Note From the President Diane Maheux, FHFMA

I can’t believe another year has flown by so fast. For those of you that joined us for the Annual Meeting at Church Landing in Meredith, NH in March – wasn’t that fun? It was great to see everyone and honor our members at the annual awards event.

For those of you that were not able to make it, you missed a great event that was packed with information. HFMA recognizes our volunteers for their efforts. We recognize that we are an organization that operates because of the efforts of our volunteers. If it was not for the volunteers that contribute countless hours of time, our chapter would not have education opportunities, a newsletter, or certification assistance.

At our annual awards ceremony on Thursday, March 16, 2017 we honored the following HFMA members:

Joseph Loring, FACHE earned the William G. Follmer Bronze Merit Award

Peter Smith, FHFMA earned the Robert H. Reeves Silver Merit Award

Dick Ford, FHFMA earned the Frederick T. Muncie Gold Award

The following three individuals were honored by the Chapter for their extra efforts in volunteerism this past year:

Robin Fisk • Verna Lynch • Jane Piotrowski, FHFMA

National HFMA also recognized Peter Smith, FHFMA and Diane Blaha, FHFMA for 2016 Award for Certification on behalf of the chapter.

Robert Gilbert received the 2016 Multi Chapter Award for Region 1.

Our chapter also recognized three individuals who have earned the Muncie Gold Award for volunteerism but then still contributed even more volunteer time on behalf of the New Hampshire/Vermont Chapter. They all served through the officer track of the chapter and still volunteer to represent the chapter on various committees. The New Hampshire/Vermont Chapter of HFMA is proud to recognize for their efforts:

Kirsten Geoffrion • Connie Ouellette, FHFMA • Amy Vaughan

The success of our chapter rests in the hands of our volunteers. Thank you all for your hard work and dedication to HFMA and the New Hampshire/Vermont Chapter!

Sincerely,

Diane Maheux

In This IssueWords From Your President ..................................... 1

Credentialing Strategies ............................................. 2

Certification Corner .................................................... 6

Welcome New Members ........................................... 6

Legislative Update ........................................................... 7

Women In Leadership Conference ........................ 9

Upcoming Events......................................................... 11

Annual Meeting ........................................................... 12

Chapter Committee Chairs ..................................... 14

Chapter Officers .......................................................... 15

www.nhvthfma.org

#NHVTHFMA

THE OFFICIAL NEWSLETTER OF

Newsletter Policy and Committee

Editor Erin Cutter, MBA

MOUNTAIN VIEWS is published five times a year. Our objective is to provide members with information regarding chapter activities as well as ideas to help the individual in the performance of his/her duties.

EDITORIAL POLICY The editor strongly encourages the submission of material for publication. The editor reserves the right to edit material and accept or reject contributions whether solicited or not. Send all correspondence to:

Erin Cutter 250 Pleasant Street, Concord, NH 03301 603.230.7370 • ecutter@crhc.org

NEWSLETTER COMMITTEE

KARL BAKER, Clifton Larson Allen

CAROL BARRETT, Elliot Hospital

DIANE BLAHA, Blaha Consultants, LLC

JUDI DEAVERS, Dartmouth Hitchcock Medical Center

EVAN DRESSEL, Wentworth Douglass Hospital

ROBIN FISK, Fisk Law Office

EMILY ANNE NOLTE, Pricewaterhouse Coopers, LLP

JANE KAPOIAN, NH Healthy Families

PAULA MINNEHAN, NH Hospital Association

JANE PIOTROWSKI, Dartmouth Hitchcock Clinic

GERRI PROVOST, Elliot Hospital

ERIC WALKER, NH Healthy Families

Opinions expressed in articles or features are those of the authors and do not necessarily reflect the views of the Healthcare Financial Management Association, New Hampshire/Vermont Chapter or the editor.

May/June 2017

Diane Maheux

MOUNTAIN VIEWS 2

Credentialing Strategies to Streamline Your Physician Enrollment ProcessAuthors: Emily Anne Nolte, CHFP - Manager, Lauren Christian, CHFP Sr. Associate, Spencer Budd – Associate, PwC

The Importance of Credentialing

The process of credentialing refers to both obtaining approval for a provider to practice at a hospital (i.e. privileging) and to be reimbursed for services by a particular payer. Both processes require satisfying many criteria, including proof of identity, education, training, licensing, and board certification, as well as verifying malpractice insurance and reviewing any claims or investigations of fraud, abuse, or misconduct. A robust, comprehensive credentialing program is key for every healthcare provider organization.

