Relax and put your feet upall the tools you need are right at your fingertips… · 2013. 4. 19. · need are right at your fingertips! Meet the new NJ HFMA Website.....page 7. ARMDS

new jersey chapter

March/April 2009 • vol 56 • num 1

Relax and put your feet up....all the tools you need are right at your fingertips!Meet the new NJ HFMA Website.....page 7

ARMDS

Besler

CBIZ KA Consulting

Executive Resources, LLC

Fox Rothschild LLP

Healthcare Financial Services

Health Ware Concepts

Health/ROI

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 Ethics ..............................................25Who’s Who in NJ Chapter Committees ....27Focus on Finance ...........................................29

Mark Your Calendar .......................................31Certification Corner .......................................33Focus on Members ........................................35New Members .................................................36Meet A New Member ....................................38New Member Service: Resume Bank ......38Job Bank Summary .......................................39Advertiser Focus.............................................48

focus•advertisers•

focus•features•

focus•points• focus•cover•

Dynamic Connections - The New HFMA NJ Web siteby Al Rottkamp ............................................................................................................................... 7

HITECH Act Greatly Expands Scope of HIPAA’sApplicability and Enforcement and Increases Civil MonetaryPenalties for Violations

by Helen Oscislawski and Michael Kline ......................................................................................... 11

Ways to Keep a Compliance Program Vibrantby Lisa Neff-Wheeler and Paula Shorter .......................................................................................... 16

The PRRB Giveth and the CMS Taketh Awayby James Robertson, Esq. and Barry Liss, Esq. .............................................................................. 19

New Jersey’s New Codey Law – New Limits on PhysicianOwnership and Referrals

by Elizabeth G. Litten and John Zen Jackson ................................................................................. 21

Inpatient Medicaid Rates Diagnosis Related Groups (DRG)System Proposed Changes

by Scott Besler ............................................................................................................................... 24

CFO Member Spotlight:Karen Lumpp, Trinitas Regional Medical Center ............................................ 30

Member Spotlight: Tony Consoli............................................................................ 32

NJHFMA Hosts Its First Webinar to Rave Reviewsby Tracy Davison-DiCanto, CHFP, MBA ........................................................................................... 40

A Photo Recap of the NJ HFMA/NJAAHAMAnnual Joint Meeting

Photos by Steve Aaron, ARC Group Associates ............................................................................... 42

2009 Annual Institute: Meet Our Keynote Speakers .............................. 44

Courtesy ofSteve Aaron

ARC Group Associates

Focus 1

March/Apri l 2 0 0 9

2 Focus

focus/hfma

DEADLINE FOR SUBMISSION OF MATERIALIssue Date Submission Deadline

January/February December 15March/ April February 15May/June April 15July/August June 15

September/October August 15November/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 Laura Hess at 888-652-4362 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 consistent

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 Management Associationor the Publications Committee. Neither the Healthcare Financial Management Association nor the Publications Committee shall be responsible for slight variations in production quality ofpublished 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, [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 LLPAl Rottkamp,MBA,Vice Chair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CrothallSteve Aaron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ARC Group AssociatesLynn Chiantese . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .New Jersey Hospital AssociationMark P. Dougherty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Johnson Controls, Inc.Joan Hendler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Remex, Inc.Laura Hess, FHFMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NJHFMARhonda Maraziti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .WithumSmith + BrownWilliam McCann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Healthfirst NYDavid A. Mills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Deloitte ConsultingHelen Oscislawski, Esq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fox Rothschild LLPErum Raza, Esq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fox Rothschild LLPJames A. Robertson, Esq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Kalison McBrideRoger D. Sarao, CHFP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Jersey Hospital Association

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

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

DanWillis – 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 2008-2009ChapterWebsite . . . . . . . . . . . . . . . . . . . . . . . .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


Focus 3

The President’s View . . .

I have just returned from my first round of golf this season, although the weather was alittle cool, the smell of spring is in the air and there is still a lot of rust on my golf swing.More about golf a little later.

Since the beginning of the year, the Chapter and all of its volunteers have continued toamaze me with all of their accomplishments and successes. Firstly, the past two quarterlymeetings, January and March, have had attendance figures near the 200 mark. The Januarysession was a joint meeting with the NJ Chapter of AAHAM, while the March session weteamed up with the NJ chapter of HIMS. Congratulations to our HFMA co-chairs of bothevents as well as our colleagues at the respective associations. On another education eventnote, the Chapter had its first ever webinar conducted by the Education committee and itwas a tremendous success. More webinars are planned in the very near future so check our website on a regular basis.

Speaking of our website, have you checked it out yet? It has been revamped and it looks GREAT! Thanks to all membersof the Publications/Website committee for all of their effort in giving us a fresh look.

Several of our Past Presidents are participating on a National Level in HFMA. Greg Adams will become a national HFMAofficer beginning in June 2009. In four years, he will become the National Chairman. Greg is only the second individual fromNew Jersey to reach this prestigious position. Beginning in June, Stella Visaggio will serve on the Principal and Practice Boardand Rick Parker will become a member of the Chapter Advancement Team. Last, but not least, Cheryl Cohen will serve asRegional Executive for Region 3 (NJ and Pa.) in 2011/2012. Congratulations to Greg, Stella, Rick and Cheryl!

So now, more about golf. There are two upcoming events that I would like you to note and hope you consider joining yourcolleagues for some fun and networking. Let us keep our fingers crossed for good weather! The dates are April 20th at ArchitectsGolf Club and May 7th at Fiddler’s Elbow. Please check our website for details.

On a final note, several of our members are creating presentations to be used in Yerger award applications. The chapter willbe submitting several applications on various accomplishments over the past year. We should hear in early June as to whetheror not our applications were winners. Once again, thank you to all who volunteer their time and talent to make this such awonderful organization.

Sincerely,

Joe Dobosh, MBA

Joe Dobosh

makingconnections


Dear Readers:

Recently, I was dining with one of my brainiest friends, former New Jerseyhospital executive Christopher Olivia, MD (now President and CEO of WestPenn Allegheny in Pittsburgh), and he quoted Warren Buffett as having said,“It’s only when the tide goes out that you learn who’s been swimming naked.”I love that quote, and mention it here because it aptly describes what seems toface many businesses, whether health care-related or not, when faced with achange of circumstances. Those that are not prepared are often left scramblingfor cover or swimming into deeper, more dangerous waters, while those whoanticipated the change in tide can simply walk out onto dry ground, eitherknowing that they are or not caring that they aren’t covered. Our regular readers and active Chapter members arelikely to be among those that anticipate sea changes.

Speaking of sea changes, the new website is up and better than ever. If you haven’t yet seen it, you haven’t yet real-ized that it truly is an accessible, easy-to-use resource for you and your organization and colleagues. I think I willalways prefer reading paper, but the New Jersey Chapter website was specifically redesigned to be a useful tool andsource of up-to-date information of concern to our members and others within the health care industry. OurPublications Committee Co-Chair, Al Rottkamp, has written an article that is included in this issue that details boththe process and the result of months (years?) of work on this redesign.

I suggest you log onto www.hfmanj.org, add it to your favorites, put your feet up, and see for yourself whether thesite is relevant to your work. If you do not find the site useful, please let me know. Though we love the positive feed-back, negative feedback will help us make improvements.

Here’s to the anticipation of warm, sunny beach days at the Jersey shore and planning for appropriate cover when thetide goes out.

Regards,

Elizabeth G. LittenEditor

From the Editor . . .

4 Focus

Elizabeth G. Litten

6 Focus

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Focus 7

continued on page 8

Dynamic Connections -The New HFMA NJ Website

by Al Rottkamp

The ContentThe new platform affords implementation of several

new features not found on the previous platform: GoogleAnalytics, surveys, polls and community associations. Thedesign is more current, lighter and allows flexibility in con-tent presentation. We started with a strong identity and fourwords that describe the chapter: Informative, Pro-active,Community and Leadership.

The Home page is packed with new features including content sections on each sideof the page, Featured Events down the center, a new membership directory link and ahorizontal navigation bar.

Al Rottkamp

The Concept(Nothing too crazy.) That was the

only guidance on their faces as I fin-ished my presentation to the Board fora new website.

We all knew we needed to updateand upgrade our website, but we alsoneeded to blend the familiar and user-friendly with new functionality and adesign that would meet the technolog-ical expects of the next generation ofmembers.

If you haven't surfed to the HFMANew Jersey website yet, this is a greattime to visit. Google HFMA NJ ortype the URL in your address boxhttp://www.hfmanj.org.

Don't forget to bookmark the site toyour desktop.

The website is a publication. Its pur-pose is to both complement and sup-plement our printed publication,Garden State FOCUS. We designedthe new website with an eye on con-tent, technology and making connec-tions. Conversations about designing anew website started early last summerand the Board approved the project inNovember 2008. The new site wentlive February 18, 2009 on an Orbiusserver.

Hot Topics

ProfessionalEducation

The MarketPlace

News from theCommittees

Technologies

Register Online

NewIdentityLogo

Searchthe site

ChapterNews

FOCUS

OtherHFMAChapters

PayPalEVENTS

continued from page 7

Look to the Hot Topics section for current news on RAC's,important studies, New Jersey law, retail, etc.

The Professional Education section features certificationand career advancement information. Did you know thecertification exam was revised this year? Look here and inFOCUS for that edge to pass the new test.

The Marketplace discusses managed care and generaltrends. This is one of the new sections designed to reach outto our membership and the general public.

News from the Committees is a front page section for our14 committee groups to push important news. Look for newsabout patient access, patient financial services, reimburse-ment trends, etc.

Technologies is another one of our new sections. Look forhardware, applications and platform information.

Chapter News highlights open positions, important dates,scholarships, etc.

The FOCUS section provides a sneak peak at topics in thenext issue.

The Other HFMA Chapter links provides links to MD,PA and NY chapters.

All upcoming Featured Events are listed with a short sum-mary. Clicking on the link opens to a new page with a calen-dar and more information. Registration is now availableonline, including the option to pay by credit card. This newplatform allows internal website search functionality. Typing‘CFO’ in the search box results in hits that include Directors,Officers, and past issues of FOCUS, to name just a few. Thenavigational bar is horizontal, allowing for more productiveutilization of the entire Home page space. The links across thetop navigational bar are:

• About HFMA

• Events

• President’s Message

• Committees

• Snippets

• Job Bank

• Garden State FOCUS

• Membership

• Contact Us

8 Focus


BBUUIILLDD UUPP YYOOUURR RREEVVEENNUUEE BBAASSEE……………………………………EEXXPPEENNSSEESS WWIILLLL FFAALLLL IINN LLIINNEE

REVENUE STRATEGIES: OTHER CAPABILITIES:• Environmental Scans RAC Technical Assistance • Comprehensive Community Needs Assessment Debt Compliance Review/Analysis/Implementation Services • Strategic/Business Plans Physician Development • FQHC Development - Physician Need Assessment • New Product Line Development - Medical Staff Development Plans • Horizontal/Vertical Integration Analysis - Satisfaction Surveys

EXECUTIVE RESOURCES, LLC 1955 State Highway 34, Suite 3-B, Wall, NJ 07719

Tel 732-974-7200, Fax 732-974-7299 Email [email protected] Website www.execresources.net

(Harry Wright, Bill Cusick, Larry Sargent)

The most popular sections, as indicated by YAHOOWeblog Analytics, are the Job Bank, Events and FOCUSpages. The Job Bank is by far the most popular section. Weexpanded the functionality of this area by incorporatingonline forms, payment options and a revised flow. Click onthe Post A Job icon to access instructions and the online form.Payment options include pay by check or online, with PayPal.For hiring organizations, your open position is posted inGarden State FOCUS and on the website. The strength ofour membership combined with the success of the AnnualInstitute, Quarterly Meetings and publications, attracts re-cruiters with open positions from other states. Therefore welist open positions by state on the left and by date posted, inthe center. Logos are added to individual job descriptions asthey are received.

The Events section includes a calendar and upcomingevents listed by date. Click on the event name to find moredetails, registration and payment information. The most pop-ular event is the Annual Institute.

We expanded the Garden State FOCUS section to includeseveral new features; 1) each issue is presented with the coverimage and Table of Contents, 2) all six issues from each yearare presented down the center and 3) past issues are availablethrough 2006. The current issue is uploaded and available ap-proximately two weeks after publication.

The TechnologyWhile the previous website was on a YAHOO server, the

new site is with Orbius. They operate a scalable platform andwe have access to both website and platform developers. Theirtechnology allows everything from basic website services tosocial networking. Any information that we collect from sur-veys or polls belongs to HFMA NJ and is private.

Although animation and Flash technologies are common,they can cause problems. Server side software can detectwhich browser you are using, but not firewall permissions orbandwidth/loading issues on your side. Therefore we decidedto keep the application light by not generating animations orFlash content.

AnalyticsThe previous website on YAHOO’s server utilized Weblog

Expert as the analytics package. Typical statistics from 2008are below:

Visitors per month: 5,000Time spent on website: 4 to 7 minutesMost Popular Page: Job Bank

Most Common Viewing Hours: 8 am to 3 pm. (howeverthere is activity 24/7)

Most Common Browser: Internet Explorer, versions 6 & 7.

Least Common Browsers: Firefox, Safari and InternetExplorer version 5.

Search Engine Spiders: active 24/7, are on the site for lessthan one second and are from around the world. They alsohave unusual looking website addresses.

There is a positive, direct correlation between hits and thedate Pulse is emailed to HFMA NJ membership.

