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new jersey chapter
July/August 2008 • vol 55 • num 1
•ThePasscodeRequest See page 7
•FY09StateBudget:LeanFiscalTimesor NewWorldOrder? See page 19
Audit & assurance services Tax planning & compliance Consulting servicesresecnarussa&tiduA ailpmoc&gninnalpxaTTasecivr secivresgnitlusnoCecna
ARMDS
Besler
CBIZ KA Consulting
Executive Resources, LLC
Fox Rothschild LLP
Health Ware Concepts
IMA Consulting
JH Cohn, LLP
Medical Account Solutions
McBee Associates, Inc.
Norris, McLaughin & Marcus, P.A.
Parente Randolph, LLC
William H. Connolly & Assoc.
WithumSmith+Brown
Who’s Who in the Chapter .........................2The President’s View
by Joe Dobosh, MBA ......................................3From the Editor
by Elizabeth G. Litten, Esq................................4Focus on Industry......................................20Proaction Corner........................................23Focus on Ethics..........................................26
Focus on Members ...................................27Meet Some of Our New Members ........33New Members ............................................34Job Bank Summary ..................................35Mark Your Calendar ..................................35Focus on Finance ......................................36Certification Corner...................................40Advertiser Focus........................................48
focus•advertisers•
focus•features•
focus•points• focus•cover•
The Passcode Requestby Helen Oscislawski, Esq. ............................................................................................................. 7
Hospital Billing Practices Scrutinized: Increased Exposure toLiability Under the Federal False Claims Act
by Erum Raza, Esq. ........................................................................................................................ 12Business Office Collector Productivity Standards
by Chris Karman.............................................................................................................................. 15
Hospital Worker Fired for Divulging Patient InformationCan Sue For Wrongful Termination
by Harris Neal Feldman, Esq. .......................................................................................................... 17
FY09 State Budget: Lean Fiscal Times or New World Order?by Randy J. Minniear....................................................................................................................... 19
The Results Are In On The NJ HFMA C.A.R.E. Forum’s2008 Compliance Integration Survey
by Kelly Dziedzic, CHC, CPAT and Angela Milillo, MBA, CHC, CPC.................................................... 21
CFO Member Spotlight:John Gantner, Meridian Health.................................................................................... 29
Member Spotlight: Al Rottkampby James Yarsinsky, CPAM ......................................................................................................... 31
The 2008 NJ HFMA Scholarship Recipientsby Laura A. Hess, FHFMA ................................................................................................................ 37
NJHA Introduces New Financial Pandemic Planning Tool for Healthcare Community
by Laura A. Hess, FHFMA ................................................................................................................ 40
June Quarterly Meeting: “Healthcare Change Is Certain:Are You Prepared?”
by Julius Green ............................................................................................................................... 41
NJ Chapter Earns Six Awards at the ANI!by Laura A. Hess, FHFMA ................................................................................................................ 46
Cover courtesy ofHermitage Press, Inc.
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2 Focus
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DEADLINE FOR SUBMISSION OF MATERIALIssue Date Submission Deadline
January/February December 15March/ April February 15May/June April 15
July/August June 15September/October August 15
November/December October 15
Advertising Policy/Annual RatesThe Garden State “FOCUS” reaches over 1,000 healthcare professionals in various fields. If you have a product or service you would like the healthcare financial industry to know
about, please take advantage of this great opportunity!Contact Joan Hendler at 609-921-8950 to place your ad or receive a copy of the Chapter’s advertising policy. The Publications Committee reserves the right to refuse any ad not consis-
tent with the overall mission of the Chapter. Inclusion of an ad in this Newsmagazine does not infer endorsement of the product or service by the Healthcare Financial ManagementAssociation or the Publications Committee. Neither the Healthcare Financial Management Association nor the Publications Committee shall be responsible for slight variations in productionquality of published advertisements. Effective July 2006 Rates for 6 bi-monthly issues are as follows:
EDITORIAL POLICYOpinions expressed in articles or features are those of the author(s) and do not necessarily reflect
the view of the New Jersey Chapter of the Healthcare Financial Management Association, or thePublications Committee. Questions regarding articles or features should be addressed to theauthor(s). The Healthcare Financial Management Association and Publications Committee assumeno responsibility for the accuracy or content of any articles or features published in theNewsmagazine.
The Publications Committee reserves the right to accept or reject contributions whether solicitedor not. All correspondence is assumed to be a release for publication unless otherwise indicated. Allarticle submissions must be typed, double-spaced, and submitted as a Microsoft Word document.Please email your submission to:Elizabeth G. Litten, Esq. [email protected]
REPRINT POLICYThe New Jersey Chapter of the HFMA will not reprint articles published in Garden State FOCUS
Newsmagazine. Individuals wishing to obtain reprint authorization must obtain it directly from theauthor(s) of the article. The cover of the FOCUS may not be used in the reprint; however, the reprintmay note that the article was published in a specific issue. The reprint may not imply endorsementby the HFMA, directly or indirectly.
IDENTIFICATION STATEMENTGarden State “FOCUS” (ISSN#1078-7038; USPS #003-208) is published bimonthly by the New Jersey
Chapter of the Healthcare Financial Management Association, c/o Elizabeth G. Litten, Esq., Fox Rothschild,LLP, 997 Lenox Drive, Building 3, Lawrenceville, NJ 08648-2311Periodical postage paid at Trenton, NJ 08650. POSTMASTER: Send address change to Garden State“FOCUS” c/o Laura A. Hess, FHFMA, Chapter Administrator, Healthcare Financial Management Association,NJ Chapter, P.O. Box 6422, Bridgewater, NJ 08807
OBJECTIVEOur objective is to provide members with information regarding Chapter and national activities,
with current and useful news of both national and local significance to healthcare financial profes-sionals and as to serve as a forum for the exchange of ideas and information.
Ads should be submitted as print ready (CMYK) PDF files along with hard copy. Payment must accompany the ad. Deadline dates are published for the Newsmagazine. Checks must be payable to theNew Jersey Chapter - Healthcare Financial Management Association.
Publications CommitteeJohn Manzi, Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IMA ConsultingElizabeth G. Litten, Esq., Chair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fox Rothschild LLPJoan Hendler, Vice Chair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Remex, Inc.Steve Aaron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ARC Group AssociatesLynn Chiantese . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .New Jersey Hospital AssociationMark P. Dougherty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Johnson Controls, Inc.Dennis P. Hancock . . . . . . . . . . . . . . . . . .New Jersey Healthcare Facilities Financing AuthorityLaura Hess, FHFMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NJHFMARhonda Maraziti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .WithumSmith + BrownWilliam McCann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Publication ConsultantDavid A. Mills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Deloitte ConsultingHelen Oscislawski, Esq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fox Rothschild LLPErum Raza, Esq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fox Rothschild LLPJames A. Robertson, Esq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Kalison McBrideAl Rottkamp, MBA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Professional ServicesRoger D. Sarao, CHFP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Jersey Hospital AssociationJames Yarsinsky . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Expeditive
NJ HFMA Chapter OfficersPresident, Joseph J. Dobosh, Jr., MBA . . . . . . . . . . . . . . . . . . . Children’s Specialized HospitalPresident-Elect, Brian P. Sherin, FHFMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . Besler ConsultingSecretary, Mary T. Taylor, MBA, FHFMA . . . . . . . . . . . . . . . . Southern Ocean County HospitalTreasurer, Lisa R. Hartman, MPH . . . . . . . . . . . . . . . . . . . . . . . . Princeton Healthcare System
NJ HFMA Board MembersMichael Alwell, FHFMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Atlantic Health System
John Brault, CHFP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Englewood Hospital & Medical Center
Lindsey S. Colombo, FHFMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Raritan Bay Medical Center
Mary M. Cronin, FHFMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Besler Consulting
Tracy Davison-DiCanto – Junior Board Member . . . . . . . . . . . . .Princeton Healthcare System
Dennis P. Hancock . . . . . . . . . . . . . . . . . .New Jersey Healthcare Facilities Financing Authority
Marilyn A. Koczan, FHFMA, MPA, CPAM . . . . . . . . . . . . . . . . . . . . . . . . .Meridian Health System
Anthony T. Orlando . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Englewood Hospital & Medical Center
Michael A. Richetti, CPA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Chilton Memorial Medical Center
David J. Wiessel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Ernst & Young, LLP
Dan Willis – Junior Board Member . . . . . . . . . . . . . . . . . . . . . . .Children’s Specialized Hospital
Caitlin C. Zulla, CHFP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .MD-X Solutions
Sean J. Hopkins – Ex-Officio . . . . . . . . . . . . . . . . . . . . . . . . . .New Jersey Hospital Association
NJ HFMA Advisory CouncilCheryl H. Cohen, FHFMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Pantheon Capital
Dorothy Lindstrom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Somerset Medical Center
John Manzi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IMA Consulting
Richard C. Parker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .CBIZ KA Consulting Services
Who’s Who in the Chapter 2007-2008Chapter Website . . . . . . . . . . . . . . . . . . . . . . . .www.hfmanj.org
Display Full Page Half Page Quarter PageBack Cover – Full Page Color $4,600 NA NAInside Back & Front Covers – Full Page, Color $4,350 NA NAFirst Inside Ad – Full Page, Color $4,250 NA NAFirst Inside Ad – Full Page, Black & White $3,450 NA NAInside Ad – Color $3,450 $2,600 NAInside Ad – Black & White $2,150 $1,450 $875Center Spread – 2 Full Pages, Color $5,900 NA NACenter Spread – 2 Full Pages, Black & White $3,800 NA NA
July/August 2 0 0 8
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The President’s View . . .
I welcome you to the start of the 2008/2009 Chapter year. I am honored to serve youas the Chapter’s President and thank you in advance for all of your support during theupcoming year. National’s theme this year is “Making Connections” and I will endorse thattheme for our Chapter. Now is the time we need to make the connection with our col-leagues, as well as our customers.
The New Jersey healthcare industry has gone through major changes and will continueto do so this year with continual ratcheting down of reimbursement, a change in the fiscalintermediary and imminent RAC audits. Hospitals will be facing difficult decisions on theservices they can provide to those needing healthcare and still remain financially viable. Asan organization, the Chapter’s Board and all of our committees will strive to keep its mem-bership abreast on the “hot” topics at monthly, quarterly educational sessions, our annual institute as well through articles inthe FOCUS.
In early June, the board, the committee chairs and co-chairs met to discuss and select goals for the coming year using CATteam members to help facilitate the discussion. A few goals resonated: Increase participation by our current membership at thecommittee levels for succession planning of chairs; increase attendance at all of our education sessions and development of amarketing plan targeted at specific areas of improving the overall Chapter’s success. All of this will allow us to meet HFMANational’s requirement, through its Chapter Balanced Score Card, which I will discuss in detail in future issues of FOCUS.
Some upcoming events that you should place on your calendar and consider attending:• September 9, 2008 - Quarterly Meeting Pro Action Committee (Woodbridge Hilton)• September 26, 2008 - Beginners Golf Outing (The Architects Golf Club, Lopatcong, NJ)• October 15-17, 2008 - Annual Institute (Borgata Hotel, Atlantic City)In addition, our Education Committee is in the process of finalizing the schedule of monthly sessions that will educate you
on the most current industry topics.I would like to congratulate Cheryl Cohen, our past President, on a very successful year, receiving four Yergers and two
additional awards from National. I feel privileged to be working with such a talented and “forward thinking” group of Boardmembers and committee chairs and co-chairs this year. I am encouraged in accomplishing our goals together. I hope that you,if not already, become active in our Organization, to not only grow professionally but to ‘Make the Connection’ for future suc-cesses. If the Chapter leadership can be of any assistance to you in this regard, please contact any Board member or myself.
Sincerely,
Joe Dobosh, MBAPresident, New Jersey Chapter of the Healthcare Financial Management Association
Joe Dobosh
makingconnections
July/August 2 0 0 8
Dear Readers:
As those of you who are active in this Chapter know, our fellow New JerseyHFMA members are an extremely knowledgeable, interesting, and interestedgroup. Just read the “Member Spotlight” on my committee co-chair, AlRottkamp, the “CFO Member Spotlight” on John Gantner, or any of the NewMember blurbs, and you cannot help but notice our impressive achievementsand great personalities! I enjoyed meeting many of our active Chapter mem-bers at the Leadership Retreat in Egg Harbor in June, and am confident thatour new Chapter President, Joe Dobosh, will continue Cheryl Cohen’s push togrow and improve our Chapter, and to create new connections among us andbeyond.
One new (and rather unusual) connection I am pleased to announce is the connection our publication committeewill soon have with Abu Dhabi, UAE. One of our publications committee members (who is also a health care asso-ciate here at Fox, and the author of the article on False Claims Act prosecutions in this issue) has taken a year’s leaveof absence to move to Abu Dhabi with her family. While her husband, a physician, is working at the nearby MayoClinic, Erum Raza has agreed to act as a “foreign correspondent” for our magazine, reporting on her observations onhealth care abroad. We wish Erum well, and look forward to hearing from her and publishing her reports in futureissues.
The health care world seems to be shrinking in many ways – locally in some respects, and globally as the reach of UShealth care expands. To many reading this, the shrinkage is most evident in terms of reduced charity care dollars andthe reduced number of fiscally sound New Jersey hospitals we have today. Worldwide communication allows expand-ed access to overseas services that can be imported back to our local hospitals, and expanded access also creates newrisks. But just as the Mayo Clinic, Johns Hopkins, the Cleveland Clinic, and Partners Harvard Medical International,to name a few, have recently expanded into the Arab market, so, too, might our views of our health care “market”,and opportunities for growth, expand.
Regards,
Elizabeth G. LittenEditor
From the Editor . . .
4 Focus
Elizabeth G. Litten
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6 Focus
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Hospital attorney Jen Ral-Konsil took a phone call one dayand was greeted by a voice that was pleasant and professional,but unmistakably belonged to a person from a country overseas.The caller introduced himself, and then nonchalantly asked herto kindly provide him with the passcode to access to her hospi-tal’s encrypted patient data contained in a file. Excuse me? washer initial reaction, which was then followed by several ques-tions, including “Where exactly are you calling from?” and “Howdid you obtain a file containing our hospital’s encrypted data?”
The caller confirmed that he was indeed calling from outsideof the United States, and he explained that his company con-tracted with a New Jersey entity called NJ Billing Corp. to fur-nish certain outsourced data processing tasks. Ah-ha, thoughtJen, now NJ Billing Corp. was a name that she recognized. Shewas also fairly certain that NJ Billing Corp. was one of the hos-pital’s HIPAA Business Associates! With this realization, shepolitely informed the caller that she would have to get back tohim once she reviewed the matter further.
After hanging up, Jen Ral-Konsil leaped out of her chairand over to the vendor contract file cabinet on the other sideof the room. She thumbed through the dozen or so HIPAABusiness Associate Agreements (“BAAs”) in her file untilfinally coming to a copy of the executed HIPAA BAA for NJBilling Corp. With the BAA in hand, she returned to herchair and began re-reviewing its terms relating to HIPAA pri-vacy and security. At this point, a multitude of issues beganpopping into her head, one after the other. Jen decided thatit was time to place a call to her longtime friend and HIPAAguru, Noel Itall.
Jen Ral-Konsil: “Noel, you won’t believe what just hap-pened. I just got off a call with a person outside of the UnitedStates who asked me to provide him with the hospital’s pass-code to an encrypted data file containing protected healthinformation! He told me that our business associate, NJ Bill-ing Corp., outsourced some of its contracted services to a for-eign company. Now, the hospital’s protected health informa-tion, or “PHI,” is in the hands of employees located overseas.Our HIPAA BAA with NJ Billing Corp., which, by the way,I did not draft, does not outright prohibit this. What I needto know, Noel, is whether under HIPPA our business asso-ciate is to disclose our PHI to a foreign subcontractor?”
