Winter 2015 HOA HeartBeat Newsletter_FINAL.pdf


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Volume 67 | Issue 3 Winter 2015

heartbeat H E A LT H C A R E F I N A N C I A L M A N A G E M E N T A S S O C I AT I O N S E R V I N G T H E K A N S A S C I T Y C H A P T E R Programming .............................2 Webinars ....................................2 President’s Corner ......................3 Membership Directory ................5

Virtual Conference ......................6 Officers and Directors.................7 Corporate Sponsors ....................7

Joint Fall Conference..............8&9 Region 8...................................10 Patient Protection Regulations ..11

MHA Update .............................12 New Members ..........................14 Get-To-Know-A-Member ..........15 HOA November Programming ...16

Outpatient Prospective Payment System Final Rule 2015 By Sue Brammer, CPA, FHFMA, Partner | BKD, LLP The Centers for Medicare & Medicaid Services (CMS) released the final 2015 Outpatient Prospective Payment System (OPPS) rule in the November 10, 2014, Federal Register (FR). The rule is effective January 1, 2015. This article highlights several of the major provisions related to outpatient services. The complete text may be found online. Consistent with past years, the OPPS rules exclude critical access hospitals and Indian Health Service hospitals as well as hospitals located outside the 50 states, District of Columbia and Puerto Rico.

Rates The Medicare rates will increase by 2.2 percent, more than the 2014 increase of 1.8 percent. The increase includes a 2.9 percent market basket increase, reduced by 0.5 percent multifactor productivity adjustment and a 0.2 percent adjustment as mandated by the Patient Protection & Affordable Care Act. CMS projects an increase in Medicare payments of approximately $5.1 billion. For hospitals failing to meet the quality reporting requirements, their rates will continue to be reduced by 2 percent. Rural sole community hospitals (SCH) also will continue to receive the 7.1 percent additional adjustment. Table 49 of the FR includes the estimated rate changes for the various hospital types, which includes an estimated 2.3 percent increase for urban hospitals, 1.9 percent for rural hospitals, 3.1 percent for major teaching hospitals and 2 percent for nonteaching hospitals. For hospital-specific information, CMS has included on its website an impact file organized by provider number. In analyzing the rate changes, it is important to also evaluate the impact of the wage index changes. Sixty percent of the outpatient payment remains adjusted by the wage index. Similar to the Inpatient Prospective Payment System (IPPS) regulations for federal fiscal year 2015, CMS is implementing the new core based statistical areas (CBSA) from the Office of Management & Budget (OMB) based on the 2010 census. For hospitals negatively affected by a CBSA change, there is a one-year transition period during which the hospital will be paid 50 percent based on the old CBSA wage index and 50 percent paid based on the new index.

Article continues on page 4

mark your calendars National Webinars

Heart of America Programming

Live Webinars Feb 3 Revisiting Lessons Learned from the ICD-10 Testing Front Lines

The topics listed are subject to change and will be more clearly defined as the program year progresses:

Feb 17

Navigating a Return on Investment to Transition to Value-based Care

Feb 18

Improving Revenue Cycle Performance . . .

FEBRUARY 19, 2015 Back by popular demand! Healthcare 101 Mary Mirabelli, National HFMA Treasurer and Secretary Speaking Location: St. Joseph Medical Center, Kansas City, MO

Mar 4

Achieving Payment Clarity: How Gwinnett Medical Center’s Collections Program Inspires Positive Financial Results and Patient Loyalty

Mar 19 Pre-Eligibility Screening of Your Supply Chain Data

Webinars available for one year... Available until: Mar 13 How to Develop and Maintain Supply Chain Transparency and Control Apr 28

Improving Price Transparency: A Consensus-Based Approach

Jun 6

Back to the Future: Transcription’s Past Is Coding’s Future

If you are interested in presenting a webinar, please contact Kurt Belisle at [email protected].

Topics Include: - Revenue Cycle - Stark and Anti-Kickback - Benchmarking and Productivity - Taking Charge of Patient Financial Management - And More! Lunch 8:30 am – 4:30 pm $65

MARCH 26, 2015 First Annual! Women in Healthcare Luncheon $25 APRIL 23, 2015 Lunch 12:00 – 4:30 pm $65

Leadership/Organizational Skills & Awards Banquet Location: Ritz Charles

Region 8 Webinar FEBRUARY 17, 2015 12:00PM – 1:30PM CST

The Importance of Properly Reporting Charity Care and Bad Debt

View all upcoming on-demand webinars HFMA provides webinars available one calendar year following the live webinar date and year. Most on-demand webinars are free for HFMA members and $99 for non-members, unless otherwise noted. Go to http://www.hfma.org/Templates/OnDemandWebinars.aspx?id=6730 to view all available on-demand webinars with topics that include: - Accounting & Financial Reporting - Finance & Business Strategy - Payment, Reimbursement, & Managed Care - Revenue Cycle - Technology - And others – page 2 –