We loaded the new site with Google Analytics software.This will allow us to monitor visitors from other countriesand individual states. To date, we have received visitors fromNew Jersey, Pennsylvania, Maryland, New York and severalother states.

Under Consideration and Reaching OutAlthough the new site was launched February 18th, we are

already working on the next phase of development. Some ofthe requests under development include:

Resume Bank

Surveys

Interactive learning applications

Polls

Mobile presence

More information will be available as these services go live.

Nothing too CrazyIt’s the Digital Age. We like iPods, G3 phones, 50 inch

TV's and surfing. MySpace, Facebook and Linked-In arecommon destinations and showcases for many people.Although Shaq O'Neil may have over 80,000 fans on Twitter,I doubt anyone would want to track the number of meetingswe attend or purchase orders we have signed on a minute-by-minute basis.

The new website is significantly different than the previousone. This site was designed to present dynamic content ona scalable platform. Images and files are scaled down to asmaller size for more efficient utilization of bandwidth.Photographs and graphics were added to personalize theexperience. There is a Site Map at the end of this article forreference.

Focus 9


continued on page 10


10 Focus

Designing a website is a significant endeavor and requires astrong group. So Thank You to the HFMA NJ Board, especiallyJoe and Brian, the Publications Committee, especially Laura,Elizabeth, John, Dennis, Tracy, and Steve and the website devel-opers George, Tina and Matt.

Site Map - Table of ContentsHome Page

Navigation bar, Search, Membership Directory link

Chapter News

EventsHot TopicsProfessional EducationThe MarketplaceNews from the CommitteesTechnologiesCurrent FocusSurrounding HFMA Chapters

About

NJHFMA Team

Officers

Directors

Advisory Council

Past Presidents

Chapter Information

Sponsorship Opportunities

Educational Programs & Meetings

Links

Chapter Awards

Certification

EventsUpcoming Events - Information & Registration

Calendar

President’s Message

CommitteesCommittee Master List

Sections for all committees. Includes Goals, Chair persons& minutes.

Snippets

Professional Education

The Marketplace

News from the Committees

Technology

Job Bank

Post a Job - Instructions, email & PayPal LINK

Open positions listed in post date and by State

NJ Colleges and Universities

Garden State FOCUSCurrent Issue with cover image, Table of Contents and issue

download link

Past Issues

FOCUS Information- article policy, advertising

Sponsorship Information

Membership

Benefits

Classifications

Scholarship Information

Directory - Link to National

Join - Link to National

Contact Us

Telephone, email, mail address

Ask a question - FAQ

About the AuthorAl Rottkamp is a member of the HFMA NJ chapter and theAssociation for the Advancement of Medical Instrumentation(AAMI). He holds an MBA and an MS in BiomedicalEngineering. As an employee of Crothall, he is Director ofTechnology Management, Robert Wood Johnson UniversityHospital at Hamilton. Al can be reached at [email protected].



Focus 11

HITECH Act Greatly ExpandsScope of HIPAA’sApplicability and Enforcementand Increases Civil MonetaryPenalties for Violations

by Helen Oscislawski and Michael Kline

Those who are superstitious may believe that bad things hap-pen on Friday the 13th, but we will leave it to each individualand entity to formulate conclusions regarding the HealthInformation Technology for Economic and Clinical Health Act(the HITECH Act), which Congress passed late on Friday,February 13, 2009, and President Obama officially signed intoeffect on February 17, 2009.

The HITECH Act addresses various aspects relating to theuse of health information technology (H.I.T.), including pro-viding for federal funding by way of grants and incentive pay-ments in order to promote H.I.T. implementation. This articlefocuses, however, on Subtitle D of the HITECH Act, whichincludes important, new and far-reaching provisions concern-ing the privacy and security of health information that willmaterially and directly affect more entities, businesses and indi-viduals in more diverse ways than ever before. These changesare further elaborated upon below, but this article can onlyhighlight certain prominent issues under the HITECH Actand is by no means a comprehensive review of this lengthy andcomplex Act. For questions and additional guidance on theHITECH Act, contact your Fox Rothschild attorney or theauthors of this article.

Civil Monetary Penalties and Enforcement ExpandedThe HITECH Act amends the civil monetary penalty

(CMP) provisions for HIPAA violations to include tieredincreases in amounts of CMPs as follows:

• Where a person “did not know,” at least $100, but nomore than $50,000, for each such violation

• Where there was “reasonable cause” but no willful neg-lect, at least $100, but no more than $50,000, for eachsuch violation

• If there was willful neglect, at least $10,000, but nomore than $50,000, for each such violation

The new CMP provisions areeffective and applicable immedi-ately to all violations occurringfrom and after the date of enact-ment of the HITECH Act. Also,within three years after the enact-ment of the HITECH Act (Feb-ruary 17, 2012), the Secretary ofthe federal Department of Healthand Human Services (DHHS) isobligated to establish regulationsthat will allow individuals harmedby privacy and security violations to receive a percentage ofany CMP or monetary settlement collected with respect tosuch offense.

The HITECH Act also authorizes each state attorney gen-eral (AG) for the first time to begin pursuing civil actions forHIPAA privacy and security violations that have threatened oradversely affected a resident of the AG’s respective state. Forany violation that occurs on or after February 17, 2009, stateAGs are now authorized to obtain statutory damages onbehalf of any such residents of their state in an amount equalto $100 for each violation of a single requirement, up to atotal of $25,000 for violations of that requirement. Attorneys’fees are also allowed to be collected by an AG for pursuingcivil actions for HIPAA privacy and security violations.

Expanded ApplicabilityThe HITECH Act now directly obligates business associ-

ates to comply with the HIPAA Security Rule’s administra-tive, physical and technical safeguard requirements, includingdeveloping and implementing comprehensive written securi-ty policies and procedures with respect to the protected health

Michael Kline

Helen Oscislawski


12 Focus


Focus 13

information (PHI) that they handle. Failure by business asso-ciates to abide by such requirements can result in CMPs beingassessed directly against them.

In addition, any organization, with respect to a coveredentity, that provides data transmission of PHI to such entity(or its business associate) and that requires access to PHI on aroutine basis must now be treated as a business associate andenter into a HIPAA-compliant business associate agreement.Examples of such entities include HealthInformation Exchange Organizations, Re-gional Health Information Organizations,or “any vendor that contracts with acovered entity to allow that coveredentity to offer a personal health recordto patients as part of its electronichealth record.” Where such entitieswould now be considered “business asso-ciates,” they then are also required todirectly comply with the HIPAA SecurityRule provisions, which the HITECH Actmade directly applicable to business asso-ciates. It then follows that such organiza-tions are now also directly subject topotential CMPs and statutory damages forviolations.

New Privacy and Security Require-ments

• Security Breach Notification Re-quirements: Security breach notifi-cation requirements under theHITECH Act go into effect 30 daysafter the date that interim final regu-lations are promulgated, which willbe no later than 180 days after thedate of enactment of the HITECHAct (August 16, 2009). Covered enti-ties, business associates and vendorswho handle personal health recordsare required to abide by breach noti-fication requirements. Violations ofthis requirement by vendors wouldbe treated as an unfair and deceptiveact or practice in violation of theFederal Trade Commission Act. If abreach affects more than 500 individ-uals of a particular state, notice als0must be provided to prominentmedia outlets following the discoveryof the breach.

• Complying with Requested Restrictions: Every cov-ered entity must now comply with an individual’s re-quested restriction on how it uses and discloses the indi-vidual’s PHI if the disclosure is to a health plan for pur-poses of carrying out payment or health care opera-tions, and the PHI pertains solely to a health care item orservice for which the health care provider involved hasbeen paid out of pocket in full.


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14 Focus

• Minimum Necessary Disclosures: Within 18 monthsafter the date of enactment of the HITECH Act(August 17, 2010), new guidance shall be issued gov-erning what constitutes the “minimum necessary” forpurposes of disclosures under the privacy rule. Coveredentities must, when otherwise permitted, disclose onlythe “minimum necessary” to accomplish the intendedpurpose for such disclosure.

• Accounting of Disclosures with EHRs: Covered enti-ties that use and disclose PHI through electronic healthrecords (EHRs) are required to provide individuals withan accounting, when requested, for the prior three-yearperiod. Uses and disclosures of PHI through EHRsinclude treatment, payment and health care operations.Covered entities with EHRs may need to beginaccounting for disclosures as early as January 1, 2011,depending on when they acquire and begin to use anEHR.

• Access Rights to Electronic Format: The HIPAAPrivacy Rule is amended to give individuals the right toobtain access to their PHI in electronic format, if theyso request.

• Health Care Operations: The definition of “healthcare operations” will be reviewed by the Secretary ofDHHS by August 17, 2010, and narrowed or clarified.

• Marketing: The HIPAA Privacy Rule is amended tolimit when a covered entity may disclose PHI as part ofa health care operation if it receives or has receiveddirect or indirect payment in exchange for making suchcommunication, except in specified circumstances.

• “Sale” of PHI: Covered entities and business associatesare prohibited from directly or indirectly receiving anyremuneration in exchange for any PHI of an individualunless a valid authorization is obtained from the indi-vidual, except in a very limited number of circum-stances, including research, public health activities,treatment of the individual, and in connection with thesale of a covered entity to a buyer of the business. Thenarrow list of exceptions are all subject to any addition-al restrictions that may be found in regulations regard-ing “sale of PHI” to be promulgated by the Secretary ofDHHS no later than August 17, 2010. The effectivedate of the ban on the sale of PHI under the HITECHAct is six months after the date that the final regulationsare promulgated.

• Effective Date: Unless otherwise specified, the effectivedate of all provisions is one year from the date of enact-ment of the HITECH Act, or February 17, 2010.

What Should Affected Entities Do?At a minimum, affected entities that are already subject to

HIPAA compliance should begin making the followingchanges:

• Update Notice of Privacy Practices to reflect changes inprivacy and security policies

• Update HIPAA privacy and security policies accordingly• Develop a detailed Breach Notification Policy that

complies with HITECH and any state law counterpartto the new federal breach notification provisions

• Expand business associate lists to include vendors andothers

• Update Business Associate Agreements to includeexpanded new requirements

What Should Entities that Have Not Previously BeenSubject to HIPAA Do?

Entities that have not yet been subject to HIPAA compli-ance or have had limited compliance requirements underHIPAA should examine the new scope of HIPAA, as it maybe applicable to them under the HITECH Act in order notto unintentionally become non-compliant.

About the AuthorsHelen Oscislawski is an attorney in the Corporate Department ofFox Rothschild LLP. She concentrates her practice in the areas ofgeneral corporate and health care law, and provides a wide vari-ety of corporate and regulatory services to clients. Ms. Oscislawskiis widely-recognized for her experience with and understandingof laws affecting the use and disclosure of health information,including HIPAA's privacy and security requirements. She wasappointed by Governor Corzine as the sole attorney of the NJHealth Information Technology Commission. She can be reachedat [email protected]

Michael J. Kline is a partner in the Corporate Department ofFox Rothschild LLP. He concentrates his practice in the areas ofcorporate and securities law, including complex corporate trans-actions, mergers and acquisitions, financing, and federal securi-ties regulations under the Securities Act of 1933 and theSecurities Exchange Act of 1934. Mr. Kline also counsels andassists hospitals, nonprofit foundations, skilled nursing facilities,and other clients in handling overlapping business, financial,and legal issues. For over 25 years, he has served as general coun-sel to Deborah Heart and Lung Center and Deborah HospitalFoundation in Browns Mills, NJ. Mr. Kline can be reached [email protected].


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CBIZ KA Consulting Services, LLC 1-800-957-6900 x110 www.kaconsults.comFor a free RAC webinar, please visit www.RACAuditor.com.

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16 Focus

Developing a health care compliance program is only thebeginning. The challenge is to effectively implement a pro-gram that is vibrant and one that is able to change to meet theobjectives of the organization. Having a program that onlycomplies with the regulations is just the first of many steps.Creating a robust program that enables an organization tooperate effectively, ethically, and is able to grow and change asan organization evolves are the fundamental pillars of success.

In today’s market, organizations have various models, scaleand staffing compliments. Some are located in one locationand others have multiple locations that could span the nationor perhaps the world. Furthermore, some organizations havestarted small and have grown rapidly, sometimes within ashort period of time. Taking a compliance program and keep-ing it top of mind is no small feat, no matter what your modellooks like. As organizational structures change it is imperativeto create and revise your compliance program to meet thesechanges. It is of equal importance to develop a program towhich everyone is committed. The question is where shouldyou start and what tools should you use to achieve these goals?Though there is not one definitive answer, there are strategiesthat can make the end goal one that is feasible. This articlewalks you through some techniques that may be used on yourjourney towards developing a vibrant compliance program.

As an organization transforms and changes, existing compli-ance programs need to be periodically reviewed and refreshed.

The goal of a refresh is to con-firm that adequate policies andprocedures are in place to com-ply with the Center for Medicaidand Medicare Services (CMS)risk area policies and withHIPAA privacy regulations. Thefocus should be on confirmingthat your program complies withthese regulations and that anynecessary operational changesthat are required take place. Inorder to assess and refresh acompliance program, the focusareas displayed in the chartbelow should be considered.Continuous assessments of boththe program and the work that isperformed by your staff membersshould surround each topic inorder to tailor your program’sneeds.

