HFMA Annual Conference Roundup
By Adam Abramowitz, Senior Manager, Sales and Marketing
CBIZ KA Consulting Services traveled to Denver last month for the 2022 HFMA Annual Conference. Making our return to the conference for the first time since 2019, there were a lot of familiar faces to see and new people in the healthcare industry to meet. To our delight, traffic at our booth in the exhibit hall was robust. We had numerous conversations with healthcare finance leaders about critical issues and needs. In particular, there were three areas that stood out in terms of needs in the marketplace.
Medicaid Eligibility (especially for small hospitals)
As the staffing crunch has caused havoc throughout the healthcare industry, many hospitals have lost staff that performed critical Medicaid eligibility functions. As our conversations at the HFMA conference confirmed, the loss of staff has resulted in a decrease in Medicaid revenue as many hospitals lack the resources to enroll qualified patients for Medicaid. While larger organizations with more resources could be in a better position to withstand the loss of staff in this area, smaller hospitals are far more sensitive to losing one or two key employees. As a result, a number of people in the conference talked to us about our virtual Medicaid eligibility solution, Virtual Eligibility Counsellors (VEC), which can help hospitals screen and qualify patients for these vital federal and state programs.
Denial Management
Payers continue to come after hospitals and health systems relentlessly in terms of denials, downgrades and partial payments. With this onslaught of denial activity, many organizations are struggling to execute strategies that effectively respond to these denials AND reduce them moving forward. In particular, we spoke with a number of people at the conference who were getting slammed by DRG downgrades and medical necessity denials by their commercial and Medicare Advantage payers. Some organizations needed assistance with triaging their denials – which ones to appeal, others were looking for appeal outsourcing, while some others wanted a holistic partner to help them reduce denial activity moving forward.
CBIZ has worked with many clients throughout the country on these issues. We understand how devastating denials can be on an organization’s bottom line, the time and resources needed to fight them, and the difficulty created in financial projections and how it relates to negotiating payer contracts. We’ve had a lot of success in overturning medical necessity denials and DRG downgrades and several people in the conference were interested in hearing more about how we’ve helped clients in these key areas.
Physician Coding Reviews
Hospitals and health systems continue to acquire physician practices and it’s safe to say that many organizations haven’t reviewed the coding quality of these practices. At the conference we spoke with a number of organizations that were interested in auditing their physician practices. In particular, many organizations realize that they haven’t conducted a third-party review of their physicians since the office visit E&M guidelines were changed in 2021. Many of the people we spoke with were concerned that their physicians were leaving money on the table by not coding to appropriate levels. And in our experience, we have found this concern to be warranted. With new rules for medical decision making and time-based standards, physicians now have more tools to code cases to optimal reimbursement levels, but unfortunately many physicians are failing to capture this revenue.
Overall, the HFMA Annual Conference generated a lot of good conversations about what is going on in the healthcare finance industry and what needs leaders have for their organizations, and we were happy to be there. For any questions on CBIZ’s services and solutions, please contact Adam Abramowitz at [email protected] or 609-220-5627.