communicator - aaham chapter winter 2011.pdfhuge success in 2010 and will continue in 2011 at...
TRANSCRIPT
It has been an awe-
some experience to
serve as your Presi-
dent in 2010 and I an-
ticipate serving the
remainder of my term
through 2011. Thank
you for making this
chapter great. The work you do in your
career is not easy and it is my hope to do
all I can to make it easier.
Our Roundtable Discussions were a
huge success in 2010 and will continue
in 2011 at various and convenient parts
of the Carolinas. Our last discussion
centered on things we did well during
the year and the things we could have
done better. This is a good question to
ask yourself as you begin a new year.
On Thursday, February 17, 2011, our
chapter will co-sponsor a workshop with
the Southern Atlantic Healthcare Alli-
ance, at Wake Medical Center’s An-
drews Center in Raleigh. This workshop
will focus on upcoming Medicaid audits
and JW modifiers. More information
will be available after the first of the
year.
I always welcome your ideas, thoughts,
and comments. Feel free to contact me
anytime.
Blessings for a great 2011,
President, Carolina Chapter
Chairman of the Board
Steve Duncan
President
John Cook
First Vice President
Wanda Welch
Second Vice President
Charlynne Lynch
Treasurer
Kevin Young
Secretary
Theresa Johnson
Presidents Message
I N S I D E T H I S
I S S U E :
Committee
Chairs
2
Corporate
Sponsors
4
Upcoming
Events
5
A Healthy You
for a Healthy
Bottom Line
6
Happy Together 8
Automation is
the key to Effi-
cient Health
Care Reform
10
Hospitals Can
Assist the Unin-
sured in Getting
State & Federal
Risk Pool Cov-
erage
12
Changes in Pro-
fessional Certifi-
cation
13
2010-2011 Board Members
B E C O M E A M E M B E R
T O D A Y ! CAROLINA
COMMUNICATOR W I N T E R 2 0 1 1
CAROLINA CHAPTER
C A R O L I N A C O M M U N I C A T O R
Committee Chairs 2010-2011
P A G E 2
Certification
Chapter Excellence Constitution & By-laws Corporate Partner Education
Membership
Historian Legislative
Glenn Martin/Duke Health System
[email protected] 919-620-1271
Anita Bennett/Maria Parham Med Center
[email protected] 252-436-1855
Deborah Gray/Lenoir Memorial Hospital
[email protected] 252-522-7676
Susan Phelps/McKesson Provider Technologies
[email protected] 336-541-2619
Josette Anzalone /Granville Health System
[email protected] 919-690-3237
Qwanda Fisher-Jones/Advanced Patient Advocacy
[email protected] 804-545-8078
Rayanna Moore/Appalachian Regional Healthcare System
[email protected] 828-262-4100
Charlynne Lynch/Wake Forest Univ Baptist Medical Center
[email protected] 336-713-4708
P A G E 3 CAROLINA CHAPTER
Pictured left to right : Kim Walsh - Duke University Medical Center, Lori Sickelbaugh - Lexington Memorial Hospital and National Secretary, Theresa Johnson -Duke University Medical Center and Larry McLean - Duke University Medical Center and Carolina AAHAM Secretary
FUN IN THE SUN….
AAHAM Annual National Institute
Ft. Lauderdale, Florida
P A G E 4
2010 Corporate Partners
Contact
Debbie Gray
for more
information on
how to
become a
Corporate
Partner
(252) 522-7676
or
C A R O L I N A C O M M U N I C A T O R
AccessOne Medcard www.accessonemedcard.com Tony Mary 704-301-7278 Acryness www.acryness.com John Cook 704-799-3550 Credit Financial Services www.creditfinancialservices.com Lynn Campbell 919-687-2015 FirstPoint, Inc. / Mosaic Outsource Solutions www.firstpointresources.com Steve Duncan 800-678-4590 Healthport www.healthport.com 803-264-4798 MEDARX www.medarx.com Ruthie Waters 866-855-7622
Merchants Association Collection Division, Inc. www.macd-inc.com Saber Grotticelli 813-244-4115 Paragon Revenue Group www.paragonrevenuegroup.com Brylan Gann 800-264-0384 ParrishShaw and Co. www.parrishshaw.com Julie Shaw / Brent Parrish 800-872-1818 Professional Recovery Consultants www.prorecoveryinc.com Geoff Miller 919-489-7791 The Outsource Group www.theoutsourcegroup.com Bill Peters 704-941-6101
Corporate Partners Contact Information Looking for Solutions?
