May 2014

KHSC Newsletter - Volume 1, Issue 12

Lean Denial and Appeals Management Tools to
      Recover Revenue and Improve Processes

Denials and underpayments are defects in the revenue cycle that indicate a provider's inability to comply with payer requirements or a payer's inability to accurately pay a claim. Finding a solution to manage the complexity of health insurance denials and appeals is an important strategy for hospitals to optimize their profitability. A good denial-management solution can provide process and workflow improvements to help identify and appeal denied claims. KHSC's partner provider, Etactics, has a solution that can work for you.

The Etactics' web-based solution, AppealsPlus, provides process and workflow improvement in identifying and appealing these underpaid and denied claims. It is a web-native tool that automatically analyzes ERAs and applies rules to place suspect payments and denials in the appropriate queues. It adapts to comply with your payer contracts and timelines. It also utilizes dashboards and key performance indicators, including MAP keys, to provide quantitative management where data is measured and used to drive decisions. The trending analysis assists in identifying root causes of denials and educates staff to prevent future denials. The Etactics solution is a totally independent system and can work with any health information system or clearinghouse.

AppealsPlus provides an annotated view of each case's explanation of benefits to rapidly identify and interpret the reason for denial. Processes can defined to guide each step in the dispute process, eliminate missed appeal deadlines, assign tasks, generate email notifications, and facilitate communication across your hospital or health system.

AppealsPlus helps increase productivity by standardizing processes and providing explicit instructions for each step in reviewing, fixing and/or appealing a denial. Data is automatically extracted from electronic record archives into case records. The data in the case records can auto populate fields in the complex payer forms that are converted into fillable PDFs. The same data can be merged into appeal letter templates using Microsoft Word. This results in significant time saving and reduction of transcription errors.

If you have any questions or are interested in hearing more about the AppealsPlus from Etactics, please contact Ray Dalessandro at (330) 342-0568 Option 3.

Today's Top Four Employee Relations Must Dos

Every manager and business owner knows deep in their heart what employees need; yet frequently, they don’t have the time to focus energy and efforts on the things they know they should do. The reality is, managers don't have the time NOT to focus energy and dedicate time to staff.

A recent Career Builder survey indicates that 59 percent of employees are generally satisfied; 21 percent plan to change jobs in the coming year. Organizations and managers who have not focused on employee relations will find staff leaving in this new job market. Five categories, referenced time and again in employee focus groups and one-on-one sessions, identify strategies for improved employee relations:

• Communications: Employees never say, "My company shares too much information." Employees feel they are the last to know, and too little information is shared. A few tips for increasing communications:
  • Email staff when job openings are available and when positions are filled.
  • Hold regular staff meetings. The key to any successful meeting is to have an agenda. Create a basic agenda with items that are discussed each meeting, and set aside time to discuss other items.
  • "Managers take to long to make decisions," is a frequent complaint. Be sure to follow up with employees, and let them know where you are in the decision-making process. Simply sharing where you are will let them know you have not ignored them.
  • Keep your promises (or don't make them).
• Recognition: Employees want to feel valued! It is surprisingly simple to implement the following:
  • Verbal recognition must be specific so the employee can repeat the behavior. Consider if this employee would like public or private praise. At times, a simple "thank you" is all that is needed.
  • Anniversaries: Managers should take the time to congratulate staff for work anniversaries and reference appreciation for contributions on a specific project.
  • "Your favorites" is a form provided annually for employees to share with their manager the kind of "praise and recognition" they would appreciate at different dollar levels. If you would like a complimentary form, please email Kristin@ScottHR.com.
  • Incentives can be crafted around organizational goals that are specific for departments or individuals. Craft goals around measurements that will increase revenue dollars, and everyone wins. The incentive should be fully funded by the increase on the measurement.
  • Performance Management: Employees truly do have a desire to put forth their best efforts. The challenge lies in managers not having difficult conversations with staff to teach them to learn from their mistakes or identify training needs. Employees prefer to be coached to improved behavior. Yes, there are those exceptions of employees who seem to have no desire to improve, but generally, as individuals, we seek acceptance and approval, especially from our bosses. Managers must set performance expectations to hold employees accountable.
• Onboarding practices need to be impressive: Employees never have a better impression of an organization than in the first 90 days. Heartbreaking! Follows a few onboarding tips:
  • Email (or mail) as many documents to new staff members before they start, including: an employee handbook, job description, benefit enrollment forms and information (so they can discuss with their family), emergency data sheets, payroll-required forms, direct deposit and other items specific to your organization.
  • Ensure the following is ready upon their arrival: work space, uniforms of any type, name badges, computers, phones, computer sign-on, time clock sign-in and all those other important items.
  • The manager should create a success plan that details priority items for the employee to learn and priority tasks to complete. The success plan is an essential element.
• Fair and Equitable Wages: Organizations must ensure starting wages are perceived to be fair for the market and industry. Review internal equity issues, create wage bands, identify comparative ratios and ensure solid communications. Many organizations distribute annual benefit statements to staff sharing not only their wage and compensation information but also the value of benefits and other perks provided, so employees can see in print the value of their full compensation and benefits package.