Jim Mozena, President

Dear Heart of America HFMA Members Another year has passed and the excitement of the New Year is upon us. 2015 is the 50th anniversary of the Medicare program being signed into law by President Lyndon Johnson, which forever changed the health care environment. We have several challenges this year, including the additional portions of the ACA which go into effect in 2015, and the implementation of ICD-10 on October 1 (if it happens this year). HFMA national and local resources are available to provide education to our members and to assist in meeting the challenges. We look forward to some great upcoming programs and networking opportunities, so please join us at the next event.

Call for Committee members! The Heart of America chapter is planning for the 2015-2016 fiscal year, and we are looking for committee volunteers. Being a part of a committee provides you with the opportunity to network with the 300 members of our chapter. The following provides a description of the various committees available to members. 1. Programming committee – Assist in the planning of educational events during the year. Typically a member will assist in one event during the chapter year.

Roadshows If your facility would like to have an on-site educational event for your staff or co-workers, please contact Mea Austin at [email protected]. There are over 15 topics to choose from, including Team Building, Leadership and the ACA.

Membership As of January 13, 2015 our membership total is 306 members. We still need to add 36 new members to reach the goal of 342. As we have done in the past, any member who refers a new member will be entered in a chapter drawing for $200. Also, you may be eligible to win the following from National: - HFMA apparel item, duffel bag, or smartphone accessory - $25, $100 or $150 Visa Prepaid Cards - Cash prizes of $1,000 or $2,500 - Apple iPad Mini - Grand Prize of $5,000* - will be paid as follows: $3,000 for the - winner and $2,000 donated to a charity of their choice. I look forward to seeing you at the next meeting!

2. Membership committee – Assist with coordinating events for new members, including lunch meetings and meeting new members at programs. 3. Social Media committee – Assist with the monthly updating of the website and LinkedIn. 4. Certification committee – Educate members about the certification and assist individuals with the test. 5. Publications committee – Plan and organize the quarterly newsletter. Coordinate photographer at HFMA events 6. Networking committee – Coordinate networking events, including the golf tournament, happy hours, and sporting events.

Educational Events As of December 10, 2014, the total number of education hours for the year was 2,934. Our chapter goal, as set by National, is 4,555 hours, and we need your assistance to reach the goal. If you are unable to attend the Chapter’s live events, please check out the HFMA National website at http://www.hfma.org/Templates/UpcomingWebinars. aspx?id=613) for live, on-demand, and self-study webinars. The chapter receives hours for the time that you take each webinar.

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Final Rule 2015, continued...

C-APC & Other APC Changes A major change is the implementation of 25 of the 28 proposed comprehensive ambulatory payment groups (C-APC), which CMS defines as “a classification for the provision of a primary service and all adjunctive services provided to support the delivery of the primary service.” The 2014 final rules included the regulations regarding assigning device-dependent APCs for a single service payment effective January 1, 2015. The 2015 FR is a continuation of the discussion regarding C-APCs. For the C-APC codes, the status indicator is J1. These 25 C-APCs represent 219 procedures. Table 6 includes the list of exclusions from the C-APC services. Table 7 lists the C-APCs, which include 12 clinical families. The families are important because if there is more than one service with two different families, the payment will be based on the higher. Finally, Table 8 lists the add-on codes that are evaluated for the complexity adjustment. Not to be confused with C-APCs, CMS also has composite APCs, which also receive a single payment for groups of services performed together normally. It is important to review the changes related to composite APCs. CMS is conditionally packaging ancillary services that are “integral, ancillary, supportive, dependent, or adjunctive to a primary service.” Ancillary services with a geometric mean cost of $100 or less will be conditionally packaged; they will be paid only if that service is the only one on the claim. Service performed with an emergency room visit, for example, will not be paid. Exceptions to this rule for preventive services can be found in Table 1. Other services excluded from packaging are certain psychiatric and counseling-related services, low-cost drug administration services and add-on drugs like immunizations. The APCs conditionally packaged as ancillary services are listed in Table 12. CMS also finalized changes to conditional package services with status indicator X (ancillary services). CMS will delete status indicator X as of January 1, 2015. These services will be assigned status indicator Q1 (conditionally packaged) or S (significant procedure, not discounted when multiple). Ancillary services will not generate separate payment in 2015 if provided on the same date of service as a procedure or visit. CMS also finalized the packaging of add-on codes assigned to device-dependent APCs. All medical and surgical supplies covered under the OPPS now will be packaged. Other changes include: • CMS finalized its proposed changes to device-dependent edits beginning in 2015 and will require facilities to report a device code for procedures currently assigned to a device-dependent APC.

