February 17th, 2012
by: John Pfeiffer
Palmetto recently upped the ante for claiming Medicare / Medi-Cal bad debts for California providers as described in their recent letter to providers (download here).
Medi-Cal Share of Cost (SOC) is a small co-payment that some Medi-Cal patients are required to pay. Previously Palmetto allowed a 2% reduction of crossover bad debts as an estimated amount of SOC in lieu of reducing by the actual SOC.
Now, Palmetto is requiring providers to reduce their bad debts by the actual SOC. If any SOC was actually collected on a claim, then the corresponding Medicare bad debt would be reduced by that amount. If any amount of SOC was uncollectible, then to claim the bad debt for that portion, the provider would have to prove that they made reasonable collection efforts, a difficult process in many cases, and doubly so when trying to collect from Medi-Cal beneficiaries.
If a provider is not confident that they can prove reasonable collection efforts were made, HFS recommends they reduce the bad debt claims by the SOC amount shown on the Medi-Cal Remittance Advice whether any portion of it was collected or not. This means foregoing a small amount of bad debt, but it also removes a significant obstacle to convincing Palmetto that your bad debt log is squeaky-clean.
Please feel free to contact me (John Pfeiffer) or your HFS Client Service Representative for advice and help on this issue.
Download Palmetto Letter
TAGS: bad debt collections, medi-cal bad debts, medicare, Palmetto
Posted in Hospital Management, Medi-Cal Payments, Regulations, Reimbursement | No Comments »
February 16th, 2012
by: Steve Rousso
The following is an introduction to the white paper HFS Consultants developed with the support of the California Healthcare Foundation.
Author: HFS Consultants
Introduction
The Patient Protection and Affordable Care Act (ACA) is an ambitious endeavor to improve health care in the United States. One of the ACA’s key features is the Accountable Care Organization (ACO). ACOs will contract with the Centers for Medicare and Medicaid Services (CMS) to provide comprehensive coordinated services for a defined population of Medicare beneficiaries. If they meet quality standards and reduce costs, ACOs will share in the savings.
California’s rural areas constitute 85% of its land mass and are home to 5 million people, or 13.7% of its total population. This population faces many challenges that affect its health status and the delivery of health care services:
- A higher level of poverty
- Lower levels of educational achievement
- Travel distances and travel times
- Higher rates of chronic disease
- A shortage of health care providers
- Financial problems for many current rural health care providers
The Accountable Care Act acknowledges these issues for rural areas nationwide and indicates intent to improve rural health conditions. The ACO provisions in the ACA specifically address rural communities. At the same time that CMS is promoting ACOs (federal ACOs), the marketplace has accelerated the development of organizations and business relationships that perform in an ACO-like manner (commercial ACOs).
Both federal and commercial ACO development has implications for California’s rural communities. The purpose of this white paper is to address several questions:
- How relevant is the ACO legislation and concept to California rural communities?
- What are the benefits and costs of participating?
- What are the consequences of not participating?
- Do California rural communities have the resources and necessary conditions to develop or participate in an ACO?
- What are specific communities doing to develop or participate in ACOs? What lessons can rural communities and providers learn from these specific endeavors?
TAGS: Accountable Care Organization, Patient Protection and Affordable Care Act
Posted in Community Clinics, Health Clinics, Regulations, Rural Healthcare | No Comments »
February 14th, 2012
by: Bill Deane
The Centers for Medicare & Medicaid Services (CMS) approved the State Plan Amendment (SPA) for California on May 23, 2011. In the process, CMS approved the elimination of Medi-Cal payments to FQHCs and RHCs for certain “optional benefits” including adult dental, podiatry, and chiropractic services. Read the rest of this entry »
TAGS: adult dental, Center for Medicare & Medicaid services, chiropractic services, podiatry
Posted in Medi-Cal Payments | No Comments »
February 2nd, 2012
by: Don Whiteside
Executive Transition- This is more of a personal view, not a strictly professional one. One of the joys of my job as a healthcare recruiter is the relationships I have with very senior healthcare executives. I’ve been very lucky with a career that allows me access to some of the best minds leading California hospitals, health systems, and other healthcare businesses. This stretches across regional and organizational boundaries- CEO’s, CFO’s, COO’s, other Hospital execs and Board members, physicians and other clinicians. Read the rest of this entry »
TAGS: unemployed executive transition
Posted in Executive Search, Interim Placement, Recruiting | No Comments »
January 30th, 2012
by: Gwynn Smith
Part of the HFS Consultants “complete solutions for healthcare management” is located at the NEW Fresno office. The Fresno office primarily works in Revenue Cycle Management . Its expertise is in areas of billing and collections in which HFS personnel will utilize the client’s system or our own to collect, rebill and manage outstanding claims. The HFS personnel are experienced in the billing regulations and requirements of HIPAA, Medi-Cal, Medicare and commercial insurance companies. The Fresno office is largely utilized for outsource billing, which includes billing, follow-up, collection and backlog reduction. Services aren’t isolated to offsite support only. If deemed necessary, onsite assistance will be provided to a client. Read the rest of this entry »
TAGS: billing and collections, revenue cycle management, Sierra Kings District Hospital
Posted in Health Records, Hospital Management, Reimbursement, Revenue Cycle Management, Revenue Recovery, Staff | No Comments »
January 23rd, 2012
by: Cecilia Murillo
The Health Professional Service Area designation was established by the Federal Office of Shortage Designation (OSD) to identify geographic areas or population groups with a shortage of primary health care services. HPSA designations are a prerequisite to applying for Rural Health Clinic certification, the National Health Service Corps (NHSC) Loan Repayment Program, California’s State Loan Repayment Program (SLRP), J-1 Visa waivers, and some state funding. A geographic HPSA designation can also increase Medicare payments for physician services.