Give them a call…
Special thanks
to all our corporate partners
for their support!
Program Agenda 2011 Emerging Issues in Revenue Cycle Management John Cook, President, Carolina Chapter of AAHAM
What to Expect: North Carolina Medicaid Audits Understanding the JW Modifier Glenn Krauss, Revenue Cycle and Health Information Management Consultant
Right the Wrongs of Point of Service Collections Paula Bost and Scott Cecil, Wake Forest University Baptist Medical Center
Registration Fee: $50 per attendee (Lunch included)
P A G E 5
Presents a Program for Revenue Cycle and Healthcare Professionals
Thursday, February 17, 2011
10:00 am – 4:00 pm The Andrews Center at WakeMed
3000 New Bern Avenue, Raleigh, NC
Registration available online at www.aahamcarolina.org
CAROLINA CHAPTER
Mark Your Calendar
P A G E 6
C A R O L I N A C O M M U N I C A T O R
A Healthy You for a Healthy Bottom Line
Maximum Brain Power is essential to be at our peak performance level during the day. The brain is a hungry organ. The foods you choose can sharpen your focus and concentra-tion. Assist in enhancing memory, attention span and brain function. The foods we eat also affect our energy level, mood and stress level.
Complex Carbohydrates: The body absorbs whole grains more slowly keeping blood sugar and energy levels stable. They trigger serotonin development, increase blood flow and help with short term memory and attention span. Foods: Whole grain breads and pasta Brown rice Whole grain cereal
Cashews, Almonds and Hazelnuts: Are nuts that are rich in vitamin E that is associated with less cognitive decline. Rich in pro-tein and contain Magnesium, which is a mineral that plays a vital role in converting sugar into energy. Magnesium deficiency can drain your energy.
Lean Meats: Lean meats contain amino acid tyrosine which boosts levels of dopamine and norephineph-rine. Brain chemicals that that help you feel more alert and focused. Also contain vitamin B12 which combats insomnia and depression.
Fish, nuts and green leafy vegetables -Omega 3 Omega 3 builds gray matter and cell membranes in the brain. They help to keep emotional balance and a positive attitude throughout the day.
Egg Yolks: Contain choline, a nutrient that boosts brain power by accelerating the signals sent to nerve cells in the brain.
Yogurt: Helps produce neurotransmitters in the brain to improve signals amongst neurons.
Blueberries: Protect the brain from oxidative stress and improves learning capacity.
Dark Chocolate: Contains theobromine which boosts your energy and mood.
Water: Hydrating your body is so important to your health. Water is the principal component in your body and every system depends on it. Water carries nutrients to your cells and flushes toxins out of vital organs. When you become dehydrated stress hormones increase, your metabolism slows down and you are left feeling drained and tired.
By:
Monique Crook PFS Manger MedWest-Haywood Clyde, NC
W I N T E R 2 0 1 1
C A R O L I N A C O M M U N I C A T O R
Exercise: Daily exercise boosts your energy level, gets blood flowing to your brain and elevates your mood.
Avoid Soft Drinks! You may get a quick boost of energy due to the large amounts of sugar but you will experi-ence a decline in brain power later in the day. A few simple changes to your diet will ensure your brain is working at an optimal level and reduce your stress levels.
Power up your ability to concentrate on your next big day. Eat breakfast:
A glass of 100% fruit juice Whole grain toast with an egg or whole grain bagel with salmon 1 cup of coffee
Get a good night sleep Stay hydrated (at least 8, 8oz glasses a day) drink first glass upon rising. Your body is
dehydrated after 8 hours of sleep. Exercise to sharpen your thinking by increasing oxygen and blood flow.
I wish you all optimal health in the New Year
and a very healthy bottom line.
P A G E 8
By:
Tim
O’Connor
&
Brian
Shannon
HAPPY TOGETHER... John Cook, President of the Carolinas AAHAM
chapter, sent out an email to all members in
November of 2010. The email explained that
the chapter was conducting a survey to better
understand how providers feel about working
with vendors and vice versa. The intention of
this survey was to gather data and share mutual
perspectives in a way that could clear up any
misconceptions while helping both parties bet-
ter partner on future opportunities.