• All implantable prosthetic supplies now are packaged with the related surgical procedures. This general category includes items such as ostomy skin barriers and phalanges. Replacement prosthetic supplies at a time later than the initial surgical procedure and outside the hospital still will be available through the DMEPOS Fee Schedule. It appears nonimplantable prosthetic devices, such as braces and splints, commonly provided in emergency room vis its and physical therapy department continue to be payable through the DMEPOS fee schedule. • CMS will use a high- and low-cost threshold for skin substitutes based on the weighted average mean unit cost for all skin substitutes based on claims data. These costs were factored when assigning the application procedure CPT codes into the correct APC. CMS also will evaluate skin substitute applications to determine whether to use pass-through payment through the device pass-through process versus the drug pass-through process when setting future payment rates. The Healthcare Common Procedure Coding System (HCPCS) codes for skin substitutes have expanded from two in 2014 to 61 distinct codes in 2015. The vast majority of the codes (43) continue to be packaged. Only 18 HCPCS codes had or continue to have pass-through status. Tables 34 and 35 offer further detail. • Any new or revised CPT codes after July, when the proposed rules are released, will not be included in the final rules or quarterly up dates. Instead, new and revised codes will be delayed in adoption for a year. The exceptions are those CPT codes that describe a whole new technology or procedure not previously addressed under OPPS. Those new CPT codes would be priced and made effective outside the annual rate-setting process. This change is effective January 1, 2016. Therefore, only codes released by the American Medical Association by July 1, 2015, will be included in the final rules for 2016. • Nonpass-through drugs and biologicals separately payable under OPPS will be reimbursed at the average sales price plus 6 percent. • The inpatient-only list has been modified to add CPT 22220 (osteotomy of spine including discectomy, anterior approach, single vertebral segment; thoracic) and delete CPT 63043 and 63044. See Addendum E for the complete list of inpatient-only codes. The recalibration of the APC-relative payment weights was computed similar to the 2014 final rule methodology. Refer to Addendum A and B for the relative weights for 2015.

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Final Rule 2015, continued...

Provider-Based Departments In an effort to gather more information about payments made to off-campus provider-based departments, CMS is creating HCPCS modifier PO, which should be added to the outpatient claims for services provided in off-campus PBDs effective January 1, 2016. The definition of “on campus” is not changing—the main building or buildings adjacent to the main campus or within 250 yards of the main buildings. Reporting of the modifier is voluntary for 2015. In addition, CMS is changing related place of service (POS) codes on a professional claim. The POS 22 (outpatient hospital department) will be deleted and replaced by two POS codes to indicate on-campus or off-campus. The new POS codes will be available by July 1, 2015. The POS 23 for emergency room visits will continue. Finally, please note the above changes for off-campus provider-based facilities do not include remote or satellite facilities as defined by 42 CFR 413.65(a)(2) and 42 CFR 412.22(h), respectively.

Quality Provisions With regard to the outpatient quality reporting (OQR) program, CMS is adding one measure (OP-32: Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy) for 2018 that was proposed to be added for 2017. Prior to reporting the measure, CMS will perform a preliminary analysis to allow hospitals to review their scores and provide feedback. CMS also is excluding one previously adopted measure (OP-31: Cataracts—Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery) for 2016, making it voluntary for 2017. CMS has redefined “topped out” and removed two such topped out measures (OP-6: Timing of Antibiotic Prophylaxis and OP-7: Prophylactic Antibiotic Selection for Surgical Patients). OP-04: Aspirin at Arrival will be retained in the Hospital OQR Program

requirements. Clarifications related to the data submission for OP-27: Influenza Vaccination Coverage among Healthcare Personnel was included and delayed data collection for two measures (OP-29: Endoscopy/Polyp Surveillance: Appropriate Follow-up Interval for Normal Colonoscopy in Average Risk Patients and OP-30: Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adnomatous Polyps—Avoidance of Inappropriate Use). Other changes include revisions to the validation procedures and criteria for extraordinary situation extensions or exemptions. Program resources and requirements can be found on QualityNet.

Physician Certification Based on the 2014 IPPS final rule, CMS requires physician certification, including an admission order, for all inpatient admissions. However, the 2015 OPPS final rule changed this requirement so that as of January 1, 2015, physician certification is required only for longstay cases expected to last at least 20 days and for outlier cases. The admission order remains required for inpatient stays.

Other The OPPS rules also include numerous changes to APCs, CMHCs and physician ownership expansion issues that are beyond the scope of this article. It is evident from the 2015 OPPS rules that CMS plans to continue consolidating and packaging payments in subsequent years. It is important to evaluate the impact of the 2015 and future changes. For more information, contact your BKD advisor. Article printed with permission from BKD, LLP, www.bkd.com. All rights reserved.