Scott HR LLC passionately serving organizations' human resource needs by developing processes and systems that serve management and employee needs. Their service philosophy is to build long-term relationships with clients by providing solid recommendations and business practices balanced with compliance, employee engagement and budgetary considerations.

KHA Workers' Compensation Fund Employee Safety Update

Some Kansas Health Service Corporation members have hit the ground running this year in their employee safety efforts. For the first quarter of 2014, Chris Saiya conducted a behavioral safety presentation at seven member hospitals. The presentation focused on informing employees how the 2011 changes to the Kansas Workers' Compensation Law impacts them and provided education on placing priority on their own safety while at work. The information was presented with the intentions to inform, persuade and entertain while addressing this critical topic, and feedback received from attendees has been positive. In total, approximately 750 employees from member hospitals in Beloit, Winchester, Neodesha, Pratt, Ellinwood, Hoisington and Stafford have attended this training. Additionally, three of these hospitals, Beloit, Neodesha and Hoisington, have allowed KHSC the opportunity to perform an office ergonomics presentation to their employees. This presentation was a live demonstration for employees whose primary working environment is a computer workstation and addressed both workstation arrangement and employee behaviors that contribute to discomfort, strain and injury. KHSC continues to expand its efforts to provide the most practical and cost effective solutions for a variety of patient handling and movement hazards commonly faced by your patient caregiving staff. If your organization has not yet scheduled a presentation for your employees, KHSC encourages you to do so. If you need assistance in the interim with regard to employee safety, please contact Chris Saiya at (785) 233-7436.

Automate Your Patient Communication
      Best Practice to Save Time and Money

The Etactics IntelliStatements™ process is an automatic revenue cycle management solution geared towards decreasing the self-pay and patient responsibility balances of hospitals. This state-of-the-art revenue cycle solution makes use of a workflow-based metric tracking program. Being able to view the metrics of your patient responsibility revenue cycle will allow you to make changes that helps to lower your costs and increase your collections on self-pay and patient responsibility balances.

By automating your hospital or health system's best practices, you can rest assured that your in-house collection efforts are being executed in the most productive manner with a minimal amount of overhead. Consider IntelliStatements as an alternative to costly pre-collection or early-out programs.

By utilizing our scoring (Patient Propensity to Pay Index), eligibility and online workflow portal, you will spend less and collect more. IntelliStatements allows you to achieve multiple goals through one tool. It will reduce statement expense by as much as 40 percent, increase patient satisfaction with targeted and clear patient communications, and collect 25 percent more in balance after insurance and self-pay responsibilities. Hospitals can collect higher percentages from self-pay and "balance after insurance" accounts, spend less on collection efforts, and improve patient loyalty. This solution also provides shorter account receivable days.

