Thank You to Our Platinum and Presidential Sponsors

2006 Issue 4

2006/2007 ISSUE Four
Corporate Sponsor Program
We gratefully acknowledge the commitment of our Corporate Sponsors who assist in the funding of the Chapter's programs and activities

Presidential Level
Ernst & Young, LLP
Human Arc
Long-O'Shea & Co. LLC

Platinum Club
CPS Statement & Paper Management System, Inc. Fenner Consulting
HRSI/FirstCredit International Corp.
Joseph R. Harrison Company, LPA
JP Recovery Services, Inc.
MedQuist, Inc.
Meridan Leasing
NatCity Investments, Inc.
Revenue Group/HRS
Total Practice Management

Gold Club
Kreg Information Systems
Squire, Sanders & Dempsey LLP

Silver Club
Healthcare Funding Solutions
Robert Half International
Masters Associates Receivables Management, Inc.
Quadax, Inc.

Bronze Club
Bruner-Cox, LLP
Calfee, Halter & Griswold LLP
CDR Associates, LLC
Engelhardt & Emrhein
HMC Group
Howard, Wershbale & Co.
ImaCS, Ltd.
KeyBanc Capital Markets
Mutual Hospital Services
NCO Financial Systems Inc.
OSI Support Services, Inc.
Per-Se Technologies
Professional Receivables Control, Inc.
Receivables Outsourcing Group
Resources Global Professionals
Ryerson Management Associates
UCB-A Receivables Management Company
Vorys, Sater, Seymour & Pease LLP
Wise Management Services, Inc.
Wolfskill & Associates

HFMA Northeast Ohio
Chapter Officers 2006-2007

Christopher Milligan

Karen J. Mihalik

Vice President
Charles S. Josey

Suzanne M. Tschetter

Brian K. Quinn

Chapter Coordinator
Kathleen A. Much

Board of Directors

Maureen A. Wood
Cynthia A. Dormo Robert S. Matitia Brian C. Nestor Laurie A. Rauser Mary Jayne Reedy Anna Sulewski

Visit HFMA National at:

Visit HFMA Northeast Ohio at:

Click here for Past Newsletters

HFMA Northeast Ohio

Joyce Gusman

Human Arc

Jorie Novacek

Parma Community General Hospital

Maureen Campbell
The MetroHealth System

Laurie A. Rauser
The MetroHealth System

Mary Jayne Reedy
Human Arc

Steve Rybka
United Collections Bureau

Email the Committee


President's Message

Dear fellow HFMA members:

Thank you for your support of HFMA during this 2007 - 2008 year. Your membership provides us an opportunity to deliver timely information, quality education and outstanding networking with fellow healthcare finance professionals. We provide local events that partner with national level resources to help you meet your needs.

This year's theme is "Make A Difference". HFMA Northeast Ohio makes a difference in many ways. We look forward to having each of you take advantage of these opportunities this year:

  • Get information - HFMA's educational resources are comprehensive, timely, and easy to reach. You can Make A Difference for your employers and professional development by accessing these tools through local education sessions, national programs, and online resources available to you.
  • Get connected - The membership of HFMA includes the best of the best in our local market and throughout the country. Attend an HFMA event and take advantage of the opportunity to share best practices, make a connection, and build your personal network. It is these relationships which Make A Difference to us throughout our careers.
  • Get certified - HFMA offers a certification program that will Make A Difference in your professional credentials. It's an opportunity to stand out in your field. Join me as I embark upon this journey to get certified this year!
  • Get involved - We have a strong team of volunteer leaders at the local level that continue our tradition as an award-winning chapter in our region and at the national level. This group consists of dedicated leaders in our field that I am fortunate to work with. If you'd like to Make A Difference through committee involvement, we're excited to share the opportunity to develop your leadership skills and provide an enhanced level of professional networking.
In This Issue:
click or scroll to see as article

I look forward to seeing you this year at an HFMA event.


Karen Mihalik
Northeast Ohio HFMA Chapter President, 2007-2008

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Membership Message

NEO HFMA Welcomes...