Membership Directory – Now ONLINE! For the 2014-15 year, we have utilized the HFMA National website to provide an up-to-date electronic database for our current membership listing. HFMA Online Membership Directory (Requires Log-In and Password) After you log-in, click on “My Account” in the upper right hand corner, then select “Membership Directory.” Under “Chapter,” use the drop down box to select “Heart of America” to see a full listing of our current members. While you are there, please take a moment to review and update your information.

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VIRTUAL CONFERENCE 2015

Not to be missed. FEBRUARY FEBRUARY 5, 5, 2015 2015

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Matt Matt Salo Salo E Executive xecutive D Director irector N National ational A Association ssociation ooff M Medicaid Directors edicaid D irectors

HFMA HFMA members: members: Free Free N Non-members: on-members: $$175 175 ((includes includes fifirst-time rst-time m membership embership through through May May 2 2015) 015)

S SIGN I G N UP UP T TODAY O D AY FOR FOR H HFMA’S F M A ’ S VIRTUAL V I R T U A L CONFERENCE C O N F E R E N C E – FEBRUARY F E B R U A R Y 5, 5 , 2015 2015

hhfma.org/virtualconference f m a . org /v i r t u a lc on f eren c e – page 6 –

Officers and Directors 2015 HEART OF AMERICA CHAPTER OFFICERS

BOARD OF DIRECTORS 2013-2015

President President-Elect Vice President Secretary Founders/DCMS Treasurer

Mea Austin Heath Leuck Cathy Kindle Karrie Pence Mary Knollmeyer

Jim Mozena Paul Knudtson Michelle Narayan Todd Kenney Todd Kenney Matt Robertson

2015 PUBLICATION COMMITTEE Jessica Baird, Co Chair Cathy Kindle, Co Chair Kelly McWhorter

Deadline for submission of articles for the next newsletter is March 13, 2015.

2014-2016 Jessica Baird Damara Harper Esteban Ponce

816-407-2041 816-691-2010 913-890-5017

Keely Roach

2015 Corporate Sponsorship PLATINUM

GOLD

BKD, LLP Bank of America Merrill Lynch Haase & Long Human Arc McGladrey LLP Mercer MMIC

Bank of Kansas City Commerce Bank

Sincere appreciation is extended to our corporate sponsors for 2014. Your support of our Chapter significantly improves our ability to offer quality programs to our members. Please consider joining our fantastic group of sponsoring organizations.

SILVER Cardon Outreach Country Club Bank

If you are a service provider, please contact: Mea Austin 785-842-0726 Mary Knollmeyer 913-791-3500 x 4018

Come join us! HFMA volunteers receive opportunities for professional development, information, networking, and advocacy and earn Founders points when they participate in a chapter committee. The 2014-15 committee chairs and co-chairs are as follows: Audit Committee Keeley Roach 816-474-4253 x21507

Fall Workshop Committee Paul Knudtson, Chair 816-932-0336

Programs Committee Michelle Narayan, Co-Chair 913-791-4260

By-Laws Committee Mary Knollmeyer, Chair 913-791-3500 x4018

Social Media/Networking Committee Heath Leuck, Co-Chair 816-347-2859 Kalinda Tenborg, Co-Chair 913-234-6654

Nominating Committee Andrea Lindsay, Chair 816-502-7033

Sponsorship Committee Mea Austin, Co-Chair 785-842-0726 Mary Knollmeyer, Co-Chair 913-791-3500 x4018 Membership Committee Todd Kenney, Chair 816-701-0266 Website Matt Michalak, Chair 817-308-7338

Directory Robert Fowle, Chair 913-319-6209 Certification Damara Harper, Chair 816-781-7200 Publications Committee Cathy Kindle, Co-Chair 816-691-2010 Jessica Baird, Co-Chair 816-407-2041

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Link Committee Frankie Forbes, Chair 913-341-8600