After completing the initial refresh, subsequent reviews ofboth the program and claims that are being processed canreveal where you may have gaps in staff members adhering topolicies and procedures. Process/system gaps that can lead to

by Lisa Neff-Wheeler and Paula Shorter

Ways to Keep a ComplianceProgram Vibrant

Lisa Neff-Wheeler

Paula Shorter

MAIN BUSINESSOFFICE

SITE A SITE BSITE C

REMOTE SITES


Focus 17

non-compliance with the existing regulatory requirements canand should be revealed through these reviews. Through thedue diligence process you may also discover that when staffmembers are pressed for time, or do not know where to obtainthe right answers, they may avoid following policies and pro-cedures consistently. Inconsistencies can be driven throughlack of knowledge or from the information not remaining atthe forefront of your staff members’ minds. So, what can youdo to mitigate these trends from reoccurring? One techniqueis to establish a corrective action plan that incorporates theimplementation of a communication strategy that keeps thecompliance program as a priority in your staff member’s day-to-day activities. One major component of a communicationstrategy is to establish a brand that symbolizes the importanceof the program and its messages. Most often having a dedicat-ed email box that displays the name and brand of your com-pliance department not only raises awareness, but can elevatethe level of priority of the email. It can also provide staff mem-bers with an alternate method to send compliance relatedquestions that may be facilitate clarification and knowledgebuilding, rather than reporting of violations. A dedicatedemail account can provide staff members with another venueto get the “right” answer rather than making assumptions.This venue of communication can also provide a greater levelof awareness and attention to regulatory updates, literatureand communications that need to be disseminated in an effi-cient and timely manner.

Now that you have created a robust communicationprocess that includes your brand, statistics show you willalways have a small percentage of staff that might not be asresponsive as the rest or who will pick and choose what theyfeel is “important.” Having any element of potential non-compliance may leave you feeling that you haven’t achievedyour goal or may leave you asking the question, was itenough? Well there may be some truth to that, but there is asolution: assessments. Process gaps can be assessed in twoways: 1. Administrating an anonymous survey, and 2.Compliance reviews/audits. A survey can assist in assessingwhether your staff members were able to correctly respond tosome standard compliance questions that are outlined in thecommunication/reference materials. It can also provide met-rics surrounding what and how much of your policies andprocedures have been understood and are being followed. Theresults of the survey can not only help determine if your staffmembers have not completely understood the content pro-vided, have not retained it, or didn’t take the time to read it,but also provide you with some baseline metrics to trendimprovements. The review process is of even greater impor-tance as the results can help identify specifically where theissues are. The gaps can also help pinpoint if the issue is indi-

vidual based, department based or organization wide.Throughout this journey it is important to remember that

the role of compliance is to monitor and provide staff memberswith updates, processes and tools that will enable them to per-form their assignments in a compliant manner. It is equallyimportant to be able to measure their effectiveness on a contin-uous basis. As issues arise or gaps are identified, implementingcorrective actions that deal with such findings should include atraining program that focuses on specific compliance topics.The training program can be organized by department/projectneed, organization need or in some cases, individual needs.Organizations can use a mixture of different training styles thatinclude Webinars, “Lunch and Learn” sessions and classroomstyle trainings. The training should have a lot of variety andoptions and should reinforce regulatory requirements and yourorganization’s policies and procedures. Additionally, the train-ing should provide practical examples of how to leverage thelearnings from a process stand point. Quite often providingstaff with real case scenarios can assist in giving them contentthey can relate to. Once a training program has been executedit should be coupled with assessments. Assessments can be use-ful in confirming the efficacy of the presentation and under-


Area of Focus Objectives

DiagnosticReview

Updates

Processes

Staffing

Training

Validate

Implement

A diagnostic review will assist in confirming all necessaryprocesses and procedures are in place to meet existing andfuture HIPAA regulatory requirements.

The compliance program and its policies and procedureshould be updated to reflect regulatory changes.

All processes should be enhanced and refined to address anygaps that have been identified through program reviews andwork processed by staff members.

Identify and deploy additional staff to the complianceteam to provide greater focus on area for exposure.

Develop a robust training program and curriculum that pro-vides staff with education on policies, procedures and appro-priate billing protocols.

Develop a process to validate that all staff have completedannual training and have passed the training curriculums asappropriate.

Roll out all revisions to the new program and provide staff withany documentation that will assist in their efforts to comply.

Staffing

Training

Processes

Reviews

Updates



18 Focus

standing of the training material. Assessments should enhanceyour ability to proactively define retraining needs and createrefresher material in a timely manner; and in some instancesmay influence process changes or new reviews.

The next technique that should be considered to raiseawareness of regulatory and policy changes is publication of acompliance newsletter. The newsletter should include contenton: regulatory updates, compliant behavior reminders, vari-ous methods/strategies that need to be reinforced, tips onavoiding violations, and lists of upcoming events and train-ings. “Compliance Facts” email blasts and other referencematerials that staff members can post on the walls of theirwork stations as references can be very helpful tools and serveas a positive complement to the newsletters.

In addition to the above, establishing an annual complianceweek can also help in keeping your compliance program freshand provide staff with an event to look forward to. The week’sevents should focus on reinforcing new compliance relatedcontent as well as key points that need to be kept top of mind.The materials used should be a blend of email blasts, interac-tive trainings, trivia type games that are facilitated at an indi-vidual and group level. And most important – prizes! Prizes forparticipation or correct responses to questions presented ontraining assessments or even through games are nice rewards.

Last, the most important component of a vibrant, effectivecompliance program is to perform consistent reviews of workperformed to confirm that there are no process gaps, under-standing gaps, or need for redesign of existing policies andprocedures or modifications to existing information systems.The outcome of such reviews can reveal where staff membersexhibit non-compliant behavior to complete their work or toassist others in responding to data requests. The findings canbe used to generate case study type training material, to dealwith the individual(s) directly, to educate staff on appropriatepractices and, lastly, to develop processes to help keep theseissues from reoccurring.

These reviews can also enable an organization to betterdefine necessary system and process changes. Such informa-tion can enable the compliance team to assist the effected de-partment/function to redesign and improve existing processeswhich in turn should help minimize the applicable compliancerelated issues in the future. An effective output of these reviewsshould include the definition of information system controlreports which can proactively be used in the future to efficient-ly define compliance related issues. That being said, it is im-portant that your compliance team be involved in any organi-zational redesign activities to make sure that the existing poli-cies and procedures are modified, and to make sure that theorganization continues to be compliant with regulatory re-quirements. Inclusion of operation staff members on the com-

pliance committee can assist with this too.Though all of these techniques are paramount in develop-

ing a program that is fresh and vibrant, it is just as importantto review, revise and continuously validate that measures havebeen taken to drive compliant behavior. Empowering staff byreiterating they are ALL responsible for the success of theorganization and to encourage and reward those who escalatepotential non-compliant behavior is critical and sends theright message to the organization. It is also just as vital toquickly deal with any violations and to use those findings asteaching points for the organization as a whole.

The steps outlined in this article are not the only methodsyou can use to improve your compliance program, but theyare time-tested techniques that can be leveraged in whole orpart to help your program to get to the next level and to keepyour compliance program in the forefront of your organiza-tions goals.

This article contains general information only and is basedon the experiences and research of Deloitte practitioners.Deloitte is not, by means of this publication, rendering busi-ness, financial, investment, or other professional advice or serv-ices. This publication is not a substitute for such professionaladvice or services, nor should it be used as a basis for any deci-sion or action that may affect your business. Before making anydecision or taking any action that may affect your business, youshould consult a qualified professional advisor. Deloitte, itsaffiliates, and related entities shall not be responsible for any losssustained by any person who relies on this article.

Copyright © 2009 Deloitte Development LLC. All rights reserved.Member of Deloitte Touche Tohmatsu.

About the AuthorsLisa Neff-Wheeler is a senior manager for Deloitte ConsultingExtended Business Services LLC who specializes in providingthird party A/R outsourcing solutions for her clients and alsoserves as the Compliance Officer for the Extended BusinessOffice Solutions Practice. Ms. Neff-Wheeler has over 19 years ofhealth care provider revenue cycle experience. She can be reachedat: [email protected]

Paula Shorter is a Manager in Deloitte’s Extended Business OfficeSolutions (EBOS) practice. She has over 13 years of consulting ex-perience in the area of revenue management, program manage-ment, outsourcing/offshoring and accounts receivable management.Mrs. Shorter currently works as an associate compliance and qual-ity manager. Her primary responsibilities include providing leader-ship, guidance, and enforcement of HIPAA and federal regulatoryguidelines to off-shore and on-site EBOS practitioners. She can bereached at: [email protected]



Focus 19

Despite numerous victories at the Provider Reimburse-ment Review Board (PRRB) level, hospitals are getting uni-formly reversed nationwide by the CMS Administrator onnumerous issues involving the DSH percentage. One of thekey battlegrounds involves the meaning of “eligible for med-ical assistance under a State plan approved under title XIX.”New Jersey providers have argued that the percentage mustinclude charity care patients on the theory that charity care isan “approved plan under XIX” and therefore, under the plainmeaning of the statute, charity care is within its definition.On the other hand, fiscal intermediaries (and indeed, CMS)argue that the term “medical assistance under a State planapproved under title XIX” is synonymous with Medicaid.Under their interpretation, charity care patients cannot becounted because charity care is not available to anyone eligi-ble for Medicaid.

The emerging litigation trend suggests that hospitalsshould expect to engage in a lengthy battle against CMS andthe fiscal intermediary, beginning at the Provider Reimburse-ment Review Board and likely ending in the Court ofAppeals. At stake is the amount of DSH funds a hospital mayreceive.

The Medicare DSH adjustment is generally calculatedaccording to a formula that is based upon the determinationof a hospital’s “disproportionate patient percentage.” The dis-proportionate patient percentage is the sum of two fractionsexpressed as percentages.1 The first fraction is known as theMedicare/SSI Fraction, or, the “Medicare Proxy.” The numer-ator includes days attributable to patients who were both“entitled to benefits under [Medicare] Part A” and entitled tofederal SSI benefits.2 The denominator includes days attribut-able to patients who were “entitled to benefits under Part A ofthis title” (i.e., Medicare Part A).

The second fraction is known as the “Medicaid fraction” or“Medicaid Proxy.”3 The numerator of the Medicaid fractionincludes the total number of hospital patient days during thefiscal year attributable to patients who were both: (i) “eligiblefor medical assistance under a State plan approved under titleXIX” and (ii) not “entitled to benefits under [Medicare] PartA.” The denominator of the Medicaid fraction includes thetotal number of hospital patient days for the fiscal year. To theextent the numerator is larger, the Medicaid proxy will lead to

increased DSH payments. There-fore, ensuring that all patientdays are counted in this numera-tor is an important objective.

Nationwide, hospitals havebeen filing literally hundreds ofappeals to the PRRB challengingthe way in which fiscal intermedi-aries calculate these percentages.Although numerous issues areraised in these appeals, one ofthe most common battlegroundsis the intersection of charity careand Medicaid and how thataffects the numerator of theMedicaid proxy.

A recently decided case heardby the Court of Appeals for theDistrict of Columbia Circuit wasdecided in May 2008, in which theCourt of Appeals reversed the U.S.District Court below.4 The case involved determiningwhether hospital days attributable to Ohio’s Hospital CareAssurance Program should be deemed days for which patientswere eligible for “medical assistance” under a State planapproved by [Title] XIX and thus, included in the numeratorof the Medicaid proxy.

This 25-hospital litigation was initiated at the PRRB. TheBoard determined that it lacked the authority to resolve the mat-ter because it involved a “question of law” and granted an expe-dited judicial review.5 Consequently, the case was initially heardin the Federal District Court for the District of Columbia.

All hospitals involved in this appeal participated in Ohio’sHospital Care Assurance Program, or “HCAP.” HCAP isOhio’s program for the indigent which is funded by MedicaidDSH funds. Ohio uses participation in the HCAP programto determine, in part, the amount of revenue hospitals willreceive in Medicaid DSH funds. Thus, Ohio’s HCAP is sim-ilar to New Jersey’s charity care program; both are part of theirrespective state plans which are approved by the Secretary ofHealth and Human Services under title XIX.

The PRRB Giveth and theCMS Taketh Away

by James Robertson, Esq. and Barry Liss, Esq.

James Robertson

Barry Liss



20 Focus

The District Court held in favor of the hospitals. Itsrationale was that the plain meaning of the statutory languagerequires the inclusion of HCAP days in the numerator of theMedicaid proxy. The District Court found that Ohio’s HCAPprogram was part of the medical assistance program that wasapproved under Title XIX and therefore, based upon the plainlanguage of the statute, patient days attributable to HCAPmust be reflected in that numerator.

Approximately one year later, the Court of Appealsreversed. The Court of Appeals determined that the phrase“medical assistance under a State plan approved under TitleXIX” is interchangeable with the Ohio’s Medicaid program,based upon its reading of the rules of statutory construction.Accordingly, the Court reasoned, patient days for thosepatients eligible for HCAP could not be included in theMedicaid proxy numerator because HCAP was not Ohio’sMedicaid program. In reaching this decision, the Court ana-lyzed: (1) whether the underlying language in the SocialSecurity Act was intended to mean that “medical assistanceunder a state plan approved under Title XIX” was simplyanother way of saying “Medicaid”; and, if so, (2) whetherHCAP could be construed as “Medicaid.”

The Court made the following points: (1) the MedicareDSH provision pertaining to the calculation of the Medicaidfraction expressly references the Medicaid statute; and (2) theidentical phrase, “medical assistance under a State planapproved under Title XIX,” is used throughout the SocialSecurity Act. Therefore, the Court concluded, all uses of thephrase, “medical assistance under a State plan approved underTitle XIX,” in the Social Security Act are intended to mean“Medicaid.”

The Court also noted that under Ohio’s administrativecode, HCAP is clearly distinguished from Ohio’s Medicaidprogram.

