The MA-RI Chapter of HFMA held two half day seminars on Nov. 12th and 19th for individuals new to the healthcare sector. The Day One agenda was “Fundamentals of Healthcare Financial Reporting”, presented by Allison Dolan, Sr. Manager in Healthcare Services at BDO USA, LLC, and “Law, Compliance and Regulations”, presented by Tim Hogan, Sr. VP and Chief Compliance Officer at Boston Children’s Hospital.
Topics covered under “Financial Reporting” included: Monthly Financial Reporting (Basic statements and key indicators to include as well as sample statements and Best Practices), Annual Financial Statements (the ‘Audit” and how each statement relates to the others; Recently Issued Accounting and Reporting Standards), Federal Form 990 and MA form PC (non-profit reporting), Other Reporting (Reimbursement reports for different types of facilities, MA Uniform Financial Report and Form 3ABC Tax Exemption Form). The presentation also included an extensive appendix of Financial & Operating Indicators (Ratios), Formulas and Acronyms.
Issues covered under “Law, Compliance and Regulations” included: What Compliance means, The Office of Inspector General (OIG), Eight Essential Elements of a Compliance Program, OIG Compliance Guidance, the Differences and Overlap of Internal Audit and Compliance, Key Risk areas, False Claims billing, Causes of Billing Errors, Identifying risk using internal and external data, Laws governing Referrals – Safe Harbors, Enforcement examples, Health Insurance & Affordability Act (HIPAA) and Data Breach notification requirements.
The Day Two agenda was “Introduction to Managed Care”, co-presented by Karen Granoff, Sr. Director of Managed Care Policy for the Massachusetts Health & Hospital Association and Diane Dobbins, Director of Contracting for Beth Israel Lahey Health Performance Network and “Revenue Cycle Management and Calculations” presented by Scott Ramer, Director of PWC’s Health Industries Advisory Practice.
Topics covered under the “Managed Care” presentation included first an overview of Managed Care that covered: An explanation of what is Managed Care, a Brief History of Health Insurance, and Managing Care in the time of COVID and the Massachusetts Market and Health Care Reform. That was followed by Managed Care in the Real world examples that covered the Massachusetts Landscape, Types of Managed Care Contracts, Contracting Organizational Structure, Negotiation Process and Stages and concluded with a few practical tips.
Issues presented under the “Revenue Cycle” presentation included: The Revenue Cycle Model, A Patient Journey Map, Technical Key Performance Indicators (KPIs), Provider Enrollment, Registration/Financial Clearance, Coding/Charge Capture, Pre-Billing Functions, Billing Process, Adjudicating the Claim, After the Initial Denial, Patient Responsibility and Technology Advancements.
As always, this annual event was well attended and incredibly informative. Until next year, thank you to all the speakers for their time and expertise as well as corporate sponsors who make all this possible.
Rick Markello is an HFMA Board member and Principal of Old Silver Beach Consulting, LLC, specializing in Healthcare on-site management is a variety of c-suite roles or consulting in operations improvement, financial turn-arounds and mergers. He is currently serving as CFO at Silver Hill Hospital in New Canaan, CT.