We are pleased to report that a total of thirty
members responded to the survey, eighteen of
which were providers. The following is a sum-
mary of the key points taken from the data re-
ceived:
First, let’s review the information collected
from providers. Approximately 40% of all
responders of this survey categorized the fre-
quency of vendor communications to be
“driving them crazy.” When providers were
asked how many times per month it was appro-
priate for a vendor to contact them, 100% said
that “one to two” connections were appropriate.
When providers were asked what method of
communication they preferred from vendors,
60% answered “email” as their primary choice
and “tradeshows” came in as second on the list.
“Phone” correspondence and “Dropping in”
came in as their least favorite.
When providers were asked what is most im-
portant to them when choosing a vendor, 79%
stated that the “products/services they offer”
were paramount. “Price” was second. The
“company they were partnering with” and the
“sales person they were dealing with” were far
less important to them. Additionally, an over-
whelming majority (89%) of providers prefer to
use vendors partnered with their state chapter
(ie. AAHAM, HFMA, etc.). Furthermore,
almost three out of four providers like to do
business with vendors who are affiliated with
their specific Group Purchasing Organizations
(ie. Premier, SAHA, etc.).
Questions eight, nine and ten of the provider
surveys were open-ended and allowed for re-
spondents to type in answers.
When employees from hospitals were asked “why
they do not respond to vendors after a good initial
meeting”, providers replied as follows:
“VP or decision maker not interested”
“Determined to not have a need or do not see a
benefit”
“Not interested in pursuing the product right now
or budgets prevent us from moving forward”
“Organization will not approve the purchase or
whatever the vendor wants to sell us”
When providers were asked what things “vendors
do that sometimes annoy you”, they answered as
follows:
“Continue to contact me after I said there is not a
need”
“Do not accept not now as an answer”
“Keep calling/emailing me after I have not re-
turned their call”
“Talk down about their competitors”
“Going over my head or around me as the contact
person”
“Read word for word from a PowerPoint presen-
tation”
And when providers were asked to give vendors
“one piece of advice to better work with them”
they replied as follows:
“Listen to our needs and do not promise things
you do not have”
“Make yourself available both during and after
the sale”
“Know the product/service you are selling and
understand our business”
“Do not put pressure on me and do not show up
unannounced”
“Please understand that we have many responsi-
bilities being asked of us and while your sale is
important to you, it is likely not at the top of our
priority list”
That concludes the summary of the provider re-
sponses. Let’s now take a look at how the ven-
dors responded to similar questions. Vendors
typically communicate with providers via email
and phone. Email aligns well with how the pro-
viders like to be responded with but phone is not
preferred by them.
C A R O L I N A C O M M U N I C A T O R W I N T E R 2 0 1 1
P A G E 9
Additionally, the high majority of vendors (75%) agree that
contacting providers once or twice per month is appropriate.
So the frequency of vendor communications appears to be fine
in theory, yet almost two out of five providers said vendors
were driving them crazy in terms of communication. There
may be a disconnect between how often vendors are communi-
cating with providers versus how often they think is acceptable.
When vendors were asked why “providers chose you over an-
other company”, 80% said it was because of their “products
and services.” Interestingly, vendors seem to assign a greater
importance to the quality of their company and to themselves
(as the sales person) than do providers. When vendors were
asked why “providers chose another company over you”, 67%
responded because “the other company had superior products/
services.” The second most common answer was because “the
hospital preferred the other sales person more”, which the data
from the provider surveys did not support.
Similar to the providers, the final open-ended survey questions
for the vendors seemed to solicit the most interesting feedback.
When vendors were asked “what is most challenging for you
when dealing with providers” their answers were as follows:
“Getting them to respond to me after showing initial interest”
“Not returning calls or emails”
“Getting them to focus on the value we add and how that dif-
ferentiates us from competitors.”
“ Being able to speak with the decision maker.”
When vendors were asked “what things would you ask the pro-
viders do differently when communicating with you” they re-
plied as follows:
“If the person or hospital is not interested in moving forward,
please just tell me that early in the process. It is fine if provid-
ers do not want to proceed, but please have the courtesy to tell
me why and I will move on.”
“The respect of a return phone call or email.”
“Just be honest about their actual level of interest and what is
standing in the way of them making a decision.”
“Good, bad or indifferent….please just let us know.”