IntelliStatements automatically tracks account payment activity and triggers appropriate workflows. The workflows are designed around various criteria including: practice business rules, balance levels, optional Propensity to Pay Scoring, etc. IntelliStatements will block excessive "balance forward statements." The solution is HIM software independent.

If you have any questions or are interested in hearing more about the Etactics IntelliStatements solution, please contact Ray Dalessandro at (330) 342-0568 Option 3.

Financial Challenges Top Health Care CEO Concerns:
      People, Process and Technology to the Rescue

The American College of Healthcare Executives is an international professional association of health care executives. During a recent study, executives announced their top Issues for the coming year.

In the study, "Financial Challenges" ranked No. 1 on the list of hospital CEOs top concerns. The survey was sent to 1,091 hospital CEOs who are ACHE members 388 or 36 percent responded The lowest numbers indicate the highest concerns for CEOs

With Medicare reimbursement penalties due to re-admittance, turnover costs due to unhappy and disengaged employees, and preventable medical error malpractice costs, it's more than difficult to manage your financial challenges. There are three key areas where you can focus and engage your organization to regain control, cut costs and create a culture of accountability.

People Process Technology EmployeeTalk, a unique online communication service, was recently endorsed by the Kansas Health Services Corporation as the preferred sole source employee/patient engagement solution provider for all Kansas hospitals. EmployeeTalk's pulse communication survey methodology helps health care organizations focus dialog to leverage their number one asset, their people. By opening communications with employees and patients, you will better understand your operational and process challenges, opportunities and collect suggested solutions in which to take action. Your team will provide you their cost cutting and process ideas where improvements are required.

EmployeeTalk Financial Benefit Summary:

• Improve Patient Safety and Quality Care by creating a culture of accountability.
• Maximize your Medicare Reimbursements by improving team communications to minimize medical errors and reduce re-admittance.
• Reduce Employee Turnover by identifying employee satisfaction concerns, taking action and recognizing individual service excellence.
• Improve your Change Management Success by engaging your employees before, during and after change.

Propio Language Services: Supporting You in
      Delivering the Highest Quality Patient Care

The following story was recently shared with us by a new client.

An elderly Latino man came to see me. It was evident that he could not speak or understand English, and I certainly could not speak or understand Spanish. It also was clear that he would not be able to afford the medication required for the serious condition I had diagnosed during his visit. So I gave him some samples and with hand gestures and a loud voice told him, "Take one a day." Zero comprehension. So I wrote it on a note for him--once/daily--and sent him home. That evening, I got a call from his daughter. "Doctor, how many pills is my father supposed to take?" "One a day," I told her. "In fact, I wrote it on a script for him." "Doctor," she said, "once" is pronounced "on-say" in Spanish. It means 11." I paled as I thought of the severe consequences that would have resulted from this man taking 11 times the recommended dosage of this powerful medication!

Then the doctor told us, Don't ever underestimate the importance and value of the interpretation services you provide. They are critical to providing safe, effective care.

At Propio, we are passionate about the work we do. Thousands of people are victims of medical error, have inadequate access to basic life services for themselves and their children and are unable to have successful personal, legal and business interactions because they cannot effectively communicate due to a language barrier. Propio Language Services provides access to critical interpreting and translation services that improve their quality of life.

Propio connect people over the phone in less than a minute to qualified interpreters in more than 200 languages. They also have interpreters available in person. We offer document translation, video voice-overs, and simultaneous interpreting for meetings and conferences. We also have access to professional translators covering more than 80 languages. Because our translators are native speakers, they also have the cultural sensitivity to suggest appropriate changes to localize the content, as needed. All of Propio's interpreters and translators are 100 percent HiPAA compliant and bound by a set of ethical standards that preserve confidentiality and ensure professional conduct.