Having reached those determinations, the Court conclud-ed that HCAP days cannot be counted in the numerator ofthe Medicaid proxy because: (1) HCAP is not Medicaidunder Ohio’s administrative regulations; (2) HCAP is not“medical assistance under a State plan approved under TitleXIX,” i.e., “Medicaid” as intended under the Social SecurityAct; and (3) only “Medicaid” patient days can be counted inthe numerator of the Medicaid proxy. Therefore, HCAP wasout, the numerator was diminished and the DSH distribu-tions were smaller.

On December 28, 2008, the hospitals filed a petition tothe U.S. Supreme Court to review that Court of Appeals deci-sion. It is not known at this time whether the U.S. SupremeCourt will grant certiorari.

While Adena is not binding on The Third Circuit, it will

undoubtedly be used as ammunition against any hospital thatadvocates for the inclusion of charity care days in theMedicaid proxy numerator. Nevertheless, the Third Circuitcan reject the rationale of the Adena court and create a juris-dictional split on the issue. It is essential, therefore, that hos-pitals timely file appeals with the PRRB in order to preservetheir right to challenge these calculations.

Additionally, a range of other DSH calculation issues arecurrently working their way through all levels of review,including the PRRB, the Administrator’s review, district courtproceedings and courts of appeal. These include: (1) whethernewborn patients were properly linked to their Medicaid eli-gible mothers; (2) whether patients who were dually eligiblefor Medicaid and Medicare were properly counted; (4) how tocharacterize Medicare managed care days; (5) how to charac-terize Medicare secondary payor days; (6) whether the fiscalintermediary used the correct SSI percentage when it deter-mined the Medicare fraction; (7) whether swing bed skillednursing days should be included in the Medicaid proxy; and(8) how to characterize beds used for observation.

Although the appeals process is lengthy, the PRRB remainsthe initial step towards any type of recourse. Therefore,whenever hospitals receive their annual Notice of ProgramReimbursement from the CMS fiscal intermediary, a PRRBappeal must always be considered.

About the AuthorJames Robertson and Barry Liss are Principals of Kalison,McBride, Jackson & Hetzel, P.C., a 16-attorney boutique healthcare law firm located in Warren, New Jersey, representing healthcare providers throughout New Jersey, and specializing in reim-bursement issues for the hospital industry.

1See 42 U.S.C. § 1395ww(d)(5)(F)(vi); 42 C.F.R. §412.106(b).

2SSA §1886(d)(5)(F)(vi)(I) and 42 C.F.R. § 412.106(b)(2)(i)(B).

3See 42 U.S.C. § 1395ww(d)(5)(F)(vi)(II); 42 C.F.R. §412.106(b)(4).

4Adena Regional Medical Center, et al. v. Michael S. Leavitt, Secretary, UnitedStates Department of Health and Human Services, 524 F.Supp. 2d 1 (D.D.C.2008); rev’d, Adena Regional Medical Center, et al. v. Michael S. Leavitt,Secretary, United States Department of Health and Human Services, 527 F.3d176 (D.C.Cir. 2008).

5This is curious, because the PRRB decided a similar case brought by fiveOhio hospitals in 2004 involving seventeen different appeals. (i.e.,Ashtabula County Medical Center, et al. v. Blue Cross Blue Shield Associa-tion/AdminiStar Federal, Inc._PRRB Decision 2005-D49, rev’d AshtabulaCounty Medical Center, et al. v. Blue Cross Blue Shield Association/AdminiStar Federal, Inc. CMS Administrator Decision (Oct. 12 2005).Adena appears to revisit this issue.



Focus 21

Long before United States Congressman Pete Stark (D-CA)pushed for prohibitions against physician self-referrals ofMedicare and Medicaid patients (now known as the “Stark”law), New Jersey Senator Richard Codey was working on leg-islation prohibiting physicians from making referrals to healthcare services in which they held ownership interests whether ornot Medicare or Medicaid was the payor. Sensibly dubbed the“Codey” law, the New Jersey version of what would parallel theStark law is about to undergo its first significant amendmentsince taking effect back in 1991, further defining whether andwhen New Jersey physicians can refer patients to health careservices in which the physicians hold ownership interests.

The new Codey law, Senate Bill 787, was approved by thefull Senate on December 15, 2008 and by the full AssemblyFebruary 5, 2009. When signed into law by the Governor andafter taking full effect (up to 12 months following enactment),the new Codey law will freeze the number of certain physician-owned ambulatory care and ambulatory surgery facilities towhich physician owners may refer patients. It will also add anew level of regulatory oversight over physician practices thatperform a type of office-based surgery (surgery performed inthe physician’s medical office -- so-called “single room” surgerypractices), rather than in licensed ambulatory surgery facilities.

Many policy makers and legislators, including CongressmanStark, have argued that health care utilization and costs areincreased inappropriately when physicians are permitted to reapfinancial profits from their referrals of health care services.Physicians will make fewer referrals that are medically unneces-sary and motivated solely to generate profits, so the argumentgoes, if they cannot benefit financially from their referrals. InNew Jersey, however, in the wake of the original Codey law, thephysician self-referral prohibition has been moderated by theview that, in some instances, self-referrals should be allowed, orperhaps not really considered as referrals.1 Thus, hundreds ofphysician-owned licensed surgery facilities2 and physician-owned surgical practices3 currently operate in New Jersey, ren-dering services to patients sent by the physician owners with the

services being directly provided bythe referring physician owner.

In late 2007, an earthquakestruck the physician-owned facili-ty landscape.4 A ruling by aSuperior Court trial judge inBergen County, New Jersey, whilelimited to the litigants involved(and, thus, not precedent-setting),caused deep fissures in the groundon which many physician-ownedfacilities were built. The judge inGarcia, et al v. HealthNet of NewJersey, Inc. v. Wayne Surgical Center,LLC (No. BER-C-37-06, decidedNovember 20, 2007) held that, despite the proliferation ofphysician-owned surgical facilities and the existence of a widelycirculated letter by the Board of Medical Examiners (“BME”)interpreting the Codey law in such a way as to permit physicianreferrals to certain surgical facilities in which the referring physi-cians held ownership interests, these referrals were illegal. ThisBergen County decision had involved a licensed ambulatorysurgery center which was owned by New Jersey licensed physi-cians who had been referring their own patients there for surgi-cal procedures. It was followed a few months later with a deci-sion by a Superior Court trial judge in Union County in the set-ting of a “single room” surgical practice that had not requiredlicensure. In Endo Surgi Center, P.C. v. Liberty Mutual InsuranceCo. (No. UNN-L-228-06 dated March 26, 2008), this judgesimilarly ruled that the physician owners had violated theCodey self-referral ban.

Fastforward fourteen months, and the after-shocks of theGarcia ruling (which is under appeal as is the Endo Surgi case)have barely abated. Debates ensued and many continue,despite the enactment of S.787: under what circumstances isa physician making a referral? Is it a referral when the physi-

by Elizabeth G. Litten and John Zen Jackson

New Jersey’s New CodeyLaw – New Limits onPhysician Ownershipand Referrals

John Zen Jackson

Elizabeth G. Litten

co



22 Focus


cian provides the referred service herself, and bills in her (orher practice’s) name? Which physician-owned facilities shouldbe licensed by DHSS (and potentially subject to the ambula-tory care facility assessment used to offset the cost of hospitalcharity care)? Should referrals of certain types of services beexempt from the prohibition, either because they are unlikelyto result in overutilization or because patients benefit fromphysician investment in these services? Where should the linebe drawn between DHSS-regulated health care facilities andBME-regulated physician practices?

Key aspects of S.787 include the following:• “Single-room” surgical practices will be required to reg-

ister with DHSS (existing practices will have a year afterenactment to register; new practices that file plans with themunicipality within 180 days of enactment may also registerto operate, if they register prior to commencement of servic-es), and shall, as a condition of registration, get certificationfrom the Centers for Medicare and Medicaid Services(“CMS”) as a surgery center or accreditation from a CMS-recognized accrediting body. Registered surgical practicesshall then be required to report specified patient informationto DHSS on an annual basis.

• DHSS-licensed ambulatory care facilities must getambulatory care accreditation from a CMS-recognized ac-crediting body within a year of enactment.

• No new registrations for surgical practices and no newambulatory care facility licenses for surgery services will beissued by DHSS after enactment, except under specified cir-cumstances (including transfer or relocation); no new surgicalpractice registrations will be issued unless the facility’s planswere filed with the municipality within 180 days after enact-ment. However, new licenses may be issued for facilities thatwill be jointly owned by a general hospital in New Jersey andone or more other parties, and for facilities owned by a hos-pital or medical school.5

• The original Codey law exemption for referrals of litho-tripsy services and radiation therapy pursuant to an oncolog-ical protocol will end, but physicians holding interests in suchfacilities prior to the first day of the 12th month followingenactment may continue to make referrals to facilities inwhich they hold financial interests.

• Similar to the original Codey law, physicians will be per-mitted to send patients for medical treatment or a procedurethat is provided at the physician’s medical office and for whicha bill is issued directly in the name of the physician or the


Focus 23

physician’s medical office. “Medical office” is not defined inthe original Codey law or in S.787.

• Physicians will be permitted to refer patients to DHSS-registered surgical practices and DHSS-licensed ambulatorysurgical facilities in which they hold financial interests, aslong as the referring physician personally performs the proce-dure; the physician’s remuneration as an owner or investor isproportional to his or her ownership interest and not to thevalue or volume of referrals; all clinically-related decisions ata facility owned in part by non-physicians are made by physi-cians and are in the best interests of the patient; and disclo-sure of the physician’s financial interest is made at the time ofthe referral. The disclosure must include information relatedto whether the facility is considered “out-of-network” by thepatient’s insurance carrier or third party payer.

The BME’s regulations will require amendment followingthis enactment. It will be interesting to see if the amendmentswill be narrowly tailored to conform with the new law, or ifthe BME will attempt (as it has twice before over the last twodecades, to no avail) to overhaul the entire, often painfullyoutdated, regulatory scheme. Many in the industry wouldwelcome an attempt to make the BME regulations compati-ble with federal law (for example, with respect to the in-officeancillary services and group practice provisions in the Starklaws). Often, compliance with federal law and compliancewith the BME regulations seems awkward, if not impossible.Similarly, an overhaul of the BME regulations might encour-age collaboration between the BME and the DHSS and resultin better delineation of where the BME’s oversight over physi-cian practices and the DHSS’s oversight over health care facil-ities begins, ends, or overlaps.

Perhaps most interestingly, the new Codey law foreshad-ows a shift that goes well beyond the original Codey law’s pre-scient (pre-Stark law) focus on physician self-referrals andoverutilization of health care services. Rather than simplypicking up the ambulatory surgery facility debris left in thewake of the Garcia decision and letting the industry re-builditself upon a new delineation of permissible referrals, the newCodey law all but fixes in place the number and types ofambulatory care facilities that will exist in New Jersey goingforward. In this respect, the new Codey law resonates moreof long-forgotten certificate of need and health planning pol-icy than it does of the original law’s concern with physicianprofit motives and overutilization. Perhaps, after the newCodey law is enacted and the dust settles, the health care facil-ity landscape in New Jersey will look more like it did in 1985than it did in 2005.

About the AuthorsJohn Zen Jackson, Esq. is a Principal and Director of Kalison,McBride, Jackson & Hetzel, P.C., a 16-attorney boutique healthcare law firm located in Warren, New Jersey, representing healthcare providers throughout New Jersey. He is also Certified by theSupreme Court of New Jersey as a Civil Trial Attorney.

Elizabeth G. Litten is a partner in Fox Rothschild LLP’s HealthLaw Practice, resident in the firm’s Princeton, New Jersey office.She has been a health law attorney for over 19 years, with a focuson New Jersey regulatory issues, and is a registered governmentalaffairs agent in New Jersey .

1These modifications were developed as a result of agency interpretations(including those contained in letters responding to particular physicianinquiries) and were premised on the idea that prevalent, non-abusive med-ical office arrangements and practices should not be disrupted.

2In general, all health care services, except those provided in a physician’sprivate practice, must be provided in health care facilities licensed by theNew Jersey Department of Health and Senior Services (“DHSS”). N.J.S.A.26:2H-1 et seq.

3DHSS regulations define “surgical practice” as “a structure or suite ofrooms which has the following characteristics: 1. No more than one roomdedicated for use as an operating room which is specifically equipped toperform surgery, designed and constructed to accommodate invasive diag-nostic and surgical procedures; 2. One or more postanesthesia care units ora dedicated recovery area where the patient may be closely monitored andobserved until discharged; and 3. Established by a physician or physicianprofessional association surgical practice solely for his/her/their privatemedical practice.”

4Comments by the authors on these developments were presented in TheWayne Surgical Center Decision: A Critique and An Update, 54 GARDENSTATE FOCUS 7 (January/February 2008).

5While ambulatory care facilities licensed to provide surgery as of the date ofenactment may continue to be owned by non-licensed entities or individu-als, only entities that are owned directly by New Jersey-licensed hospitals ormedical schools, or are owned directly by hospitals in combination withother parties or entities, will be granted a new license to operate. However,entities owned in whole or in part by non-licensed (non-hospital, non-physi-cian) parties that are not yet licensed to operate a facility, but that have filedplans, specifications, and required documents with the Department ofCommunity Affairs or the municipality where the facility will be located, asapplicable, will be permitted to continue to seek licensure and, oncelicensed, to operate as an ambulatory surgery facility.