David R CooperSenior Account ExecutiveCaremedic Systems
James A BaraonaDirector Of FinanceSt. John West Shore Hospital
Robert F. WaitkusSenior Director TaxationCleveland Clinic Foundation
Ronnie A Nicholson-DavisProgram AnalystVHA
Gabrielle B. LoveDirector, Corporate DevelopmentCase Western Reserve Univ.
Jane AbbottFinancial AnalystSt. John West Shore Hospital
Jolene M CarnabuciDirector of OperationsACE Recovery, Inc.
Todd IndreSenior Contract AnalystCleveland Clinic
Adam M LuntzDirector Of Budgeting And ReimbursementAultman Health Foundation
Christopher AlbrechtAccountantCleveland Clinic
David Lienert CSC Group
Gaila LeslieAccount ExecutiveHtp Inc.
Keeth F. StoneSr. Financial AnalystUniversity Hospitals
Matt Mckenna  
B. Keith McmahanManager, Cost, Budget & ReimbursementSouthwest General Health Ctr.
Jeff HaleVice President Information SvsChildren's Hospital Medical
Scott JahnAccountantMarymount Hospital
Stephanie DeFrancoDecentralized AccountantCleveland Clinic
Jim RozborilBusiness AnalystOntario Systems
Katie McVeyProject CoordinatorBridgeway Search Group
Keith W. JohnsonVice President, Third Party AdministratorApex Benefits Services, Llc
Mark W ValentineChief Financial OfficerHospitalists Mgmt. Group
Robert A BattistaDirector Decision Support ServicesUHHS/CSAHS - Cuyahoga, Inc.
Robert ZimmermanPresident/COOThe CSC Group
Aaron B LoydStaff ConsultantErnst & Young, Llp
Dale Van GorderDirector Of Business DevelopmentInventurus Knowledge Solutions
Thomas E HendersonMba CandidateWeatherhead School Of Bus. at CWRU
Anne Lazzerini  
Coletta VictorAccount ExecutiveTransunion
Maria A. KreitzburgDirectorCompmed Analysis
Mary Ellen ShawAccount ExecutiveTransunion
Nancy FrancisStaff AccountantEast Liverpool City Hospital
Nancy SpicuzzaAccount ExecutiveTransunion
Scott WatsonAnalyst, Strategic And Financial PlanningUniversity Hospitals

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Upcoming Events

Listed below are the remaining events planned for the 2006/2007 program year. Details and dates are announced as soon as they are available. Check the events calendar section of often for updates on events.

Volunteer Appreciation OutingSeptember 7, 2007
Medical Group/Post Acute CareJanuary 2008
Patient Financial ServicesFebruary 21, 2008
Past President's RecognitionMarch 27, 2008

HFMA's September Meeting

We have an outstanding day planned for you!

Strategic Financial Facility Planning
Jane Benjamin, Vice President, Kaufman Hall
Top 10 Things That Should Keep a CFO Awake at Night

J.B. Silvers, Weatherhead School of Management, Case Western Reserve University
Volunteer Appreciation Outing

Register at"

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ANI Recap

Dear Fellow HFAM Members:

It is hard to believe that my year as chapter president is over. This comes with mixed emotions; relief that I can now have my Saturday afternoons back to work on things other than my HFMA duties, and confidence that the chapter leadership headed up by chapter president Karen Mihalik will do an outstanding job leading our chapter and a great sense of pride for what we accomplished in the past year, capped off by the recognition that our chapter received at this years Annual National Institute (ANI) in San Diego, California. Our chapter received five awards this year, more than any other year. We were recognized for excellence in the following areas:

  • Hottum Award - for education performance improvement. This award is a direct result of the hard work put in by our program chair/vice president Chuck Josey and all of the program chairs and committee members.
  • Yerger Award - for outstanding improvement in our corporate sponsorship program. We received this very prestigious award as a result of the hard work put in by president elect, Karen Mihalik and the entire corporate sponsorship committee.
  • Yerger Award - for outstanding performance in member services. We were selected to receive this award based on the succession planning concept that was put in place this year and was a result of the foundation put in place our past presidents, Maureen Wood and Barry Franklin.
  • Bronze Award - Excellence in Certification. The leadership team made it one of our key objectives to improve on the number of certified members this year. As a result, our certification chairman, Bob Matitia and his committee did a remarkable job in increasing our number of certified members, a focus that will continue in 2007/2008.
  • Bronze Award - New Member Retention. The membership committee under the leadership of Mary Jayne Reedy and Suzanne Tschetter did an incredible job this year in making sure that new members to our chapter were made to feel part of our chapter and as a result, became more involved in the chapter. This focus is truly a key initiative in insuring the future growth and success of our chapter.