We know your mission is to provide the highest quality patient care. As you pursue that mission, if you need to improve communication by overcoming language barriers of any kind, we can help. Contact Rob Campbell, partner, Propio Language Services, at (913) 800-4785.

Medicare Education Events Assist Local Communities

Thank goodness, spring is now here! While many changes come with the shift in seasons, one thing not changing is in the fear and anxiety lingering in the minds of Medicare beneficiaries around health care reform. Since Obamacare rolled out, many questions have been unanswered, and we continue our efforts combating bad or missing information.

Each fall, since 2005, the Medicare team at Schreck Financial Group hosts Medicare education events throughout the state of Kansas. People are seeking answers in record fashion. Last year, we hosted more than 3,600 people at 98 events, sponsored by 118 health care providers including independent pharmacists, physicians and their practices, and community hospitals.

These events educate attendees on health care reform, changes that the reform has made to the Medicare program, and possible changes we see coming. Our goal is not only to educate and inform people, but we strive to clear up people's confusion, while saving them money. Attendees come to the event confused about how Obamacare's rules apply to them, but they've told us they're happy to leave with the answers they've needed.

At the end of the events, we recommend that Medicare-eligible attendees get a no cost, independent analysis done on their prescription drug plan benefits and their Medicare supplement coverage. PDP plan benefits can change drastically each year, so getting this done is beneficial. We did reviews for more than 1,900 people last fall. For those who saved money by making a change, the average household savings was $3,252 per year! For families on a fixed income, that's more than $250 per month of breathing room in their budget. What a thrill it is to be able to help people save so much, doing so without having to change providers!

Outside of helping people in the fall, we work year round helping Kansans who are starting Medicare chose the right plans for them. There also is a misconception that you can only make changes to these plans at the end of each year. While that is true for drug insurance plans, people can review their Medicare supplement options any time.

If your facility is interested either in sponsoring a future Medicare education event in your community, or if you're a current sponsoring facility curious as to how we can be of help throughout the year, contact Amy Porter, Medicare event coordinator, at Schreck Financial Group, (800) 349-9296.

Addressing the Challenges (and Cost)
      of Employing Physicians

In December 2013, The Kansas City Star reported: "In unprecedented numbers, America's doctors are trading in their autonomy for regular work hours and a hospital paycheck. Hospitals across the country have been buying up hundreds of doctors' medical practices and hiring thousands of formerly independent physicians.

"Since 2000, the number of doctors on hospital payrolls nationwide has risen by one-third, according to the American Hospital Association. "Hospitals may lose as much as $250,000 a year on newly-employed physicians during their first three years. "No one wants to be left out," said Joy Grossman, senior health researcher with the Center for Studying Health System Change … It becomes a war between hospitals to acquire practices."

As health care undergoes a paradigm shift forcing hospitals to look for ways to reduce expenses without diminishing value and opportunity to their physicians, how can hospitals not only survive, but thrive with their employed physicians?

One idea is to offer physicians an alternative compensation arrangement. A properly structured alternative compensation arrangement does not increase the cash expense of the hospital, but simply allows the physicians to receive any portion of their compensation in a more tax-efficient and financially rewarding manner. This type of structure provides clear and immediate benefits for both the physicians and the hospital:

Many KHA members are facing similar challenges: Recruiting and retaining key physicians, reducing expenses, limited tax-advantaged savings opportunities and significant budgetary constraints. Utilizing time-tested strategies with rules clearly defined by the Internal Revenue Service, an alternative compensation arrangement can help address many of the physician alignment issues plaguing hospitals today while delivering exceptional tax and financial benefits for the physicians, executives and hospital.

Jason Boccardi is president of LifeSolutionz, an independent consulting firm specializing in the innovative design, implementation and service of alternative compensation arrangements. For more information, contact Jason at (866) 234-9728. Visit LifeSolutionz online.