24 Focus

At a meeting on February 5, 2009, the Division of MedicalAssistance and Health Services (DMAHS) and its consult-ants, Myles and Stauffer, presented an overview of the newproposed inpatient Medicaid DRG system hospital inpatientrate methodology. Also at this meeting, DMAHS issued thedraft of the proposed regulations for the new Medicaid fee-for-service reimbursement methodology for inpatient hospitalservices and an initial run of each hospital's inpatientMedicaid rates under this new methodology.

The current inpatient Medicaid rates in New Jersey havebeen in effect since 1993 (using 1988 as the base year) and

have been increased for inflation byan economic factor each year. The past twenty years have seenmajor changes in the health care industry, including advances intechnology and reduced lengths of stay, but also added coststhat are not fully covered under the current rates. This imple-mentation will mark the most important change since the rateswere adjusted for teaching back in October of 1996.

DMAHS, along with Myles and Staffer, have developed anew methodology to calculate Medicaid inpatient rates whichwill have a significant impact all New Jersey hospitals. Inaddition to the revised base year, the new rates include anupdated grouper, new relative weights, and outlier thresholds,as well as add-on payments for critical care service and low-income utilization.

It is anticipated that the regulations setting forth this newmethodology will be proposed for comments in or aroundApril 2009 with the scheduled implementation of these ratesto begin this coming August.

In order to prepare for the new rate system, it is recom-mended that each hospital review its individual data for accu-racy and compare the data to its existing payments. Unfor-tunately, at this time the detailed data used in calculating thenew inpatient rates are not available and will not be availableuntil the formal release of the proposed regulations. Oncethese data are released, it will be imperative for hospitals tolook at the statewide calculations and impacts to understandthe significance of this rebasing project and the appeal oppor-tunities based on the data used and the calculations under thenew methodology.

While DMAHS had requested that comments on thedraft of the proposed regulations be submitted to it byFebruary 20th, there still may be an opportunity to submitcomments prior to the publication of the proposed regula-tions in April.

About the AuthorScott Besler is the Business Development Director at BeslerConsulting, providers of financial and operational consultingservices to healthcare organizations.

by Scott Besler

Inpatient Medicaid RatesDiagnosis Related Groups(DRG) System ProposedChanges

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We are proud of our excellent reputation, and we invite you to checkwith any of our valued client references.

If you would like to know more about our services please visit ourwebsite at www.hcfs.org, or contact Larry Friia at 973-429-8530 x7116or at [email protected], or Jerry Castoria at x7191 or at [email protected] would welcome the opportunity to send you information on ourcompany or schedule a meeting at your convenience.

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Focus 25

"Never underestimate the other guy's greed." This isn't justa classic line from the 1983 Brian De Palma film, Scarface (writ-ten by Oliver Stone). It also reflects the attitude that has causedthe economic disaster we're now clawing ourselves out of.

Isn't it time for a new way of thinking?I propose the following leadership guidelines for healthcare

financial managers--and everyone else whose decisions canaffect the financial well being of other people.

1. WHAT'S GOOD FOR THE GANDER IS GOOD FORTHE GOOSE.

At a time when companies are slashing their labor forcesand freezing salary increases, and when some employees arebeing asked to take lower-paying positions, it is deeply uneth-ical for leaders to retain their sky-high compensation and toexpect enormous bonuses. They should follow the example ofMichael Kneeland, CEO of United Rentals, who recentlyasked for, and was given, a 20% pay cut. Let's hear morereports like this one.

2. KNOW YOUR PRODUCT.According to a recent three-part story in The Wall Street

Journal, the willingness of investors to buy and sell financialproducts whose complexity they didn't fully understand wasone of the primary catalysts of the bust. From our currentsober perspective, it seems unbelievable that self-identifiedexperts could be involved in transactions with so much atstake and at the same time be ignorant about exactly what itis they were buying or selling, but this is what happened, andon a grand scale, no less.

Because money was being made in these deals, no onethought to question what was going on or had the strength ofcharacter to speak up about any suspicions. However, know-ing your product isn't a nicety of doing business. It is an eth-ical obligation—to your company, your clients, and yourself.

3. WINNING (AT ALL COSTS) IS FOR LOSERS.Most of us were taught that we should treat people the way

we'd like to be treated ourselves. However, too many businessleaders have failed to take this seriously. Instead, the guidelineseems to be, "Get all you can by any means necessary." Lookat credit-card companies that charge exorbitant interest rates,changing customers' fees without telling them why. Thesecompanies defend such practices on the grounds that theywill lose their competitive edge if they don't play hardball.

This kind of leadership is shortsighted, unfair, and ultimate-ly bad for business, since the consequences will be more feder-al regulation and oversight. Good leaders know that if theydon't regulate their businesses themselves, someone else will.

4. TELL THE TRUTH.A leader has an ethical obligation to be honest with stake-

holders about issues that directly concern them. One of theseissues is the leader's own health. Consider the recent 10%drop in Apple stock after CEO Steve Jobs announced that hewas taking a five-month medical leave of absence. BecauseJobs battled pancreatic cancer several years ago, there wasspeculation that his cancer had returned, even though Jobshad announced earlier that he was merely suffering from a“hormone imbalance.” While stockholders may have pun-ished Jobs for his announcement, he did the right thing insaying he was taking a leave for medical reasons. There is noshame in being ill, and true leadership involves being forth-coming about one's illness—and anything else that can affectthe flourishing of the organization.

5. PREVENT HARM.When you can reasonably foresee that a decision is likely to

hurt people and you make that decision anyway, you're beingboth irresponsible and stupid. For example, subprime mortgagelenders and brokers who lend money to people likely to defaultare enriching themselves at the expense of the rest of us, sincethe federal government may be called upon for financial rescue.

What such predators don't realize is that in the long run,their practices will come back to haunt them in the form of

•Focus on Ethics•

by Bruce Weinstein, Ph.D., The Ethics Guy®

Ask the Ethics Guy®!Are You a Good Leader?You will be if you draw on key ethicalprinciples. Here's how to do it.

Bruce Weinstein



26 Focus

bankruptcy filings, bad PR, and perhaps even prison time forthe worst offenders. The good leader recognizes that prevent-ing harm to clients and company alike is both an ethicalresponsibility and a wise business policy.

6. DON'T EXPLOIT.It is easy to take advantage of a situation for financial gain,

but doing so isn't consistent with good leadership. AfterHurricane Ike hit last year, the wholesale price of gasolineshot up, which was nothing more than price gouging.

In the short run, companies that exploited a natural tragedymay have profited financially, but the long-term negative con-sequences are real and significant: In New York State, for exam-ple, more than a dozen companies were fined more than$60,000 for unfair business practices following HurricaneKatrina. Of course, the reason to do the right thing is simplybecause it is the right thing to do. But it is also true that tak-ing the low road can be harmful professionally and personally.

7. DON'T MAKE PROMISES YOU CAN'T KEEP.…..…and keep the promises you make. There are rare circum-

stances in which we not only have a right but an ethical obli-gation to break a promise, but generally speaking, we have astrong duty to be true to our word. This is, after all, one ofthe primary ways that we show our respect to people. Recallthat last March, Dr Pepper said it would give out free cans ofsoda to “everyone in America” if Chinese Democracy, the long-overdue album from Guns ‘n’ Roses, came out by the end ofthe year. When Axl Rose surprised the music world by releas-ing the album in November, the beverage company wasunable to deliver a soft drinks to everyone who wanted one(Whether it's ethical for a band that has only one of its orig-inal members to call itself “Guns ‘n’ Roses” is another matter.)Good leaders are careful to make only those promises they arelikely to keep and keep the promises they do make. Whenthey are unable to keep those promises, they own up to it,which brings us to the next rule of good leadership:

8. TAKE RESPONSIBILITY FOR YOUR MISTAKES.Transparency and accountability should be the new buzz-

words. This means, in part, that business leaders who makemistakes should apologize to those they have let down and dowhatever is necessary to make amends. In the wake of the toyindustry's lead-paint scare in 2007, Mattel CEO RobertEckert took the high road and told a Senate subcommitteethat the company failed “by not closely overseeing subcon-tractors in China whose toys didn't meet U.S. safety stan-dards,” and that Mattel was working with the Consumer Pro-duct Safety Commission to ensure that these products wouldbe safer. It must have been extraordinarily difficult for Eckertto apologize publicly, but by finding the courage to do so, hedemonstrated ethical leadership.

9. PEOPLE, NOT PROFITS.We often recite—incorrectly—President Calvin Coolidge's

statement, “The business of America is business.” (What heactually said was, “The chief business of the American peopleis business.”) But far more important is what followed thatstatement: “Of course the accumulation of wealth cannot bejustified as the chief end of existence.” Coolidge’s policies areoften blamed for bringing about the Great Depression, but ifenough people had heeded the latter statement, perhaps ourhistory would have been different. Money has no intrinsicvalue; it is good only for what it can get us. For the goodleader, this means that the ultimate goal in business—andlife—is not hoarding riches but making things better for all,especially the neediest.

10. BE KIND, NOT KING.The relentless quest to be No.1 can blind us to what's real-

ly valuable in life: being a decent human being. Yes, goodleaders are enthusiastically devoted to accomplishing theirmission, but this pursuit cannot be at the expense of the wellbeing of others. For example, leaders with the unenviable taskavoid taking the easy way out. No one likes being the bearerof bad news, but the good leader does so with the dignity thatleadership of the highest order demands.

BONUS RULE: YOU ARE NOT YOUR CAREER.It’s admirable to be passionate about your job, but passion

can easily become obsession, and that’s where the dangerstarts. When your life’s work becomes your life, it is time totake a step back and reevaluate your priorities. I’ve alreadyshown why you ought to take vacations and stay home whenyou’re sick. More critical than either of these is recognizingwhat's really important in life—and it’s not your career, nomatter how satisfying that may be. Good leaders not onlymake room for family, friends, and spirituality; they knowthese are the things that truly make life worth living.

It should be obvious by now that the above rules apply notjust to those in healthcare financial management but to every-one else, too. They are, after all, based on the five fundamen-tal principles of ethics: Do No Harm, Make Things Better,Respect Others, Be Fair, and Be Loving. As Peter Druckerpointed out, it is not enough to do things right; we must alsodo the right things. The good leader today is concerned notonly with getting from A to B, but with deciding whether Bis worth getting to in the first place.

About the AuthorDr. Bruce Weinstein is the public speaker and corporate consultantknown as The Ethics Guy®. He writes the ethics column forBusinessWeek.com, and his latest book is, “Is It Still Cheating If IDon’t Get Caught?” (Macmillan/Roaring Brook Press).

How ethical are you? Take his ethics quiz at TheEthicsGuy.com.



Focus 27

CHAIRMAN/EMAIL/ CO-CHAIR/EMAIL/ SCHEDULED MEETING LOCATION BOARDCOMMITTEE PHONE PHONE DATES/TIMES LIAISON

Jeff Noonan Maria Facciponti First Tuesday of the Month Mike AlwellCertification [email protected] [email protected] 9:00 AM Conference Calls [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] 9:00 AM Saul Ewing Offices [email protected]

609-893-1200 x5580 215-972-7124 Attendee Code: 7719071 in Princeton 201-444-9900

Jeff Weinstein Marcy Slchman Third Tuesday of each Month Mary CroninEvents & Networking [email protected] [email protected] 5:30 PM Woodbridge Hilton [email protected]

908-806-8222 732-536-9115 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

Tony Consoli Deborah Shapiro First Tuesday of each Month Brian SherinInstitute 2009 [email protected] [email protected] 9:00 AM Conference Calls [email protected]

973-401-5223 201-617-7100 Attendee Code: 3322355 609-514-1400

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

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.

28 Focus

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Focus 29

A.

Q.

The national rollout of the recovery audit contractor (RAC)program was temporarily put on hold this past November,while the Government Accountability Office (GAO)reviewed protests about the RAC contractor selection processfiled by two vendors, Viant, Inc. and PRG Schultz, USA, Inc.that were not awarded permanent contractor status. OnFebruary 4th, it was announced that the parties involved inthe appeal withdrew their appeals, thus lifting the stay on theRAC program.

I have been hearing a lot about the RAC program. Howwill it affect my New Jersey hospital? My facility isalready understaffed and under financial pressures. Do Ireally need to prepare for this?

Yes! My recommendation is… Don’t Be an Ostrich! That is,you cannot bury your head in the sand about the RAC pro-gram and think it will go away on its own. Members of yourhospital board and management team have a fiduciaryresponsibility to deal with this major Medicare billing take-back issue, and to ensure the financial viability of your facili-ty. Everyone, including those hospitals that have until August1 of this year or later, should prepare or continue on thecourse of RAC preparedness. That includes assessing deficien-cies, quantifying the take-back risk and establishing a trackingmechanism. Here are three recommended best practices tofollow:

1. Identify systemic coding and clinical documentationproblems within your organization.

By conducting your own internal audit of patient recorddocumentation and billing coding practices, you should havea good sense of the level of accuracy within your system. Ifthere is indeed a high level of inaccuracies or consistent mis-coding of documents, this is an issue that needs to be ad-dressed immediately! If you don’t, it will ultimately lead toregular RAC take-backs year after year, if the RAC programdoes not end in 2009! Moreover, you will have a huge com-pliance issue to address and control. Education is the keycomponent here, and it is incumbent on the hospital to puttogether a permanent multi-disciplinary RAC committee todeal with the RAC issues on an ongoing basis.