As you can see, 2006/2007 was a banner year. Each of the very aggressive initiatives that the leadership team set as goals for this year were not only met, but exceeded, resulting in our chapter being recognized by national. The entire membership, volunteers and chapter leadership truly showed that they had the "Courage in Leadership" to make our great chapter even better. It was truly my honor to be a small part of this success and I am looking forward to the coming year as our chapter leadership continues to "Make a Difference."

In closing, I would like to thank the entire leadership team for all their hard work this past year and all of you for allowing me the honor to represent our chapter.

Chris Milligan
Past President/Chairman
Northeast Ohio HFMA

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Past Event Recaps


The program was led by speaker Laura Hay, who is the COO for The Ohio Society of CPAs. She made professional ethics very interesting and covered the 3 hour program well.

The definition of Ethics is: An organic study of humanity and its evolving sense of rightness, goodness and justice. Thus, one view is the study of "ethics" is the study of "morals."

There has been a gradual shift in business morals and ethics over the years as evident with the recent events of WorldCom and Enron that resulted in Federal legislation, i.e. Sarbanes Oxley. An Ohio CPA is held to a high level of standards to maintain his/her certification. The Accountancy Board of Ohio specifies Integrity, Objectivity and Professional Competence to ensure ethical behavior. Another necessity of accountability is acting in the Public Interest.

Ten ways to mess up for Ohio CPA License

  • Don't submit an address change to the Accountancy Board
  • Fudge on your CPE report
  • Don't respond to Board communications
  • Renew your CPA "dues" with the Ohio Society of CPAs instead of your license
  • Advertise and open a firm before it is registered
  • Don't use an engagement letter
  • Withhold client records after the clients requests them
  • Don't pay your child support
  • Don't repay student loans
  • Don't pay your taxes

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Kudos to You!

Brian Nestor just received his MBA from Kent State University.

Grace Jen of CCF passed the PFS Specialty exam in June.

Joyce Gusman has accepted the job of CBO Director for MED3000.

Julia DiFrancesco made Partner at Ernst & Young.

Sue Densmore is now Vice-President and Controller of Humility of Mary Health Partners, effective in January.

President Elect Chuck Josey proudly announced the birth of his baby girl, born on July 21. Her name is Kendel Rachel. Congratulations to Chuck and his family!

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While unpaid patient bills continue to soar, more hospitals than ever are examining how to manage their bad debt. But what should leaders of your hospital do if they want to realize value from the bad debt charged off over the years - and how do they do this without creating patient complaints or PR problems? The solution for many hospitals is to sell the bad debt to the right buyer.

Most hospitals charge off their unpaid self-pay patient receivables at 120 days. Traditionally, the patient's balance is then sent to a collection agency. At this point, the hospital no longer carries the bad debt on their books. An advantage of this approach is that it frees in-house staff to focus on the collection of newer accounts. However, a primary disadvantage is that it often takes up to two years for the hospital to recover any funds.

An Injection of Cash from a Third Party Purchaser

Today many hospitals are opting to sell their bad debt to a third party purchaser who will handle the hospital's bad debt professionally and compassionately - without generating patient complaints.When compared to the collection agency approach, this strategy offers immediate cash up front, continued cash flow over time and better community relations.

Many third party purchasers provide upfront cash for delinquent and charged off self pay and balance-after-insurance accounts. In addition to increased and regular cash flow, hospitals receive other benefits that impact the bottom line. Foremost is a reduction in administrative costs. There's no need to manage a collection agency and no need to update account information or continue to try to collect on old accounts.

