Habitat for Humanity Greater San Francisco’s premier construction project, the most advanced Habitat development west of New York City, is a group of condominiums that will become home to 36 local working families.  The site is located at 7555 Mission Street in Daly City, just 1 block from the Colma BART station.

The four-story structure built on a podium garage is Habitat Greater San Francisco’s most ambitious development to date and is a cornerstone of the Grand Boulevard Initiative, exemplifying the revitalization that is underway along El Camino Real to provide compact, urban design and construction in a pedestrian-friendly, transit-oriented corridor.

Clients and others are invited to join us for staff volunteer days such as HFH.  Contact us at 510-768-0066 for information on upcoming events.

HFS can transform that data into an analytical tool that will provide the following:

• Drill down to the cost drivers of each DRG
• Help you to understand the services provided and the timeframe in which they are provided
• An understanding of the physicians and post-acute providers who were paid by CMS for services provided
• The diagnoses of the patients involved
• Other factors that will be critical in developing a price proposal for CMS

Our team members can use these tools to assist you in understanding:

• The DRGs of interest
• Constructing the care management plans for managing these patients
• Identifying unrelated diagnosis and DRG carveouts
• Determining your bundled episode bid for CMS

For more information or to schedule a consultation, please contact David Robeson, HFS’s Director of Feasibility, Valuation and Capital Planning at: 510-768-0066 or davidr@hfsconsultants.com

The CBWI is a provider specific wage index which accounts for a hospital’s cost of labor using commuting patterns. The commuting patterns represent a hospital’s labor market by the number of workers that commute from home to work. This information can be collected from Census results and the Bureau of Labor Statistics (BLS); however HHS believes the most accurate reflection of commuting data derives from hospital records (e.g. payroll). Therefore, the CBWI would likely create a new data collection process, whereby providers would submit employee information by geographic unit (e.g. zip codes, census tracts).

The CBWI would also eliminate the use of Metropolitan Statistical Areas (MSA) for purposes of grouping hospitals into labor markets, i.e. Core Based Statistical Areas (CBSA). The elimination of MSAs addresses the concern of “cliffs” in the current wage index system.  A “cliff” occurs when hospitals are in close proximity, but exist in separate CBSAs, and receive varying wage indices. The CBWI would also greatly reduce, and potentially eliminate, special wage index provisions such as geographic reclassifications, Section 508 reclassifications, out-migration adjustments, rural floors, and frontier state floors. It is projected that providers with current geographic reclassifications would experience the greatest decrease to their wage indices as a result of the CBWI system.

It is likely, yet undetermined, that the Medicare cost report and occupational mix survey will remain as primary sources for computing a provider’s average hourly wage (AHW). However, under the CBWI, a provider’s “net” AHW would be determined by the percentage of employees that reside in each geographic unit (e.g. zip code). For instance, assume the AHW of zip code A and B is $40.00 and $35.00, respectively. If 50% of a hospital’s employees reside in zip codes A and B, then the provider’s adjusted “net” AHW would be $37.50 ($40.00*.50 + $35.00*.50).

If Congress agrees to the proposed CBWI system, any changes would likely be phased in over a number of years. Moreover, if Congress does approve of the CBWI, there are still many details to be resolved between CMS and the provider community through the rule making process. HFS does not expect any changes to be implemented in the near future; rather we expect to see any changes phased in over multiple years.

For additional information and insight, please contact Trahan Whitten at 714.656.4486; trahanw@hfsconsultants.com, or Fred Fisher at 714.656.4489; fredf@hfsconsultants.com.

David Kim, Director of Management and Operations Consulting

The Operations and Management practice that Rich led will now be headed up by David Kim, who was a manager on Rich’s team. David has proven that he will be very capable of leading the practice team to help our clients attain ambitious results, often under challenging circumstances. David has twenty years of experience in the industry having held management and director-level positions at Kaiser, Catholic Healthcare West, Texas Health Resources, APM, CapGemini and Ernst & Young.