With limited resources already fighting the daily fight of

documenting good quality careand getting paid appropriately forit, outsourcing your internal auditfunction is an option many facili-ties are exploring. With the cur-rent high demand for accountantsand internal auditors, it can bemore efficient and cost effectiveto draw upon resources from out-side the facility. The hospital can,in effect, “borrow” high cost andscarce resources that would nototherwise be available. Even if youhave a strong in-house internalaudit department, hiring an outside internal auditor to pro-vide an objective opinion, as well as lend additional experi-ence, can prove to be extremely beneficial in these circum-stances.

2. Clearly state your financial position.In addition to assessing coding accuracy levels, your inter-

nal audit should also identify the risk level of potential take-backs your facility may endure. It is important to understandthat you need to project your cash flow based on the poten-tial RAC take-back, as not doing so could affect your finan-cial position, including meeting your bond covenants. Forexample, lending institutions and bonding authorities arewell aware of the potential RAC take-back issue and will wantto know what actions the hospital has taken to ensure theaccuracy of their cash flow position and remain compliantwith existing covenants.

3. Implement the right software to assist in the cleanclient documentation.

There are many established companies and consultantswho offer software solutions that can manage your clinicaldocumentation for Medicare compliance, your coding accu-racy, as well as financial assessments, potential RAC exposure,and RAC response and appeals management. Having thesetools in place can greatly enhance your staff ’s ability to bemore responsive when it comes to preparation and fightingthe inevitable fights that will come along with the RAC pro-gram.

Leo Paul D’Orazio

Answers to your Accounting and Tax Questions

Don’t Be a RAC Ostrich

•Focus on Finance•


30 Focus

FOCUS: CFO backgrounds are diverse, please tell us aboutyours. How did you get started? What is your education andprofessional background?

KAREN: I graduated from Babson College with a Bachelorof Science degree, then started right in as a staff auditor withTouche Ross in Newark, New Jersey. I specialized early on inHealth Care, becoming a certified public accountant andmoving up through the ranks, and focused on auditing andconsulting services for New Jersey hospitals. Mergers in theaccounting firms resulted in my working for Deloitte &Touche, then later I moved on to Coopers & Lybrand, thenPricewaterhouseCoopers.

Afterwards, I joined Atlantic Health as a director in financefor Special Projects, which included my involvement with thesale of the then Passaic General and numerous bond financ-ings. Then I received further responsibilities as director offinance for Overlook Hospital.

FOCUS: Did you ever think, all those years ago, that youwould be here, doing this today?

KAREN: Actually yes, I just was not sure which hospital Iwould serve or the exact role I’d play.

FOCUS: What new skills do you think are needed for risingCFOs?

KAREN: You definitely need people skills and the ability tolisten and stay focused on what really matters. You have to fil-ter out a lot of noise and the “flavor of the month ideas” tofocus on those issues that are critical to your organization’sfinancial viability and long term survival.

You also need to challenge and develop the managers andstaff of your organization. You need to develop your organiza-tion’s future leaders, and delegate responsibility effectively.Lastly, in order to address the very complex issues facing hos-pitals today, you need to reach outside of finance to the clini-cal areas and make sure they have the financial informationnecessary to effectively manage and understand the conse-quence of their decisions.

FOCUS: What are your hospital’s specifics – are youa single facility or part of a system? Do you have a religious

affiliation? Please describeyour location, demograph-ics and the services offered atyour hospital.

KAREN: Trinitas RegionalMedical Center is the soleprovider of acute care services in the City of Elizabeth andEastern Union County. We are a Catholic teaching institutionsponsored by the Sisters of Charity of Saint Elizabeth in part-nership with Elizabethtown Healthcare Foundation.

Trinitas was established in January 2000 following the con-solidation of Elizabeth General Medical Center and St.Elizabeth Hospital. Previously, Elizabeth General had acquiredthe Alexian Brothers Hospital, so Trinitas today is really a com-bination of the three hospitals that served Elizabeth for over acentury. Our Centers of Excellence represent the strengths thatwere developed by those hospitals and furthered by Trinitas.These Centers include Cardiology, Cancer, Maternal/ChildHealth, Behavioral Health, Renal, Wound Care, Sleep Dis-orders, Women’s and Senior Services. The Trinitas School ofNursing is a cooperative program with Union County College,and with over 2,000 students it is one of the largest in theUnited States.

We operate two campuses, Williamson Street (the former St.Elizabeth Hospital) and New Point (the former AlexianBrothers Hospital). Trinitas has 319 acute care beds, 142 long-term care beds, consisting of (adult and child) and 70 acute careopen, closed and child adolescent psychiatric beds and 15 resi-dential treatment beds.

Recently, we changed our name from Trinitas Hospital toTrinitas Regional Medical Center to more clearly reflect thebreadth of our many services.

FOCUS: Can you tell us about your hospital's: a) turnaround,b) new building, c) new infrastructure, d) new proceduresoffered, etc?

KAREN: In December we purchased a daVinci robotic sur-gical system and we have already performed over a dozen OBand prostate procedures. Also, we recently acquired RapidArcradiotherapy technology which provides radiation treatmentsin as little as 90 seconds. With the closure of nearbyMuhlenberg Regional Medical Center, we signed an agree-

CFO Member Spotlight:Karen Lumpp, Trinitas RegionalMedical Center


Karen Lumpp


Focus 31

ment with the Plainfield Neighborhood Health Center tobecome the medical home for maternity services, resulting inan expected 800 additional births.

FOCUS: What types of financing are utilized to meet thehospital’s goals?

KAREN: Due to the consolidation of three facilities we havea heavy debt burden with legacy debt. Our debt is a combi-nation of variable-letter of credit backed, fixed, tax exemptand taxable debt, including bank debts, capitalized leases andbonds. We have taxable bonds that will convert to tax exemptin 2010, which will reduce our future interest expense. As aresult of current market conditions we do not have any newfinancings on the drawing board.

FOCUS: What are your spare time activities?

KAREN: I love bird watching and gardening, and I mustadmit I am very passionate about environmental issues. I also

enjoy and have had the opportunity to travel around theworld to some very off-the-beaten-path locations, such asMadagascar, Ethiopia, Tibet, Papa New Guinea, BotswanaNamibia and many more. Lastly, I enjoy reading, but neverhave enough time to read all the books I buy.

FOCUS: What are your professional memberships?

KAREN: I’m a member of the New Jersey State Society ofCPA’s, American Institute of Certified Public Accountants,and, of course, HFMA.

FOCUS: You are just told you have 30 minutes to pack - youare going to a sparsely populated island. What would youbring, besides food, clothes, hygiene products, etc?

KAREN: I would bring my hammock, binoculars, gardentools and about hundred books that I’ve been meaning toread.

So, don’t be an ostrich! Being aware and proactive withregard to the RAC program will put you in a much strongerposition, so when the RAC audit contractors descend uponyour facility with first wave of RAC Demand Letters, surpris-es are minimized.

About the AuthorLeo Paul D’Orazio, MBA, FACHE, is Director of HealthcareServices Group, based in the New Brunswick, NJ, office ofWithumSmith+Brown, Certified Public Accountants and Con-sultants. He has directed many consulting engagements for hos-pitals and physicians, home healthcare, mental health andaddictive disease and outpatient treatment facilities, and is aFellow in the American College of Healthcare Executives. Leocan be reached at [email protected].

Focus on Financecontinued from page 28

mark your calendar . . .May 1, 2009 8:30-3:00pm4th Annual ScientificSymposium: Healthcare DeliveryReform Issues, Challenges andTactics for SuccessSeton Hall University

May 7, 2009 all dayAnnual Golf OutingFiddler’s Elbow CC

June 11, 2009 all dayQuarterly MeetingWoodbridge Hilton


32 Focus

FOCUS: Please provide us with a short bio on yourself.

TONY: I am a Senior Vice President with Marsh and a mem-ber of the firm’s National Healthcare Executive Committee. Istarted my career as an insurance broker and risk managementconsultant in 1986 with Johnson & Higgins in New YorkCity. My interest and involvement in the healthcare industrybegan right away as one of my first assignments was with theformer Beekman Downtown Hospital. Over the years, I haveworked for other brokers, including a previous engagementwith Marsh, and have served hospitals and other clients rang-ing from physicians to academic medical centers, pharmaceu-tical manufacturers and medical device companies. I was alsovery fortunate to have worked on the hospital side withSolaris Health System for seven years in a variety of rolesincluding risk, insurance and operations management. Work-ing with the excellent team there was an enormous influenceon me, both personally and professionally, and truly sealedmy commitment to the healthcare sector.

I graduated from the University of Notre Dame with a BBAwith Concentration in Finance.

FOCUS: Please talk about your employer and your dutiesthere.

TONY: Marsh is the world’s leading insurance brokerage andrisk management advisory firm and is a unit of Marsh &McLennan Companies (MMC), a global professional servicesfirm with more than 55,000 employees and annual revenueexceeding $11 billion. Marsh specializes in various industry ver-ticals including Healthcare, Life Sciences, Financial Institutionsand Real Estate, to name a few. Industry specialization enablesus to provide appropriate advisory services and resources toclients of all sizes. MMC also is the parent company of GuyCarpenter, the risk and reinsurance specialist; Mercer, theprovider of HR and related financial advice and services; OliverWyman, the management consultancy; and Kroll, the risk con-sulting firm.

I returned to Marsh in 2003 as a Client Executive in thefirm’s Healthcare Industry Practice. In that role, my main objec-tives are to provide insurance and risk advisory services to myclients and to lead the development of new client relationshipsfor the firm’s Healthcare Industry Practice in the Northeast.

FOCUS: Please name a few ofthe special challenges you face inyour position.

TONY: I am very fortunate inthat I really enjoy my work. I geta great deal of satisfaction fromhelping my clients address currentand emerging risk and from supporting my colleagues inthose same efforts for their clients. Clearly, we are in a verychallenging economic and regulatory climate. However, I’m a“glass half full” guy. These challenges enhance the need forsound risk management advice and put further emphasis oncreative problem solving and the ability to deliver results formy clients and colleagues. Accomplishing that in these diffi-cult circumstances is very gratifying.

FOCUS: What advice can you give other professionals thatare interested in entering your line of work?

TONY: Master the material. You must know the technicalaspects of the job in order to deliver excellent results to yourclients. It is the best investment in career and value to clientsyou can make.

Work hard to learn the business. Consulting of any kind,in any industry, requires not only technical expertise but alsoan in depth knowledge of the industries you serve. A profes-sional can not help guide a client if he/she does not trulyunderstand the operating environment and its challenges.Join associations like the HFMA and get involved.

Never forget that the client comes first. Period.

FOCUS: What are your hobbies and outside interests?

TONY: I’m a sports nut. I went to Notre Dame and amtherefore a crazy ND football fan. Luckily, my wife and twindaughters are also into sports. I coach fencing and lacrosseand spend many weekends with my family at their games,gymnastics meets, etc. We all love to ski and play golf. I amalso an avid reader and recently have been into American his-tory.

FOCUS: Thank you for taking the time out of your busyschedule to be interviewed for this edition of MemberSpotlight.

TONY: Thanks for the opportunity. Don’t forget the NJHFMA Institute is October 14-16!

Member Spotlight:Tony Consoli

Tony Consoli


Focus 33

Newly Certified!Kevin Chmura, CHFPTracy Davison-Dicanto, CHFPChristine Hajsok, CHFPVicki Ozmore, CHFPDan Williams, CHFP

Congratulations from the Certification Committee!

There’s still time to get into the raffle:Have you thought of becoming certified? Now is a great

time to do it. The NJ HFMA Board has agreed to fund araffle this year with $50 per person that achieves the CHFPor FHFMA designation (up to a maximum of $500). If youachieve your certification between June 1, 2008 and May 31,2009, you will automatically be entered into the June 2009drawing and could be the lucky winner of up to $500.00.

So what does it take to become a Certified HealthcareFinancial Professional?

• Membership - Be a current regular or advanced memberof HFMA for at least two years

• Exams - You must successfully complete the Core examand one specialty exam (Accounting and Finance,Patient Financial Services, Financial Management ofPhysician Practices, or Managed Care) within a 24-month period

• Education - Complete a minimum of 60 semester hoursat an accredited college or alternatively, you may com-plete 60 hours of relevant professional development

• Professional Experience - Two years of experience inhealthcare financial management

• References - HFMA Chapter President or other chapterofficer and your CEO or immediate supervisor

• CHFP Certification Application/Affidavit - Your signatureand the seal of a notary public are required

Test your Knowledge:When any form of health care is provided to a member in

exchange for a scheduled payment in advance of service ren-dered, this is known as:

A. Pre-admission careB. Capitated careC. Managed careD. Up-front care

For the answer and more information about the HFMAcertification program go to: www.hfmanj.org/Certification orcontact one of the members below.

NJ Chapter Certification Contacts:Jeff Noonan, CHFP – Committee ChairWork Phone: 201-786-6000 x 6015Email: [email protected]

Maria Facciponti, FHFMA – Committee Co-ChairWork Phone: (973) 614-9100Email: [email protected]

Michael Alwell, FHFMAWork Phone: (973) 656-6949Email: [email protected]

•Certification Corner•


Focus 35

Red Bank, NJ – WithumSmith+Brown, PC (WS+B),Certified Public Accountants and Consultants, is pleasedto announce that Jeffrey G. Blumengold, FHFMA, CPA,has joined the firm as a Partner based in the Red Bank office.Mr. Blumengold will assist in leading WS+B’s HealthcareServices Group.

Jeff has over 30 years of accounting and consulting experi-ence in the healthcare industry. He is a CPA in New Jerseyand New York and a Fellow in the Healthcare FinancialManagement Association (FHFMA). Jeff specializes inhealthcare financial, regulatory, reimbursement and opera-tional activities. His experience includes managing a diverseclient base consisting of health systems, hospitals, nursinghomes, home healthcare agencies, assisted living facilities,continuing care retirement communities, physician grouppractices and managed care organizations.