Noel Itall on HIPAA: “Great question, Jen. In general,unless the terms of the underlying contract specifically pro-
hibit it, I am not aware ofany law that expresslymakes it illegal for NJBilling Corp. to out-source such services toforeign subcontractors.However, as you havenoted, the unique issuehere is that the relationship also involves releasing PHI toemployees in a foreign country. As you know, the hospital isdirectly responsible under HIPAA to assure that it is compli-ant with the Privacy Rule and Security Rule, so these areimportant questions to be asking.
You already know that the Privacy Rule does not requirethe hospital to first obtain a written authorization frompatients before disclosing their PHI to third parties (i.e., ven-dors) that need such PHI in order to perform a health careoperation function, like billing, coding and other data pro-cessing, on behalf of the hospital. In such cases, a writtenagreement - the BAA - must be entered into between the hos-pital and its business associate. You said that there is aHIPAA-compliant BAA in place between NJ Billing Corp.and the hospital. Therefore, the BAA should include the lan-guage required by HIPAA with regard to how NJ BillingCorp. may use and disclose the hospital’s PHI.
By executing a BAA, a NJ Billing Corp contractually obli-gated itself to protect the hospital’s PHI and to not use or fur-ther disclose the PHI other than as permitted or requiredunder the BAA or as required by law (American). Amongother things, the Privacy Rule requires the BAA to includelanguage stating that the business associate will ‘ensure thatany agents, including a subcontractor, to whom it provides PHIreceived from, or created or received by the business associateon behalf of, the covered entity agrees to the same restrictionsand conditions that apply to the business associate withrespect to such information.
I think that this provision accomplishes two things. First, itrecognizes that business associates, like NJ Billing Corp. maysubcontract certain functions and will need to release PHI to itsagents or subcontractors. Second, it forces the business associ-ate to require the subcontractor to agree to the same privacy andsecurity restrictions, conditions and standards that apply to it.
July/August 2 0 0 8
Focus 7
continued on page 8
The Passcode Requestby Helen Oscislawski, Esq.
Helen Oscislawski
July/August 2 0 0 8
8 Focus
continued from page 7
So, if the subcontractor is not able to meet HIPAA’s standards,or does not agree to meet such standards, the business associatecannot release the PHI to such subcontractor.
So here, if the foreign subcontractor agreed to abide byHIPAA before NJ Billing Corp. released the hospital’s PHI toit, then NJ Billing Corp. would technically be compliant withthe terms of the BAA and what is required under HIPAA forthat particular disclosure to occur.
Jen Ral-Konsil: “Ok, I guess I can accept that. But, do youreally think that the foreign subcontractor is going keep ourPHI confidential and secure at the same level of that isrequired under HIPAA’s Privacy Rule and Security Rule? Afterall, a foreign contractor, and its employees, may not even knowwhat HIPAA is, never mind understanding, implementingand complying with all of its requirements and restrictions. So,as a practical matter, their ‘agreement’ to comply may be inef-
fective. So, who is ultimately responsiblefor ensuring that the foreign subcontrac-tor is complying with HIPAA’s privacyand security standards?”
Noel Itall on HIPAA: “Very good point,and I agree. Since foreign data privacy lawsvary greatly, how effective a particular sub-contractor is in meeting HIPAA’s standardsmay also vary. Certain countries, like thosethat are a member of the European Union(EU), have laws that in some instances offereven broader data privacy protections thanthose available in the United States. Thereare other countries, however, that offeressentially little or no legal protections fordata privacy, and so subcontractors han-dling PHI in those countries may be lessprimed to what could be an inappropriateuse or disclosure of PHI. In addition, theabsence of a strong foreign privacy law mayeliminate at least one basis upon which aUnited States litigant could potentiallypursue legal action in that foreign countryfor an unauthorized use of their PHI.
At the very least, I recommend that acovered entity require its business associatesto obtain any such “agreement” from sub-contractors in writing. I also tell the cov-ered entity to require the business associateto execute essentially the same form of BAAthat was signed by the business associate,but modified slightly for the subcontractor.I call this a ‘HIPAA-Compliance Agree-ment’ or ‘HCA,’ which could be preparedas a stand-alone or an addendum to anymain contract in place between the parties.
Now, I should highlight that having awritten HCA in place between your businessassociate and its foreign subcontractor is notspecifically required under the Privacy Ruleor Security Rule. As a result, you may getsome push back from more HIPAA-savvy
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July/August 2 0 0 8
Focus 9
business associates who are aware of this. Nonetheless, as a prac-tical matter I believe that it is important for a business associate’sforeign subcontractor to execute a HCA. First, it provideswritten documentation, or proof, if you will, that the subcon-tractor has ‘agreed to’ the same restrictions and conditions agreedto by the business associate. Second, at the very least, it putsthe foreign subcontractor on notice of exactly what is expectedof them when we ask that they comply with HIPAA’s standards.If you want to look at a sample HCA I recently prepared fora client of mine that had a foreign subcontractor issue, I cane-mail you a copy.”
Jen Ral-Konsil: “Thanks, I would definitely like to haveone for my file.”
Noel Itall on HIPAA: “No problem, I’ll send you a copyas soon as we hang up. But, now that I’ve pointed out twopotential sources – foreign privacy laws and the HCA - for thesubcontractor to know what restrictions and standards applyto it when handling the hospital’s PHI, let me respond to yourquestion regarding who is responsible for ensuring that theforeign subcontractor is actually complying.
Interestingly, the Privacy Rule does not specifically requirethe hospital to monitor either NJ Billing Corp. or its foreignsubcontractor to ensure that either or both are complyingwith the terms of their agreement to comply with HIPAA.Instead, the hospital would not be in compliance with thestandards applicable to disclosure of PHI to its business asso-ciate if the hospital “knew of a pattern of activity or practice ofthe business associate that constituted a material breach or viola-tion of the business associate’s obligation under the contract orother arrangement” and the hospital did not take reasonablesteps to cure the breach or end the violation. If such stepswere unsuccessful, then the hospital would be required toeither terminate the contract with NJ Billing Corp., or, iftermination is not feasible, report the problem to the federalgovernment. Similarly, the HIPAA-required provisions con-tained in a BAA do not include any requirement that thebusiness associate oversee their foreign subcontractor toensure that it complies with the privacy and security terms ithas ‘agreed to’.
That said, the Privacy Rule also contains language that thehospital must obtain ‘satisfactory assurances’ that NJ BillingCorp. is ‘appropriately safeguarding’ the hospital’s PHI. In myopinion, this clause imposes the overarching duty on acovered entity. So, for instance, if you know that NJ BillingCorp. is using a foreign subcontractor in a country with weakor nonexistent privacy laws, and the executed HCA may noteven be enforceable against the foreign subcontractor, Ibelieve that the hospital would be justified in demanding thatNJ Billing Corp. offer something additional to demonstratethat its foreign subcontractor is capable of and will protect thePHI in accordance with our privacy and security standards.”
Jen Ral-Konsil: “Like what?”
Noel Itall on HIPAA: “Well, for one, I think that you wouldwant NJ Billing Corp. to provide some verification that the sub-contractor is a legitimate operating business, rather than somefly-by-night operation that has little or no business reputation touphold. A foreign subcontractor that pops up as ‘here today,’could be ‘gone tomorrow,’ and worse, could potentially be afront for international criminal activity, like medical identifytheft rings. Get a client list for the foreign subcontractor, and ifpossible one or two actually business references.
You could also ask NJ Billing Corp. to make a representa-tion that it has personally reviewed its foreign subcontractor’sprivacy and security policies and procedures and verified, asbest as possible, that they meet the requisite standards. If theforeign subcontractor can’t even produce written policies andprocedures, then this would not provide me with ‘satisfactoryassurance’ that my PHI will be handled appropriately. Youcould also ask for verification that the foreign contractor’semployees receive adequate HIPAA training. From a securityperspective, the foreign contractor should be able to demon-strate that its computer systems contain adequate technologi-cal safeguards, like passwords, logoff, and encryption softwarefor when the PHI is sent back to the United States.
Finally, even though I just explained that oversight is notrequired under the Privacy Rule, you may want to require NJBilling Corp. to have some means of periodically ‘checking’that its foreign contractor is in compliance with HIPAA. Oneway to do this is through unannounced audits by a com-pliance officer employed or hired by NJ Billing Corp. If theforeign subcontractor is committed to providing a top-quali-ty, HIPAA-compliant service, then it should have no issuewith agreeing to and permitting such inspections.”
Jen Ral-Konsil: “Those are good suggestions. Now, whatif the hospital or NJ Billing Corp. affirmatively learns thatforeign subcontractor is not ensuring the privacy and securityof the PHI in a manner that meets HIPAA’s standards? Whatare our obligations in that instance, and who enforcescompliance?
Noel Itall on HIPAA: “Well, since foreign subcontractorsin most instances will not be covered entities, the U.S. federalgovernment would not be enforcing the subcontractor’s com-pliance with HIPAA. So, the sole source of the subcontractor’s obligation would be the terms of its ‘agreement’ with the busi-ness associate. Furthermore, since there is no direct agreementbetween the hospital and the foreign subcontractor, and so noprivity, the hospital would not be in a position to enforce theterms of any agreement between NJ Billing Corp. and its sub-contractor. Therefore, to answer your question, it would be NJBilling Corp. that is in the best position to enforce its foreigncontractor’s compliance with their agreement.
However, enforcing any such agreement could be problem-atic, if not impossible, depending on the legal system of the
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10 Focus
foreign country, which may range from comparable to that ofthe United States to non-existent. Thus, NJ Billing Corp.may well have difficulty enforcing any such agreement with its subcontractor in foreign courts. Even if the agreementrequires U.S. law to apply and provides that all disputes besettled in U.S. courts, if the contractor is situated in anothercountry and has no property or contacts in the U.S., such aprovision will offer small comfort. Thus, NJ Billing Corp.’sonly option then may be to terminate the agreement.
As for the hospital, I think I previously mentioned thatcovered entities must terminate their agreements with a busi-ness associate if they ‘know’ of a pattern of activity which is amaterial violation of the agreement and are unable to cure it.Furthermore, under the Privacy Rule, covered entities arerequired to mitigate any harmful effects of a wrongful use ordisclosure of PHI by the covered entity or its business associ-ates. So, in short, if the hospital actually learns that the for-eign contractor is not complying with its agreement with NJBilling Corp., it must require NJ Billing Corp. to cure thebreach caused by its foreign contractor, or the hospital mustterminate its agreement with NJ Billing Corp. Additionally, ifharmful effects could flow from a wrongful use or disclosureby the subcontractor, the hospital may need to take affirma-tive steps to mitigate such effects.
If the hospital adheres to the foregoing standards, it shouldbe able to demonstrate that the hospital at least has compliedwith the black letter law of the Privacy Rule, and hopefullyavert any penalties from the U.S. federal government for non-compliance resulting from a breach caused by a foreign sub-contractor. However, as a practical matter if patients are dam-aged by a breach caused by a business associate or its subcon-tractor, they will seek compensation from the hospital.Although HIPAA does not include a private right of action,claims for breaches in privacy may provide a legal basis to pur-sue such claims anyway. Fore instance, patients could attemptto argue that the hospital knew, or should have known, thatsuch arrangement with the foreign subcontractor was inher-ently problematic and risky because privacy laws did notapply and any agreement to comply was not enforceable any-way, but the hospital allowed it anyway, and this caused thebreach of patient’s PHI, which resulted in emotional and eco-nomic harm to the patient.”
Jen Ral-Konsil: “That is exactly right, the hospital will bethe one that gets sued. Any suggestion on how to managethat liability?”
Noel Itall on HIPAA: “That’s the tough one. Of courseyou could include an indemnification clause that obligates NJBilling Corp. to reimburse the hospital for any damages,costs, penalties etc. that the hospital may incur as a result ofthe actions of NJ Billing Corp.’s foreign subcontractor. But,
as you know, without adequate insurance, whether or not youwould actually recover this amount from NJ Billing Corpwould depend on a number of factors, including its financialviability. Commercial insurance may not cover claims result-ing from privacy and security breaches caused by foreign sub-contractors, but you should check the hospital’s policy as wellas that of the business associate more specifically.”
Jen Ral-Konsil: “This has all been very helpful, Noel. Youknow, although I can understand that we should be lookingfor ways to cut costs and curtail spiraling expenses in healthcare, services involving PHI should not be outsourced to for-eign countries without adequate safeguards in place. I thinkthat this would just amount to floating the risk from a specif-ic known cost, to one that is potentially unknown in the eventof a breach or unauthorized use of PHI.”
Noel Itall on HIPAA: “I agree, completely.”Jen Ral-Konsil: “I also just noticed that the NJ Billing
Corp. agreement is up for renegotiation at the end of thismonth. I am definitely going to ask for changes to be madeto some of the terms based on the discussion we had today.Thanks for all your help, again. If you can, send me thatHIPAA-Compliance Agreement, I would appreciate it. I wantto make sure that we require all of our business associates toobtain such an agreement with respect to any foreign subcon-tractor that we agree can be used.”
About the AuthorHelen is a corporate attorney with the Princeton offices of FoxRothschild LLP. Helen provides a wide variety of transactional andregulatory services to clients. With respect to the health care indus-try, she regularly assists clients in their efforts to understand andapply the multitude of regulatory requirements with which healthcare businesses must comply today. Helen has substantial experiencewith HIPAA and health information privacy and security, patientconsent requirements, facility and provider licensure requirements,fraud and abuse compliance, among other areas. Helen maintainsa blog where she posts current developments in electronic healthinformation exchange, and privacy and security law. You can viewher blog at http://hipaahealthlaw.foxrothschild.com. Helen can bereached at [email protected].
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Focus 11
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July/August 2 0 0 8
12 Focus
Over the past couple of years, health care providers (andhospitals in particular), have experienced a marked increase inthe scrutiny of their billing practices. In 2008, one of themost common ways for the federal government to cut spend-ing and maintain the viability of the health care industry hasbeen to combat health care fraud and abuse through theactive enforcement of federal anti-fraud compliance laws,such as the federal False Claims Act (the “FCA”) against hos-pitals. Under the FCA, hospitals that participate in federallyfunded health care programs, such as Medicare, Medicaid orTRICARE, can be subject to steep penalties for submitting orcausing the submission of improper claims for payment.
In a recent U.S. Department of Justice (“DOJ”) pressrelease regarding a $26 million settlement agreement enteredinto between an Atlanta-area hospital and the government,and which was based on FCA allegations against the hospital,the U.S. Attorney involved in the investigation stated, “thissignificant settlement demonstrates our commitment to pro-tect public funds from fraud and abuse. Every hospital thatsubmits claims to the Medicare program must ensure that itsservices are billed appropriately. We will continue to vigorous-ly pursue Medicare providers who disregard billing rules.” Inthe same press release, an Assistant Attorney General wasquoted for his statement that “health care providers in theMedicare program have an obligation to turn square cornerswhen dealing with the government. This means that hospitalsmust go the extra mile to ensure that any claims for paymentthey submit to Medicare reflect the correct level of service.”
The following practices, among many others, have beenthe subject of recent FCA investigations of hospitals’ billingpractices, spearheaded by the OIG along with other govern-ment agencies: (1) billing outpatient-level admissions as inpa-tient admissions; (2) submitting claims for short inpatientadmissions (e.g. one-day stays), where services were such thatthey should have been billed on an outpatient “observation”basis or as an emergency room visit; (3) submitting claims foradmissions where the hospital admitted patients for a certainnumber of days (e.g. 3 days), without meeting the criteria fora covered admission; (4) submitting claims for services that
were not adequately documented in the patient’s medicalrecord, including dispensing medication and conducting lab-oratory studies without written orders signed by a physician;(5) inflating charges relating to chemotherapy, blood services,and other infusion services; and (6) performing medically“inappropriate” or “unnecessary” procedures.
If found to have violated the FCA for any reason, whetherintentionally or not, hospitals can be required to pay the fed-eral government “treble damages” or up to three times theamount of any federal monies that were lost as a result ofimproper reimbursement. Hospitals can also be required topay additional penalties for violation of the FCA, in theamount of $5,500 to $11,000 per claim, if the defendant isfound to have “knowingly” submitted or caused the submis-sion of a false or fraudulent claim to the United States. Moreoften than not, hospitals who have FCA claims broughtagainst them will settle the claims at a high cost, in lieu ofbeing involved in potentially lengthy, burdensome, and dis-paraging litigation. Notably, entering into a settlement agree-ment does not require a hospital to admit to liability.
