The Texas Tumbleweed FirsT Place aT 2009 ani! The Texas ...€¦ · Save the dates from March 2008...

Please welcome2010-2011 Chapter officers:

President: Chris Morgan, CPAM 1st VP: Scott Noel, CPAT, MPA2nd VP: Alan Speigelhauer Secretary: Karol HopkinsTreasurer: Angie Box Board Chair: Marji Henry, CCAM

2010-2011 Committee Chairs:

Corp. Partners Chair: Lora Willis Membership Chair: Julie Shaw Practice and Standards Chair: Patt Lowe Certification Chair: Emily Goertz Legislative Chair: Greg Page Chapter Excellence Chair: Sheila Weber Constitution & Bylaws Chair: Greg Hightower

Publications Chair: Carolyn GayWebsite Chair: Robin Gates Education Chair: Carolyn Swanson Chapter Administrator: Debbie Peterson, CMP Management

It’s Official!

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Tumbleweed wins

FirsT Place aT 2009 ani!

Save the Date: March 19, 2010

2010 Spring Regional Professional Development Seminar

Los Colinas Medical Center Irving, TXFor more information visit www.txaaham.orgcall 512-314-9177 email [email protected]

Thanks to the 2008-2009 officers and

committee chairs for their service to our Chapter:

This Issue

The President ’s

Message.. .P.2

Calendar of Events. . .P.3

Cert i f icat ion Corner. . .P.4

Did you miss it. . .P.5 - P.6

Corporate

Sponsors. . .P.7

Tumbleweed wins f i rst

p lace.. .P.7

RACs.. .P.8 - P9

Greetings to all! At the time of this writing, the h o l i d a y s are fast

approaching and our busy days get even more hectic. As I was preparing for this, my first message as the president of the chapter, I thought about all the hard work put in by past members of this board to get us to this level. The strength of our chapter has come from those individuals. I would encourage each of us to

remember our roots and thank the ones who brought us here. I hope that I can bring that same level of inspiration and advancement to the chapter.

On a business note, this is an interesting time in healthcare. As news develops on these changes, AAHAM and your chapter will keep you informed. No one knows the changes that are coming. As Bill Spare once told me “My crystal ball broke years ago.” We will assist you in adapting to these changes through

our education programs. I hope you will join us as we make these opportunities available to you. Between the regional education and the Annual State Institute, we will bring you the most up to date and pertinent information helping you in the management of your facilities. This is your association. We are here to serve you. How can we serve you better?

Happy New Year!

Chris [email protected]

A Message from the President

2

by Auld Lang Syne

President: Marji Henry, CCAM 1st VP: Angie Hawkins, CPAM 2nd VP: Shelly Carney Certification: Patt Lowe Constitution & Bylaws: Dana Mojica Education: Scott Noel, CPAT, MPA Legislative: Cheryl K. Barrett Practice & Standards: Chris Morgan Scholarships & Awards: Misty Davis Chapter Administrator: Jessica Medlyn, CMP Management

Secretary: Carolyn NottinghamTreasurer: Angie BoxBoard Chair: Bill Spare, CPAMChapter Excellence: Terry Sánchez Allison,CPAMCorporate Partners & Nominating: Bill Spare, CPAMFinance: Christian O’ ConnorMembership: Julie ShawPublications: Carolyn GayWebsite: Robin Gates

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Calendar of Events CPAT/CCAT/CT examsFebruary 15-26, 2010 For more information, [email protected]

March 1, 2010Registration deadline for al lApri l /MayCPAM/CCAM/CPAT/CCAT/CCT examsFor more information, [email protected]

March 19, 2010Spring Regional MeetingLos Colinas Medical Center - Irving, TXWatch email , website, and newsletterhttp:/ /www.txaaham.org/

Apri l 26-May 1, 2010Spring CPAM/CCAM examsFor more information, [email protected]

June 9-11, 20102010 Annual State Institute (ASI)Marriot Austin Airport SouthAustin, Texas Watch email , website, and newsletterhttp:/ /www.txaaham.org/

October 6-8, 20102010 Annual National Institute (ANI)Harbor Beach MarriotFort Lauderdale, Florida

http://www.vhci.net/

Save the dates from March 2008 to March 2009, the U.S. unemployment rate has increased from 5.1 percent to 8.5 percent, with young workers facing an above-average increase. For workers age 20-24, the unemployment rate increased from 9.4 percent to 14 percent, and for workers ages 55 and older, it increased from 3.4 percent to 6.2 percent.