18th Annual Joint Fall Conference While the Royals were gearing up at Kauffman Stadium for the second game of the World Series, the 18th Annual Joint Fall Conference commenced on October 22 at the Adams Pointe Conference Center in Kansas City with 114 attendees. Jim Mozena, Heart of America Chapter President, presented the opening remarks for the 3-day conference, while Brad King, principal with CliftonLarsonAllen, provided a perspective on national and local trends in provider collaborations in the first session. Other speakers included Dr. Douglas Pogue, Medical Director for BJC Accountable Care, Patrick Sulzberger, Partner with Total Solution Partners, Sandy Praeger, Kansas Commissioner of Insurance, Mike Ashley, Vice President of Lancaster Pollard, Chad Powers, Vice President and General Counsel for Medical Reimbursements of America, Inc., Brian Coffey, CEO of Hamilton County Hospital, Morgan Waller, Director at Children’s Mercy Hospital, Beth Ann Stansbury, CPA with BKD, Greg Beech, Senior Analyst with eSolutions, Inc., Corinna Goron, President of Healthcare Reimbursement Services, Inc., Kristin DeGroat, Attorney with Southwest Consulting Associates, Roger Weiss, Chief Operating Officer at CACi, Thomas McAuliffe, Missouri Foundation for Health, Jim Landman, J.D., PhD, Director, Healthcare Finance Policy with National HFMA, Kristen Loney, President of Business Development, Opus Solutions, Andrew Wheeler, Vice President of Federal Finance, MHA, and Steve Renne, Vice President of Children’s Health and Medicaid Advocacy, MHA. The conference also offered a vendor fair and multiple opportunities for networking and entertainment. The first night included a World Series party with ballpark snacks and a win for the Royals. Thursday evening was filled with mystery and suspense as participants enjoyed a murder mystery dinner. We would like to thank all of the speakers and conference attendees who made this year’s Joint Fall Conference a success!

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2 1

2&3

Andrea Lindsay and Jim Mozena network with Tracy Packingham, Region 8 Executive (2nd from left), and other conference attendees.

The Wednesday evening entertainment included a large screen, the World Series, and an impressive array of ballpark snacks!

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Joint Fall Conference, cont.

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7 4 5 6 7 8 9 10&11

11 Shanna Hanson and John Maschger John Travis and Mary Knollmeyer MHA Speakers Andrew Wheeler and Steve Renne presented on the Federal and State legislative and regulatory influences on hospitals. Jessica Lillard from St. Luke’s in Kansas City won the grand prize – a flat screen TV! Brian Coffey (left), pictured with Paul Knutson, is the CEO of Hamilton County Hospital located in western Kansas. He shared how telemedicine expanded healthcare access for his community and improved their bottom line. Dr. Douglas Pogue, Medical Director for BJC Accountable Care, provided an update on the ACO landscape and insights from a recent meeting with Medicare officials. Great food and lots of laughs were supplied by the murder mystery dinner during Thursday evening’s entertainment.

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Tracy Packingham, Region 8 Executive

Greetings Fellow HFMA Members Happy New Year!!! As I write this, the football season is winding down and the Super Bowl is right around the corner. It reminds me of what a great team we have within HFMA. “TEAM” Together Everyone Achieves More. I believe that TOGETHER we can truly achieve anything. Being part of the HFMA Line Up has been a phenomenal journey that I have had the opportunity to be a part of. As I talk with other members, officers and colleagues, I realize that I am not alone in this reflection. The chapter leaders and members of Region 8 make a fabulous team. Please reach out and become part of your chapter. Regardless of whether you are a sports fan, be a fan and love the Association of which we are a member. Become a part of a “team” of dedicated healthcare Professionals. “Lead the Change”, with the constant change we all have talents and contributions. Not one of us can do it ALL. Get involved and make the most out of your membership. Thank you for the continued support of all of our officers, directors, volunteers and members. Our chapters are truly exceptional. Region 8 ROCKS!!!

Winter Sponsor Spotlight: McGladrey LLP About McGladrey LLP The rapid evolution of the health care field presents a variety of tough challenges. Improving patient care and safety while coping with everrising costs is difficult enough. But today’s health care leaders must also deal with complicated and fast-changing reimbursement systems, cumbersome tax codes and unpredictable revenue cycles – all while managing disparate risks and pursuing capital for investments in everything from information technology to advanced medical equipment. What’s more, industry executives must adapt to an array of complex changes mandated by recent health care reform legislation.

Power comes from being understood.® When you trust the advice you’re getting, you know your next move is the right move. That’s what you can expect from McGladrey. That’s the power of being understood. For more information, contact Karrie Pence at 816.751.1831. Experience the power. Go to www.mcgladrey.com/healthcare

At McGladrey, the fifth largest accounting, tax, and business consulting firm in the United States, we are committed to serving clients in all sectors of the health care industry. In addition to assurance and tax planning, we provide business services such as revenue performance improvement, information technology services, operational and strategic consulting, third-party reimbursement and regulatory services, cost report preparation, risk management, ICD-10 transition, valuation services, and merger and acquisition integration and optimization. We work with more than 4,000 health care institutions around the country. To learn more about our comprehensive, coordinated and cost-effective solutions, visit: www.mcgladrey.com/healthcare.