Prior to joining WS+B, Mr. Blumengold was a partner inthe Forensic & Dispute Services (F&DS) practice of DeloitteFinancial Advisory Services, where he led the Health CareF&DS Group in the Northeast. Before joining Deloitte, hewas the founder and leader of a Health Care Services Auditand Consulting practice for another regional accounting firm.

Jeff earned his MBA in Public Accounting from theBernard M. Baruch College, City University of New York,NYC, where he also received his BBA degree in the Teachingof Accounting and Business Practice. He is currently on theBoard of Directors of the Metro-New York Chapter of theHealthcare Financial Management Association (HFMA). He

has been the recipient ofthe Muncie, Reeves andFollmer Founders awardsfrom HFMA. In addition,Jeff previously served on theNational HFMA Principles& Practices Board and earli-er in his career, was anAdjunct Professor for boththe City University of NewYork and the New YorkInstitute of Technology,where he taught undergrad-uate accounting in the eve-nings.

Jeff has frequently presented to numerous local, regionaland national healthcare organizations throughout his career,and was recently featured on a nationally distributed health-care industry focused DVD covering the topic of healthcarecompliance and fraud.

At WS+B, Jeff will help to lead and coordinate theHealthcare Services Group offerings relating to the tri-statehealthcare marketplace. In addition, he will be involved inconsulting, regulatory compliance and litigation relatedengagements, providing services to health care providers,insurance companies and law firms. Jeff can be reached [email protected].

Jeffrey G. Blumengold, FHFMA, CPAJoins WithumSmith+Brown, PC

•Focus on Members•

Jeffrey G. Blumengold


36 Focus

New Members

John PattersonMercer Associate(973) [email protected]

Jay GoldDaughters of Israel, Inc.Chief Finance Officer(973) [email protected]

Dorothy GrassiAtlanticare Regional Medical CenterCustomer Srv/Support Manager(609) [email protected]

Al GutierrezShore Memorial HospitalPresident / CEO(609) [email protected]

Kathie OerfradiAtlantic Health System IncFinance Manager(908) [email protected]

Anthony GaliotoSaint Barnabas Health Care SystemSenior Accountant(732) [email protected]

Lilia PizarroBudget Director(973) [email protected]

Andrew MaroldaThe Beekman GroupManaging Director(646) [email protected]

Surendra KumarRohna, LLCFinancial Analyst(856) [email protected]

Pamela ThomasSaint Clares Health SystemDirector, Health Information(973) [email protected]

Bret BisseyIMA ConsultingDirector, Regulatory Compliance(484) [email protected]

Brenda ClemonsBesler ConsultingSenior Consultant(732) [email protected]

Patricia GoebelBesler ConsultingMedical Billing Consultant(732) [email protected]

Maria Lopes-TyburczySmmc, Inc.Director Of Patient Access(973) [email protected]

Brendan KeatingKPMG LLCManaging Member(973) [email protected]

Giulia SavianoElectronic Medical Record Consultant(201) [email protected]

Kenneth ChangSibson ConsultingVice President & Consulting Actuary(860) [email protected]

Kathy KellyMedassets, Inc.Client Service Associate(201) [email protected]

Won/Lost Record Price

C.C. Sabathia .616 $181 million A.J. Burnett .534 $82.5 million Batting Avg

Mark Teixeira .290 $180 million

Health/ROI vsthe ALJ RAC Cases

over 90% Priceless

George Steinbrenner,Brian Cashman…Stop wasting your money.

George/Brian,You need to reach us at the following:

Ellen Scott, RN, Clinical Director

(516) 616-0200 Ext. 209

Robert Jacobs, President

(516) 616-0200 Ext. 201

The Yankees should be contracting with

Regarding the RAC

George Steinbrennerrge SteinbrennerSteinbrennerbrennererBrian Cashman…

George Steinbrennerrian Cashman…rge Steinbrenner

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38 Focus

Meet A New Member

Who is your employer,and what is yourposition?

What was your first jobas a teen?

What do you like bestabout your workresponsibilities?

A job I would enjoydoing without pay is...

My favorite place is...

I will not eat...

If I’m not at work, youwill find me...

Adam Bavifard

I am an Associate Banker at M&T Bank, located in Saddle Brook, NJ. Our team cov-ers the New Jersey market through Middle Market and Commercial Real Estate,and of course we specialize in Healthcare Lending.

My father was an entrepreneur. He was a General Contrator and built customhomes. I worked as a site supervisor.

It gives me an opportunity to meet the needs of clients while also learning abouttheir businesses. While developing a relationship, it’s great to hear what keepsthem up at night, and how we might be able to come up with a viable solution.

Somehow helping children. Pretty vague, I know, but helping kids is one of themost rewarding activites.

The outdoors.

Brussel Spouts.

At the gym or spending time with family and friends. I also am working with theUnited Way of Bergen County to start a young leaders group.

As a service to our members during the cur-rent economic difficulties, the NJ HFMAChapter will be offering a Resume Bank.Resumes will be posted on our web site, free ofcharge, for our members currently seekingemployment. Resumes should be submitted toLaura Hess at [email protected], and will beposted within 5 days of receipt.

Resumes should be submitted with a job category indicated,and will be posted accordingly. Job categories are as follows:

Accounting/Finance Managed CareAdministration Patient Financial ServicesReimbursement Patient Access Services

Since resumes normally contain personalinformation, it will be up to the applicant as tohow much personal data to include on theirresume. A suggestion would be to post by firstname, do not include address, and give anemail address or phone number for potentialemployers to contact you.

Resumes will remain posted for one month or until themember contacts Laura Hess at [email protected] to removethe posting.

A “go live” date for this service will be announced in thePulse. Stay tuned!

NNeeww MMeemmbbeerr SSeerrvviiccee CCoommiinngg SSoooonn::RReessuummee BBaannkk!!

New Member Service Coming Soon: Resume Bank! As a service to our members during the current economic difficulties, the NJ HFMA Chapter will be offering a Resume Bank. Resumes will be posted on our web site, free of charge, for our members currently seeking employment. Resumes should be submitted to Laura Hess at [email protected], and will be posted within 5 days of receipt. Resumes should be submitted with a job category indicated, and will be posted accordingly. Job categories are as follows: Accounting/Finance Administration Reimbursement Managed Care Patient Financial Services Patient Access Services Since resumes normally contain personal information, it will be up to the applicant as to how much personal data to include on their resume. A suggestion would be to post by first name, do not include address, and give an email address or phone number for potential employers to contact you. Resumes will remain posted for one month or until the member contacts Laura Hess at [email protected] to remove the posting. A “go live” date for this service will be announced in the Pulse. Stay tuned!


Focus 39

BUSINESS MANAGER OF MEDICAL & SURGICAL UNITS

Jersey City Medical Center

REIMBURSEMENT ANALYSTFletcher Allen Health Care

DIRECTOR OF FINANCEElizabeth Seton Pediatric Center

SENIOR INTERNAL AUDITORElizabeth Seton Pediatric Center

VICE PRESIDENT FOR AUDIT & COMPLIANCENew York University Langone Medical Center

NETWORK CONTRACTING ASSOCIATE DIRECTORUnitedHealthcare

CORPORATE DIRECTOR, MID-REVENUE CYCLEMANAGEMENT

A large multi-hospital health system based in thePhiladelphia area

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•

The fee for a Job Box listing is $200.00 per position fora one-time placement in the Garden State FOCUS maga-zine and a two-month posting on the HFMA-NJ website.Only one position per ad please.

The Job Box listing will be put on the HFMA-NJ websitewithin 5 days of receipt, and will be put in the nextscheduled issue of FOCUS magazine. The magazine liststhe job title and the hiring organization, and refers readersback to the web site for more the complete listing.

The deadline for ad placement in FOCUS is typically the15th day of the month prior to the issue date of GardenState FOCUS, which is published six times per year(January, March, May, July, September and November).

The ad must contain the following information: 1. Hospital/organization name. 2. Position (e.g., financial analyst, controller). 3. Department or position to whom position will

report (e.g., Chief Financial Officer). 4. Brief job description. 5. Educational/professional experience required

(e.g., Bachelors Degree with a minimum three years experience in hospital finance or account-ing).

6. Contact person at hospital/organization with name, address, telephone, fax and e-mail.

To post your ad in our job bank, please visithttp://www.hfmanj.org/Job-Bank-form.page.

Guidelines for placing a Job Bank advertisement in theGarden State FOCUS magazine and HFMA-NJ Website


40 Focus

NJHFMA Hosts Its First Webinar to Rave Reviews

by Tracy Davison-DiCanto, CHFP, MBA

In the current economy and as more hospitals and com -panies may close their doors throughout 2009, the NewJersey Chapter Board of Directors and Education Committeehave taken the initiative to explore new avenues for meetingour mission of providing members with opportunities forprofessional growth through sound educational programs.Out of this exploration came the concept of running web inarson a variety of topics. Webinars provide a great means of costand time savings – no mileage and tolls from commuting tothe meeting location, no time spent for the commute, and theability to run the session at a significantly discounted ratesince many of the normal meeting expenses go into hostingan educational session (space, food, A/V equipment). In con-junction with HFMA National’s webinar technology, theNew Jersey Chapter hosted its very first webinar on February12, 2009.

In order to be as cost effective as possible, the session wasoffered at a special site rate of $75.00. Offering a site rateallowed many providers and companies the opportunity tooffer the education session to many employees rather thanjust a select few, all for one low price. The ninety minutes ses-sion, entitled “Using Operational Benchmarking to ImprovePerformance,” was presented by Kevin Sheeran, NationalDirector of Operational Improvement for Thomson Reuters.It offered participants a context for the adoption of externalcomparisons in today’s healthcare management process.During the session the objectives, common pitfalls and theeffective use of operational comparative data (benchmarking)were discussed. The webinar was well received by the 45attendees who participated. The session was rated a 4.35 outof 5, and comments from participants when asked the ques-tion of what did they enjoy about the presentation rangedfrom: presentation was clear and concise, convenience of thesession, ease of the desktop connection and the ability to ask

questions and participate inpolling questions, great sub-ject overview, and useful sta-tistical slides.

Given the success of the firstwebinar session, we will behosting a second webinar pre-sented by Besler Con sulting onApril 21, 2009 from 10am-12pm entitled Util ization Re -view: Hos pi tal’s First Line ofDefense in Preventing In ap propriate and Un nec es sary Ad mis -sions. Giv en the upcoming RAC audits, this will be a timelyand informative session that will benefit Case Man age mentUtil i zation Reviewers, Physician Ad visors, Clinical Doc u men -tation Improvement Specialists, Chief Financial Officers, Man -aged Care Exec u tives, Com pli ance, Risk and Quality Man agersas well as Finance, Patient Accounting, Health In for ma tionMan agement and Reimbursement Staffs. This session will lookto explore the high-risk target areas for medical short stay andsurgical admissions. Also, there will be instruction on how todetermine the appropriate level of care based on the severity ofillness, to meet the medical necessity requirement under theConditions of Participation for Hospitals. In addition to iden-tifying and reviewing cases studies for the appropriate setting,participants will review the importance of ensuring complianceand minimizing the organizations risk. We look forward to hav-ing you attend. Registration information can be found on theChapter’s website at www.hfmanj.org.

If you have any questions about the upcoming webinar,other educational opportunities, or how to join the Chapter’sEducation Committee, please reach out to Tracy Davison-DiCanto at [email protected].

Tracy Davison-DiCanto


Focus 41

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42 Focus

A Photo Recap of the NJ HFMA /NJAAHAM Annual Joint MeetingTuesday, January 13, 2009At The Woodbridge Hilton

• Healthcare Reform in the New Administration

Speaker: Paul A. Miller, PLC, Miller/WenholdCapitol Strategies, LLC

• Electronic Standardization - Where AreWe, Where Will We Be?

Are facilities and payors using the transaction setsto their full advantage?Speaker: Jim Whicker, CPAM, Director ofElectronic Commerce/EDI, Accounts ReceivableManagement - Intermountain Healthcare, Utah;Chair, WEDI

• Can Your Patient’s Trust You? Are YouProtecting Their Data?

Discussion will focus on Security and Privacy risksimpacting healthcare including recent incidents inHealthcare Risk Management across the data lifecycle and other regulatory issues. Specific topicsthat will be covered are Red Flag Alert and IdentityTheft.Speakers: K.H.Maman, Director, Technology Risk,Deloitte & TouchePeter Kolchmeyer, Senior Manager, Deloitte &Touche

NEW TECHNOLOGIES – NEW SOLUTIONSARE YOU PREPARED?

Photos by Steve Aaron, ARC Group Associates

209 people attended this very successful program which was arranged by the NJ HFMA Patient Financial ServicesCommittee, the NJ HFMA Patient Access Committee, and the NJ AAHAM Chapter.

The agenda included:

K.H. Maman

Paul Miller

Peter Kolchmeyer

Brian Sherin, FHFMA


Focus 43

• “Getting and Keeping Cash”, Prospering in the Settingof MS DRGS and Recovery Audit Contractors.

Speaker: Jim Hull, Hull Resource Management Group

• Revenue Cycle Staff Recruitment and RetentionSpeaker: Kevin Brophy, FHFMA, Director, PFS, CBIZ KA

• Revenue Cycle Processes - New Technologies -Scheduling, POS Collections, Quality Assurance, Self Service Kiosk

Panel Discussion with Providers including representativesfrom Atlantic Health, Meridian Health, Palisades MedicalCenter and Princeton HealthCare System

• Best Practices for the “Department of Collections”How are you managing your Revenue Cycle? How to maxi-mize your claim scrubber and other process improvementshospitals have implemented.