Quite often, investigations of a hospital’s coding andbilling practices are sparked by private persons, also known as“whistleblowers” or “relators” who initiate qui tam lawsuits.Qui tam is a Latin phrase meaning “he who brings a case onbehalf of our lord the King, as well as for himself.” The FCAexplicitly permits any individual with knowledge that an indi-vidual or organization is submitting false claims to the feder-al government to file a law suit where the person has informa-tion that the named defendant has submitted or caused thesubmission of false or fraudulent claims to any federally fund-ed program (e.g., Medicare or Medicaid). In the context ofhospitals, the whistleblower is often a physician with privi-leges at the hospital, a nurse or other employee of the hospi-tal, a competitor, a patient, or any other person who hasknowledge about the hospital’s billing practices.
Under the FCA, a whistleblower does not have to havebeen personally harmed by the defendant’s conduct, and thefact that the whistleblower participated in the fraud does notprevent the individual from bringing suit. The incentive to
by Erum Raza, Esq.
Hospital Billing PracticesScrutinized: Increased Exposure toLiability Under the Federal FalseClaims Act
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whistleblowers to spark investigations is that the FCA prom-ises that they can share from 15% to 25% of any monies thegovernment recovers if the government joins in the law suit,and up to 30% if the government decides not to intervene. Ifthe whistleblower participated in the fraud, and a court findsthat such whistleblower planned or initiated the fraud, thecourt may reduce his or her award. If the whistleblower isconvicted of criminal action in connection with the fraud, heor she will not be awarded any monies.
By law, a qui tam complaint must be “filed under seal,”which means that all records relating to the case must be kepton a secret docket by the court and are not publicly availablefor 60 days or longer while the government investigates theallegations and decides whether to join the lawsuit. Investi-gations are often conducted jointly by the OIG, the DOJ, theFederal Bureau of Investigation (“FBI”), and other federaland or state law enforcement agencies. A whistleblower mustalso file a “disclosure statement” with the DOJ containingsubstantially all the evidence in the possession of the whistle-blower. The disclosure statement is not filed in court, and isnot available to the named defendant. Thereafter, the localDOJ attorney (the “U.S. Attorney”) will investigate the alle-gations in the complaint and the disclosure statement, usual-ly in conjunction with one or more law enforcement agencies.
The investigation may involve specific investigative tech-niques, including subpoenas for documents or electronicrecords, witness interviews, compelled oral testimony fromone or more individuals or organizations, and consultationswith experts. If there is a parallel criminal investigation,search warrants and other criminal investigation tools may beused to obtain evidence as well. At the conclusion of theinvestigation, the DOJ may choose to join in, decline tointervene in, move to dismiss, or settle the whistleblower’sclaim. If the DOJ intervenes, often times, it will file its owncomplaint setting forth its statement of the facts and the reliefsought. The DOJ may also assert additional claims arisingunder other statutes in its complaint that a private citizenwould not be entitled to assert. Once the hospital and/orother defendants are served with a copy of the government’scomplaint, they are required to file an answer to the com-plaint within 20 days.
Although bringing a qui tam lawsuit is not an easy decisionto make based on the detailed process for filing the claim, aswell as the possible ripple effect on the whistleblower’s personaland professional life, this type of lawsuit is becoming an increasingly common way to report purported health care fraudfor various reasons, including the potential for significant finan-
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cial rewards, moral and ethical obligations, and the job protec-tion that is guaranteed to whistleblowers under the FCA.
In addition to investigations initiated by whistleblowers,increasingly, private audits by Recovery Audit Contractors(“RACs”) under contract with the government often lead toFCA investigations of hospitals. The Centers for Medicareand Medicaid Services (“CMS”) initiated the RAC Demon-stration Program (the “Demonstration Program”) in 2004 todetermine whether the use of RACS would be a cost-effectiveway to ensure that correct payments are being made to pro-viders. In 2006, Congress made the RAC program perma-nent. Over the past three years, RACS have returned morethan $300 million dollars to the federal government from pri-vate audits conducted in only three states. What is concern-ing to many is that a larger, national program covering privateaudits by RACS was rolled out in 19 states beginning in theSpring of 2008 (the “RAC Program”). In October of 2008,five additional states will be added to the RAC Program.
RACs have a significant financial incentive to participate inprivate audits since the RAC Program permits them to keepapproximately 20% of any overpayments recouped by the gov-ernment. The Office of Management and Budget (the “OMB”)estimates that Medicare payment errors total approximately$10.8 billion per year. It is estimated that approximately 4.5 mil-lion Medicare claims are filed each work day and 9,579 claimsare filed per minute. While it would be a logistical and financialnightmare for the government to review each and every claimfiled, the OIG and government contractors are reviewing a frac-tion of these claims with the assistance of RACs. Among numer-ous critics of the RAC Program, Don May, Vice President forPolicy at the American Hospital Association, has described theRAC Program as follows, “What we have here is bureaucrats andgovernment contractors coming in and trying to second guesswhat doctors and nurses have done…They’re playing Mondaymorning quarterback.”
Although there is no way to completely insulate a hospitalfrom government investigation, there are several risk manage-ment steps hospitals can consider to avoid exposure to liabil-ity under the FCA:
(1) Select persons or entities that perform the billingfunctions extremely carefully and with caution; indi-vidual physicians and the hospital can be held respon-sible for false claims submitted on their behalf even if they were not aware of it;
(2) Supervise all persons or entities performing the billing function on an on-going basis;
(3) Perform routine in-house audits of charts and claimsubmissions for completeness, accuracy and medicalnecessity;
(4) Make sure all billing personnel are aware of and com-
ply with all government regulations regarding filingclaims;
(5) Encourage employees to report mistakes, questions,concerns, and wrongdoings of any kind related to thecoding and billing functions to hospital administration;
(6) As soon as a problem is detected, take immediate actionto prevent similar mistakes or further wrong-doing;
(7) Ensure medical records provide clearly written andadequate documentation of all services and proce-dures provided;
(8) Provide all personnel involved in billing at any level,with adequate formal training (or access to formaltraining) in billing procedures;
(9) Engage outside experts, consultants, and attorneys toperiodically review and audit billing policies and pro-cedures before they are scrutinized;
(10) Avoid providing and billing for unnecessary services;if there is no overall benefit to the patient that out-weighs the risk, inconvenience, or cost of the serviceor procedure, the procedure is medically unnecessaryand it is unethical to knowingly provide such serviceor procedure for financial gain;
(11) If you have doubts about the appropriateness of yourcoding policies and procedures, seek written instruc-tions from local Medicare carriers, the AmericanMedical Association (“AMA”) Department of Codingand Nomenclature, or Health Care Financing Admin-istration (“HCFA”); and
(12) Respond to an investigatory inquiry or complaintimmediately.
A delay in responding to an investigatory inquiry can ulti-mately prejudice a hospital’s ability to resolve a case favorably.In the event that your hospital becomes the subject of aninvestigation, immediately secure a qualified attorney whocan prepare and assist in your defense in a timely manner andengage a medical billing expert (“MBE”) to testify, if neces-sary, as to the medical necessity and reimbursability underexisting Medicare guidelines of the services and diagnostictests at issue, as well as to the adequacy and appropriatenessof the medical record documentation, and the hospital’sbilling and records practices, policies and procedures.
About the AuthorErum Raza is a corporate attorney, resident in the Princetonoffice of Fox Rothschild LLP. Her corporate and tax practice focuson various issues relating to professional service practices andclosely held businesses; and the purchase and sale of businesses.She is admitted to practice in New Jersey and New York and spe-cializes in health care law and business transactions.
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Business Office CollectorProductivity StandardsAre your follow-up staff and collectorsworking accounts in an effective, proactive manner while meeting yourdaily productivity standard?
by Chris Karman
In this article we will discuss the advantages of implement-ing and managing a collector productivity monitoring pro-gram in a business office environment. For ease of reference,we will consider both third-party follow-up staff and self-paycollectors as “collectors” since productivity standards shouldbe developed for both positions, and the process is the same.Why monitor productivity? We have observed that collectorsworking with no productivity standards, and the correspon-ding accountability that goes with them, work one-third toone-half as many accounts as those who are held to a stan-dard. That can easily amount to $20,000 per collector inannual lost salary expense alone. In addition, the opportuni-ty cost of accounts not worked will always exceed the lostsalary expense by a substantial margin, since just one large-balance account that "slips through the cracks" due to aninadequate work effort can cost the facility hundreds of thou-sands of dollars. Add to that the value of collecting moneyearlier in the cycle, and the benefit of implementing and man-aging a collector productivity-monitoring program couldpotentially be measured in the millions of dollars.
BACKGROUNDWith the demands inherent in managing a business office
operation, productivity standards are often ignored or merelytalked about, but not always implemented and monitored.More importantly, if productivity standards are in place, theymay be utilized exclusively as a volume target for collectionpersonnel rather than to coach employees, remove collectionobstacles, or discipline under-performing employees. Businessoffices go to great lengths to acquire and utilize informationsystems solutions to populate work queues for collectors, butfrequently do not bother to track follow-up activity on a dailyor weekly basis. If the collector is not working the accounts asif the balance were his or her own, departmental performancewill suffer, as will the accounts receivable (A/R), and cash
goals will become very difficult to meet or exceed. We can notcover all of the details of implementing collector productivitystandards here, but we will outline the key concepts.
KEY ISSUESChallenges
Reduction of A/R, Net A/R Days, and increased cash col-lections are goals shared by every business office. As we allknow, staffing business offices across the country is very diffi-cult in urban, suburban, and rural areas alike and, often, wehave to resort to hiring unqualified or inexperienced staff thatrequire extensive training.
When you couple this with uncooperative insurance com-panies that consistently delay and/or short-pay accounts,managing an A/R has become one of the more difficult jobsin the healthcare sector.
Many business offices across the country are populated withlong-term managers, supervisors, and line staff who have diffi-culty accepting change and understanding the importance ofproductivity standards. These facilities may think it is a goodidea to purge long-term employees. While it is true that thelonger employees are allowed to function without a productiv-ity or quality standard in place, the more they will battleagainst the implementation thereof, a wholesale purge is sel-dom necessary. Experience shows there are two realities when itcomes to implementing productivity standards: 1) Newemployees are easier to train and immediately hold to the stan-dard, and 2) many of the existing employees can achieve thestandard, if that standard is implemented positively and fairly.The peer pressure created by standards also helps some employ-ees that are under-performers join their better-performingpeers, especially if there is an incentive plan in place.
Business offices sometimes feel alone in their quest to imple-ment and subsequently enforce productivity standards. In real-
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Chris Karman
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ity, several individuals and departments have to be engaged in the implementation process. Most importantly, the ChiefFinancial Officer, who is ultimately responsible for the overallperformance of the business office, must play a central role inthe final approval and continued support of the new produc-tivity monitoring program. The Human Resources (HR) De-partment plays an integral role because the key to success is thewillingness of management to initiate the counseling and dis-ciplinary process after a continued failure on the part of theemployee to meet the standard. HR must understand the newprogram and the business office must prove to HR that everycollector is being held to the same standard. Additionally, insome hospitals and health systems, Information Systems mustbe relied upon to generate reports of col-lector activity to monitor productivity.There are other key figures in the processas well, including the Chief InformationOfficer and his or her management teambecause without accurate data available atthe specified times, the initiative will fail.
Planning and Implementing the NewProductivity Program
Implementing follow-up productivitystandards is not a simple task, but can beaccomplished by any business office.Before establishing and implementing astandard, the following three steps shouldbe followed:
1. Collector activity level should bemonitored to obtain current-state baseline productivity metrics.
2. Work functions should be organized and streamlined.3. The collector should be involved in the establishment
of the standard.The involvement of the collector is crucial to the process
because it leads to better cooperation. Management author,Henry Sisk, was quoted by Charles Mowll in a HealthcareFinancial Management Association (HFMA) article titledControlling the Patient Accounting Department. He defined awork standard as "a unit of measurement established to serveas a model or criterion for work performance." A standardshould challenge the staff to excel, but perfection can not bethe expectation in most cases.
The most effective method for implementing productivitystandards is a combination of historical performance and timestudies. The quality and experience of the staff plays a role indetermining the standard, as well as the quality of the trainingprogram and follow-up techniques being utilized. Supportingtechnology can play a major role, as well. In the initial steps,
the business office will begin to monitor the performance ofthe collectors. In addition, quantitative analysis in the form ofa time study should be performed on the collection process.The time study will provide the business office with a realisticacknowledgement of the time required to perform the follow-up function under various circumstances, including differenttimes of the day and payer-specific challenges.
As stated above, the time standard must take into consid-eration training, unavoidable delays such as insurance compa-ny hold times, and employee fatigue. Managers may want toconsult industry subject matter experts or other healthcareorganizations to determine the fairness and viability of thestandard being considered.
Once the standard is set, it is best towork with Human Resources to deter-mine a fair implementation schedule. Forexample, if the daily productivity stan-dard is set at 65 accounts per day or 325per week, the implementation scheduleshould allow for a ramp-up period. So,the initial target may be 35 accounts perday starting on week one, with a weeklyramp-up to the 65 accounts per day thatwill eventually be the expectation. Begin-ning with the 35 accounts per day targetmeans the collector will be working oneaccount every 12 minutes. That is a veryreasonable expectation, taking into con-sideration the various tools, such as theinternet, that are available to the modernday collector.
Managing the Productivity Monitoring Program Once the productivity standard is implemented and
reviewed with the collection staff, business office manage-ment must work with Information Systems or PatientAccounting report analysts to devise a reporting and trackingsystem. The system must provide accurate and timely datacomparing actual performance to the established standard.Weekly reports should be prepared, identifying each follow-up representative, and should be used by business office man-agement to evaluate performance and enforce the standard.
As mentioned earlier, enforcement of the productivitymonitoring program is vital to its success. In addition, busi-ness office management can reward employees who sur-pass the standard, and can help motivate all performers byconnecting the productivity monitoring program to theemployee evaluation process.
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continued from page 15
Once the productivitystandard is implemented
and reviewed withthe collection staff,
business office managementmust work with
Information Systems orPatient Accounting report
analysts to devisea reporting andtracking system.
A recent New Jersey Appellate Court case added a newvariable to the ever-challenging considerations related topatient confidentiality, and the decision may have a far-reach-ing impact for hospitals and other types of heath care pro-viders, as well as healthcare workers. In Serrano v. ChristHospital, the court ruled that a wrongful termination lawsuitby a former hospital worker who divulged patient informa-tion could proceed. In reversing the lower court’s dismissal ofthe case, the Appellate Court stated that it sought to balancethe competing public policies of patient confidentiality andpublic safety.
I. Patient Information RevealedThe plaintiff, Elia Serrano, a hospital employee since 1988,
worked as a secretary in the hospital’s ICU department. Shehad signed a confidentiality statementindicating that “patient care data” wasconfidential and that she was barredfrom revealing this and other confiden-tial information “at all times, both atwork and off duty.” In 2004, while in thecourse of her employment, she translatedfor an elderly Spanish-speaking patientto help determine whether the patienthad meningitis. During this exchange,she met with the patient’s daughter andlearned of the daughter’s children. She also learned that thedaughter was instructed to have her children examined by adoctor before returning them to school.
That evening, the plaintiff learned that one of these chil-dren went to the same school as her own child. When she tookher child to school the next day, she observed the other childin the classroom coughing. Based on what the plaintiff knewof the grandparent’s medical condition, she decided to take herchild home. When the teacher approached Ms. Serrano to askwhy she was taking her child home, the plaintiff told theteacher about the sick grandmother, and that the family wasadvised not to bring the children to school until cleared by adoctor. Further discussion between Ms. Serrano and the
teacher revealed that no paperwork had been submitted to theschool confirming that the child had been examined by a doc-tor. The teacher asked plaintiff to relay this information to asocial worker who contacted her later that day.