When vendors were asked why “providers may not return their
communications following a good meeting”, they shared the
following:
“Competing priorities, although these were not articulated
when asked what they might be.”
“Even though they ask for a proposal, they may not really be
interested in buying. Or, perhaps they use our proposal to get
their current vendor to lower their price.”
“The organization was really not prepared to take action on a
purchase and make a change.”
And finally, if vendors could “give providers one piece of ad-
vice that might enhance your relationship” it would be as fol-
lows:
“Please just tell me if you cannot or do not want to pursue
a business relationship. If you tell me that and why, I will
stop contacting you. The lack of reciprocal communica-
tion is hard to manage sometimes.”
“Please respond to emails or phone calls I send to you,
even if brief.”
“Please just be down to earth and upfront with me. We are
all adults and in business. Just communicate and be open
with me and we will be OK.”
The main themes that seem to have come from this survey
are:
Providers make decisions on what to buy based on the
quality of the product/service being offered. The company
and sales person have less to do with the ultimate direction
they will make.
Providers prefer to do business with vendors who are af-
filiated with organizations like AAHAM and also relevant
Group Purchasing Organizations.
When providers do not respond to a vendor’s inquiry it is
likely because the hospital or their boss is not supportive
of them moving forward.
Providers would like vendors to stop contacting them over
and over again, and in particular after they have said they
were not interested.
Vendors seem to want providers to better communicate
with them. This seems to include more regular response to
communication in general, but also related to specific op-
portunities.
Vendors would like providers to be upfront and honest
with them. If hospitals cannot or chose not to pursue a
purchase, that is fine, but please share that information as
soon as you know.
Hopefully these survey results provide more insight as to
how each party views the other. These responses should
enable both providers and vendors to be more empathetic
to each other’s situation. Once we better understand what
is important to our respected partners, the sooner both
sides can move towards a productive business relationship.
Happy buying and selling Together in 2011!
P A G E 1 0
On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) into law, expanding Medicaid
and forming health insurance exchanges. The goal of the bill is for all Americans to have access to some form of medical coverage.
Medicaid is expected to play a major role in covering more uninsured people and providing eligibility to nearly all people under age
65 with income up to 133 percent of the federal poverty level (FPL). Medicaid, along with its smaller companion program, the Chil-
dren’s Health Insurance Program (CHIP), is expected to cover an additional 16 million people by 2019. Health insurance exchanges
are to be formed by 2014 to help insurers comply with consumer protections, compete in cost-efficient ways, and to facilitate the
expansion of insurance coverage to more people. However, both government programs, Medicaid and the Government-Sponsored
Enterprises (GSE), will have to coordinate in some way with each other.
A great deal of the burden in the coordination and enrollment of these programs will fall on the states. According to the Kaiser Com-
mission on Medicaid and the Uninsured, it is commonly understood that “given the expected new demands on Medicaid eligibility
and enrollment systems, and continuing fiscal strains on states, the impetus to streamline and automate Medicaid systems has never
been greater.” Many believe this task will be difficult for states to execute. U.S. hospitals expect a $155 billion reduction in Medicare
and Medicaid funding over the next decade as a result of the ACA’s cost for health care reform. Disproportionate Share Hospitals
will be affected more so than most since they receive a significant portion at a higher rate of reimbursement for services that treat
more uninsured than insured. The Center of Budget and Policy Priorities found that 48 states had budget short falls in 2009 and
2010, and estimates that 46 states will continue to have budget shortfalls in the following year, which places the States’ ability to
provide matching funds in question. With budgets decreasing, unemployment and Medicaid eligible patients increasing, and health
insurance exchanges forming, how do hospitals continue to assist their patients and ensure the fiscal health of the hospital?
Douglas Elmendorf, head of the Congressional Budget Office (CBO), recently remarked in a letter to Senator Max Baucus, Chair-
man of the Senate Finance Committee, that one of the greatest difficulties in enrolling people who are eligible for government pro-
grams is the application process itself. One solution he saw was to create a more “efficient enrollment process.” Elmendorf indicated
that an additional 14 million people would become eligible for Medicaid and CHIP under the new ACA guidelines. Even if states
accomplish the goal of streamlining and automating Medicaid systems, it does not mean that patients will actively seek out and en-
roll themselves. Since there will be more Medicaid-eligible patients than ever before, hospitals will require a process that will
quickly screen and fill out all the extensive paper work in order to expedite and secure approval for Medicaid and other programs.