© 2014 McGladrey LLP. All Rights Reserved. MCG-1214KV

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Treasury Finalizes Patient Protection Regulations for Tax-Exempt Hospitals Charitable hospitals play a crucial role in the health of the communities they serve. Medical debt has become one of the largest types of debts owed by consumers, followed only by mortgages and auto loans. Hospitals with a 501(c)(3) status who use aggressive debt collection practices have fallen under the scrutiny of both the Internal Revenue Service and the Consumer Financial Mea Austin Protection Bureau. The Affordable Care Director of Solutions Act (ACA) included additional consumer Haase and Long, Inc. protection requirements for charitable hospitals to protect patients from abusive collections practices and to insure they have access to information about financial assistance. On December 29th, 2014, the U.S. Department of the Treasury took the final step to provide guidance on the ACA provisions.

of financial assistance and how to obtain more information. A “plain language summary” of the FAP is required only if and when the hospital sends a written notice about potential extraordinary collection actions. Additionally, the applicable 120 and 240 day periods set out in the proposed rules were clarified as starting on the first “post-discharge” billing statement.

The final regulations reduce the compliance burden on hospitals and insure that reasonable efforts are made to determine if patients are eligible for financial assistance. The revisions eliminate the need to have a plain language summary of the Financial Assistance Policy (FAP) included with all (and at least three) billing statements and with all other written communications. Moving forward, patient bills need only include a general notice informing patients about the availability

These requirements took effect shortly after the ACA passed in 2010. The final regulations apply to tax years beginning after December 20, 2015. For prior tax years, hospitals can rely on a reasonable, good-faith interpretation of the previously proposed regulations.

Hospitals can inform visitors about their FAP by posting information in the emergency and admissions areas, not necessarily in all public areas. A new addition to the final rule requires hospitals to describe which providers are covered by their policies and which are not. Hospitals cannot exclude an outsourced emergency department from its FAP and retain tax exemption. The final rule identifies some changes in calculating amounts generally billed (AGB), adding that Medicaid rates can be used as part of the calculation. Hospitals are allowed to change the method used to determine AGB at any time as long as patients are notified of the change.

For further information, contact Mea Austin at: [email protected].

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Andrew B. Wheeler, Vice President of Federal Finance, Missouri Hospital Association

2015 Federal and State Legislative and Regulatory Outlook As the 113th United States Congress ends and the 114th begins, “shots across the bow” are already taking place to reform and protect the integrity of the Medicare program. The U.S. House of Representatives Committee on Ways and Means recently released discussion drafts, which have the potential to influence the Medicare program. These documents can be used to gain an understanding about what hospitals might be facing in 2015. The Hospital Improvements for Payment Act of 2014, released in November 2014, contains several sections aimed to reform the Medicare program. The draft is intended to address nine specific issues, including a new hospital prospective payment system, a new per diem rate for short lengths of stay, repeal of the two-midnight payment reduction policy, improvements to the recovery audit program and expanded access to Medicare data. Other proposed sections include retrospective and prospective hospital solutions to address problems in the Medicare appeals process, repeal of the “ObamaCare Bay-State Boondoggle,” and changes to the critical access hospital 96 hour condition of payment provision.

A “hospital organization” is one that operates one or more hospital facilities, which is defined as a facility that is required by a state to be licensed, registered or similarly recognized as a hospital. Multiple buildings operated under a single state license are considered a single facility. Following the language of the federal law, no exemptions or exclusions are provided for tax-exempt governmental hospitals. A tax-exempt hospital’s omission or error regarding its community health needs assessment will not be viewed as noncompliant if it is minor and either inadvertent or due to reasonable cause and is corrected by the hospital. A tax-exempt hospital’s financial assistance policy must list the providers, other than the hospital itself, delivering emergency or other medically necessary care in the hospital, and specify which providers are covered and not covered by the hospital policy. article continues on next page...

The Protecting the Integrity of Medicare Act of 2014, also released by Ways and Means as a discussion draft, would combat fraud, waste and abuse in the Medicare program. Sections of PIMA include preventing wrongful Medicare payments, use of Smart Card technology, modifications to face-to-face encounter documentation requirements, reducing improper payments through Medicare administrative contractor outreach and education programs, and the renewal of MAC contracts. On the federal regulatory front, the Internal Revenue Service now has finalized the rule on standards for tax-exempt hospitals regarding financial assistance, collection practices and community health needs assessments. While the rule finalizes a 2012 proposed rule on financial assistance and a 2013 proposed rule on community health needs assessments, several nuances to the rule have changed. The changes include: The final rule changes the threshold for translating financial assistance documents into primary language of those with limited English proficiency. A tax-exempt hospital’s financial assistance policy and related documents must be translated for each population that exceeds 1,000 individuals or 5 percent of those likely to be affected by, or have an encounter with the hospital, whichever is less. The proposed rule included a threshold of 10 percent of the residents of the community served by the hospital.