Beginning this year, the OSD is requiring that all 2008 designations be submitted to the Office of Statewide Health Planning and Development (OSHPD) no later than April 2, 2012. If you received a new designation or renewed it in 2008, you must reapply now. Failure to renew your designation will result in the loss of one or more benefits stated above.
HFS Consultants can assist you in renewing or applying for a new designation and submit all the necessary information to OSHPD. Our Licensing & Certification division has completed over one hundred HPSA designations for rural communities and has spoken on this subject throughout California. For more information, please contact Cecilia Murillo at 510.768.0066 ext. 288 or by email at ceciliam@hfsconsultants.com
Posted in Uncategorized | No Comments »
January 10th, 2012
by: Don Whiteside
Hospitals face a change in chief executive leadership for many reasons. A CEO might announce sudden retirement, get promoted to a larger hospital or health system, resign for personal matters or have a difference of opinion with the board of directors regarding the hospital’s strategy and direction.
As HFS Consultant’s managing director of executive search and business development, my experience has been that when there’s a vacancy in the CEO position, it’s often because there’s some kind of crisis and it’s indicative of problems in the organization.
Read the rest of this entry »
TAGS: executive search, health system, Hospital Interim CEO
Posted in Hiring, Interim Placement | No Comments »
December 6th, 2011
by: Rich Gianello
An Interview with Rich Gianello, CEO
Q: How did HFS get started in 1991?
A: We were working for the healthcare division of an East Coast CPA firm when we were notified that it was closing. Starting with a small amount of existing work, Steve Rousso and I set up meetings with rural hospitals up and down I-99 and made sales calls for three or four days. We talked about financial feasibility and reimbursement opportunities. One of the jobs from those calls was to become the interim CFO at Westside District Hospital in Taft. That’s how we started.
Q: What was going on in healthcare at the time?
A: The same issues that exist now existed then, the same pressures. There are constant regulatory changes; federal and state programs keep decreasing reimbursement and all facilities must continue to provide quality patient care at less cost. You are expected to do more with less resources. This is a highly regulated government industry. The methodology constantly changes, for example, changing from ICD-9 coding to ICD-10 coding, a much more sophisticated and complex system. But the pressure still exists to cut costs and operate more efficiently.
Read the rest of this entry »
Posted in Reimbursement, Revenue Cycle Management, Staff, Strategic Planning | No Comments »
November 29th, 2011
by: John Pfeiffer
You may have received the email below from DHCS requiring your hospital to submit a new Quality Assurance Fee (QAF) Survey by 12/30/11. One of the reasons DHCS is collecting this information is to determine how revenue and expense from the QAF program (aka the provider fee program) are recorded on the 2010 OSHPD annual reports. If QAF data were reported incorrectly, it could skew Medi-Cal DSH payments. DHCS is requiring all hospitals to apply, whether they receive DSH or not, and whether they are a private or public hospital.
Read the rest of this entry »
TAGS: DHCS hospital Quality Assurance Fee (QAF) Survey, QAF program OSHPD annual reports
Posted in Health Information Technology, Healthcare Legislation, Hospital Management | No Comments »
This summer I was contacted by SPARK, a youth development program whose mission is to inspire middle school youth through workplace-based apprenticeships. The organization was founded in 2001 to help address the astounding 20% nationwide high school drop-out rate.