Individuals won't be registered for these programs and taking advantage of their benefits until they find themselves in need of it, sick
in the hospital. The car insurance industry has shown us that just because the state mandates auto insurance does not mean every
driver has it. Often times, an accident will have to occur before an uninsured motorist looks to find insurance. In order for the hospi-
tal to gain reimbursement, it will have to educate patients on their options, and assist them with their enrollment in Medicaid, insur-
ance exchanges, or other available programs.
The verification of information will also have greater importance as the ACA established the new IRS Code Section 501(r), which
requires hospitals to take action and confirm if a patient is eligible for financial assistance, and states look to implement investiga-
tions similar to (Recovery Audit Contractor) RAC audits on Medicare. The Washington Post recently published an article on North
Carolina’s hiring of IBM to review the past six years of Medicaid data for questionable payments. Now more than ever, the burden
of proof is being placed at the feet of the hospital, not the patient.
In their executive summary titled “Optimizing Medicaid Enrollment: Perspectives on Strengthening Medicaid’s Reach under Health
Care Reform,” Julia Paradise of the Kaiser Commission on Medicaid and the Uninsured and Michael Perry of Lake Research Part-
ners, found and suggested “it is appropriate for CMS to spearhead automation efforts by developing model enrollment systems for
states and providing technical assistance and incentives to promote their adoption.” Whether or not the states will be able to accom-
plish this remains to be seen, whereas hospitals are afforded a better chance of success on the front lines of patient interaction and
care and have a major incentive to assist patients in enrollment than the state. The only way hospitals can handle the volume of nec-
essary enrollment while driving down costs is through automation.
Automation is the Key to Efficient Health Care Reform
By: Christopher Thunder and Ryan Brebner, R&B Solutions, Waukegan, Illinois
P A G E 1 1 CAROLINA CHAPTER
In doing this, hospitals keep with best practices, and all patients are screened for multiple programs at once with the same
questions, which eliminates the possibility of repetition and other forms of human error. Automation also enables providers
to maximize staff time and efforts, and allow the service to be offered in outpatient areas. Programs with integrated calcula-
tors can compute spend-down requirements, as well as insurance exchanges enrollment fees by the 2014 ACA deadline. All
of this information is kept on file for report generation and the IRS 990, which will also eliminate duplicate applications in
multi-system hospitals. At the end of the interview, the tool will bring forth the completed application for the best program
the patient is eligible for, any necessary attachments, an electronic signature, and the documents required by the state for
eligibility determination, such as electronic pay stubs and tax return information. By being electronic, the application is
then capable of being submitted online, or by facsimile, with tracking information returned to the hospital.
If the goal of Healthcare Reform is for all Americans to have access to some form of medical coverage, then hospitals will
need to play the largest role in assisting people towards the proper access channel and the appropriate form of eligibility.
Hospitals are in the unique position of seeing patients when they will need coverage the most: at the time of care. The ACA
does offer some direction in terms of an approach to handle the millions of newly eligible patients, but the guidance does
not provide the means to properly assist the millions more currently now eligible or eligible-but-not enrolled. Unfortunately,
the current state of the economy means hospitals will have to do more with less, and assist a greater number of uninsured
patients. Automation will be the key component at the state level (as laid out in the ACA), and also for hospitals to handle
the Medicaid increase and maximize their reimbursement across a variety of repayment options.
Christopher Thunder is a freelance writer for R&B Solutions, a Medicaid Advocacy company headquartered in Waukegan,
Illinois.
Ryan Brebner is Manager of Business Development for R&B Solutions, and is responsible for leading the company’s sales
and marketing. Ryan is an active member of HFMA, AAHAM, and NAHAM. Ryan graduated from Saint Norbert College
in DePere, Wisconsin with a Bachelor of Arts in Politics and Philosophy. For further information, Ryan Brebner can be
reached at 847-887-8514.
About R&B Solutions: (www.randbsolutions.net) R&B Solutions is a leading Medicaid Advocacy corporation that both uninsured patients and medical providers alike have
come to trust to solve many of the problems facing uninsured patients and the medical facilities from which they seek help.