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The final regulations allow a tax-exempt hospital to change the method it uses to determine “amounts generally billed” at any time, so long as the change is reflected in the hospital’s financial assistance policy documents. The billing periods specified in the regulation will begin with the first “post-discharge” billing statement, rather than the first billing statement. A plain language summary of the hospital’s billing policy must be included with one post-discharge written communication. Also, billing statements must include a notice about the availability of financial assistance and how to get information about the hospital’s financial assistance plan. The IRS had previously proposed that a financial assistance policy summary be included with all billing statements and other written communications during the first 120-day billing period. Notice requirements for “extraordinary collection actions” are narrowed in the final rule.

be the cornerstone of MHA’s advocacy efforts during the 2015 state legislative sessions. A key component will be explaining the positive experiences of bordering states that have expanded Medicaid eligibility. Results of expansion are starting to surface, contributing to marked improvements in payer mix, utilization trends and reduction in uncompensated care expenses. Recently, Arkansas Hospital Association, in conjunction with the Arkansas Chapter of the Healthcare Financial Management Association, released a document illustrating the major effects of Medicaid expansion on their hospitals. According to the report, uninsured admissions have decreased more than 46 percent, uninsured emergency room visits are down more than 35 percent and uninsured outpatient visits have decreased 36 percent. In addition, the losses incurred to treat the uninsured in Arkansas have declined by $69 million through June 2014. To date, Missouri’s border states that have expanded coverage include Iowa, Illinois, Kentucky and Arkansas. As a nation, 27 states and the District of Columbia have all expanded Medicaid coverage, with four other states currently considering expansion, including Tennessee. This now places Missouri in the minority among states. Once again, MHA will be coordinating its advocacy efforts with a broad coalition of organizations that support Medicaid transformation.

Within the state of Missouri, the Missouri Hospital Association will continue to work diligently with community leaders and state officials to decrease Missouri’s uninsured rate. Medicaid transformation will

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Connecting industry expertise with customized solutions is how healthcare systems and patients grow stronger.

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Welcome New Members! Rene Bowling Manager, Patient Financial Services Liberty Hospital Work Phone: (816) 407-4713 Email: [email protected] Lacey Bredehoeft-Fiene Director of Accounting, Western Missouri Medical Center Work Phone: (660) 262-7311 Email: [email protected] Essence Montgomery Administrative Director of Finance Work Phone: (785) 270-7636 Email: [email protected] Matthew Hamilton Revenue Cycle Strategist, Cerner Work Phone: (816) 301-2053 Email: [email protected] Jeremy Pelski Revenue Cycle Executive, Cerner Work Phone: (816) 914-5274 Email: [email protected]

Kelly McWhorter Business Development Associate, Kforce Work Phone: (913) 890-5017 Email: [email protected] Heather Fraley Executive Recruiter, Kforce Work Phone: (913) 890-5027 Email: [email protected] Cory Miller Vice President - Commercial Lending, UMB Bank Work Phone: (816) 860-7177 Email: [email protected] Gabrielle Lindsey Product Manager, UMB Bank Work Phone: (816) 860-7276 Email: [email protected] Lesli Elting Staff Accountant, Myers and Stauffer LC Work Phone: (309) 255-1611 Email: [email protected] Aundral Wilmore Staff Accountant, Myers and Stauffer LC Work Phone: (913) 234-1229 Email: [email protected]

LET OUR STRENGTH BE YOUR ADVANTAGE Mercer has the expertise, tools, and scale to address the needs of your system’s investment pools and retirement plans. We offer a valuationbased investment discipline and a unique approach to quantifying risk, and can also streamline your governance processes and vendor relationships. MERCER INVESTMENT SOLUTIONS FOR THE HEALTH OF YOUR INVESTMENT PROGRAM For more information, contact Michael Ancell at +1 314 982 5709 or at [email protected]; or visit www.mercer-hammond.mercer.com.

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Get to Know a Member How did you hear about the Heart of America Chapter of HFMA and why did you join? Commerce Bank has historically been very active in HFMA at a national level as well as all the local chapters within our footprint. Since I am a Healthcare Industry specialist, I greatly appreciate the education and ability to meet new and interesting people. What do you hope to gain out of being a member of HFMA? I hope to continue to deepen my knowledge base so I can provide my clients and prospective clients with the expertise they need to make sound financial decisions. What do you like most about your job? I enjoy helping solve complex financial problems in such a highly regulated and ever changing industry. What advice would you give someone entering the healthcare field? Cultivate a passion for serving others, and never stop learning!