Credentialing helps to ensure providers are qualified to provide high quality care, a key piece of patient safety. A lapse in credentialing status can be a violation of payer contracts, potentially jeopardizing revenue from payers and other federally funded programs. A lapse also exposes hospitals to possible negligence and malpractice claims, which can be costly to an organization’s reputation and finances. Further, failing to institute proper quality controls can reduce revenue in a value-based reimbursement environment, a source of revenue that is likely to continue to grow.

Deciding Your Credentialing Approach: Balancing Investment and Control

Deciding whether to outsource credentialing or manage the process inhouse depends on your organization’s ability to invest time and resources as well as the organization’s desire to have control over the process.

Organizations willing to invest heavily in resources and technology in exchange for the most control should consider pursuing a delegated in house credentialing model. This option typically makes the most sense for large organizations. Investing in this model requires hiring and training credentialing staff to remain current on accreditation standards and payer contracts, maintaining the proper staff to provider ratio, as well as supporting an internal audit team. Technology is needed for internal Key Performance Indicator (KPI) monitoring, automated tracking of payer contracts, and provider documentation due dates. System integration is also critical to provide an accurate, real-time list of providers across all platforms.

Pursuing the non-delegated path requires less investment, but requires dependence on payer timelines to credential physicians. A dedicated department or individual, depending on the size of your organization, is needed to maintain this process for the provider, and should still be supported by an internal tracking system of payer contracts and due dates.

Outsourcing requires minimal investment in technology, hiring and training, but depends on the vendor to credential physicians. Technology and training are managed externally in exchange for a vendor fee. Clear processes and vendor management responsibility will need to be established and maintained, but require the least time and energy once the vendor has been selected and implemented, assuming the vendor follows processes as expected.

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MOUNTAIN VIEWS 3

Managing the Credentialing Life Cycle

Staying on top of the credentialing life cycle is critical to maintaining compliance, accelerating physician onboarding, and preventing lapses in credentialed status.

To accelerate incoming physicians’ ability to gain credentials, coordinate with physician recruitment to make start dates contingent on submission of credentialing documents. Beginning with prospective candidates, providers should be aware of the credentialing process and what they will need to accomplish before seeing patients, including any required documents and expected timelines. As soon as they have accepted their offer, new physicians should begin the credentialing process. Coordinate with payers early by sending out prepared contracts when final offers are given to prospective physicians.

Preventing a lapse in credentialing status starts with an internal work-queue of anticipated or known due dates for credentialing activities. To

emphasize the importance of current credentialing, appoint physician champions to promote credentials maintenance and encourage timely submission of documents. Develop a relationship with payer contacts to keep communication channels open, stay on top of deadlines, and have a forum to escalate potential issues. Coordinate with internal mail delivery systems to ensure timely distribution of hardcopy notifications from payers.

Organizational Controls to Monitor the Credentialing Process

Once the credentialing approach has been decided and processes have been established throughout the credentialing life cycle, controls should be put in place to monitor, maintain, and correct issues as they arise.

Particularly for organizations with delegated credentialing from payers, remaining audit-ready is critical to protecting revenue, and begins with internal strategies to establish, educate, and enforce organizational credentialing priorities. A policy and procedure committee should maintain organizational policies based on regulations, accreditation standards, and payer contracts and communicate them to staff in a timely fashion. This is critical to organizational awareness and alignment on credentialing requirements.

An internal audit group of independent auditors with knowledge and expertise of audit processes, all relevant policies and procedures, and audit templates can provide objective feedback to keep the organization ready for the real deal. A process for escalating and monitoring providers who are at risk

Continued from page 2

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should be installed, with provisions to terminate providers who do not maintain appropriate status. Formal training during onboarding and periodic refreshers for existing employees should use lessons learned from past audits as training points to avoid repeating mistakes.

Understanding the health of an organization’s credentialing process requires establishing credentialing KPIs and monitoring them against benchmark values. Average credentialing time should be monitored to reduce onboarding time for new physicians, reduce risk of a lapse in credentialed status, and maximize physician productive time. Organizations should strive to stay below the industry target of 60 days average credentialing time, and take immediate corrective action if this KPI exceeds 90 days.