Hospitals may even reduce risk by selling accounts. In a recent legal case, a Circuit Court of Appeals determined that a creditor cannot be held liable for mistakes or "acts" of a third-party debt purchaser. Translated into the healthcare environment, this means that a hospital that sells its delinquent accounts to a third party vendor may not be liable for errors or transgressions that the buyer might make when trying to collect from a patient.

Accentuate the Positive, Eliminate the Negatives

Fear of patient or community reprisal is a valid concern of hospitals that are considering selling their delinquent patient accounts. But, there are many practical measures a hospital can take in anticipation of this potential stumbling block.

The first thing a hospital can do is to make sure that the contract with the debt-purchasing vendor prohibits the vendor from re-selling the accounts. Another important stipulation of a contract ensures that the hospital can recall the account under specific pre-determined conditions. Both of these contractual conditions help the hospital maintain as much control as possible over their sold accounts.

The Final Diagnosis

Hospitals can get more out of their bad debt portfolio -- and still treat their patients professionally and compassionately. But careful, due diligence is obviously critical to ensure you are partnering with a healthcare-experienced vendor who knows how to answer patients' questions and thus avoid potential disputes. Choosing the "right" debt purchaser should reflect a hospital's mission, vision and strategies. Here are some guidelines that can help with your decision process and end result.

Establish your requirements. Understand what your goals are.
Engage other areas of your hospital. Input from risk management, patient admissions and the hospital's PR department can help determine additional needs.
Establish a vendor pool. As you collect names of vendors, find out:

  • Does the vendor specialize in purchasing and servicing healthcare receivables?
  • Does the purchaser resell or outsource accounts to third parties?
  • Get a first-hand look at the vendor's processes. An onsite visit to the vendor's Customer Call Center gives insight into how accounts are treated.
  • Does the purchaser handle accounts sensitively, minimizing patient complaints?
  • Are the purchaser's employees well trained and professional?
  • Are collectors monitored to ensure compliance?
  • What are the vendor's business practices, collection tools, and procedures?
  • Scrutinize the vendor's background. Are collectors FDCPA-trained and knowledgeable about HIPAA privacy rules?

Mitch Patridge is CEO of the San Diego based Varisol and CSI Financial Services. He can be reached at (858)200-9201 or at

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Automation Can Improve Your Days And Customer Satisfaction
By Christopher Thunder and Ryan Brebner, Business Development Executive R&B Solutions, Waukegan, Illinois

Healthcare providers have been moving rapidly towards electronic patient records and other upgrades in technology. Upgrades undoubtedly will help not only patients, but hospital budgets as well.

With the uninsured population rapidly growing past 46 million Americans, state budget crunches, and an increase focus on fraud, hospitals have begun to look towards grabbing a bigger piece of the pie and most importantly properly assisting the uninsured and under-insured. Automating the Medicaid and Charity process is one way to ensure that best practices are followed and assistance is given only to those who need it.

The Lewin Group, a national health care and human services consulting firm for public, non-profit, and private sectors, published a report entitled Electronic Applications Present Opportunities to Improve Enrollment into New York's Public Health Insurance Programs. The article concluded that an automated system reduces errors, duplication, staff effort and time, common mistakes, and increased real-time access to enrollment data. Furthermore, according to a General Accounting Office (GAO) study, up to 60% of Medicaid applications are rejected for administrative reasons, not because of ineligibility.

The Lewin Group also found that although automation may increase compliance with application submission, it may not assist them in attaining the required documents or meeting eligibility criteria. At the time of this article, there are only a handful of companies promoting a software or online program that claim to meet these needs. Of them, some are simply verification tools to confirm Medicaid enrollment. Others use credit information to try and determine eligibility in one program or another. However, very few companies have taken the current pen and paper process and transferred it onto a computer screen.

As of only a few years ago automation had not been brought to government health insurance programs, either internally or externally. Healthcare providers across the nation have been moving rapidly towards electronic patient records and other upgrades in technology due to strong government recommendations. In the long run, we are told technology upgrades undoubtedly will help not only patients, but hospital budgets as well. Now, several companies offer an automated process to screen uninsured and underinsured patients for Medicaid and Charity programs. However, companies offering such a solution vary greatly not only in their product offering but in their knowledge of state Medicaid programs and hospital charity guidelines.