As a result of this disclosure, the school requested that thecoughing child be removed from school and be examined by adoctor. The coughing child’s mother complained to the hospi-tal, and “the hospital terminated [the] plaintiff based on thisalleged breach of its confidentiality policy.” Subsequently, Ms.Serrano filed suit against the hospital for wrongful termination.
II. The AppealThe Appellate Division panel concluded that the plaintiff
was arguably discharged in violation of a “clear mandate ofpublic policy.” Recognizing that although “the hospital’s con-
fidentiality rule is rooted in publicpolicy…these privacy protections arenot absolute,” and such privacy pro-tections should be weighed against acompeting public policy implicated bythe plaintiff ’s actions in this matter.While “there is no statute among themany laws enacted by our Legislaturethat expressly permits a hospital work-er of plaintiff ’s stature to reveal confi-dential patient information in order to
protect children from a perceived health hazard…ourLegislature has adopted numerous laws designed to protectthe well-being of children.” The Appellate Division conclud-ed that because the plaintiff ’s disclosure of confidential infor-mation was arguably mandated by public policy, she couldproceed with her case.
III. Impact of the Appellate Division RulingThe appellate court made clear that this is not a judgment
in favor of the plaintiff or the employer hospital, but a ruling that this dispute presents questions for a jury to determine:“we offer no prognostication as to how the competing values
Hospital Worker Fired for DivulgingPatient Information Can Sue ForWrongful Termination
by Harris Neal Feldman, Esquire
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…privacy protections shouldbe weighed against
a competing public policyimplicated by theplaintiff ’s actions
in this matter.
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SUMMARYBusiness office management must retain tight control of
employee performance to meet or exceed departmental goals.Management should continue to use other performance im-provement and monitoring techniques, such as account and pro-cess audits and work observations, but the most effective results-based method is to plan, implement, monitor, and enforce pro-ductivity standards. The productivity monitoring program ismost effective when combined with applicable quality standards,appropriate A/R stratification, and an aggressive collection cycle(e.g., calling on high-dollar accounts once per week, starting atthe 21st day).
The productivity monitoring program is the first step tocontrolling your A/R, and the potential benefits are impres-sive. A six-hospital regional health system implemented pro-ductivity monitoring at two of its facilities as a pilot program.They experienced an increase in cash collections of over $1M
per month for those two hospitals over a five-month periodand intend to implement the productivity monitoring pro-gram system-wide as a result. Based upon our observations,their experience is not unique.
Implementing a productivity monitoring program willhelp you get better results from your collectors; and it willaccelerate and improve cash collections. It is an initiative thatany business office can implement with the proper executivesupport, and it involves minimum cost. The benefits morethan justify the cost and effort.
About the AuthorChris Karman is a Director with IMA Consulting in the area ofRevenue Management. He is an expert in all facets of PatientAccess and Patient Accounts management. Chris can be reachedat [email protected].
continued from page 16
of the hospital’s confidentiality rule and plaintiff ’s allegedinterest in protecting a schoolroom full of children from apotentially deadly disease should ultimately be prioritized.”In other words, rather than having the wrongful terminationsuit quickly dismissed by asserting there was a clear patientconfidentiality policy, the court opened the door for this kind
of dispute to proceed regardless of the confidentiality policy. It is important to note that this is only one unpublished
decision of a panel of the Appellate Division; however, it serves as guidance – and possibly even a warning – to employ-ers to consider that New Jersey courts may weigh public pol-icy concerns with unambiguous written employee policies topossibly defeat summary judgment in a wrongful terminationcase. This may come as a surprise for hospitals and healthcare providers used to the strict provisions and regulations –such as HIPPA and other state-specific laws – related topatient confidentiality. In light of this recent decision, healthcare employers would be well served to consult with theirattorneys when drafting or redrafting all employee policiesand contact experienced counsel when defending a case ofwrongful termination.
About the AuthorHarris Neal Feldman is an attorney with the Cherry Hill, NewJersey office of Schnader Harrison Segal & Lewis LLP. He hasexperience in all phases of civil litigation in state and federalcourts at the trial and appellate level, with an emphasis on busi-ness litigation, labor and employment law, defamation andproduct liability matters. Mr. Feldman has successfully represent-ed corporations, small businesses and individuals at varioushearings, mediations, arbitrations and trials.
Hospital Worker Firedcontinued from page 17
“we offer no prognosticationas to how the
competing valuesof the hospital’s confidentiality
rule and plaintiff ’s allegedinterest in protecting a
schoolroom full of childrenfrom a potentially
deadly diseaseshould ultimatelybe prioritized.”
The New Jersey Legislature passed the FY09 state budgeton June 23, seven days ahead of the Constitutional deadlineof June 30. In a year dominated by a national recession, andwith a budget set to cut spending from last year’s level by$600 million, proposed cuts to hospitals and municipalitiesdominated the debate. In the end however, it was the issue ofpension reform for state workers that offered only a mild hic-cup in the closing days of the budget debate.
While the outcome of this year’s budget, as it relates tohealthcare, did not reflect the work of one of the New JerseyHospital Association’s (NJHA) most comprehensive advocacycampaigns in recent history, it may clearly serve as a bell-wether of change to come in the way our state delivers itshealthcare.
In terms of dollars and cents, the most critical impact ofthe budget on the hospital industry was a $111 million (a15.5 percent reduction) reduction to charity care fundingfrom last year’s level. This number includes a $32 millionrestoration from the original cut to charity care of $143 mil-lion, making the total for charity care funding $605 million.A newly created Healthcare Stabilization Fund received anadditional $9 million from its original proposal, for a total of$44 million. This fund was designed to grant the Commis-sioner of Health and Senior Services broad-reaching authorityto provide financial assistance to hospitals viewed to be at riskof closure. However, the distribution of the fund remains amystery, and the implementing legislation for the fund allowsthe Commissioner to grant money to non-hospital healthcareproviders.
Along with the cut, an equally disturbing component ofthe budget plan is the method in which the reduced fundingfor charity care is to be distributed. Pursuant to theGovernor’s original proposal, hospitals will be grouped intothree tiers generally based on their charity care patient loads.Additionally, corridors will once again be used to spread the$32 million in restoration as far as possible.
Facilities in the first tier will be reduced by 5 percent over-all, but will not receive more than a 20 percent increase or
greater than 100 cents onthe dollar and no greaterthan a 40 percent reduc-tion, or less than 60 cents on the dollar. Hospitals in tier twowill be cut by 37 percent and will not receive any more than50 cents on the dollar. They will also be prevented fromreceiving more than a 20 percent increase or a 40 percentdecrease. Finally, hospitals in the third tier will receive only 10cents on the dollar.
Hospitals are not the only healthcare providers hurt in thisyear’s budget. The nursing home industry will also be grap-pling with a reduction in funding and will be receiving onlyan $11 million restoration to the original cut of $45 millionin state Medicaid funding. This funding will provide facili-ties that are not high Medicaid occupancy facilities with aninflation adjustment. Approximately 60 percent of all theMedicaid days in nursing homes are provided in homes thatare not high Medicaid occupancy homes. This means thathomes with less than 75 percent Medicaid occupancy willreceive a much lower inflation adjustment than those withgreater than 75 percent Medicaid occupancy. The way this$11 million restoration is being applied, some Medicaid ben-eficiaries will benefit less than others simply by virtue ofwhich facility they live in.
In addition, nursing homes will receive no funds related torebasing of Medicaid rates this year because of the eliminationof this part of the funding formula in the Governor’s budget.This equates to another $24 million reduction in state dollars,and a resulting loss of federal matching funds in an equalamount, for at total cut to nursing homes of $75 million.
NJHA had advocated since the budget’s introduction for full restoration of charity care funding to FY08 levels arguingthat cutting funding for state-mandated charity care will onlyfurther threaten the industry. Seven hospitals have closed inthe last 18 months and five have filed for bankruptcy. Halfof the hospitals in the state are losing money with operat-ing margins far below the national average. Now the industry
FY09 State Budget: Lean Fiscal Times or New World Order?
by Randy J. Minniear
Randy J. Minniear
continued on page 20
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20 Focus
is faced with a budget that cuts $111 million from thecharity care system, a critical source of funding for NewJersey’s hospitals.
Both the Corzine Administration and Legislative leader-ship have indicated that next year’s budget may contain evengreater fiscal constraint. NJHA has already begun strategiz-ing new approaches to addressing the chronic underfundingof healthcare providers in anticipation of next year’s budget.
With a Presidential election in November and New Jersey’sgubernatorial election next year, the time for change in ourstate’s healthcare may be at hand. Already, an initial phase ofa legislative plan for universal healthcare coverage has passedand the second phase is expected in the fall. Discussions of
the possible conversion of Horizon Blue Cross Blue Shield ofNew Jersey to a for-profit entity also abound. With all ofthese moving parts currently in the pipeline, one thing is forcertain: We may very well be witnessing a historic evolutionin healthcare delivery at both the state and national level.
About the AuthorRandy J. Minniear has managed NJHA’s state legislative advocacyefforts since 2004 as Vice President for Legislation and Policy.Before his service at NJHA, he worked as Director of GovernmentAffairs at the Chemistry Council of New Jersey. He began hiscareer in government relations work as Chief of Staff to formerSenate President John O. Bennett.
continued from page 19
In December 2003, Congress passed the Medicare Prescrip-tion Drug, Improvement, and Modernization Act (MMA) of2003. Under section 911 of the MMA, referred to as MedicareContracting Reform, Congress requires that the Centers forMedicare and Medicaid Services (CMS) replace the current fis-cal intermediary (FI) and carrier contracts with competitivelyprocured contracts that conform to the Federal AcquisitionRegulation (FAR). Under the new Medicare AdministrativeContractor (MAC) contracting authority CMS has six years,between 2005 and 2011, to complete the transition ofMedicare Fee-for-Service (FFS) claims processing activitiesfrom the FIs and carriers to the MACs. CMS plans to award atotal of 15 A/B (both Part A and Part B) MAC Jurisdictionsacross the country, through a competitive bidding process.
On October 24, 2007, CMS announced that HighmarkMedicare Services was awarded the Jurisdiction 12 MedicareContract to provide the Medicare Fee-for-Service (FFS) PartA and Part B administrative services for the states of Penn-sylvania (PA), Maryland (MD), New Jersey (NJ), Delaware(DE) and the District of Columbia (DC). CMS directedHighmark Medicare Services to commence MAC transitionactivities on March 5, 2008 with implementation of all work-loads by the end of 2008. The following chart outlines theimplementation date in more detail:
States Current FI/ ImplementationCarrier Date
MD/DE Trailblazer Health Enterprises 7/11/2008
PA/MD/DC Part A Highmark Medicare Services 8/1/2008
NJ Part A Riverbend 9/1/2008DE Part A and National Government NJ Part B Services 11/14/2008PA Part B Highmark Medicare
Services 12/12/2008
Highmark Medicare Services has established a provider edu-cation program, which is directed at educating providers andtheir staffs about Medicare programs and policies. These educa-tional resources include the following: “Ask the Contractor”teleconferences, group education, computer-based trainingmodules, teleconferences, and webinars. Specific dates for thoseevents are forthcoming on the “Calendar of Events” section oftheir website: http://www.highmarkmedicareservices.com/cal-endar/index.html.
Medicare Administrative Contractor(MAC)- Summary & Transition
•Focus on Industry•
by Scott Kazanjian, IMA Consulting
Recognizing that the scope of Compliance Programs andthe profile of the compliance professional was changing, in2007 the Compliance Forum re-branded itself the Compli-ance, Audit, Risk and Ethics (C.A.R.E.) Forum. In 2008, theC.A.R.E. Forum elected to survey New Jersey providers toevaluate this progression and will use the results in guidingthe Forum’s future activities.
In the survey responses and analysis we sought to identifythe respondent, evaluate the integration and collaboration ofCompliance and other hospital committees and activities, thedesign of the organizational risk assessment and evaluate cer-tain aspects of board and management education.
Respondents:The response to the survey was distributed to all NJHFMA
members via email. It was asked that only one person per hospi-tal or healthcare system complete and submits the survey; twenty-two (22) responded representing 8 hospitals, 13 multi-hospitalsystems and one nursing home. Of the thirteen multi-hospital sys-tems, ten respondents represented three or fewer hospitals; threerespondents represented four or five hospital systems. From theseresponses, it was concluded that approximately one half of the sev-enty-eight acute care hospitals in the state were represented.
As expected, fourteen or 63% of respondents were compli-ance officers; four were Chief Financial Officers; one generalcounsel; three respondents whose titles were director or man-ager of compliance and internal audit.
Although seven respondents indicated that only one full-time equivalent (FTE) works in the Compliance Department,the survey results indicated that many departments are nolonger composed solely of a Chief Compliance Officer. Fourrespondents work in departments comprised of five or moreFTEs while eight respondents work with three FTEs and threerespondents with two. Titles represented included thirteenChief Compliance Officers; ten Directors of Corporate Com-pliance; one Corporate Compliance Manager; five certifiedinternal auditors; four non-certified internal auditors; three cer-tified medical coders, seven administrative support personneland three “other” individuals not otherwise identified.
Program CollaborationThe survey questioned respondents about the collabora-
tion between compliance and other programs within the
organization, specifically asking if compliance assumed over-sight for the program or if the collaboration was formal, infor-mal, or if no relationship existed.
As shown in the table, the collaboration of compliancewith key hospital functions is varied. Some responses wereanticipated, such as the relationships between Complianceand HIPAA, (both Privacy and Security), Internal Audit, andLegal. Of particular interest to the Forum was the integrationof compliance with patient safety, quality, and risk manage-ment; the results of the survey indicate that there is still a lackof formal collaboration between hospital compliance pro-grams and these programs.
The Forum was surprised at the lack of formal integrationof compliance with Medicare Conditions of Participation,Graduate Medical Education and Research/IRB functions
The Forum concluded from the program collaborationresponses that the compliance function in New Jersey hasslowly started to expand its focus in response to national trends and the demands of the industry, but that some organ-izations appear slower in the adaptation process than others.
Committee RelationshipsThe Forum also wanted to examine the role and the rela-
tionship of the compliance officer (or the person responsible
The Results Are In on the NJHFMAC.A.R.E. Forum’s 2008 ComplianceIntegration Survey
Compliance Compliance ComplianceCompliance formally informally has no
oversees collaborates collaborates relationshipthis function with this with this with this
function function functionRevenue Cycle Management 0.0% 36.4% 45.5% 13.6%Legal/General Counsel 18.2% 50.0% 27.3% 0.0%State Survey/Licensure 18.2% 13.6% 40.9% 22.7%Medicare Conditions of Participation 22.7% 31.8% 27.3% 13.6%HIPAA Security 13.6% 50.0% 36.4% 0.0%HIPAA Privacy 50.0% 40.9% 9.1% 0.0%Research/IRB 9.1% 27.3% 27.3% 31.8%Other Accreditation Agency 13.6% 4.5% 54.5% 22.7%Joint Commission Accreditation Standards 9.1% 18.2% 50.0% 18.2%Graduate Medical Education 0.0% 4.5% 36.4% 50.0%Life Safety 4.5% 9.1% 45.5% 36.4%Patient Safety 0.0% 18.2% 54.5% 22.7%Medical Staff Office 9.1% 13.6% 63.6% 9.1%Quality Management 0.0% 27.3% 54.5% 13.6%Risk Management 9.1% 31.8% 45.5% 9.1%Internal Audit 31.8% 27.3% 40.9% 0.0%
continued on page 22
July/August 2 0 0 8
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by Kelly Dziedzic, CHC, CPAT and Angela Melillo, MBA, CHC, CPC
July/August 2 0 0 8
22 Focus
for the operation of the compliance function within the or-ganization) to key committees within the organization. While itwas not surprising to see that eighteen respondents indicatedthat they were either members of executive of senior leadershipor they report to executive or senior leadership, it was surprisingto see that four respondents indicated no relationship with exec-utive or senior leadership. The Forum wondered if this indicatesa reporting relationship with the Board level only. Two respon-dents indicated no relationship with the Board Compliance/Audit Committee while fifteen reported to this committee andseven are members of the committee. Fifty percent indicatedthey also report to the full Board of Trustees while thirty-eightpercent have no relationship with the full Board.