Tracking denials and adjustments related to credentialing is a useful indicator for measuring effectiveness of the credentialing process. This can be done by generating a report on the total number of claims denied and number of accounts written off due to incomplete credentialing. Finally, a lapse in credentialed status for physicians in your organization indicates a breakdown in the re-credentialing process, which should be reexamined to determine where the breakdown occurred and how to resolve it going forward.

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MOUNTAIN VIEWS 5

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MOUNTAIN VIEWS 7

The State Fiscal Year (SFY) 2017 NH legislative session continues with legislators considering a number of bills that have crossed over from one body to the other. The big story of the last couple of weeks was that the House was unable to pass a budget to send over to the Senate. Consequently, the Senate began their budget work last week using the Governor’s budget, since there is no House budget to consider.

The Senate Finance Committee has asked for the House Finance Committee’s recommendations and is likely to consider some of their proposals during the Senate phase of the budget.

The next few weeks will be busy at the State House with the Senate budget writers crafting their version of the SFY 18/19 State budget, while other committees continue hearings of various pieces of legislation.

NHHA and our members continue to have significant concerns with the proposed annual budgeted uncompensated care funding levels for Disproportionate Share Hospital (DSH) payments owed to the acute care hospitals. The Governor’s proposed budget underfunds the DSH program by approximately $150 million over the biennium, and potentially violates the settlement agreement reached in 2014 between the state and the hospitals after two Superior Court judges had ruled that the Medicaid Enhancement Tax (MET), which is used to fund the DSH program, was unconstitutional.

The settlement agreement established minimum and maximum levels of funding needed to sustain the DSH program and protect both the state and hospitals. Hospitals are projected to pay MET taxes of approximately $236 million in FY 2018 and $243 million in FY 2019, with DSH payments expected to be at the agreed upon cap of $241 million each year. The Governor’s budget, which funds DSH at approximately $166 million per year for the next two years, would be in violation of the settlement agreement.

It is our belief that the prudent approach would be to budget the DSH program at the agreed upon cap as outlined in the MET settlement agreement. NHHA will work with the State Senate Finance Committee to provide information and advocate

for the proper funding of the DSH program for the next two years.

All of the bills that NHHA is following can be found on our web site at http://bills.nhha.org/ which includes links to bill language, the prime sponsor, hearing dates/times, and the current status of the bill.

STATE UPDATERECENT LEGISLATIVE ACTIVITY

Listed below are bills of particular importance to hospitals and health systems this year. NHHA is following many more bills, which will be included in future updates of the NHHA Legislative Newsletter.

HEALTH CARE INFORMATION/PRIVACY

SB 61, relative to medical records of a deceased spouse or next of kin

SB 61 would change who can access medical records of deceased individuals. The bill expands access to “next of kin”.

NHHA testified on the bill when it was heard in House HHS committee in last March. The committee was supportive of the amended bill but chose to amend the bill to move the language from the Probate statute into the Medical Records statute, which NHHA was in agreement with. The bill passed the House and the Senate.

NHHA position: Support as amended

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HEALTH INSURANCE

HB 329, establishing a committee to study balance billing

HB 329 establishes a legislative committee to further study the issue of hospital affiliated providers (anesthesiologists, pathologists and radiologists) that are independent and choose not to contract with the same insurance carriers as those with whom the hospital contracts.

NHHA testified that we are neutral on the bill since it is a study committee; however we do question the need for legislation. The Senate HHS committee held a hearing on the bill in late March. The full Senate passed the bill on 4/6/17.The bill now heads to the Governor’s desk to be signed into law.

NHHA position: neutral

LICENSING/CERTIFICATION

HB 184-FN, (New Title) relative to the license requirement for medical imaging and radiation therapy and relative to registration by practitioners with the board of medical imaging and radiation therapy

HB 184-FN, as introduced, would have repealed the law establishing a board of medical imaging and radiation technologist, which was created by legislation last year.

NHHA testified in opposition to repealing the law. The bill was amended to allow more time for the Board of Medical Imaging and Radiation Therapy to create their rules that will guide the licensure process. NHHA supports the amended bill. It was heard in Senate Executive Departments and Administrations committee on March 22nd. The full Senate passed the bill in late March and it has been signed into law by the Governor.

NHHA position: support as amended

HB 322, adding rulemaking authority to require completion of a certain survey as part of the license renewal process for health care providers

HB 322 requires, as part of the license renewal process, completion by licensees of a survey provided by the Office of Rural Health, Department of Health and Human Services, for the purpose of collecting data regarding the New Hampshire primary care workforce.