One of the options available in the marketplace at this time can be easily defined as Enrollment Verification. This product is valuable in that it provides hospitals with the knowledge that an individual is already enrolled in a government program. This saves the provider time and money in the review of a patient. Unfortunately, this does not help the hospital with patients not enrolled in Medicaid. Furthermore, it does nothing to address he hospital's charity needs.

In response to hospital's needs for charity and Medicaid screening, many companies developed programs that use credit information to determine eligibility. Credit information is a valuable asset for hospitals to have because it will assist them in determining who may be eligible for charity, and who can be moved on to bad debt. An additional benefit is that these programs provide address and social security verification, and the patient's available credit; all of which can help hospitals prevent against fraudulent activity. The downside is that credit scoring alone should not be used to determine Medicaid or charity. A credit score is unable to find whether a person is blind, pregnant, or disabled. It does provide important information, but not necessarily information that accurately determines Medicaid or Charity.

Several companies offer an automated process to screen uninsured and underinsured patients for Medicaid and Charity programs, but their knowledge of state Medicaid programs and hospital charity guidelines varies greatly..

Perhaps the most complete option is the automated application tool. This system takes a hospital's and eligibility company's current process and refines it through technology. In doing this, hospital's keep with best practices and all patients are asked the same questions, eliminating the possibility of repetition and other forms of human error. Many of these tools also enable providers to utilize staff without requiring extensive Medicaid knowledge or training, and allow the service to be offered in outpatient areas. Those with integrated calculators compute spend-down requirements with income and assets to facilitate easy point-of-service collection. All of this information is kept on file for report generation and the elimination of duplicate applications in multi-system hospitals. At the end of the interview, the tool will bring forth the appropriate application form, necessary attachments, and the lists of documents required by the state for eligibility determination, including recording undocumented immigrants. By being electronic, the application is then capable of being submitted online or by facsimile with the use of an electronic signature. Regrettably, this option is not widely offered as a result of the fact that not all states accept electronic applications, and ~ since the application process itself is not standardized ~ the company needs to have knowledge of each states' applications in order to customize and configure them into the program. This requires extensive programming and costly man-hours for each new state, which is why so few companies offer it.

Unfortunately, the process itself goes beyond an application, and the measure of quality healthcare providers must recognize in these programs is whether it will assist in simply easing the manual methodology or streamline the entire progression. Depending on the format of the program, applicants may find themselves denied for care they are eligible for simply because the automation they are filtered through has completely removed the human element of the problem itself, in which case the program has merely verified their poverty level.

Just as a hammer needs a carpenter to function, technology should not remove the element of human interaction. As is the mark of any good tool, it assists and refines human procedure. From first glance, a great deal of the products available on the market were rushed to meet the demands the uninsured and underinsured patients placed on the hospitals, and designed to automate their patient inventory as opposed to integrating a patient care priority within it. Inasmuch as these programs are beneficial from an accounts receivable point-of-view, their connection or expertise in the Medicaid process in regards to the patient exists solely as a design term within the program.

In the end, all automated options should be viewed as valuable services, and the choice each provider makes is based largely on what that hospital needs. When looking to outsource, hospitals should consider the motives and knowledge behind the company that creates the software. The true motive of outsourcing should be to lesson the burden of the hospital but also simultaneously extend their mission. The more hospitals lean towards automating Medicaid and charity programs, the greater pressure they will be able to put on federal and state governments to automate the Medicaid program itself. The greatest benefit for all parties will occur when there is a universal standard capable of incorporating each other's technological format.

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Puzzler - Summer Paintings

At a recent painting competition, Eileen's rendition of a Constable was not last. Jenny only just managed to avoid last place and came third. The lady who painted a Monet was very successful and took first place. Ada beat the lady who painted the Taylor and the lady who painted the Van Gogh beat Vera. Can you determine who painted what and who won?

E-mail your answer to Jack Bailey at All correct entries will be included in a drawing and one lucky entrant will receive a $25 gift certificate.

Previous puzzle: Two Boxers
Answer: The boxers are both women
Winner: Bill Emrhein of Engelhardt & Emrhein won a $25 gift Visa gift certificate.

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