R&B Solutions offers a wide variety of solutions for medical providers to assist their patients. The company uses highly-
trained patient advocates efficient in State Human Services processes, internally developed software, and years of legal ex-
perience to identify and assist the uninsured. R&B Solutions offers expertise in the field of Medicaid Advocacy (inpatient
solution), Solutions for Uninsured Patients (SUP), outpatient solutions, and RAMP (Rapid Application for Medical Pro-
grams), proprietary software that screens for Medicaid and charity eligibility. Founded in 1986, R&B assists health care
providers and their uninsured patients across the United States.
P A G E 1 2
C A R O L I N A C O M M U N I C A T O R
Join the Carolina Chapter of AAHAM today!
Contact Rayanna Moore at
(828) 262-4100 for
Membership Information.
Hospitals Can Assist the Uninsured in Getting State & Federal Risk Pool Coverage
NC High Risk Pool Lowers Federal Pool Rates Up to 31%
One of the major obstacles faced by the North Carolina Health
Insurance Risk Pool, Inc,, better known as Inclusive Health, is
raising awareness about our existence and reaching individuals
that are uninsured and need affordable health insurance options.
Since opening our doors in January 2009, we’ve had success with
enrollment events and publicity through media across the state.
This year, we are also extremely excited about a statewide adver-
tising campaign launched in December. Also effective January
1st, Inclusive Health lowered its rates for the new federal high
risk pool by 10% - 31%. As a result of all of these efforts, our
name is getting more known throughout North Carolina: traffic at
both our web site, www.InclusiveHealth.org, and our toll-free
customer service phone line continue to increase each month.
So at this point we are grateful for this opportunity to turn to
you the front line to uninsured individuals with pre-existing
medical conditions to ask your help. North Carolina’s hospitals
were very supportive of the establishment of Inclusive Health.
And no other group is more important in assisting North Carolini-
ans in figuring out how to pay for the health care they need than
hospital financial management staff.
Indeed, hospitals have played a valuable role in Inclusive
Health’s efforts to spread the word to the estimated 200,000
North Carolinians who may need us. Inclusive Health has helped
orient hospital financial assistance staff around the state in our
eligibility and application process and individual hospitals have
stepped up to inform and assist their patients in applying. In ad-
dition, facilities have hosted enrollment events staffed by Inclu-
sive Health and its participating agents where over 700 commu-
nity members have come to seek information and assistance in
applying for coverage. Among the standouts have been Novant
Health and Gaston Memorial. It is important that hospitals make
uninsured individuals aware of Inclusive Health and that there are
options in getting and finding insurance with an affordable pre-
mium even if you have a pre-existing medical condition.
Affordability is always an issue for the uninsured seeking health
coverage. For this reason, we are particularly excited about of-
fering more affordable rates to our Inclusive Health – Federal
Option members and applicants who are enrolled under the Fed-
eral Pre-Existing Condition Insurance Plan. The federal pool rate
reduction is part of a range of efforts to enhance the affordability
of Inclusive Health for North Carolinians with pre-existing condi-
tions. It follows the risk pool’s October announcement of a $2.1
million federal grant to fund premium subsidies to Inclusive
Health - State Option members. The subsidies take the form of
discounts of 20 - 43 percent based on income of up to 300 per-
cent of poverty through a program known as Inclusive Health
Assist. We expect to help up to 1,000 eligible state pool members
reduce their monthly premiums through Inclusive Health Assist.
For more information or to download an application, please go
to: http://www.inclusivehealth.org/stateoption/subsidy.htm.
News of the federal rate reduction comes just as Inclusive
Health kicks off a statewide ad campaign today in an effort to
raise awareness among uninsured North Carolinians that they do
have an affordable health insurance option. The TV and billboard
ads are aimed at increasing the number of members enrolled in
Inclusive Health – Federal Option as enrollment to the federal
pool has been lower than expected. Our members offer a com-
pelling portrait of how decent and affordable health coverage
changes peoples’ lives. Through this campaign, our message to
North Carolinians with pre-existing conditions as Janet Riggs
says in her ad is that “You are insurable”. And with these rate
reductions and premium subsidies, Inclusive Health is more af-
fordable than ever.
We would like to challenge North Carolina’s hospitals to do
whatever they can to make your patients who could benefit from
Inclusive Health, aware of our existence and to assist them in
how to apply. Anyone interested in Inclusive Health can visit
www.InclusiveHealth.org or call the Customer Service line at
(866) 665-2117. If you are interested in scheduling a training for
your staff on Inclusive Health or in hosting an enrollment event
please contact Lisa Gibson at (919)783-5766.