It’s important to be able to impress potential employers with your skills, knowledge and exceptional interpersonal skills. Obtaining your certification is one way to measure your yardstick for success. Below are key Certification dates to remember:

2009/2010 AAHAM Certification Schedule CPAT/CCAT/CT examsFebruary 15-26, 2010 March 1, 2010Registration deadline for allApril/MayCPAM/CCAM/CPAT/CCAT/CCT exams April 26-May 1, 2010Spring CPAM/CCAM exams Patt Lowe, Certification Chair, Texas Bluebonnet ChapterTexas Health ResourcesDirector Self-Pay & CharityPhone (682) 236-3426 Fax (682) 236-4606

2010 Annual State Institute

& Vendor Exhibit Marriot Austin Airport South

Austin, Texas

For more informationVisit www.txaaham.org, call 512-314-9177 or

email [email protected]

Patt Lowe Says Italy was Magnifico!

Our Certification Committee Chairperson, Patt Lowe, recently traveled to Italy with her mom, sister and brother-in-law. She said the trip was awesome and she’s already trying to find a way to go back. Perhaps the next certification exam should be conducted in Rome. What do you think?

Patt’s favorite sights included the Trivi Fountain and the Coliseum.

Certification CornerBy Patt Lowe, Certification Committee Chair, AAHAM Bluebonnet Chapter and Director of Self Pay & Charity, Texas Health Resources

Save the Date: June 9 - 11, 2010 CertificationClick here to learn more about AAHAM certification.

AAHAMTexas Bluebonnet Chapterhttp://www.txaaham.org/pages/certification

National AAHAMhttp://www.aaham.org/Portals/0/Documents/2009%20AAHAM%20Certification%20Brochure.pdf

http://www.txaaham.org

5

Did You Miss It?Fall Regional Development SeminarNovember 13, 2009, Houston, TexasHere’s What You Missed By Carolyn A. Gay, Publication Chair, Texas Bluebonnet Chapter and Administrator, Hollaway & Gumbert

Special thanks to:

• HCA - Houston Shared Services for their training facility; • Our speakers -- Tanja Twist, Carolyn Swanson, and Donny Zamora;• Scott Noel, Education Chair, for putting together a fine panel of speakers and another outstanding (and free) educational opportunity for our members.

A brief synopsis follows, plus program handouts can be downloaded from the Chapter’s website http://www.txaaham.org/handouts. (AAHAM membership not required to access handouts)

Captions, Comments, & Pics

Speaker Session A: Tanja Twist, Director, Patient Financial Services, Methodist Hospital of Southern California --- The Perfect Storm - RAC’s, ZPIC, MIP, MIG, PERM(introduced by Scott Noel, Program Chair, AAHAM Texas Bluebonnet Chapter)

It was no coincidence that the RAC speaker’s name was Tanja Twist because many of us felt like our stomachs were in a “twist” after

hearing Tanja’s tales from the California trenches!