David is supported by an exceptional and talented team including Will King, (previously a partner at Accenture and CapGemini, Ernst & Young); Bob VanGelder, RN (nurse consultant); Marsha eagles (Clinical Laboratory); Robert Lewis (Physician Contracting) and Rick Pierce (Data Analyst). With the support of the entire HFS team, they will continue to provide project management, turnaround, labor productivity, Lean/Six Sigma and other services that hospitals and other healthcare facilities require.

In his retirement letter to colleagues and clients, Rich wrote, “I am grateful to be part of the HFS success story. I want you to know sincerely what a privilege it has been for me to work with you over the past many years. We’ve solved a lot of problems together, and I hope you agree that it was always worth the effort.”

We agree, and I, along with everyone at HFS, wish Rich Parsons all the best in his retirement. Our firm has tripled since Rich came on board in 2003. I want to thank him for his important contributions and leadership at HFS and the role he played in helping us to achieve the significant growth that we continue to experience today.

DHCS is requiring that clinics submit a request form to the Audits & Investigations department to establish an initial Code 19 rate. If you have not yet submitted the request form for payment, your rate will be automatically set at $1. Any amount due to your clinic above this payment will not be refunded to your clinic until after you submit your year-end PPS reconciliation forms, causing a delay in reimbursement.

Once the clinic rate is set and in the DHCS system, providers can submit electronic or handwritten UB-04 claim forms to HP, using the revenue description “Healthy Families Differential Rate” in box 43.

The Children’s Health Insurance Plan Reauthorization Act of 2009 is also requiring California’s Healthy Families Program to issue one lump-sum retroactive payment for services provided between October 1, 2009 and June 30, 2011. As of the writing of this article, a retroactive payment process has yet to be arranged.

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

The following is an introduction to the white paper HFS Consultants developed with the support of the California Healthcare Foundation.

Download White Paper Here.

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?

For more: Download white paper here >>

The CA Department of Health Care Services (DHCS) had sought to remove these and other services from the State Medi-Cal program during the previous fiscal year due to state budget shortages. DHCS has long considered these services (along with acupuncture, optometric, speech therapy, psychology and audiology services) optional, and the state’s budget crisis solidified the need to remove them from the program.

On October 18, 2010, the federal court ordered DHCS to continue reimbursing clinics for these services until formal approval from CMS was given to eliminate them through approval of the specified services stated in the SPA. The approval was given in May of this year, and now DHCS is seeking to recoup payments made to FQHCs and RHCs between October 18, 2010, and May 23, 2011. The Department claims that they have the authority to recover these funds. However, legal opinion suggests that there is a possibility that because these services are provided by medical doctors, interpretation of federal law requires reimbursement.

As a reminder, some Medi-Cal dental services were not eliminated:

• Beneficiaries under 21 years of age and part of the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program
• Women 21 years and older who are pregnant and require pregnancy-related services
• Beneficiaries 21 years and older in SNFs, ICFs, DD, DDH and DDN facilities
• Limited dental services for the relief of pain, infection or trauma

It is advised that a financial assessment of reimbursements for adult dental, podiatry and chiropractic services be undertaken by clinics to determine how much money may need to be returned to DHCS; and funds should be maintained in a separate account. DHCS has not yet determined how a recoupment will take place.

I get to visit clients and candidates from large academic teaching hospitals to rural critical access facilities.On a daily basis I talk to executives that are or about to become “in transition” – meaning unemployed.  I feel their pain- I’ve been there myself.  They face uncertainty about income, career satisfaction, a possible relocation, peer respect, family issues, and more.

Some of these colleagues have never been in this situation, and others have experienced it before.  Rarely are they delighted to be facing the challenges.