When examining other committees in the organization, theForum was surprised to see the results. Forty –five to fifty per-cent did not participate with the performance improvement orpatient safety committees respectively. Fifty-five percent didnot participate with the revenue cycle committee. Sixty per-cent did not participate with the IRB, environment of care ormedical executive committees, while about seventy-seven per-cent had no relationship with the medical education commit-tee. While some respondents did indicate the receipt of min-utes from some of these committees only a handful indicatedbeing a part of any of these committees. Specifically, six on thepatient safety and IRB committees, five on the environment ofcare and revenue cycle committees, four on the performanceimprovement committee and one each on the medical execu-tive and medical education committees. The one area thatmost organizations seem to have common interface is compli-ance and internal audit and the design of the annual workplan. Seventy-seven percent indicated that their complianceand internal audit departments work together to develop theannual work plan. Only fourteen indicated that these depart-ments do not work together and this was not applicable in tenpercent of the organizations questioned.
Risk AssessmentWhen asked if the facility/system had conducted an organi-
zational risk assessment, thirty-three percent indicated that onehad never been performed. Twenty-two percent of the respon-dents stated that an organizational risk assessment had been per-formed once while seventeen percent indicated one is performannually. The remaining twenty-eight percent perform riskassessments periodically or as needed. Facilities that had con-ducted risk assessments were asked which areas were included inthe assessment. Nearly eighty-eight percent included compli-ance, while seventy-five percent included financial, privacy, andbilling/coding. Over sixty percent include operational and ITsecurity, while nearly forty-five percent include humanresources, EMTALA and regulatory issues. Only twenty-fivepercent included clinical quality in the risk assessment and
twelve percent include patient safety, OSHA and communitybenefit in the organizational risk assessment.
Quality Oversight EducationA recurrent focus, cited in compliance literature and at com-
pliance national and local meetings, is the June 2007 AmericanHealth Lawyers Association publication titled “Corporate Re-sponsibility and Health Care Quality: A Resource for HealthCare Boards of Directors.” The Forum asked if this resource hadbeen shared with the Board and senior management. Twenty-seven percent of respondents indicated that it had been sharedwith the Board of Directors and thirty-six stated it had beenshared with senior management. The rest of the respondents in-dicated that either it had not been shared or they were unsure ifit had been presented to these groups. The Forum additionallyasked if The Board of Trustees had identified quality as a corefiduciary responsibility. Fifty-nine percent indicated yes, whilethirty-six percent were unsure. Only one respondent (represent-ing five percent) answered no.
ConclusionCompliance activities for New Jersey health care providers
are beginning to expand; this growth in some areas is slowerthan in others, however, the integration of compliance withquality and risk has begun and continues to develop. Weexpect this process to accelerate as regulatory agencies beginto include quality and safety as an element of enforcementand payers integrate similar elements into reimbursement.
While it appears that this integration is more evident in someorganizations, it does not seem to be related to any specific fac-tor (size of facility, FTEs, etc). The maturity of the complianceprogram was not evaluated and thus we are unable to determineif that is a factor along the integration continuum. How the NewJersey experience compares with the national experience is alsounknown at this time. Additional information may be availableafter the Health Care Compliance Association’s (HCCA)Compliance Institute in mid-April. However, the Forum mem-bers believe that the regulatory environment will continue toevolve. Compliance with quality, safety and medical necessitystandards will extend the convergence of compliance, financeand risk management. Entities will need to adapt and integratethese functions and we will find new ways to work together inan increasingly complex fraud and abuse environment.
About the AuthorsKelly Dziedzic, CHC, CPAT is the Director of Internal Audit
& Corporate Compliance, Compliance Officer at SomersetMedical Center in Somerville, NJ
Angela Melillo, MBA, CHC, CPC is Vice President, ChiefCompliance Officer at Saint Peters University Hospital in NewBrunswick, NJ.
continued from page 21
Proaction
Corner
RE: CMS-1390-P, Medicare Program; Proposed Changes to theHospital Inpatient Prospective Payment Systems and Fiscal Year2009 Rates; Proposed Rule (Vol. 73, No. 84), April 30, 2008
Dear Mr. Weems: The New Jersey Chapter of the Healthcare Financial Management
Association (NJHFMA) welcomes the opportunity to comment onthe Centers for Medicare & Medicaid Services (CMS) proposed ruleentitled Medicare Program; Proposed Changes to the Hospital InpatientProspective Payment Systems and Fiscal Year 2009 Rates; Proposed Rule,Federal Register Vol. 73, No.84), April 30, 2008.
The following comments will apply to the various labeled sec-tions from the aforementioned proposed ruling:
Imputed Floor NJHFMA continues to support the Centers for Medicare and
Medicaid Services (CMS) proposal related to “Special Circum-stances of Hospitals in All-Urban States” set forth in the FFY 2005proposed Inpatient Prospective Payment System (IPPS) rule pub-lished in the May 18, 2004 Federal Register.
Conversely, NJHFMA objects to applying the budget neutralityadjustment for the rural floor and imputed floor wage indexes at thestate level rather than the national level. This proposal is inconsis-tent with other budget neutrality adjustments made by CMS with-in the inpatient PPS, which continue to be applied at a nationallevel rather than a state-specific level (e.g., changes to DRG classifi-cations, recalibration of the DRG relative weights, updates to thewage index, and different geographic reclassifications). In the pro-posed rule, CMS indicates that it will fund a small rural communi-ty hospital demonstration project by offsetting the increased pay-ment to these hospitals by an increase in the budget neutralityadjustment that will be applied across all inpatient PPS hospitalsnationwide. We believe that CMS’s proposal to apply the budgetneutrality adjustment for the rural floor and imputed floor on awithin-state basis reflects an inconsistency in policy that will placean undue burden on a small number of states.
Since its inception, the Medicare program has been national inscope. A proposal that would change the long-standing policy of
having all hospitals in the nation share in the funding of a nation-wide program, to one in which only several states fund select partsof a nationwide program and all states share in the funding of otherparts, is a significant and potentially troublesome precedent. De-spite the fact that the rural floor and the imputed floor provisionsaffect only certain states, they are nonetheless still a component ofthe national Medicare program.
The redistributive effect of applying the rural floor and imputedfloor budget neutrality adjustments on a state-by-state basis wouldresult in financial hardships and create operational difficulties forthe hospitals located in the affected states
The effects of within-state budget neutrality to the state of NewJersey are substantial. It is estimated that New Jersey hospitalswill effectively experience a cut of $25 million were this provi-sion of the proposed rule to be finalized. This cut would be par-ticularly devastating to the hospital industry in New Jersey, where22 hospitals have closed since 1992, and six more have closed in thelast 18 months. We have experienced a 30 percent consolidation ofthe industry in just the last two decades. Fully fifty percent of thehospitals that remain are currently losing money on operations.
Again, NJ HFMA strongly opposes CMS’s proposal to applyrural floor and imputed floor budget neutrality adjustments ona statewide basis.
Three-year Extension of the Imputed Floor The NJHFMA commends CMS for the language included in
the FY 2009 inpatient PPS proposed rule that would extend theimputed floor wage index for all-urban states for an additional threeyears, through FY 2011. However, NJHFMA urges CMS to makepermanent the imputed rural wage index floor for all-urbanstates, instead of providing for a temporary three-year exten-sion, in the final FY 2009 inpatient PPS rule.
We submit to you that New Jersey’s geographic disadvantageremains as significant today as it was when CMS originallyacknowledged the situation in the above comments. New Jersey isunique from the rest of the country in that it is bordered by the firstand fifth largest cities in the United States. Therefore, New Jersey
2008-2009 OFFICERSPresidentJoseph J. Dobosh, Jr.
President-ElectBrian P. Sherin
SecretaryMary T. Taylor
TreasurerLisa R. Hartman
BOARD OF DIRECTORSMichael AlwellJohn BraultLindsey S. ColomboMary M. CroninTracy Davison-DiCantoDennis P. HancockMarilyn A. Koczan,Anthony T. OrlandoMichael A. RichettiJohn B. ReissDavid J. WiesselDan WillisCaitlin C. ZullaSean J. Hopkins – Ex-Officio
ADVISORY COUNCILCheryl H. CohenDorothy LindstromJohn ManziRichard C. Parker
June 13, 2008 Mr. Kerry N. Weems Acting Administrator Centers for Medicare & Medicaid ServicesHubert H. Humphrey Building 200 Independence Avenue, S.W., Room 445-GWashington, DC 20201
continued on page 24
Focus 23
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July/August 2 0 0 8
hospitals have been and continue to be forced to compete for laborresources and patients in each of these markets. CMS has provided no rationale for discontinuing the imputed floor policy after FY2011, and has not provided any documentation that the aforemen-tioned “anomaly” has been alleviated.
Based on the most recent data available on New Jersey hospitals,26 facilities would be impacted by an annual amount of $70 mil-lion if this provision were removed.
The absence of the imputed wage index floor for all-urban statesin the Medicare wage index calculation would once again subjectNew Jersey’s hospitals to a significant competitive disadvantage anddramatically affect their ability to continue providing affordable,accessible and quality healthcare to the residents of our state.
Geographic Reclassification NJHFMA opposes any legislative proposal that would apply
the budget neutrality related to geographic reclassification on astatewide basis, for the same reasons we oppose statewide budg-et neutrality related to the rural floor. Geographic reclassifica-tions are necessary because the wage index system as a whole doesnot adequately reimburse hospitals their costs—its deficienciesnecessitate numerous exceptions. Individual states—the very stateswhere the wage index is most inequitable—should not be heldaccountable for paying for the entire system’s deficiencies.
Average Hourly Wage Criteria for Reclassification Hospitals have the opportunity to apply annually for reclassifica-
tion to another geographic area to receive a higher wage index. Aspart of its effort to propose wage index changes, CMS re-evaluatedthe average hourly wage (AHW) criteria for reclassification for thefirst time since they were established in FY 1993. Based on thisanalysis, CMS is proposing to change the criteria for FY 2010 andafter so that an urban hospital would need an AHW that is 88 per-cent (up from 84 percent) of the area to which they want to reclas-sify. Hospitals applying for group reclassification would need anAHW that is 88 percent (up from 85 percent) of the area to whichthey want to reclassify. In addition, CMS is proposing to re-evaluate,and, if warranted, recalibrate these criteria in the future when thereare significant changes to labor market area definitions.
While CMS’s proposal uses the most recent data, it also raises thethreshold for reclassification, thereby making it more difficult forhospitals to qualify. Making such a revision impedes hospitals’ abil-ity to offer competitive salaries to qualified individuals and, thus,provide the highest quality care and adequate access to beneficiaries.In addition, making these revisions without including additionalfunding simply moves the system’s deficiencies around, rather thaneliminating them. NJHFMA opposes CMS’s proposal to recali-brate the AHW criteria, both now and in the future.
Capital IPPS In the FY 2008 final rule, CMS made two changes to the struc-
ture of payments under the capital PPS, claiming that paymentsunder the capital PPS exceeded what was required for hospitals to
provide inpatient services. First, the agency eliminated the three per-cent additional payment that had been provided to hospitals locatedin large urban areas. Second, the agency adopted a policy to phaseout the IME adjustment to teaching hospitals over three years. In FY2008, teaching hospitals receive their full IME adjustment to capitalpayments; in FY 2009, they receive half their adjustment; and in FY2010 and beyond, the adjustment will be eliminated.
CMS’s elimination of the add-on payment for hospitals in largeurban areas cut payments to New Jersey hospitals by $123 millionfrom FY 2008 through FY 2012. Elimination of the IME adjust-ment will reduce payments to New Jersey teaching hospitals by anadditional $52 million over the same five-year period and, accord-ing to the AHA, will cut payments to hospitals nationally by $1.3billion. These cuts are based solely on the discretion of theadministration with no congressional direction and areunprecedented. According to MedPAC, overall Medicare marginswill be negative 4.4 percent in 2008. These cuts to an already under-funded system result in a decrease in capital payments that urbanhospitals cannot sustain. As an entirely urban state, these cuts willbe particularly devastating to New Jersey hospitals.
NJHFMA opposes these cuts to capital payments, whichignore how vital these capital payments are to investments inthe latest medical technology, ongoing maintenance andimprovement of hospitals’ facilities and medical education.
Post-Acute Care Transfer Policy NJHFMA opposes the expansion of the post-acute care trans-
fer provisions to include patients receiving home health careservices within seven days – rather than three days – of dis-charge, as it inappropriately penalizes hospitals for efficienttreatment and ensuring that patients receive the right care at theright time in the right place.
In general, the post-acute transfer policy penalizes hospitals forthe efficient treatment of patients. The Medicare inpatient prospec-tive payment system is a system of averages. Cases with longer-than-average lengths of stay tend to be paid less than costs, while caseswith shorter-than-average stays tend to be paid more than costs.The expansion of the post-acute transfer policy further undercutsthe basic principles and objectives of a prospective payment systemand only penalizes hospitals further. And, facilities in regions of thecountry where managed care has yielded shorter lengths of stay aredisproportionately penalized. Thank you for this opportunity tocomment.
Respectfully submitted, Joseph J. Dobosh Jr. President-NJ Chapter HFMA
continued from page 23
CHAIRMAN/EMAIL/ CO-CHAIR/EMAIL/ SCHEDULED MEETING LOCATION BOARDCOMMITTEE PHONE PHONE DATES/TIMES LIAISON
Jeff Noonan Maria Facciponti First Tuesday of the Month Conference Mike AlwellCertification [email protected] [email protected] 9:00 AM Call [email protected]
201-786-6015 973-614-9100 Attendee Code: 8412570 973-656-6949
CARE (Compliance, Audit, Tom Flynn Nancy Graham First Thursday of the Month conf. calls mostly Tony OrlandoRisk, & Ethics) [email protected] [email protected] 9:00 AM Saul Ewing Office, Princeton [email protected]
201-996-5611 732-392-8243 Attendee Code: 7165283 for face to face meetings 201-894-3280
Sue Bonfield John Reiss First Friday of each month Caitlin ZullaEducation [email protected] [email protected] 9:00AM Saul Ewing Offices [email protected]
609-893-1200 x5580 215-972-7124 Attendee Code: 7719071 in Princeton 201-444-9900
Tony Consoli Jeff Weinstein Third Tuesday of each Month Mary CroninEvents & Networking [email protected] [email protected] 5:30 PM Woodbridge Hilton [email protected]
973-401-5223 908-806-8222 Attendee Code: 7090412 732-839-1217
FACT (Finance, Julius Green Tony Panico First Wednesday of each Month To alternate between in Mike RichettiAccounting, Capital [email protected] [email protected] 8:30 AM person and conf. calls; [email protected]& Taxes) 215-972-2352 973-898-9494 x430 Attendee Code: 2916514 locations TBD 973-831-5202
Tracy Davison DiCanto John Brault First Tuesday of each Month Joe DoboshInstitute 2008 [email protected] [email protected] 9:00 AM Conference Calls [email protected]
609-430-7796 201-894-3099 Attendee Code: 3322355 908-301-5455
Bill Schweber Fourth Friday of each month Lindsey ColomboMaterials/Procurement [email protected] 9:30 AM New Jersey Hospital [email protected]
917-523-7079 Attendee Code: 3427858 Association 732-324-6031
Membership Services/ Deborah Shapiro Rosemary Nuzzo Third Wednesday of each Month Dennis HancockDirectory [email protected] [email protected] 9:00 AM Conference Calls [email protected]
201-617-7100 609-383-2114 Attendee Code: 6752870 609-292-8585
Oliver Arcilla Eileen Smith Second Thursday of each Month New Jersey Hospital Marilyn KoczanPatient Access Services [email protected] [email protected], 9:30 AM Association [email protected]
908-301-5518 732-530-2564 Attendee Code: 5084608 Board Room 732-897-7126
Laurie Grey Lisa Schaaf Second Friday of each Month New Jersey Hospital Lindsey ColomboPatient Financial Services [email protected] [email protected] 10:00 AM Association [email protected]
609-620-8383 "800-220-9300, ext. 116" Attendee Code: 7182515 Board Room 732-324-6031
John Manzi Mike Alwell Joe DoboshPolicies & Procedures [email protected] [email protected] [email protected]
484-832-0044 973-656-6949 908-301-5455
Kevin Pleasant Dan Willis Second Thursday of each Month St. Peter's Univ. Hospital Dave WiesselProaction [email protected] [email protected] 9:00 AM Finance Dept., 1st floor conf. room [email protected]
732-383-4994 908-301-5458 Attendee Code: 6104186 950 Hamilton Street 732-516-4520
Elizabeth Litten Al Rottkamp First Thursday of each month Fox Rothschild John ManziPublications [email protected] [email protected] 9:15 AM 997 Lenox Dr. Bldg 3 [email protected]
609-896-3600 609-584-6508 Attendee Code: 4172885 Lawrenceville, NJ 484-832-0044
•Who’s Who in NJ Chapter Committees•2008-2009 Chapter Committees and Scheduled Meeting Dates
For more information on our committees, including each committees’ goals and objectives, please visit our website at www.hfmanj.org.NOTE: Committees have use of the NJ HFMA Conference Call line. The call in number is (866) 459-4772.