Panel Discussion with Providers including representativesfrom Atlantic Health, Hackensack University MedicalCenter and The Valley Hospital

• Certification NJAAHAM and HFMA General Information Session

Speakers: Certification Chair from the respectiveAssociation

Jim Hull

Josette Melillo, Valley Hospital and Laura Weaver, HackensackUniversity Medical Center

Kevin Brophy, FHFMA Michael Alwell, FHFMA


2009 Annual InstituteOctober 14-16, 2009

The Borgata Hotel, Casino & SpaAtlantic City, NJ

John J. Nance, JD has been a dynamicand deeply dedicated member of the med-ical community for nearly two decades. Aworld-class speaker, consultant and best sell-ing author, John brings a rich diversity ofprofessional training and background to thequest of patient safety and medical practiceimprovement. His new book, Why Hos pi -tals Should Fly: The Ultimate Flight Planto Patient Safety and Quality Care(Second River Healthcare Press 2008), is reinventing the cultural founda-tions of

healthcare and bringing clarity to the decade-long patient safety andquality care debate. The book was awarded the American College ofHealthcare Executive’s 2009 Book of the Year Award.

One of the founding members of the National Patient SafetyFoundation, John was a member of the Executive Committee andserved on the Foundation’s board for 9 years. He is a native Texan fromDallas who earned his Bachelor’s Degree from SMU (SouthernMethodist University) and his Juris Doctor Degree from SMU Schoolof Law before admission to the Texas bar. Installed as a DistinguishedAlumni of Southern Methodist University in 2002, he is also a deco-rated Air Force officer-pilot veteran of Vietnam and Operations DesertStorm/Desert Shield—a Lt. Colonel in the USAF Reserve well knownfor his pioneering involvement in Air Force human factors flight safe-ty education. As a professional pilot, John has piloted a wide variety ofjet aircraft, including most of Boeing’s line, as well as the Air Force C-141, and has logged over 13,000 hours of flight time in his commer-cial airline (Braniff and Alaska) and Air Force careers.

John J. Nance

Steve Adubato

Steve Adubato, Ph.D., enjoys a distin-guished career as a broadcaster, author,university professor and motivationalspeaker. A trainer and coach in the areasof communication and leadership skills,Steve also served in the mid 1980’s asNew Jersey’s youngest state legislator atthe age of 26.

Steve currently anchors two ChannelThir teen/WNET (PBS) broadcasts —Caucus: New Jersey, an Emmy Award-winning public affairs television series,

also broadcast on NJN-Public Television; and Inside Trenton, anews program covering New Jersey political issues on a weeklybasis. He is also the executive producer and host of One-on-Onewith Steve Adubato, an in-depth interview program broadcast fromMaine to Virginia, including Washington D.C., on CN8-theComcast Network and Cablevision.

Steve has been the recipient of four prestigious Emmy Awardsfor his work on public television. In 1995, 2000 and again in 2001,the Mid-Atlantic Chapter of the National Academy of TelevisionArts and Sciences presented Steve with Emmy Awards in the cate-gory of “Best Host.”

In addition to his work on public television, Steve is a mediaexpert and columnist for MSNBC.com, who has appeared on theTODAY Show, MSNBC, CNBC, CBS/2 and the FOX NewsChannel as a media and communication analyst. Steve currentlyprovides political commentary on 77-WABC, the #1 talk radio sta-tion in the country, as well as WOR-710 AM and has hosted onboth networks. Most recently, Steve contributes on a regular basisto CBS 2 “Sunday Morning” and provides political commentary to“Steve Adubato...on Politics” on the CBS 2 Web site.

A much sought-after motivational speaker through his companyStand & Deliver, Steve has conducted communication and leader-ship workshops for a variety of clients in the corporate and non-profit sectors including Wachovia, Prudential, UBS PaineWebber,J.H. Cohn, Merrill Lynch, NASA, Horizon BC/BS and Johnson &Johnson. (A complete list of clients is available upon request).Stand & Deliver is a dynamic, hands-on professional developmentand executive coaching program, which Steve created to helptoday’s professionals reach their potential as leaders.

Most recently, New Jersey Monthly magazine named Steve one ofthe top five most powerful media figures in the state. In the past,

Thursday MorningKeynote Speaker: Steve Adubato

New Jersey Monthly selected Steve as one of the “50 Most InterestingPeople” in the state as well as one of the “25 Most Influential Peoplein the State.”

Steve also writes a weekly column focusing on communicationand leadership for The Star-Ledger. He is a syndicated columnist whocontributes to New Jersey Monthly, the Atlantic City Press, NJBIZ,Commerce Magazine and www.politicsnj.com, and the author ofthree books, Speak from the Heart: Be Yourself and Get Results (Simon& Schuster), and Make the Connection: Improve Your Com mu ni cat -ion at Work and at Home (Rutgers University Press). His third booktitled “What Were They Thinking?” examines highly-publicized andoften controversial public relations and media mishaps.

Thursday At NoonKeynote Speaker: John J. NanceAlso book signing at noon

44 Focus


Focus 45

James Lloyd is President and foun der of 9Screens In ter na tional, Inc.; an established LosAn geles-based con sult ing company. JamesLloyd has over 25 years experience and isnationally and in ter nationally recognizedspeaker in the areas of customer service, lead-ership, motivation, team-building and pas-sion for healthcare associations, hospitals,insurance companies and physician groups.

He has held an executive position at anational healthcare insurance company, been a director at a major training compa-

ny and served as a missionary worldwide. Mr. Lloyd is a noted lec-turer and author on topics related to strategies for change manage-ment, achieving work/life balance, team-building, and customerservice seminars. He regularly speaks on these topics and others fornumerous organizations and associations.

Mr. Lloyd has authored two books, I’m on fire, watch me burn, andTorch Tips for a Luminous Life. James has also been a guest speaker onnational radio and has dozens of recordings available via CD orDVD.

James has developed many CE credit courses as well as the follow-ing courses: Dazzling Patients, The Apology Principle, Ignite theSpark, Yield to New Ideas and Passion for Life, to name just a few.In addition, James has presented custom speeches at numerousmajor conferences as keynote speaker, such as the National Con ven -tion for Health Underwriters, The WellPoint Expo and the TheAntonius Hospital and the Mesos Medical Centre in Amsterdam.

Among the clients benefiting from Mr. Lloyd's services areproviders, hospitals, nursing and physician groups as well as not-for-profit multihospital systems; long-term care facilities; veteran’shospitals; insurance companies, and state and national healthcareassociations.

James Lloyd

Friday MorningKeynote Speaker: James Lloyd

ReservationsRoom reservations at the Borgata Hotel, Casino & Spa will becomeavailable at a later date. Room rate for single/double occupancy is$174 plus applicable taxes.

More important to his leading-edge role in healthcare, JohnNance was one of the pioneers of the pivotal safety revolution in pro-fessional communication, teamwork, and leadership known in avia-tion as CRM (crew resource management). His book about safety inhuman systems entitled BLIND TRUST, published internationally in1986, is widely credited with helping to spark not only the universalacceptance of CRM principles in aviation, but the earliest infusion ofculture-changing lessons derived from aviation into medical practice.BLIND TRUST was pivotal in illuminating serious public issues inaviation safety for the American public, and WHY HOSPITALSSHOULD FLY follows in that tradition as a major wakeup call.

John has become a trusted and internationally recognized broad-cast analyst and advocate for both medical/patient safety and aviationsafety. Before joining ABC World News and Good Morning Americain 1994, he had logged countless appearances on national shows suchas Oprah, the PBS News Hour, Today, CNN, as well as mostCanadian and English-speaking networks worldwide. In addition, hiseditorials have been published in newspapers nationwide, inclusive ofthe Los Angeles Times and USA Today, and he has been listed for morethan a decade in Who’s Who in America.

John J. Nance is also the internationally-known author of 18major books, (five non-fiction, 13 fiction), his latest being Orbit(Simon and Schuster) which released to rave reviews in March of2006 and is in development by Fox 2000 studios as a major motionpicture. Two other of his books, Pandora’s Clock and Medusa’s Child,were both made into major, successful two-part mini-series for NBCand ABC respectively, and still air periodically around the world.

Already one of the nation’s most dynamic and energizing profes-sional speakers, John J. Nance’s messages to medical practitionershave reached new heights of relevance and importance as seen in hispresentations to such pace-setting entities as the Institute for Health -care Im prove ment and a who’s who of healthcare or gan i zations.

John J. Nance lives in Seattle, Wash ing ton, and travels amonghealthcare or gan izations nationwide.


46 Focus

Join Us at the Annual NJ HFMA Golf Outing

May 7, 2009

Fiddler’s Elbow Country Club Far Hills, NJ

More information, including the full brochure and online registration,

is available on our web site: www.hfmanj.org

For information on sponsorship opportunities please contact Laura Hess at 888-NJC-HFMA, or [email protected].


Focus 47

A New NJ HFMA Web Site!!!

If you have not seen it yet, be sure to go to hfmanj.org and check out our exciting new web site! Additional web features will be available soon.....stay tuned!


48 Focus

Advertiser Focus

J.H. Cohn is among the top 15 largestaccounting and consulting firm in theUnited States. Since 1919, the Firm has

cultivated a reputation for honesty, integrity, technical excellence, and genuineconcern for clients. To learn about J.H. Cohn and its life cycle approach to help-ing middle market business owners create, enhance, and preserve wealth,please call please call Wayne Ziemann at 732.635.3211 or David Fix at732.635.3209. Visit our website at www.jhcohn.com..

Since 1986, BESLER Consulting has been assistinghealthcare providers in enhancing revenue, gainingoperational efficiencies and achieving compliance.BESLER Consulting clients benefit from a team ofhighly experienced, dedicated professionals. They bringto each engagement in-depth knowledge in a wide range of financial, operationaland compliance issues. Telephone 1.877.4BESLER • Web site Beslerconsulting.com

For over twenty-five years, CBIZ KA Consulting Services hasprovided customized financial solutions to healthcare providers.Our staff blends industry knowledge and practical experience toprovide services in the fields of reimbursement optimization,Medicare and Medicaid recovery, managed care, decision support,benchmarking and clinical resource management. For informa-tion, visit www.kaconsults.com.

Established in 1973, McBee Associates, Inc., oneof the nation’s largest, independent health care con-sulting practices, provides managerial and financialconsulting services to health care organizations. Thefirm’s consultants maintain an extensive array of

financial and managerial expertise, enabling them to resolve any financial chal-lenge that faces a health care provider today. Visit: www.mcbeeassociates.com

Founded in 1974, WS+B is one of the largest region-al accounting and consulting firms in the mid-Atlantic area with office locations in New Jersey,New York, Pennsylvania and Maryland. With over375 employees, the firm ranks among the top 35CPA firms nationwide. WS+B services hundreds ofhealth care providers in the areas of accounting &

auditing, consulting, tax, corporate governance and risk management. ContactScott Mariani at [email protected] or 973.898.9494. www.withum.com

www.foxrothschild.com

Counted among the 200 largest law firms in thecountry, Fox Rothschild LLP is a full-servicefirm with offices in Pennsylvania, New Jersey,New York, Florida, California, Nevada and Delaware, providing a complete rangeof legal services to public and private business entities, charitable, medical andeducational institutions and individuals.

Founded in 1970, Parente Randolph employs over 500 professionals andis among the top 35 accounting and

consulting firms in the United States and has been recognized for its experi-ence in providing professional accounting, tax, auditing, and consulting servicesto hospitals and healthcare systems, other healthcare providers, third-partypayors of healthcare services, and not-for-profit organizations in the mid-Atlanticstates. With over 75 people exclusively dedicated to this industry, we are readyto serve you. Visit us at www.parentenet.com

Please consider supporting our sponsoring companies

IMA Consulting provides customer-focused,cost-effective solutions to the toughest prob-lems in healthcare management. We put ouryears of experience to work for you, solvingproblems in operations improvement, financial services, revenue managementand providing related educational services. Since 1996, IMA Consulting has pro-vided services and solutions to over 200 hospitals and healthcare providersacross the United States. Call Julie Burgess at 1-484-840-1984 to learn more, orgo to www.ima-consulting.com.

The Health Care Law Group at Norris McLaughlin & Marcusis one of the largest in New Jersey. We provide a variety ofservices to clients throughout the health care field, includinghighly specialized work in the regulatory areas governingthe delivery of health care services under state and federallaw. Our health care clients include hospitals and their affiliated corporations,hospital medical staffs, nursing homes and other long-term care facilities, jointventure groups, professional practices, and other providers of health care ser -vices. For more information, visit our web site at www.nmmlaw.com.

Executive Resources, LLC provides financial, strate-gic planning, and physician-related consulting serv-ices in multiple states. Representative projectsinclude independent review organization compliance

and performance audits; debt compliance review, analysis, and implementationservices; product line strategies; revenue enhancement development; and FQHCdevelopment. We create solutions relative to challenges and opportunities in thehealth care industry. We work with CEOs and CFOs to assess what needs to bedone, develop a plan of action, and then execute the plan.

ExecutiveResources, LLC732-974-7200

877.4BESLER • BESLERCONSULTING.COM

The RACs are here!Not sure how to prepare? Not sure how to respond?

Call us.

Documents

Relax and put your feet upall the tools you need are right at your fingertips… · 2013. 4. 19. · need are right at your fingertips! Meet the new NJ HFMA Website.....page 7. ARMDS