Mandatory Risk Assessments - Seven Steps for
      Improving Your PCI/HIPAA Risk Equation

Regulations, industry frameworks and industry best practices, require organizations to conduct thorough risk assessments annually. While HIPAA and PCI have required risk assessments for years, recent large-scale data breaches suggest it's worth reevaluating your Risk Assessment Program to ensure it still aligns with your business model, risk appetite and control effectiveness.

Stealing data can be lucrative and the risks are material. Credit card numbers stolen from Target were already seeing fraudulent activity within seven days. The banks will spend an estimated $172 million to reissue cards, and total losses could top $18 billion when including fraudulent charge offs. If your risk model uses weighted values from years ago, it's time for a refresh. Keep in mind there are different risks such as regulatory risk, industry risk, breach risk and brand equity risk.

Seven Steps for Better Managing Risk

1. Document your vulnerabilities (i.e., a weakness in a system, business process or other organizational asset that can be exploited). Attack vectors evolve, so must your risk assessment.
2. Document your threats (i.e., a negative event that can potentially act upon a vulnerability). For example, does your Intrusion Detection System log numerous failed password attempts against a significant number of user accounts?
3. Invest some time to better understand likelihood and impact. For example a power outage? Can your business survive loss of power for an hour? A week? These should coincide with the business impact analysis driving your business continuity program.
4. Document the controls that mitigate specific risk, include primary, secondary and tertiary controls. Build a risk management program with sufficient detail to document risk and controls that is sustainable.
5. Validate control effectiveness. Putting controls in place without periodically testing, provides a false sense of security.
6. Assessing the risks you are managing provides the details needed to prioritize risk management, such as transferring the risk, mitigating or assuming. SecureState has developed an open source iRisk model to help quantify, but other frameworks may also be used (e.g., ISO, FAIR).
7. Manage the prioritized residual risk, by applying risk management strategies: avoidance (i.e., deciding not to have an eCommerce presence), reduction (i.e., implement additional controls or strong controls to limit exposure), transfer (i.e., purchasing cyber liability insurance), and acceptance.

Use the outcome of your risk management program to illustrate to executive management your risk posture compared to their risk appetite. If there is a gap, put together a program to align expectations, and revisit annually.

SecureState is a global management consulting firm focused on information security, privacy and compliance. We provide solutions at the program level, ensuring consistency and continual improvement when managing your risks. For more information on iRisk, and HIPAA or PCI compliance, please contact Cathleen Donne at (216) 927-8239, or Brian Dean at (216) 927-8238.

Boiler Safety Inspections, Testing and Maintenance

Despite advances in technology inspections and testing, maintenance is still crucial to safe and efficient boiler operation.

Times have changed. Improvements in boiler design and the switch to digital control systems have greatly improved boiler safety, reliability and performance. Operating efficiency also has improved, and interruptions of service have been all but eliminated. These advances have created the misconception that boilers do not need much attention. This type of thinking is understandably causing concern among maintenance and engineering managers.

Even with improvements in boiler design and construction, accidents still occur and boilers still fail. It is estimated that nearly two-thirds of all boiler failures today result from poor operating and maintenance practices.

A facility's boiler represents a major investment – and a potential danger to property and personnel. Poor operating and maintenance practices put everyone at risk. Boiler failure could cause service interruptions affecting building occupants and their operations. Significant damage could occur to the building, its contents, systems and people.

By paying close attention to safety devices and maintenance practices, maintenance and engineering personnel can avoid these negative outcomes. Here are some steps your company can take to reduce losses and downtime:

• Daily inspections (at a minimum) while in operation
• Periodic pressure relief device testing
• Annual inspections (at a minimum) and service by a qualified firm per CSD-1
• State Certificates of Operation (where applicable)

Consult with your Chubb agents for further details on boiler specifics:

 Kansas Health Service Corporation | 215 SE 8th Avenue | Topeka, Kansas 66603-3906 | Phone:(785) 233-7436 | Fax: (785) 233-8551