If the committee uses the conference call line, their respective attendee codes are listed with the meeting date information below.
July/August 2 0 0 8
Focus 25
July/August 2 0 0 8
26 Focus
It’s graduation season, and this means it’s time for jobhunting. Joining the pool of applicants will be a lot of peoplewho have been downsized, fired, or who found their previousemployment to be less than satisfying. Whether you’re a new-bie or a seasoned veteran of the job search, it's helpful to getadvice about the all-important but nerve-wracking experienceknown as the job interview.
Most of the articles on this topic are written from eitherthe psychological or legal perspective. But ethics also is—orshould be—a component of job interviews, and taking ethicsseriously is beneficial not just for the employer but also for theapplicant. Here's a look at the specific ways ethical behaviorbefore and during an interview can lead to getting the job youwant.
The art of the job interview seems to be mainly aboutstrategy: how to get from point A (unemployment, underem-ployment, or otherwise unsatisfying employment) to point B(a good job). But there are lots of ways to get from A to B,and some are more ethical than others. You can lie on yourrésumé, exaggerate your accomplishments, or mislead aprospective employer about what you can do well. Taking thelow road may lead to a job offer—but at what cost?
If you have to become someone other than yourself, whatdoes this say about your integrity? And what will happen toyou, professionally as well as personally, if it comes to lightthat you lied to get the job?
Even if you are committed to being truthful, however, it isstill possible to miss the main point of a job interview (andrun the risk of being passed over). A job interview isn't aboutyou. Or rather, it's not merely about you. It is about whetheror not the company will benefit from hiring you. Ethics isabout thinking beyond our own needs and desires, and apply-ing the ethical principle of Make Things Better in the contextof a job interview means concentrating on how you will helpthe company. This can’t be at the expense of other ethicalprinciples, such as Respect Others, which requires us to betruthful, and Do No Harm, which asks us not to say or dothings that will make things worse for others or ourselves.
Ethics thus lies at the core of any job interview. With this
in mind, here are five guidelines that you can use to ace yournext interview—by taking the high road.
1. FOCUS ON WHAT YOU WILL BRING TO THECOMPANY.
It never ceases to amaze me how many people respond tomy own job offerings with an endless discussion of why theposition will help them: “This job is perfect for me, because Ineed something that will offer me flexibility.” An employeeshould be concerned, first and foremost, with helping thecompany, not the other way around.
2. BE HONEST. Few of us are good liars, and this is a good thing. When an
interviewer asks you something to which you don't know theanswer, it's much better to admit it than to pretend otherwise.Also, misrepresenting yourself on your résumé in any way is abig mistake, not just because it will come back to haunt you(since it may not), but simply because it's wrong.
3. WHEN IN DOUBT, DON’T. The most fundamental ethical principle of all, Do No
Harm, applies to how you treat yourself as well as others.Resist the impulse to say something that would make youlook foolish, incompetent, or naive. If you're not sure abouthow something will be taken, leave it unsaid.
4. DON'T BADMOUTH YOUR PREVIOUS EMPLOYER.
Your prospective employer may ask you about previous jobsand why you left, or why you want to leave your current one.If a poor relationship with a boss or colleague was a contribut-ing factor, it's better to say something like: “My supervisor andI didn’t see eye to eye on a lot of projects,” rather than “He wasthe biggest jerk I’ve ever worked for.” Criticism at its best cen-ters on what a person has done, not on who a person is.
Personal attacks make you look petty, and this could be areason for you to be passed over for a position. Also bear in mind that professional circles can be small and tightly knit;
•Focus on Ethics•
Ask the Ethics Guy®!The Art of the Successful Job Interview
by Bruce Weinstein, Ph.D., The Ethics Guy®
Bruce Weinstein
it's entirely possible your interviewer knows your previousboss or colleagues. You don't want to acquire a reputation forbeing petty, vindictive, or tactless.
5. LOOK WITHIN. This last rule is the most important. Before you even apply
for a job, do some soul-searching, and find out what it isyou're really looking for. To embrace a company’s missionsuccessfully you have to know what your own mission in lifeis, and why you want to devote considerable time and energyto that organization. Honesty applies not just to how you dealwith your prospective employer; it also applies to how youdeal with yourself.
Yes, it’s a cutthroat world out there, and finding work isprobably more difficult now than at any time in the past fewyears. But that's no reason to throw ethics out the window. Infact, I hope I’ve shown just the opposite—that keeping ethicsfront and center is the best way to be successful.
About the AuthorDr. Bruce Weinstein, The Ethics Guy®, writes the ethics columnfor BusinessWeek.com and has appeared as an ethics analyst onNBC’s “Today Show,” ABC’s “Good Morning America”, CNN’s“Anderson Cooper 360,” MSNBC, CNBC, the FOX NewsChannel, the FOX Business Network, NPR, and many more. Formore information about Dr. Weinstein, visit TheEthicsGuy.com.
•Focus on Members•
At the NJ HFMA June Quarterly meeting on June 11,2008, Cheryl Cohen, outgoing NJ Chapter President, recog-nized and thanked the outgoing NJ HFMA Board ofDirectors and Officers for a very successful year. The chapter’s incoming Officers and Board were alsoinducted that day.
The new Board of Directors is as follows:Chapter Officers:Joseph J. Dobosh, Jr., MBA – PresidentBrian P. Sherin, FHFMA – President-ElectMary T. Taylor, MBA, FHFMA – SecretaryLisa R. Hartman, MPH– Treasurer
Board of Directors:Michael Alwell, FHFMAJohn Brault, CHFPLindsey S. Colombo, FHFMAMary M. Cronin, FHFMATracy Davison-DiCanto – Junior Board MemberDennis P. HancockSean J. HopkinsMarilyn A. Koczan, FHFMA, MPA, CPAMAnthony T. OrlandoMichael A. Richetti, CPADavid J. Wiessel
Dan Willis – Junior Board MemberCaitlin C. Zulla, CHFP
Advisory Council:Cheryl H. Cohen, FHFMADorothy LindstromJohn ManziRichard C. Parker
Thanks to all for volunteering their time to our chapter. Wewish you all a successful year!
NJ HFMA Chapter Inducts 2008-2009Board and Officers
July/August 2 0 0 8
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28 Focus
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McBeeAssociates.com
Successful solutions produce a significant return on investment, fit within the client’s culture, and provide long-term benefits. McBee Associates’ creates custom solutions that address the unique needs of your facility. Our world-class consulting team carefully balances the need for both short-term fixes and long-term solutions. Create a strong foundation of financial health with our full-service consulting services, including:
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Custom consulting services that meet your needs.
July/August 2 0 0 8
Focus 29
FOCUS: CFO backgrounds are diverse, please tell us aboutyours.
JOHN: I was born in Mountainside Hospital and raised inNutley, NJ, where I attended Nutley High School. Fromthere I moved on to Lehigh University where I received myBS and MBA degrees.
Immediately upon college graduation, I began my profes-sional career with the accounting firm of Ernst & Ernst intheir Newark, NJ office. At that time, Ernst & Ernst had onlyone hospital audit client in New Jersey which happened to beHelene Fuld Medical Center. (As an aside, the Ernst & Ernstaudit supervisor on this engagement was Dennis Hancock,present Deputy Executive Director of NJHCFFA.)
I spent seven years with Ernst & Young and left as a man-ager to become the controller of the College of Medicine andDentistry of New Jersey where I spent two years before Imoved to Touche Ross & Company. In the mid-1980s, Irejoined Ernst & Whinney as a senior manager and wasadmitted to the partnership in 1988.
I left Ernst & Young in 1992 at which time I moved toRobert Wood Johnson University Hospital (RWJUH) as ChiefFinancial Officer. My responsibilities at RWJUH changed overtime. When I left RWJUH in 2007, I was the Executive VicePresident with responsibility for operations, information sys-tems and human resources as well as fiscal affairs.
My present position at Meridian Health is that of EVP forFinance and Partner Company Operations. Meridian main-tains a full continuum of care; the non-hospital activities arereferred to as the Partner Companies.
FOCUS: Did you ever think, all those years ago, that youwould be doing this today?
JOHN: I never really thought about it, but my initialresponse is probably not. The truth is that I had so muchgoing on most of the time with family, work and other obli-gations that I never did much personal strategic planning.The important part is that I could not be happier with theend result and I consider myself to be very fortunate thatthings turned out as they have.
FOCUS: What new skills do you think are needed for risingCFOs?
JOHN: In order to be successful, tomorrow’s CFO requires amuch broader talent set than was traditionally associated with
this position. There are several key rea-sons why the skill requirements areincreasing, not the least of which is thefact that the business is becoming marketdriven, highly competitive and much lessforgiving (who remembers cost-based reimbursement?)Today’s CFO needs to be a well-rounded business person aswell as a strategic thinker. An entrepreneurial spirit, vision,ambassadorship, financial acumen, negotiation skills andintegrity will round out the attributes that will define the hos-pital chief financial officer of tomorrow.
FOCUS: What are your hospital’s specifics – single facility orpart of a system? Please describe your location, demograph-ics, and services offered.
JOHN: Approximately 97% of the people whom MeridianHealth serves are residents of Monmouth and Ocean coun-ties. The two-county area located in central/eastern NewJersey is home to all four of Meridian’s medical centers (JerseyShore University Medical Center, K. Hovnanian Children’sHospital, Ocean Medical Center and Riverview MedicalCenter), the Ocean Care Center (a licensed 24-hour satelliteemergency department) as well as a home care agency, long-term care facilities, acute rehabilitation centers, ambulatorysurgery and other facilities.
The total population in the market area is expected toincrease by 4.1% between 2007 and 2012. The growth rate pro-jected between 2007 and 2012 for the total New Jersey popula-tion is only 2.5%. For this time period and in Meridian’s mar-ket area, the pediatric population is expected to slightly decreaseby 0.6%, and the senior population is expected to significantlyincrease by 10.8%. The pediatric population throughout NewJersey is expected to decrease by 1.5%, and the New Jersey sen-ior population is expected to increase by 11.5%, a slightly high-er increase than the market area’s senior population increase.The estimated 2007 median household income for MonmouthCounty is $84,524, for Ocean County is $59,905 and for NewJersey is $69,587.
Meridian Health is dedicated to providing a complete rangeof services offering the most advanced treatment options, lead-ing-edge technology, and compassionate care delivered by ded-icated professionals.
Cardiac: Meridian is the region's leader in diagnosing andtreating cardiac needs, with Jersey Shore University Medical
CFO Member Spotlight: John Gantner, Meridian Health
John Gantner
continued on page 30
July/August 2 0 0 8
30 Focus
Center being the only hospital in Monmouth and Oceancounties licensed to perform open heart surgery performingmore than 850 heart surgeries a year.Cancer: Meridian provides quality care by combining our state-of-the-art technology, medical expertise, and research innova-tion with compassionate care. From clinical trials to the mostsophisticated cancer treatments of the day, Meridian provideseffective cancer therapies, close to home Emerging Technologies: Through partnerships with manyleading technology innovators, Meridian is actively pilotingnew uses for leading edge digital, sensory, and common con-sumer technologies, building an electronic health informationbridge between patients, their physicians, and hospitals. In-Home Care: Meridian At Home provides a wide range ofin-home personal assistance and health care solutions to keep aloved one safe, independent, and living well at home. MeridianAt Home also provides a complete range of medical equipmentand personal assistance supplies.Orthopedics and Rehabilitation: Meridian offers a broadrange of specialized orthopedic and rehabilitation services withcomprehensive services in the area to prevent and correctinjuries and disorders of the skeletal system and associated mus-cles, joints, and ligaments. Women's Health: The full continuum of women’s health servic-es are offered at Meridian. We provide services such as obstetricsand gynecology, perinatology, gynecologic oncology, and urogy-necology. Whether our patients are planning a family or are seek-ing a mammogram, Meridian provides advanced and compre-hensive services specifically tailored for a woman's unique needs.Trauma and Emergency Care: Meridian offers emergency carethrough all of its hospitals, including the state’s first satelliteemergency department and is home to the region's only traumacenter.
FOCUS: Can you tell us about any unique situation that theSystem has faced recently?
JOHN: Meridian faced a unique challenge during the firstquarter of 2008 when $242 million in outstanding auction ratesecurities (ARS) failed to remarket. Under the terms of theARS bond documents, the interest rate automatically reset tothe 12% default rate. This development began a hectic two-month process to convert the auction bonds to an alternativemode. To complicate matters, there were a variety of associat-ed decisions that needed to be considered in connection withthe various conversion options, including how to preserve thebond insurance and what to do with the underlying interestrate swap. After considering multiple conversion scenarios,Meridian decided to put 60% of the ARS into a 30-year fixedmode and 40% into variable rate bonds that were supported by
a letter of credit as well as the original underlying bond insur-ance. During the months leading up to the conversion, themajority of auctions were not failing. However, even the “suc-cessful” auctions were clearing at interest rates that averagedbetween 7% and 11% as both US and International hedgefunds swooped in to pick up some opportunistic interest rates.
The story has as happy an ending as possible in the circum-stances. The entire $242 million was converted as of March4th. The fixed interest rate bonds sold at 5.0% and the VRDBsare reworking at market equivalent rates.
FOCUS: What types of financing are utilized to meet theSystem’s goals?
JOHN: Meridian has aggressively utilized external capitalfinancing to further the strategic imperatives of the threecampuses. Moreover, Meridian is able to utilize the balancesheets of its Partner Companies to enhance debt capacityunder a Master Trust Agreement. In order to minimize capi-tal carrying costs, Meridian regularly utilizes interest rateswaps. All of Meridian’s tax-exempt hospital debt has beenissued through the New Jersey Health Care Facilities Financ-ing Authority. In general, Meridian targets a 60/40 split offixed/variable rate debt either on a natural or synthetic basis.
FOCUS: What are your spare time activities?
JOHN: Since assuming my position at Meridian Health, Ihave been residing at my family’s summer bungalow in SouthSeaside Park. This has definitely had some impact on myextra-curricular activities. I still try to fit in a daily run but Ihave traded the foothills of Morris County for the “Boards”of Ocean County. Weekends usually find me surf fishing(notice I did not say “surf catching”) for stripers and blues inIsland Beach State Park. My wife, Alison, and I also do quitea bit of cycling and kayaking. Future plans include learning tosail and I am pleased to report that I still have not been cor-rupted by the game of golf.
FOCUS: What are your professional memberships?
JOHN: American Institute of CPAsNJ Society of CPAsInstitute of Management AccountantsAARPHFMA
FOCUS: You have 30 minutes to pack for a trip to a sparse-ly populated island, what do you bring along?
JOHN: My wonderful wife, Alison, and my fishing pole.
continued from page 29
FOCUS: Al, please provide us with a short bio on yourself.