• Tanja Says: You don’t want the “N102 Code”!Translation: Re-openings of Claims Denied Due to Failure to Submit Necessary Medical Documentation (remittance advice code N102 or 56900) Source: http://www.cms.hhs.gov/RAC/downloads/Final%20RAC%20SOW.pdf

• Tanja Says: Have you had a PERM today?Translation: What is your Payment Error Rate Measure?In 2002, the PERM program was enacted by CMS to measure improper payments in the Medicaid program and the State Children’s Health Insurance Program (SCHIP) for fee-for-service and managed care claims. Source: http://www.sccgov.org/keyboard/attachments/Committee%20Agenda/2009/August%2019,%202009/202551127/KeyboardTransmittalWeb202749951.PDF

• Tanja Says: Do you need a little salt with your PEPPER?Translation: CMS directed the TMF Health Quality Institute (TMF) to develop a tool that would help hospitals prioritize their auditing tasks --- PEPPER - - - Program for Evaluating Payment Patterns Electronic Report. Source: http://www.pepperinfo.org/

You will find Tanja’s handout at http://www.txaaham.org/files/handouts/The%20Perfect%20Storm,%20Tanja%20Twist.pdf

Contact Tanja at: [email protected] [(626) 574.3565]

“Did you miss it” continues on page 6

http://www.houstonlaw.com/

6

Extended COBRA Subsidy?WASHINGTON, DC – U.S. Sens. Sherrod Brown (D-OH) and Bob Casey (D-PA) introduced a bill November 5, 2009 to extend the “COBRA” subsidy which helps unemployed workers and their families afford temporary health care coverage. Many families will lose this temporary assistance which will begin to expire on Dec. 1, 2009, if Congress fails to act. The bill is also cosponsored by Sen. Al Franken (D-MN).

“Unemployed workers should be able to focus on finding work, instead of worrying about how to afford medical care for their families,” said Brown. “This bill will make temporary health coverage more affordable and accessible for American families. No family should be one medical visit away from financial disaster.”

Full Press Release http://casey.senate.gov/newsroom/press/release/?id=9207C8C0-2DBB-429B-AAAB-AE587835DA0C

Speaker Session B: Carolyn Swanson, Senior Director, Revenue Cycle Solutions, Conifer Health Solutions --- Expect the Unexpected - The Scorecard Tells All

Scorecards created by Conifer Health Solutions are awesome! If you want to monitor your operations more succinctly, so you will know who is doing what, when, where, and how, take a lesson from Carolyn Swanson and Conifer Health Solutions. See Scorecard examples from Carolyn Swanson’s presentation on the Chapter’s website at www.txaaham.org

Contact Carolyn at: [email protected] or(469) 893.2829

2009 Scholarship Winner, Leslie Davis, gets a BIIIGGGG CHECK from Misty Davis

Speaker Session C: Donny (Z Man) Zamora, Division President, The Outsource Group --- A New Approach to Emergency Department Point of Service Collections and Financial Counseling

Z Man Says…• Control patient flow; too many ED exits = collection problems

• How long is the line outside your ED? Are patients waiting for your financial counselors to go home or is your financial counseling area a 24/7 operation?

• Your point of service collections should be point of service “sales”.

• Adopt great scripting for financial counselors from the “greats”, like Chick-fil-A and Sprint.

Z Man says the Uninsured Tidal Wave is coming! A picture is worth 1000 words.

Contact Donny (Z Man) at: [email protected] handout at:http://www.txaaham.org/files/handouts/A%20New%20Approach%20to%20Emergency%20Dept%20Point%20of%20Service%20Collection...,%20Donny%20Zamora.pdf

“Did you miss it” continued from page 5

PARRISHSHAWHELPING MEDICAL PROVIDERS RECOVER

INSURANCE BENEFITS SINCE 1992

[email protected]

www.parrishshaw.com

To learn more about our servicesContact Us!

http://www.parrishshaw.com

By Carolyn A. Gay, Publication Chair, Texas Bluebonnet Chapter, and Administrator, Hollaway & Gumbert

Tumbleweed Wins First Place journal award at 2009 ANI!

Congrats to Grace, Jessica & Carolyn!

The Texas Tumbleweed were awarded first place in the AAHAM National

Journal Awards program at the 2009 ANI. The award was accepted by Marji Henry, 2008-2009 President, Chris Morgan, 2010-2011 President, and Scott Noel, First Vice President, 2010-2011.

Congratulations to the newsletter publication and design team, Grace Rachid and Jessica Medlyn and publications chair, Carolyn Gay.