Here are some common things I try to discuss with them:

1. Take care of your family. Spouses, children, in-laws, pets, and others are also stressed by this situation.  Be aware of that and take steps to minimize it.  Don’t ignore it.
2. Take care of yourself. Remember that exercise program you never had time to do?  Use some of your “extra time” to get or stay healthy.  It’s good for your mind, your attitude, your appearance, and therefore your job prospects.
3. Start networking with your colleagues – “five years ago, dummy!” (Well, I rarely actually say that, but I think it every time.) NOW is better than later, in any case.  It’s greatthat executives reach out when they need help, and I applaud them for doing that.  It would be more effective if they had developed a professional/personal network over the years.  Go to meetings outside your organization, join professional groups, seek leadership roles in trade associations- you will be SO happy you did so when you need support.
4. Develop a new skill set. You’ve finally got some time- study up on ACO’s, or EHR implementation, or Lean Six Sigma, or Spanish (A multi lingual hospital CEO is always looked upon favorably).  If you’re a hospital CFO, study operations management, or take a class in HR.
5. Take a vacation- really. Life is short and there are few opportunities to get away and never have to call the office. Maybe you can combine this with learning Spanish. This is a really tough one for some folks, and they just want to blast ahead with their job search.  But, if there is a severance package and less financial pressure, you owe it to yourself (and your spouse) to get away for a bit and clear your mind.
6. Have patience. This is often the hardest one.  Patience is not a common attribute of highly successful people. At senior levels, job searches can take many months- sometimes years.  Plan on that.  You might well need a “second wind” (or third or fourth), and becoming discouraged and/or depressed six or twelve months from now won’t help your chances.  Sorry, but you have to face reality.
7. Repeat #1 and #2 above. I believe STRONGLY that family really is the most important thing.

The Fresno office’s clientele includes various types of healthcare providers including rural health clinics, acute care hospitals, ambulatory surgery centers, acute psychiatric hospitals, out-patient clinics including lab, radiology, and oncology, skilled nursing facilities and individual physicians. HFS Fresno works with these providers to maximize efficiencies within the revenue cycle, maximize cash flow, minimize loss of collections due to timely filing and maintain appropriate levels of A/R based on payer mix and monthly revenues. For those clients that do not have billing systems of their own, HFS operates as an offsite business office, while others may have their own systems and require HFS to clean up their backlogs (of aging claims). The HFS Fresno personnel have expertise with many of the Healthcare Information Systems such as Meditech, Siemens, HBOC, Achieve, Dairyland, HMS, Medical Manager, NextGen, Raintree, Mega West, Centricity, CPSI, Health Pro, and electronic vendors such as DSG, SSI Emdeon, NDC, Envoy, Office Ally, and ProxyMed.

Assistance to Hospital Business Office

A case study of the services that this office provides is in their recent engagement with Sierra Kings District Hospital (SKDH) of Reedley. HFS’s Fresno Office was charged with turning around the hospital’s receivables, reorganizing their business office and making a potential acquisition possible. After SKDH filed for Chapter 9 bankruptcy, HFS was consulted to get the hospital back on track and out of its financial woes. HFS Fresno aided in the restructuring by providing billers to SKDH and training SKDH staff to better handle their receivables and facilities management. Through the Fresno office’s efforts, SKDH’s cash flow was increased considerably, their accounts receivable backlog was decreased and their A/R days dropped by 51%, from 105 days down to 53 days outstanding. Additionally, by the time the Fresno office transitioned out, they had increased cash to the hospital byapproximately 2.6 million dollars.

With the recent move of the Fresno branch offices in March 2011 to a new location at 680 West Shaw Avenue in the Fig Garden Village area of Fresno, the office has begun “growth mode”. This move was done to accommodate staff growth and the expansion of services to more healthcare facilities. This growth is expected to be made possible due to the difficulties many providers are discovering with implementing the new 5010 electronic billing requirements that are scheduled to occur in 2012. The Fresno office also will be upgrading its own IT systems in November 2011 to better serve its clients by providing better reporting, more streamlined electronic billing and the ability to utilize different charge masters.

All in all, we can all expect more great things from the Fresno office and the Revenue Cycle Management side of HFS in the coming months! For more information, please contact Gwyen Smith at ext. 315.