AL: When I first started college, I wanted to be a marriagecounselor and was studying works by Jung, Freud and Maslow.My Dad informed me that I would need a PhD in Psychologyand would still be broke. That did it. I finished college with anengineering degree.
I started my career as a Biomedical Technician with ThomasJefferson University Hospital, Philadelphia, PA in 1980. CATscans and computerized central stations were new technologies.After 10 years at TJUH, I accepted a position at HahnemannUniversity Hospital as a Clinical Engineer. There was a lot ofMerger & Acquisition (M&A) activity in the Philadelphia areaduring the 90s and it was that continuous M&A activity thatallowed me to work for several hospitals and healthcare systems.Graduate Health System evolved into AHERF, AlleghenyHealth Education and Research Foundation. AHERF was sub-sequently purchased by Tenet HealthCare Corporation. In2001, I accepted a position in the Clinical Technology Services(CTS) division of Premier. Guess what? Premier sold the CTSdivision to Aramark in 2002.
Currently, I am an employee of Crothall Services Group,Clinical Engineering division and was hired specifically forRobert Wood Johnson University Hospital @ Hamilton. AtRWJ Hamilton, I am the Director of Technology Management.
Crothall Services Group offers services in five major areas;Environmental, Laundry & Linen, Patient Transport, FacilitiesManagement and Clinical Equipment. The company is nation-wide with over 1,400 clients (http://www.crothall.com).
RWJ Hamilton Hospital provides acute care and outpatientservices. We are part of the RWJ Health Network that includes13 hospitals and health centers. In 2004, the hospital wasawarded the Malcolm Baldrige National Quality Award(http://www.rwjhamilton.org ).
Along the way, I have always asked questions about howthings worked and why. As a result, I have Bachelors degrees inPsychology and Electronics from TSC (now TCNJ) and aMaster of Science in Biomedical Engineering and an MBA,both from Drexel University. Part of the graduate BiomedicalEngineering curriculum included coursework at TempleMedical School.
Between Hahnemann and Graduate, I did special effectsmakeup and special effects.
My wife thought I was nuts;how can you go from biomedicalengineering to special effects?Easy. While at Drexel, I was work-ing on a motorized artificial arm. The arm was ok, but the glovelooked terribly artificial. I started experimenting with silicone,artificial nails and fine hair. Friends convinced me to send asample to Dick Smith; he did the special effects for TheExorcist. He suggested I take a crash course in special effectswith Joe Blasco. After that training, I did special effects makeupfor Universal Studio’s Florida, a few low budget commercialsand local theater. Working as an independent artist on the roadis difficult, so after 2 years I got off the road and returned hometo working in healthcare.
I have been married to my wife Patricia for 19 years. She’sbeen supportive of me earning two Master’s degrees at night andwith all kinds of creepy special effects “stuff” laying around thehouse.
I am a member of the Association for the Advancementof Medical Instrumentation (AAMI) and was certified in1982. AAMI is a primary source of information on medicaltechnologies with approximately 6,000 members worldwide(http://www.aami.org ).
I’ve been a member of HFMA since 2004. In 2005, I joinedthe Publications Committee and discovered I enjoyed writingand the process of publishing FOCUS. In 2006, Jack Tenerelliand I worked on the NJ HFMA web site. This year I was askedto co-chair the Publications Committee with Elizabeth Litten.Joining this association was one of the best decisions I evermade; the opportunities are endless and the people areabsolutely great!
FOCUS: Please talk about your duties with RWJ Hamilton.
AL: As Director of Technology Management at RWJ Hamilton,I am responsible for providing safe, functional medical equip-ment within a defensible budget. There are over 2,000 separatepieces of medical equipment that fall into the biomedical, imag-ing or medical IT categories. My department performs the serv-ice and preventative maintenance on everything from beds tosterilizers to physiological monitors on medical networks. I man-age the outside contracts and service on the Imaging equipment;
Member Spotlight: Al Rottkamp
by James Yarsinsky, CPAM
Al Rottkamp
continued on page 32
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32 Focus
Radiology, Nuclear Medicine, CT & MR, Ultrasound, etc. I amresponsible for the departmental budget and provide monthly reports to the Environment of Care Committee. Training isimportant and this year my staff are scheduled to attend Philips,GE and Hill Rom service training schools to stay current withhospital technologies.
I’m fortunate to have a good staff that works well as agroup and with hospital departments: Nursing, Accounting,IT, Materials Management, Radiology, Lab., Facilities, etc.
FOCUS: Please name a few of the special challenges you facein your position.
AL: The challenges in Technology Management are based oncash, technological age, staffing and required inspections. One,available cash vs. new technology. The reductions in reimburse-ments from Medicare, Medicaid, charity care and insurancecompanies are pushing hospital operating margins into the red.And yet, we all ‘need’ the newest 128 slice CT scanner and thenewest 4D Ultrasound. Not only is this equipment expensive topurchase, it is expensive to properly maintain. Two, uptimewithin budget. When a major piece of diagnostic equipmentfails, we drop into a backup plan and ask two questions. One,‘what is the potential impact to our patients’ and two, ‘how fastdo I have to return this device to service?’ If we can utilize anoth-er machine, I may not have to spend $3,000 in overtime. If thedevice is near End of Life (EOL) my service expenses may behigher due to the availability of parts. Three, qualified staff areextremely difficult to find. Four, scheduled inspections. Bigthings, like treadmills and centrifuges don’t get lost, but smallthings like vacuum regulators and TENS units, well they justdisappear. It’s always a challenge accounting for those small dis-appearing items.
FOCUS: What advice can you give other professionals thatare interested in entering your line of work?
AL: This is a great profession, with many rewards. To be suc-cessful, you need knowledge and skills in engineering, medicineand business. It’s never the same; today you are working on acentral station software issue while tomorrow you could be test-ing IV pumps. You need to keep an open mind and constantlyread to stay current. Join professional associations like HFMA,AAMI, IEEE and HIMSS.
FOCUS: What are your hobbies and outside interests?
AL: My wife Pat and I hold ‘BBK’ parties. BBK is short for‘Booze and Bad Karaoke. A few years ago, I surprised (not sureif that is the right word) her with a semipro Karaoke system. It’spretty cool with about 500 songs, separate speakers, mixingboard, power amps and headphones (for me). And it worksgreat with my iPod.
I’m still trying to burn off some of this baby fat, so I like toget into the gym a few times a week. Also, I love to swim in theocean and Cedar Lakes.
FOCUS: Thanks Al for taking the time out of your busyschedule.
AL: Thanks for listening…..by the way, can you sing ?
About the AuthorJim Yarsinsky, CPAM, is president of Expeditive, a BESLERaffiliated company. He can be reached at [email protected].
continued from page 31
NOTICE
Please be advised that the 2008-2010 NJ HFMA Annual Strategic Plan
Is now available to all New Jersey chapter members.
Please visit the link below to our web site to view this document.
http://hfmanj.org/Documents/HFMANJStrPlan.pdf
Meet Some of our New Members
Who is your employer,and what is your position?
What was your first job as a teen?
What do you like best about your work responsibilities?
A job I would enjoy doingwithout pay is...
My favorite place is...
I will not eat...
If I’m not at work, you willfind me...
Larry GrygielPrinceton Healthcare System/Manager,Education & Statistical Data, Revenue Cycle.
My very first job was a Telemarketer sellingFuller Brush Products. Yes, I was one ofthose annoying telephone sales people. Butwho wouldn't need an overpriced hairbrush! It gave me my first taste in (good)customer service.
I love to problem solve and come up withthe most effective solution, as well as pick-apart & analyze things. Because my positionencompasses staffs' Education/Trainingneeds and Revenue Cycle statistical info, itallows me to do all that and more.
Caretaker for a villa located somewhere inthe Tropics. The sea, the sun....what morecould you ask for, besides money that is?
Home...after all that's where the heart is!
My words. Preparedness, knowledge, anddiplomacy, as well as not being afraid to say"I don't know", is the best recipe for notchoking on your words.
Hmmm...I like to maintain a bit of mystery,so ...Incognito.
Judy HernandezUMDNJ - New Jersey Medical School,Senior Managed Care FinancialAnalyst
Data Entry.
Analyzing numbers and helping tomake decisions.
Cook.
Home.
Raw food.
Movie theater, museum, Broadwaytheater or restaurant.
Judi HallENERGENIC (a subsidiary of South JerseyIndustries), Vice President Business Deveop-ment Management, Chief Compliance
Coat Check Girl at a popular night club, and a bagger at ACME.
Attending functions and constantly meetingnew people is always a thrill for me.
Fundraising work, and meeting/helping peo-ple first hand who are in need. I am currentlya board member for South Jersey AIDSAlliance (serving Atlantic, Cumberland & CapeMay Counties), and have been nominated tobe their next president.
Home is where the heart is...but for adultvacations I like exotic places such as MachuPicchu Peru, the Amazon, and Cambodia. Ialso enjoy family vacations at dude ranchesout west.
Seafood, gamey meats, or brussel sprouts.
With the kids....ages 4, 6, 8, 10, the 2 dogsand the man who is the passion of my life!!!
July/August 2 0 0 8
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34 Focus
New MembersAaron D. Rosenstock DGA Partners Senior Associate (610) 667-8782 ext 228 [email protected]
J. Rebecca Mills TMC Director, Health Economics(913) [email protected]
Judy Hernandez UMDNJ - University Hospital Sr. Managed Care Financial Analyst(973) [email protected]
Jon L. Hollenweger South Jersey Healthcare Manager Of Managed Care (856) [email protected]
Kathleen KuberietChamberlin EdmondsVP Implementation(973) [email protected]
Lucy CusanoInglemoor Rehab & Care CenterController(973) [email protected]
Jerraune JenkinsUMDNJDirector of Budget/Affiliate Contracts(973) [email protected]
John GeraghtyPerot SystemsHealthcare Group Solutions(201) [email protected]
Stacey BigosNew Jersey Hospital AssociationHealthcare Data Analyst(609) [email protected]
David G. WoodsPentax Medical CompanyPresident(201) [email protected]
Peter Miragliotta, Jr.BiometGeneral Manager(973) [email protected]
JoAnne ZweigNewton Memorial HospitalAssistant Director Patient Accounts(973) [email protected]
Diane RobinsonBergen Regional Medical CenterAssociate Vice President(201) [email protected]
Patti BlaneyMeridian Health SystemManager, Access Integration(732) [email protected]
Kevin KielPatient EdVP Sales & Marketing(201) [email protected]
Gina M. AckermanAtlanticare Surgery CenterDirector of Finance(609) [email protected]
Michael E GoldbergWFS Services, Inc.Director, Business Development(201) [email protected]
Janiena ThomasPatient Financial Concepts, Inc.(732) [email protected]
Loretta GersSaint Barnabas Health Care SystemSr. Accountant(732) [email protected]
Kenneth R KaanSouthern Ocean County HospitalInternal Audit(609) [email protected]
Who is your employer,and what is your position?
What was your first job as a teen?
What do you like best about your work responsibilities?
A job I would enjoy doingwithout pay is...
My favorite place is...
I will not eat...
If I’m not at work, you willfind me...
Rebecca MillsThe Medicines Company, Director ofHealth Policy and Economics.
Lifeguard.
I get paid to do a job I love with col-leagues I respect. My particular responsi-bilities provide me with the opportunityto creatively solve and look for solutionswhich provide quality economic efficien-cies around market therapies and sharethat data with HCPs.
Reading.
St. John, USVI
Insects...even for reality TV.
With a book, poolside listening to BobMarley while being cannonballed by mykids!
Kathleen KuberietChamberlin Edmonds & Associates, VPImplementation
Working for Dunkin Donuts. I was themascot (literally the donut).
My position allows me a lot of freedom andcreativity.
Working in a hospice.
The beach.
Liver.
At the beach in the summer.
Gina AckermanAtlantiCare Surgery Center, Director ofFinance
Cashier
The exposure to each area of health-care finance, since we are a smallbusiness, it is necessary to multi-task.
Home design, Interior decorating.
The beach or mountains.
Scrapple.
On the beach in the summer, snow-boarding in Vermont in the winter.
Meet Some of our New Members (continued)
DIRECTOR OF MANAGED CARE Solaris Health System
CODING COMPLIANCE & REVENUE ENHANCEMENT SERVICES CONSULTANT
IMA Consulting Services
CDM COORDINATORSaint Peter’s University Hospital
SUPERVISOR CASHIERS/CASH POSTINGTrinitas Hospital
DIRECTOR OF PATIENT FINANCIAL SERVICESTrinitas Hospital
COST ACCOUNTING ANALYSTSt. Luke’s Hospital
FINANCIAL PLANNING/REIMBURSEMENT ANALYSTSt. Luke’s Hospital
DIRECTOR/MANAGER OF REIMBURSEMENTPrinceton Healthcare System
PROJECT MANAGERWFS Services, Inc.
ACCOUNTANTAtlantiCare
STAFF ACCOUNTANTMonmouth Medical Center
DATA ANALYSTQualcare
JOB BANK SUMMARY LISTING
Job Position and Organization
HFMA-NJ’s Publications Committee strives to bring New Jersey Chapter members timely and useful information in a convenient, accessible manner. Thus,this Job Bank Summary listing provides just the key components of each recently-posted position in an easy-to-read format, helping employers reach the mostqualified pool of potential candidates, and helping our readers find the best new job opportunities. For more detailed information on any position and the mostcomplete, up-to-date listing, go to HFMA-NJ’s Job Bank Online at www.hfmanj.org.
[Note to employers: please allow five business days for ads to appear on the Web site.]
•Focus on...New Jobs in New Jersey•
mark your calendar . . .September 9, 2008 all day Quarterly Meeting Woodbridge Hilton
September 26, 2008 all day2008 Golf Institute Architects Golf Club
October 15, 2008 The Borgata,CFO Bootcamp Atlantic City
October 15-17, 2008 The Borgata,NJ HFMA Annual Institute Atlantic City
July/August 2 0 0 8
Focus 35
Don’t forget to check
our website often
for the latest news
and information:
www.hfmanj.org
July/August 2 0 0 8
36 Focus
Q.
A.
A.
Q.
Answers to your Accounting and Tax Questions
Minimizing Bad Debt for a Healthier Balance Sheet
•Focus on Finance•
Our healthcare facility is seeing a spike in non-payment ofpatient treatment with no success of collection. What canbe done to minimize the impact of bad debt?
In light of a struggling economy, it comes as no surprise thatthe occurrence of non-payment of patient treatment is on therise, particularly within the hospital sector providing charitycare on a regular basis. However, there is a surprising num-ber of “bad debt” accounts that, if handled differently, mayresult in successful collection. You may find that making afew simple adjustments within your patient registrationprocess will help streamline the process, increase efficienciesand improve collection rates.
Properly Categorize Patient AccountsMany times, an account that should have been managed as
qualifying for a government aid program, like Medicaid, wasnot screened properly at registration and could have beenclassified as charity care. If manpower is an issue at your facil-ity (and where is it not an issue?), then it may be wise to im-plement an automated information system that screens pa-tients for charity/uninsured discounts. These systems can alsocheck for eligibility for Medicaid and other government pro-grams, saving your administrative professionals many hoursof effort and decreasing bad debt situations.
Verifying Patient’s Identity and AddressIn the March/April issue of Garden State Focus, the topic
of medical identity theft was featured, offering a preventativesuggestion of requiring patients to provide three types ofidentification during any phase of their relationship with thehospital or facility, in order to confirm valid identity. Theadditional benefit of this is the confirmation of a proper mail-ing address. Surprisingly, returned mail for billing is a persist-ent problem, with industry statistics reaching 25%, thusreducing the efforts of successful collections.
Regardless if you are a healthcare system or a small grouppractice, it is worth noting that these types of identificationshould include: 1. a medical card with full name and accountinformation; 2. a New Jersey drivers license with photo (or ifno photo on the license, a second form of I.D. with a photo),and 3. a third piece of identification, preferably a social secu-rity card, but often times a credit card is acceptable, too.Don’t overlook asking for a piece of mail to verify the patients
address; we have found that manywomen typically carry a piece ofcorrespondence or two in theirpocketbooks.