Judging was based on the following criteria:

1. Purpose - To recognize excellence in journalism and graphics design in journals, newsletters and ejournal of AAHAM chapters published during the preceding period of July 1 - June 30.

2. Eligibility - All AAHAM chapters in good standing.

3. Application - Chapters entering the competition should submit the following form and copies of their journal or newsletter to the National Headquarters by July 30th, as

follows:Chapters with 20-60 National Members: 1 pdf version or hardcopy of two (2) different issues.

Our Chapter>>>>Chapters with 61-120 National Members: 1 pdf or hardcopy of three (3) different issues.

Chapters with 121 or more National Members: 1 pdf or hardcopy of four (4) different issues.

(Chapters that publish only one journal or newsletter issue per year are not eligible tocompete for this award.)

4. Judging - Submissions will be judged independently by a committee of public relationsprofessionals, journalists and graphics designers who have no direct relationship with AAHAM.

5. Awards - Awards are given in each of the three categories based on size of National

membership. The awards will be presented at the Annual National Institute and published in the fall issue of the AAHAM Journal of Healthcare Administrative Management.

7

2009 - 2010Corporate Sponsors

DIAMOND

GOLD Deco, LLC

Passport Health

Communications

ParrishShaw + Co.

SILVER Hollaway & Gumbert

Cardon Healthcare

Network, Inc

Apply / Renew Sponsorship

For a list of the benefits and to apply for or renew your sponsorship please visit us at www.txaaham.org/pages/partner. If you have any questions contact our Chapter Administrator, Debbie Peterson, CMP Management, at [email protected].

Marji Henry accepts award at ANI for The Texas Tumbleweed from AAHAM National President, Laurie A. Shoaf, CPAM

http://www.passporthealth.com/

Electronic Health Records (EHRs)

Health Level Seven (HL7)Global authority on standards for interoperability of health information technology.http://www.hl7.org/index.cfm

Certification Commission for Health Information Technologyhttp://www.cchit.org/Resource to find lists of certified E H R products

HIMSS (Healthcare Information and Management Systems Society)http://www.himss.org/ASP/topics_ehr.asp

Overview of Grants Office Resourcehttp://www.himss.org/content/files/GrantsOfficeResource.pdf

RACs, PEPPERS & MoreCMS Target AreasNote: These target areas may change based on current payment error trends.Reprinted from http://pepperinfo.org/cms-target-areas.html

One-day stays excluding transfers Numerator: count of discharges with length of stay less than or equal to one day excluding patient status of 20 (expired), 07 (left against medical advice), or 02 (discharged/transferred to a short-term general hospital for inpatient care)Denominator: count of all discharges excluding patient status 02 DRG 127 one-day stays Numerator: count of discharges with DRG equal to 127 (heart failure and shock) with length of stay less than or equal to one day excluding patient status of 20 (expired), 07 (left against medical advice), or 02 (discharged/transferred to a short-term general hospital for inpatient care)Denominator: count of all DRG 127 discharges DRG 143 one-day stays Numerator: count of discharges with DRG equal to 143 (chest pain) with length of stay less than or equal to one day excluding patient status of 20 (expired), 07 (left against medical advice), or 02 (discharged/transferred to a short-term general hospital for inpatient care)Denominator: count of all DRG 143 discharges DRGs 182 and 183 one-day stays Numerator: count of discharges with DRG equal to 182 (esophagitis, gastroenteritis and miscellaneous digestive disorders age > 17 with complication or comorbidity) or 183 (esophagitis, gastroenteritis and miscellaneous digestive disorders age > 17 without complication or comorbidity) with length of stay less than or equal to one day excluding patient status of 20 (expired), 07 (left against medical advice), or 02 (discharged/transferred to a short-term general hospital for inpatient care)Denominator: count of discharges with DRG equal to 182 or 183 DRGs 296 and 297 one-day stays Numerator: count of discharges with DRG equal to 296 (nutritional and miscellaneous metabolic disorders age > 17 with complication or comorbidity) or 297 (nutritional and miscellaneous metabolic disorders age > 17 without complication or comorbidity) with length of stay less than or equal to one day excluding patient status of 20 (expired), 07 (left against medical advice), or 02 (discharged/transferred to a short-term general hospital for inpatient care)Denominator: count of discharges with DRG equal to 296 or 297

