/her knowledge and shows interest in seeing the mentee’s growth and success. Showing interest in the mentee’s success means the mentor is able to provide honest/constructive feedback while still maintaining an open mind to the mentee’s ideas. As in every relationship, there must be give and take in order to make it work. A quality mentor will also approach the relationship as a learning opportunity for themselves, as the mentee is the future of their industry and can provide valuable insight into changes of the workforce.
If you are someone that feels you possess the above qualities, either as a mentor or mentee, and are interested in expanding your networking circle, please email Cheryle Powell at [email protected] for an application for the Mentor/Mentee program. Thank you all for the continued support of the Colorado chapter of HFMA!
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Topgolf Social EventAll registered attendees of the HFMA Colorado Annual Conference are invited to attend this fun networking event. Be sure to sign up when you register for the conference!
April 19, 2017 | 5:00 - 7:00 PM
Topgolf Centennial10601 E Easter AveCentennial, CO 80112
Topgolf is the premier golf entertainment complex where the competition of sport meets your favorite local hangout. You can challenge your colleagues to addictive point-scoring golf games that anyone from the hopeful pro golfer to a non-golfer can play. Just picture a 240-yard outfield with dartboard-like targets in the ground. The closer to the center or “bull’s-eye” you get and the farther out you hit your microchipped balls, the more points you receive.
Fun, Food & Drinks Provided!
HFMA Colorado Annual Conference Social Event
SPONSORED EXCLUSIVELY BY:
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CHA UPDATE: EAPGSBy Ryan Westrom
In 2013, the Colorado Department of Health Care Policy and Financing (HCPF) announced its plan to make changes to the outpatient Medicaid reimbursement methodology. Specifically, HCPF wanted to move from a cost-based methodology to a methodology that would more accurately classify the full range of outpatient service episodes to increase efficiency and effectiveness. With the assistance of the Colorado Hospital Association (CHA), HPCF began a series of stakeholder meetings and webinars to discuss options for outpatient payment reform. The two outpatient methodologies discussed were Enhanced Ambulatory Patient Groupings (EAPGs) and Ambulatory Patient Classifications (APCs).
After much discussion, the decision was made in March 2014 that HCPF would move to EAPGs in calendar year (CY) 2017; the implementation date was later determined to be Oct. 31, 2016. Following this announcement, HCPF held multiple EAPG informational meetings for the hospital community to learn more about the EAPG process and transition timeline. Additionally, a number of resources were reviewed during these stakeholder meetings, including EAPG implementation milestones, a review of EAPG policy decisions, weight and rate-setting methodologies, as well as the anticipated benefits of moving to EAPGs. Those benefits include payments based on resource use – as opposed to a flat percent of charge – payment transparency and coverage for the full spectrum of Medicaid outpatient services.
In October, prior to the Oct. 31 EAPG implementation date, HCPF announced its decision to postpone the Go-live date of its new Colorado interchange system. This delay directly impacted the EAPG implementation date. According to HCPF’s website: “The go-live date has been postponed four months. The original Go Live date was Oct. 31, 2016, and the new date is March 1, 2017. The new go-live date allows us to conduct more systems testing, better define system and business process changes and devote more time to working with our providers to ensure they are revalidated and enrolled in the Colorado interchange system. Hospital providers are instructed to submit claims using CPT/HCPCS codes in accordance with the Enhanced Ambulatory Patient Grouping (EAPG) payment policies which will have an effective date of Oct. 31, 2016.”
HCPF plans to continue making interim payments under the old cost-based methodology until March 1, 2017, and then do a retroactive, mass adjustment back to Oct. 31, 2016, when the new system is online. In order to avoid a delay in retroactive adjustment payments, it is important that hospitals submit the claims using CPT/HCPCS codes necessary to calculate EAPG payment (even though they are being reimbursed under the cost-based methodology). For questions on what needs to be submitted or for EAPG questions, hospitals should contact HCPF directly at [email protected]
© 2016 JPMorgan Chase Bank, N.A. Member FDIC. 208101
J.P. Morgan Proudly Supports the HFMA Colorado Chapter.
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plainsPEAKS3rd QUARTER 2016-2017 | JANUARY&
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plainsPEAKS3rd QUARTER 2016-2017 | JANUARY&
Platinum Sponsors ■ PFS Group ■ Professional Finance Company, Inc. ■ Simplee
Gold Sponsors ■ BESLER Consulting ■ BKD CPAs & Advisors ■ Clifton Larson Allen ■ Edge Process Consulting ■ EKS&H ■ Hall, Render, Killian, Heath & Lyman, PC
■ Key Bank ■ RSM ■ MMIC ■ Revenue Enterprises, LLC
■ Western Healthcare Alliance
Silver Sponsors ■ AppRev ■ Avectus Healthcare Solutions ■ BC Services, Inc. ■ BOK Financial ■ Caplan & Earnest ■ Cirius Group ■ Cleverley + Associates ■ Colorado Health Facilities Authority
■ CSC – Credit Service Company, Inc.
■ Cyberscience ■ Ernst & Young LLP ■ Professional Credit ■ HCFS, Inc.
■ Healthcare Outsourcing Network, LLC
■ Healthcare Resource Group ■ Instamed ■ Integral Healthcare Solutions, Inc. ■ J.P. Morgan Chase ■ Milliman ■ Pinnacle Healthcare Consulting ■ PwC ■ RMMI ■ TransUnion ■ UMB Bank ■ Xtend Healthcare
Provider Sponsors ■ Vail Valley Medical Center ■ Valley View Hospital
THANK YOU!We’d like to recognize and thank all of our annual sponsors. Your generous support enables the chapter to provide and enhance the quality of education programs on healthcare financial issues, as well as management, technical topics, communications, and social events. Many of the members reached by their support are key decision-makers within their own organizations and we encourage our members to utilize our sponsors’ services. A big WELCOME goes out to our new sponsors.
Editor’s Disclaimer
PEAKS & plains is published quarterly and provides general information for the entire Colorado HFMA Chapter. Opinions expressed in articles are those of the authors and do not necessarily reflect the view of the Chapter and its members. It is not designed to provide authoritative advice. Please consult with an appropriate expert if issues confront your business. Members are encouraged to submit articles or other information. Articles may be edited for clarity, grammar, and length. The editors reserve the right to accept or reject any submission.
Information to be considered for publication may be submitted to Cally Christensen at [email protected]