Again, implementing automat-ed information systems that verifypatient demographics will also en-sure accuracy of account informa-tion. These systems verify that apatient’s name, address, date ofbirth and Social Security numberall match throughout the billingsystem, and can also find updatedinformation when the U.S. Postal Service returns invoices orstatements, due to incorrect address information.
How can we reduce Medicare denials of bad debt on thecost report?
To avoid Medicare bad debt denials, hospitals and health careorganizations should take the time to regularly review their baddebt policies to ensure they are adhering to the regulations out-lined by the Centers for Medicare and Medicaid Services(CMS) in the Medicare Provider Reimbursement Manual(PRM). The following list of criteria for allowable bad debt canbe found in PRM § 308:
A debt must meet these criteria to be an allowable bad debt:1. The debt must be related to covered services and derived
from deductible and coinsurance amounts. 2. The provider must be able to establish that reasonable col-
lection efforts were made.3. The debt was actually uncollectible when claimed as
worthless.4. Sound business judgment established that there was no
likelihood of recovery at any time in the future.Furthermore, an intermediary cannot require a hospital to
change its bad debt collection policy if it has been following thesame said policy since August 1, 1987.
Use of an Outside Collection AgencyAccording to PRM § 310.2, which refers to the
Presumption of Noncollectibility, “if after reasonable and cus-tomary attempts to collect a bill, the debt remains unpaidmore than 120 days from the date the first bill is mailed to the
Lewis Bivona, Jr.
beneficiary, the debt may be deemed uncollectible.” Thus, itcan be entered in the cost report.
When a patient account goes into default, a typical proce-dural option is to send the information to an outside collec-tion agency (OCA), which will take the time to make regularattempts of contact with the patient, encouraging payment ofthe bill. It must be noted that the PRM states that if you sendnon-Medicare accounts to an OCA for collection, then youmust treat the Medicare accounts the exact same way, havingthose accounts managed by an OCA.
Some presume that if a Medicare account is now in thehands of an OCA, that it should not be considered “worth-less,” thus not qualified to be entered as bad debt on the costsheet. PRM §316 indicates that when a provider, in a laterreporting period, recovers amounts previously claimed asallowable bad debts, the provider’s reimbursable costs in the
period of recovery are reduced by the amounts recovered.Thus, even though you have officially written off the bad debt,it is okay to further pursue collections through an OCA.However, if payment is ultimately received, one must claimthis amount… no double dipping allowed!
About the AuthorsLewis D. Bivona, JR., CPA, AFE, is a Principal withWithumSmith+Brown, Certified Public Accountants andConsultants, based in the firm’s Princeton, NJ, office. He can bereached at 609-520-1188 or [email protected].
If you have a question related to accounting or tax that you wouldlike answered in the next issue of Garden State Focus, please e-mailit to [email protected]. Your questions are greatly encouraged!
July/August 2 0 0 8
Focus 37
The New Jersey Chapter of the Healthcare Financial Man-agement Association awards at least one scholarship eachMay. Eligibility for the scholarship is based on the followingcriteria:
• Member, in good standing, of the New Jersey Chapterfor the last two years.
• Spouse or dependent of a member, in good standing, ofthe New Jersey, for the last two years.
• Enrolled in an accredited college, university, nursingschool or other allied health professional school.
Preference is given to applicants pursuing degrees infinance, accounting, healthcare administration or a healthcarerelated field of study. Tuition not paid by an employee orother scholarship qualifies for the HFMA scholarship.
Our selection is based on merit, academic achievement,civic and professional activities, course of study and contentof the application and essay.
At our June 11, 2008 Quarterly meeting, Cheryl Cohenwas happy to announce that our chapter would be awardingthree $3,000 scholarships this year. The 2008 recipients are:
Sarah Alban is the daughter of member Greg Alban. GregAlban is the Director of Financial Clearance with the SaintBarnabus Healthcare System. Sarah has been accepted toRutgers University, and will begin her freshman year this fallas a Pre-Medicine major. At the time of application, Sarahachieved a GPA of 4.129 and maintains membership in boththe National Honor Society and the Spanish National HonorSociety. In addition to her academic achievements, Sarah vol-unteered her time at the Saint Barnabas Medical Center Renal
& Pancreas Transplant Department, and as a peer buddy inthe Nutley FUN FOR ALL Integrated Recreation Program,where she is an active and dedicated volunteer for specialneeds participants.
Christopher Shanahan is the son of member and past NJChapter President, Tom Shanahan, Senior Vice President andCFO of Raritan Bay Medical Center. Chris is pursuing adegree in Business Management at Johnson & Wales Uni-versity. He completed his first semester of college with a GPAof 3.64. In addition, Chris has developed strong leadershipskills through his participation in his high school ROTC pro-gram. He has also held various part-time positions includingthose of a Summer Camp Counselor, Sales Associate, andrestaurant server.
Kelly White is the daughter of Mary Lou White, ManagerCost and Financial Analysis for Atlantic Health Systems. Sheis pursuing a BSN degree in nursing at Ramapo College ofNJ. Kelly graduated from her high school with distinguishedhonors and a GPA of 3.95, and her first semester at Ramapoearned her a place on the Dean’s List and membership in theAlpha Lambda Delta Honor Society. Kelly has also been veryactive – participating in school activities, working at a localchildcare center and at Morristown Memorial Hospital, pro-viding volunteer service to the Hospital and also babysittingfor friends on weekends. She continues to work at least oneday a week at the hospital, and babysits on weekends.
Congratulations and good luck to Sarah, Chris and Kelly,as well as our additional eleven 2008 applicants, as they con-tinue their education and pursuit of their goals.
The 2008 NJ HFMA Scholarship Recipientsby Laura A. Hess, FHFMA
revenue enhancement & recovery
governmental reimbursement & compliance services
medicaid assessment & enrollment services
charge process review & management
revenue enhancement & recovery
governmental reimbursement & compliance services
medicaid assessment & enrollment services
charge process review & management
50 Millstone Road | Building 200, Suite 230 | East Windsor, NJ 08520 | (609) 918-0990
July/August 2 0 0 8
40 Focus
Certification Raffle:Congratulations to Mary Cronin, FHFMA
Mary is the recipient of $150.00from the 2007-2008 HFMA Certifica-tion raffle.
The NJ HFMA Board has againagreed to fund $50 per person thatachieves the CHFP or FHFMA desig-nation (up to a maximum of $500)into a raffle drawing. If you become
certified between June 1, 2008 and May 31, 2009, you willautomatically be entered into the June 2009 drawing andcould be the lucky winner of up to $500.00.
Certification Coaching CourseThe Certification Committee will be holding a Core Exam
Coaching Course at the Borgata Hotel Casino & Spa onOctober 15, 2008. Watch for more information in the weeklyPulse or in your mailbox.
Participants will be required to pay $100 for this CoachingCourse, however this fee will be returned upon successfulcompletion of the core exam.
New Certification Exams for 2009-2010Please note that the current Core and Specialty Exams will
be replaced with updated versions as of January 1, 2009.
Test your Knowledge:The most common definition of a short-term cash budget isone which covers a period of less than:
One year. Two years. Three years. Five years.
For the answer and more information about the HFMA cer-tification program go to: www.hfmanj.org/Certification
NJ Chapter Certification Contacts:Jeff Noonan, CHFP – Committee ChairWork Phone: (201) 786-6015 Email: [email protected]
Maria Facciponti, FHFMA – Committee Co-Chair(973) 614-9100 Email: [email protected]
Michael Alwell, FHFMAWork Phone: (973) 656-6949Email: [email protected]
•Certification Corner•
PRINCETON – One of the greatest challenges hospitals faceduring a natural or manmade disaster is maintaining cash flow.Whether it’s a flood or a pandemic, it is critical that hospitalscontinue to receive funds to facilitate payment to staff and sup-pliers and cover other services such as insurance and benefits.
To help hospitals better prepare, the New Jersey HospitalAssociation (NJHA) has just released the fourth module of itspandemic preparedness initiative, Planning Today for aPandemic Tomorrow. The Finance Planning and AssessmentTool is a comprehensive collection of checklists to help guidefacilities in maintaining continuity of financial operations.
According to Valerie Sellers, senior vice president of healthplanning and research at NJHA, “We have been holdingmeetings with state regulators, health plans and the Centersfor Medicare and Medicaid Services’ officials to discuss specif-ic plans and protocols that will be implemented to ensure
continuity of payments to healthcare providers. While focus-ing on external agencies and payers, hospitals must concen-trate also on efforts within their own facilities to prepare forany disaster that may occur. Trying to find solutions during acrisis is far too late.”
The finance module, one of 10 modules in the NJHAPandemic Preparedness Publication Series, is available onNJHA’s Web site at www.panfluplanning.com.
The complete series of 10 modules will be available by theend of the summer and will address how to develop effectivepolicies and procedures in critical areas such as Clinical Care,Ethics and Operations. Three other modules, Supplies, Logisticsand Support Services, Human Resources and Communications,are available now.
Based in Princeton, NJHA has been providing its 108 memberswith advocacy, information, research and education since 1918.
NJHA Introduces New Financial Pandemic Planning Tool forHealthcare Community
July/August 2 0 0 8
Focus 41
The 2008 FinanceAccounting CapitalTax (FACT) quarter-ly education sessiontook place on June11, 2008 at theWoodbridge Hiltonwith approximately120 people in atten-dance. Once againthe FACT Commit-tee assembled astrong program of
speakers and topics to enlighten the attendees and to educatethem on issues of the day.
The day began with the annual installation of officers. JoeDobosh (Vice-President/CFO of Children’s Specialized Hospi-tal) was installed as the incoming President of NJ HFMA.
New Jersey Hospital Association provided an overview ofthe upcoming state budget and the continuing struggle of NJhospitals. Nothing new to report on disproportionate share(DSH).
C o m m i s s i o n e rHeather Howard,New Jersey Depart-ment of Health andSenior Services, wasthe featured speaker.Commissioner How-ard provided an over-view of Health carepolicy including uni-versal healthcare, hos-pital overcrowding,etc from the perspec-
tive of the Administration. Commissioner Howard entertained arobust question and answer session following her prepared com-ments.
Lynda Smolarek (Somerset Medical Center) and JimGrosheider (Director, Solenture) discussed changes to theaudit requirements for certain 403(b) plans under ERISA.Jim discussed the expectations on a strategic basis while Lindaprovided a practiceal overlay from an organization that hasimplemented the changes. The audience feedback suggestedthat this practitioner and commentator team complementedeach other well.
Lew Bivona (Direc-tor, WithumSmith+-Brown) finished themorning session with atalk about economicand regulatory changes,new audit guidelinesand investment issuessuch as impairment.
Following lunch,John Beattie, Principal,Parente Randolph,LLC, spoke about com-pliance and what types of current issues compliance officersought to be focused on in building an effective complianceprogram for their organizations (e.g. Recovery AuditContractors).
Scott Mariani and Tony Panico of WithumSmith+Brownreviewed current tax issues including the Redesigned Form990, FIN 48, alternative investments and focus issues for theIRS including intermediate sanctions and tax exempt bonds.
Traina Companies finished the day by walking through acase study which applied the Stark I and Stark II rules. The
June Quarterly Meeting Overview:Healthcare Environment Update
“Healthcare Change Is Certain: Are You Prepared?”
continued on page 42
42 Focus
July/August 2 0 0 8
session also focused upon real estate and leasing transactions including theimplications of both FAS 66 and 98.
The education session was adjourned by co-Chair Heather Weber for thepost seminar social hour.
Interested in Getting Involved with the FACT Committee?Planning for the 2009 FACT Quarterly will begin shortly after Labor Day.
The FACT Committee is extending invitations to join the Committee.Anyone interested in joining the Committee should contact either:
Julius Green, Chair Tony Panico, Co-Chair215.972.2352 973.898.9494 [email protected] [email protected]
continued from page 41
Focus 43
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NavigatingAdversity
Agenda8:30-8:40NJHA Industry UpdateSean Hopkins, NJHA
8:40-9:30Fraud/Abuse ReviewChristopher Christie, U.S. A�orney
9:30-10:45E�ects of Budget/Charity Care Cuts on Hospital OperationsModerator: Joe Dobosh, VP/CFO, Children’s Specialized HospitalPanel:Greg Adams, Sr. VP/CFO, Holy Name HospitalTom Shanahan, Sr. VP/CFO, Raritan Bay Medical CenterJohn Gantner, EVP, Finance/Partner Co. Ops, Meridian HealthTony Orlando, Sr. VP/CFO, Englewood Hosp. & Med. Ctr.
11:00-11:50FY 09 Legislative & Medicare UpdateSteve Frankenbach, Deloi�e & Touche
11:50-12:40RACS Preparedness and Lessons Learned from NYKaren Feeley, NY Presbyterian Hospital
1:30-2:05Managed Care Segment I – Successful CollaborationsPat Wang, J.D., Health�rst
2:05-2:45Managed Care Segment II – Consumer Directed HealthcareJoe Dirienzo, Aetna
2:45-3:00NJ Medicaid Discussion
3:15-4:30Highmark – �e Transition to the New MACProvider Outreach & Education/Audit & Reimbursement Sta�
4:30 Networking & Cocktail Hour
FOCUS_AD.indd 1 7/23/08 5:51:41 PM
July/August 2 0 0 8
46 Focus
In June, 2008, at a celebration during the 55th AnnualPresident’s Dinner and Meeting at the Annual NationalInstitute in Las Vegas, Cheryl Cohen had the privilege ofaccepting four Helen M. Yerger Special Recognition Awards,the Bronze Award of Excellence for Membership Growth &Retention, and the C. Henry Hottum Award for EducationalPerformance Improvement on behalf of the NJ Chapter.
The Helen M. Yerger Special Recognition Awards recog-nize chapters for outstanding performance achieved by excel-lent efforts in programs, services, and administration.
Categories include:• Education. This category recognizes a singular educa-
tional program.• Member Communications. Recognizes a chapter’s
overall member communications program, includingnewsletters, news briefs, hotlines, audio/video and elec-tronic communications.
• Membership Recruitment and Retention. Recog-nizes the plan, process, results, and innovation of thechapter’s membership recruitment and retentionprocess.
• Collaboration. Recognizes a collaborative effort withanother organization outside of HFMA.
• Innovation. Recognizes an innovative program, ser-vice, or project.
• Member Service. Recognizes excellence and results ina singular program, service, or project
• Improvement. Recognizes significant improvement ina program, service, project, or overall chapter efforts.
Each year, chapters may submit a total of four single-chap-ter entries and there is no limit for multi-chapter submissions.Award submissions will be judged on the following criteria:needs identification, 20 points; goals and objectives, 20points; methodology, 15 points; evaluation, 15 points; andresults, 30 points. Chapters that receive at least 75 pointsearn the Helen M. Yerger Special Recognition Awards.
The NJ Chapter submitted four Yerger applications, allfour of which were selected for awards. The submissions wereas follows:
Member Service:Job Bank, submitted by the Publications Committee
Innovation:NJ HFMA Future Leaders Committee, submitted by theFuture Leaders Committee
AndJunior Board Member, submitted by Chapter President,Cheryl Cohen
Improvement Awards:NJ HFMA 2007 Annual Institute, submitted by the InstituteCommittee
As mentioned, the Chapter was also a recipient of the C.Henry Hottum Award for Educational Performance Im-provement, and the Bronze Award of Excellence for Mem-bership Growth & Retention.
The C. Henry Hottum Award recognizes chapters thatachieve a significant increase in educational performancefrom one year to the next. The award is based on exception-al growth in registrant hours over the last year.
The Bronze Award of Excellence for Membership Growth& Retention recognizes chapters that achieve outstandingperformance in membership growth and retention. Thehonor is based on the percent of net membership growth atthe end of the chapter year.
Congratulations to all!
NJ Chapter Earns Six Awards at the ANI!
by Laura A. Hess, FHFMA
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July/August 2 0 0 8
Focus 47
July/August 2 0 0 8
48 Focus
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