NHHA is supportive of the bill because the data collected from health care licensing boards, such as the Board of Medicine and Board of Nursing, is crucial to the application for Health Professional Shortage Areas. The House passed the bill on 3/8/17. The bill was heard in the Senate ED&A committee on April 26.

NHHA position: support

FEDERAL UPDATEThe House Republicans plan, the American Health Care Act (AHCA), failed to receive enough votes in the US House of Representatives last month to move forward. NH’s congressional delegation was squarely against the AHCA. Senators Jeanne Shaheen and Maggie Hassan and Congresswoman Ann Kuster have made several trips to hospitals in February and March gathering stories about the positive impact the ACA had on individuals and how any repeal and replace could have devastating impacts on our citizens. We appreciate their commitment to preserving the gains NH has made for health insurance coverage.

Continued from page 7

MOUNTAIN VIEWS 9

Women in Leadership ConferenceOn Tuesday April 18, 2017, the chapter hosted its second annual women’s conference, titled “Women in Leadership: Lead Like a Girl 2.0”. This year, the event was hosted jointly with the Northern New England Association of Healthcare Executives. It was an all-day program held at the Manchester Country Club focused on networking and leadership development. We hope you enjoy these photos from the event and consider joining us for next year’s conference.

All attendees received this notepad!

Charlene DeCesare, presenter: Leading with Confidence:

Creating a Coaching Culture

Carol Grannis, Ed.D (left) and Cindy Maher (right), presenters: Maximazing Energy in a World that Sucks You Dry.

Dr. Annabel Beerel, Founder & President, New England

Women’s Leadership. Keynote Speaker. Managing

Relationships with Women at Work: Up, Down and Across

the Hierarchy

The first fifty registrants received a copy of Dr. Annabel Beerel’s book titled Leadership and Change Management

Angel Investing Panel (left to right): Margaret Donnelly; Becky Stoughton, MBA, CLP; Liz Gray (Moderator),

NH Business Finance Authority; and Alison Pyott, CFP

MOUNTAIN VIEWS 10

YOUR PEERS, YOUR STAFF, YOUR MOVE

Win prizes for each new member you recruit.

You know – more than anyone – the value of belonging to HFMA.

Spread the word. Invite your peers, your staff, and your colleagues to join you – and join HFMA.

MOUNTAIN VIEWS 11

Upcoming Education and EventsWe hope you will join us for one or more of these upcoming events.

For more information, click the links below, or visit nhvthfma.org/events.

EVENT DATE/TIME LOCATION

REGISTER TODAY! HFMA Region 1 5/23 – 5/25/17 Mohegan Sun Resort 16th Annual Healthcare Conference Uncasville, CT

New Hampshire/Vermont Chapter SponsorsBecause of the generosity of the organizations listed below, we are able to offer quality services,

such as this newsletter, to our members. To these organizations, we say “thank you”.

PLATINUM PATRONSBaker Newman Noyes • Balanced Healthcare Receivables • Bank of America Merrill Lynch

BerryDunn • BKD CPAs & Advisors

GOLD PATRONSBESLER Consulting • Commerce Bank • E-Management Associates, LLC •Echo Financial Products, LLC

Gragil Associates, Inc. • ROI, a Bolder Healthcare Company

SILVER PATRONSCollection Bureau of the Hudson Valley, Inc. • Credit Bureau Collection Service • E4H Architecture

Helms & Company, Inc. • KPMG LLP • NFP • TruBridge • Tyler, Simms & St. Sauveur, CPAs, P.C.

MOUNTAIN VIEWS 12

Annual Meeting This year’s annual meeting was held on

March 16 and 17, 2017 at Church Landing

in Meredith, NH. The program included

presentations on a range of topics from

Data Security to Pricing Transparency.

We hope you enjoy these photos from the

event and consider joining us next year.

MOUNTAIN VIEWS 13

c o l l a b o ra t i n g f o r t h e f u t u reJ U N E 2 5 -2 8 O R L A N D O

Register now at hfma.org/ani.

Come to ANI and plug into the network that is generating real-world solutions to thechallenges of today—and tomorrow. Collaborate with your colleagues who together areleading to better outcomes for patients, shareholders, and stakeholders. Prepare yourselfto shape the future of health care.