DRG 014 Numerator: count of discharges with DRG equal to 014 (intracranial hemorrhage and stroke with infarct)Denominator: count of discharges with DRG equal to 014, 015 (nonspecific CVA and precerebral occlusion without infarct), or 524 (transient ischemia) IMPORTANT: DRGs 014 and 015 were redefined and DRG 524 was added effective with discharges starting October 1, 2002. This impacts the comparability of the proportions reported with these DRGs. Trending cannot be conducted for these DRGs using fiscal year 2003 data. Hospitals are recommended to evaluate the fiscal year 2003 data as a stand-alone time period.

DRG 079 Numerator: count of discharges with DRG equal to 079 (respiratory infections and inflammations age > 17 with complication or comorbidity)Denominator: count of discharges with DRG equal to 079, 080 (respiratory infections and inflammations age > 17 without complication or comorbidity), 089 (simple pneumonia and pleurisy age > 17 with complication or comorbidity), or 090 (simple pneumonia and pleurisy age > 17 without complication or comorbidity)

“RACs” continues on page 98

DRG 243 Numerator: count of discharges with DRG equal to 243 (medical back problems).Denominator: count of all discharges DRG 416 Numerator: count of discharges with DRG equal to 416 (septicemia age > 17)Denominator: count of discharges with DRG equal to 416, 320 (kidney and urinary tract infections age > 17 with complication or comorbidity), or 321 (kidney and urinary tract infections age > 17 without complication or comorbidity) Seven-day readmit to same facility or elsewhere Numerator: count of index (first) admissions for which a readmission occurred within seven days to the same hospital or to another short-term acute care PPS hospital for the same beneficiary (identified using the Health Insurance Claim number); patient status of the index admission is not equal to 02 (discharged/transferred to a short-term general hospital for inpatient care)Denominator: count of all discharges DRG 089 Numerator: count of discharges with DRG equal to 089 (Simple Pneumonia and Pleurisy, age > 17 with complication or comorbidity).Denominator: count of discharges with DRG equal to DRGs 089, 090 (Simple Pneumonia and Pleurisy, age > 17 without complication or comorbidity), or 088(Chronic Obstructive Pulmonary Disease)

Complication/comorbidity (CC) pairs Numerator: count of discharges for medical DRGs with a CC, excluding DRGs 079/089Denominator: count of discharges for all medical DRG pairs, excluding DRGs 079/080/089/090 3-Day skilled nursing facility (SNF)-qualifying admissions Numerator: count of discharges to a SNF with a three-day length of stayDenominator: count of all discharges to a SNF (identified by patient status code of 03 (discharged or transferred to a SNF) or 61 (discharged or transferred to a swing bed)) Source: http://pepperinfo.org/cms-target-areas.html

“RACs” continued from page 8Legislative Update - HB 1342Patient Refunds Due in 30 DaysHB 1342 was signed by the

Governor May 30, 2009 and

became law on the date

signed; however the Texas

Insurance Code has not been

updated to reflect the new

legislation. It is anticipated

that the statutes for the

81st Regular Session will

be incorporated by January

2010.

The primary focus of HB 1342

deals with EDI requirements

for health plans to use

information technology

to provide physicians,

hospitals and other health

care providers with real-time

information at the point of

service. It also prohibits

contracts between health

plans and providers from

prohibiting point of service

collections from enrollees

based on estimated member

liabilities.

The trade off is that it

also requires providers to

refund overpayments to

enrollees “not later than

the 30th day after the date...

provider determines that

an overpayment has been

made.”

To read the Bill in its entirety,

access it at the following

link http://www.journals.

house.state.tx.us/hjrnl/81r/

pdf/81RDAY73FINAL.