Ryan Stoll

What is something that most people do not know about you? I am an avid student of the Bible, and I play the piano semi-professionally. How long and why do you work in healthcare? I have specialized in Healthcare for 2 years. I chose to work in healthcare finance because I enjoy helping providers and other HC organizations cope successfully with the sweeping changes in the industry. I also greatly appreciate working with quality people that have a tremendous impact on the health, wellness, and happiness of our communities.

Winter Sponsor Spotlight: Haase + Long Stay S tay out out of of the tth he Consumer Consumer Financial Financciial Protection Protecttiion B ureau medical medical debt debt spotlight! spotl tlight! Bureau Haase H aase + Long Long can can help help with with CFPB CFPB and and 501(r) 501(r) compliant compliant solutions. solutions. We W e ccompassionately ompassionately create create zero zero balances balances with with ssolutions olutions that t ha t work up w or k u p ffront, ront, often of ten preventing preventing the the need need to to send send patients patient s to to medical ccollections ollec tions or or report repor t m edical debts debt s with with Credit Credit Reporting Re p o r t ing DJHQFLHV:HR΍HUHYHU\SRVVLEOHVROXWLRQIRUWKHXQLQVXUHG D JHQFLHV:HR΍HUHYHU \SRVVLEOHVROXWLRQIRUWKHXQLQVXUHG D QGXQGHULQVXUHG0DUNHWSODFHHQUROOPHQWȴQDQFLDOFRXQVHODQGXQGHULQVXUHG0DUNHWSODFHHQUROOPHQWȴQDQFLDOFRXQVHOiing, ng , e nrollment in in all all State State and and Federal Federal programs, programs, disability di s a b ili t y enrollment e nrollment a nd ccounseling, ounseling , payment payment plans plans and and traditional t r a di t i o n a l enrollment and ccollection ollec tion sservices. er vices. We have have been been serving ser ving the the Greater Greater Kansas Kansas City Cit y area area for for over o v er We ȴ I W \\HDUVDQGKDYH0HGLFDLGH[SHULHQFHLQIRU W \W ZRV WDWHV ȴIW\\HDUVDQGKDYH0HGLFDLGH[SHULHQFHLQIRUW\WZRVWDWHV H aase + Long Long increases increases revenue revenue and and eliminates eliminates costs cos t s with w i th Haase iinnovative nnovative ssolutions olutions that that comply comply with with 501(r) 501(r) and and prevent prevent m edical debt debt from from ffalling alling under under the the scrutiny scrutiny of the the CFPB. CFPB. medical

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call call ((785) 785) 344-3306 34 4 -3306 or email [email protected] email ma [email protected]

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HOA November Program 2

1

Discussion of Healthcare Environment and Executive Panel The always popular Executive Panel program was held on November 20 at the Ritz Charles in Overland Park, and was attended by over 100 local healthcare professionals. The first portion of the program included a presentation by Joe Watt, CPA, Partner at BKD, LLP, which provided an overview of the current healthcare environment and insight into the top issues impacting providers today. Mr. Watt touched on many hot topics, including the steady decline in reimbursement due to the transition from fee-for-service to pay-for-performance payment models, the resurgence of narrow networks and the decision of lawmakers to decline Medicaid expansion in the states of Kansas and Missouri. The executive panel was comprised of senior leaders from Mosaic Life Care, Olathe Health System, Saint Luke’s Health System, Truman Medical Centers, and The University of Kansas Hospital. Joe Watt moderated the lively discussion which focused on the impact of the Affordable Care Act (ACA), changing demographics, and the delay in converting to ICD-10, among other topics. When asked for his thoughts on the ACA John Wilson, CFO of Mosaic Life Care indicated the act had caused a decrease in net revenue for the health system. Tierney Grasser, Senior Vice President and Chief Financial Officer of Olathe Health System, stated the recession continues to have an impact on healthcare providers, especially in rural facilities. Panelists were asked to discuss the issues that kept them up at night, and Allen Johnson, CFO of Truman Medical Centers, stated the security of patient data, as well as how to continue to provide a high level of care at a lower cost. When asked what healthcare leaders need to be prepared for the future, Chuck Robb, Senior Vice President, Finance and Administration and CFO of Saint Luke’s Health System, stated that healthcare leadership must have the ability to be flexible and move quickly. Chris Hansen, Senior Vice President, Ambulatory Services and CIO of The University of Kansas Hospital, responded that the future of healthcare is in analytics. He added that data warehouses are the future; electronic medical records will provide data, but providers will need well-qualified people and teams to extract the information. The Heart of America Chapter would like to thank the executive panelists and attendees for making this program such a success!

1

Joe Watt, Partner at BKD, LLP

2

From L to R, Chris Hansen, John Wilson, Tierney Grasser, Chuck Robb, Allen Johnson, and HOA President, Jim Mozena.

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