MOUNTAIN VIEWS 14

Advisory CouncilDiane L. Maheux, FHFMA, Chief Financial Officer; Calais Regional Hospital

24 Hospital Lane, Calais, ME 04619 Phone: (207) 454-7521 x229 | diane.maheux@calaishospital.org

Certification CommitteeDiane L. Blaha, FHFMA, President; D Blaha Consultants LLC

152 Forestview Drive, Spofford, NH 03462-4616 | Phone: (603) 305-5486 | Diane.Blaha@gmail.com

Peter G. Smith, FHFMA, MC Contracting Manager; Wentworth-Douglass Hospital 789 Central Ave., Dover, NH 03820-2526 | Phone: (603) 740-2408 | peter.smith@wdhospital.com

Chapter Quality Management CommitteeDiane L. Maheux, FHFMA, Chief Financial Officer; Calais Regional Hospital

24 Hospital Lane, Calais, ME 04619 | Phone: (207) 454-7521 x229 | diane.maheux@calaishospital.org

Corporate Sponsorship CommitteeBarbara A. Lynch, Sr. Vice President, Account Management; Balanced Healthcare Receivables

164 Burke Street, Nashua, NH 03060 | Phone: (603) 546-4085 | blynch@bhrllc.com

Education CommitteeGerri Provost, Manager, Managed Care-Reimbursement; Elliot Hospital

1070 Holt Avenue, Suite 1, Manchester, NH 03109 | Phone: (603) 663-5865 | gprovost@elliot-hs.org

Jeffrey D Walla, FHFMA, CPA, Principal; BerryDunn 1000 Elm St., Ste. 1500, Manchester, NH 03101-1715

Phone: (603) 518-2643 | Fax: (603) 666-4755 | jwalla@berrydunn.com

Link CommitteeRobin J. Fisk, FHFMA, Attorney; Fisk Law Office

23 West St., Suite 4, P.O. Box 521, Ashland, NH 03217 | Phone: (603) 968-3810 | rf@fisklawoffice.com

Membership CommitteeSusan M. Carr, Patient Orientation & Referral Services Operations Manager; Dartmouth-Hitchcock Clinic

294 Daniel Webster Highway, Merrimack, NH 03054-4474 Phone: (603) 440-7647 | Fax: (603) 440-7678 | susan.m.carr@hitchcock.org

Newsletter CommitteeErin Brearley Cutter, Manager of Revenue Integrity & Customer Service; Concord Hospital

Phone: (603) 230-7370 | ecutter@crhc.org

Nominating CommitteeDiane L. Maheux, FHFMA, Chief Financial Officer; Calais Regional Hospital

24 Hospital Lane, Calais, ME 04619 | Phone: (207) 454-7521 x229 diane.maheux@calaishospital.org

Nominating Committee Member-at-LargeJudi A. Deavers, FHFMA, Compliance/Regulatory Measurement Analyst;

Dartmouth-Hitchcock 1 Medical Center Drive, Lebanon, NH 03756-0001

Phone: (603) 653-1554 | judith.a.deavers@hitchcock.org

Physician Practice Management CommitteeCarlos Gonzales, Practice Administrator; Seacoast Orthopedics & Sports Medicine

7 Marsh Brook Drive, Somersworth, NH 03878 | cg112233@gmail.com

Scholarship CommitteeMarie L. McGee, FHFMA

1135 Faybrook Road, Sharon, VT 05065-6544 | marie.mcgee@valley.net

Jeffrey D Walla, FHFMA, CPA, Principal; BerryDunn 1000 Elm St., Ste. 1500, Manchester, NH 03101-1715

Phone: (603) 518-2643 | Fax: (603) 666-4755 | jwalla@berrydunn.com

Chapter Committee Chairs 2016-2017

MOUNTAIN VIEWS 15

PresidentDIANE L. MAHEUX, FHFMA (207) 454-7521 x229 | diane.maheux@calaishospital.org

President-ElectERIC F. WALKER, CPA, FHFMA (603) 263-7116 | erwalker@centene.com

Immediate Past PresidentROBERT M. GILBERT, FHFMA (802) 740-6562 | robert.gilbert@wdhospital.com

SecretaryERICA L. MCNAMARA, CPA (802) 225-7537 | erica.mcnamara@cvmc.org

Treasurer WENDY DUMAIS (802) 230-7498 | wdumais@crhc.org

The New Hampshire/Vermont Chapter of the Healthcare Financial Management Association (HFMA) is a professional membership organization for individuals in financial management of healthcare institutions and related patient organizations.

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Chapter Officers 2016-2017

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