PDF#page=15

Publication InformationThe Texas Tumbleweed is published quarterly by the Texas Bluebonnet Chapter of the AmericanAssociation of Healthcare Administrative Management as a communication medium to Chapter members. Opinions expressed in articles are those of the authors and do not necessarily reflect the views of the Texas Bluebonnet Chapter or its members.

Members are encouraged to submit articles and report news of interest to the membership. Contact the chapter editor to obtain deadlines for submitting articles. The editor reserves the right to edit any submission for clarity and length, and to accept or reject any submission. Please send all submissions (articles in MS Word, advertising in .jpg, .pdf, or .tif files) to:

Carolyn Gay, Publications Chair • [email protected]

Submission Deadlines:Edition Publication Date Advertising ArticlesWinter January 15 January 2 December 7Spring April 15 April 1 March 15Summer July 15 July 1 June 15Fall October 15 October 1 September 15

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JOIN/RENEW TODAY!!

Chapter membership benefits & application: Go to http://www.txaaham.org/dues/renew/newmember to learn more about becoming a member of AAHAM Texas Bluebonnet Chapter.

National membership benefits & application: Go to http://www.aaham.org/Join/tabid/77/Default.aspx here to learn more about becoming a national member of AAHAM.

REGISTRATION FORM Professional Certification Webinar Series(Please return this page only. Phone numbers and e-mail

EMTALA Do’s and Don’tsThis is a “Don’t!

A man who died while waiting to see a doctor in a Philadelphia emergency room, and whose watch was then stolen, appeared to have expired within 11 minutes of signing in, a police official said. It was nearly 50 minutes later that hospital personnel noticed he appeared to be dead, a witness in the waiting room told police.

Source: Philadelphia Inquirer Full Story http://www.philly.com/philly/news/homepage/20091203_Death_in_Frankford_ER_took_11_minutes.html

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Advertising Guidelines

Advertising with sponsorship only.•All ads and logos should be in .eps, .tif, .jpg, or .pdf format at a •

minimum of 300 dpi. Ads cannot be “re-sized”. • Please do not send any graphics or logos embedded in MS Word •

or Acrobat text files.

Level Ad Size Ad Dimensions Diamond Full Page 9 3/4” H x 5 1/8” W Platinum Half Page 4 7/8” H x 5 1/8” WGold Quarter Page 2 1/2” H x 5 1/8” WSilver Business Card 2” H x 3 1/2” W

Please submit ads to Debbie Peterson at [email protected].

http://decorm.com/

PresidentChris Morgan, CPAM Grace Financial Services, LLC

First Vice PresidentScott Noel , MPA HCA - San Antonio

Second Vice PresidentAlan Spiegelhauer MAX Revenue Solut ions, Ltd.

SecretaryKarol Hopkins Scott & White Hospi ta l

TreasurerAngie Box Heal thcare Recovery

Chairman of the BoardMarj i Henry, CCAM Scott & White Hospi ta l

Corporate Partners ChairLora Wi l l is Texas Health Partners

Membership Chair: Julie Shaw ParrishShaw

Practice and Standards Chair: Patt Lowe Texas Health Resources

Certification Chair: Emily Goertz Texas Childrens Hospital

Legislative Chair: Greg Page The Methodis Hospital Chapter Excellence Chair: Sheila Weber St. Luke’s Episcopal Hospital

Constitution & Bylaws Chair: Greg HightowerDECO Recovery Management

Publications Chair: Carolyn GayHollaway & Gumbert

Education Chair: Carolyn SwansonConifer Health Solutions

Website Chair: Robin Gates Deloitte Consulting LLP Chapter Administrator: Debbie Peterson CMP Management

Chapter Officers &Committee Chairs

P. O. Box 27696Austin, TX 78755

[email protected]

http://www.cardonhealthcare.com/

The Texas Tumbleweed FirsT Place aT 2009 ani! The Texas ...€¦ · Save the dates from March 2008...

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