By:
Michael Keough
Executive Director,
Inclusive Health
P A G E 1 3
C A R O L I N A C O M M U N I C A T O R
Changes in Professional Certification
Effective January 1, 2011
Effective in January we are rolling out important changes to the way the Professional Certification Program is ad-
ministered. As an organization we want to make sure that the program maintains its reputation as the premier Pro-
fessional Certification for the Healthcare Administrative Manager. It is important that we structure our certifica-
tion program so that the achievement of past and future members is not jeopardized. We do this by:
Continuing to maintain the integrity of our Certification Program
Guaranteeing impartiality and autonomy in coaching and administration of the exam
Assuring the program structure is free from the influence of the governing Board
Ensuring an unfair advantage is not offered to examinees
To meet these important criteria, we need to make some changes to the policies and procedures related to Certifica-
tion. These are outlined below:
There must be certain separations of duties and capabilities
The Executive Committee may not participate in activities related to design, scoring, or eligibility decisions
regarding testing.
This prevents activities by the governing board that may be attempts to give advantage to a certain person or group,
or circumvent policies that are designed to preserve the integrity of the certification program.
A person who participates in designing test questions may not coach examinees or proctor exams
A person who participates in grading exams may not coach or proctor
A person who coaches may not grade exams or proctor
A person who proctors may not grade or coach
These are important because certain functions lead to knowledge of test questions, and an examinee who was
coached or proctored by someone who knew the exact questions and answers could be perceived to have an advan-
tage over other examinees. Additionally, although grading is anonymous, it is manual and could lead to the per-
ception of unfair advantage.
There must be controls on distribution of test information to prevent any unfair advantage or perception of
such to any examinee(s)
No person who participates in test authoring, grading, coaching or proctoring may take an exam for the 2 years
following that activity
This prevents an unfair “insider knowledge” advantage gained by seeing test questions in advance of testing.
All persons involved in certification activities, including examinees, must sign a confidentiality agreement.
This is important for protecting the examination questions. The bank of available questions is relatively small, and
cannot become public knowledge, lest the test become valueless.
Proctors must not only oversee the actual exam but must be willing to intervene in the event of unacceptable
activity.
Continued on page 14
P A G E 1 4
In addition, the eligibility to fulfill certain duties is changing.
Proctors may be AAHAM Certified, or any person in a manager role, so long as the proctor is neither a direct report nor direct
supervisor of the examinee. Proctors may also share or split duties, so long as each proctor meets eligibility requirements.
The number of CEU’s for coaching and grading is being increased – 2 for each hour of coaching and 1 for each test section
graded.
The Professional Certification exam will be rewritten by ad hoc committee every two years, with semi-annual review by the
Professional Certification Chair. CEU’s will no longer be available for individual submission of test questions.
AAHAM reserves the right to refuse to allow participation of individuals or groups in certification activities. Such matters will
be decided by the Certification and Executive Committees.
Because they are open to any person, nationally held coaching events may be led by persons otherwise ineligible due to prior
grading, writing etc. activities. National Coaching Events will be the only officially sanctioned coaching programs.
The Confidentiality and Proctor agreements are enhanced.
The Practices and Standards Committee will formulate policies to deal with violations of the above or other matters concerning
certification.
Here is a helpful chart showing how duties may not interrelate:
When it is finalized, we will send a copy of the updated section in the Chapter Operations Manual and related documents which can
be shared with chapter members. We will continue to send out email and blog reminders for a few months, and the changes can be
mentioned at each chapter’s next local meeting.
Chapter Certification Chairs can help make sure these changes are implemented by sharing the information with certified members,
and by taking note of who performs which certification roles for the chapter.
We will monitor the impact of these changes and evaluate any adjustments that may be needed to continue to keep AAHAM’s certi-
fication program as the premier testing program for PFS staff and professionals.
New Test Questions/Rewrite
Exam
Coach for Professional
Exams
Proctor Professional
Exams
Grade Professional
Exams
No coaching No grading No grading No coaching
No proctoring No proctoring No coaching No proctoring
No grading No question rewriting No question rewriting No question rewriting
No testing No testing No testing
Changes in Professional Certification (cont.)
P A G E 1 5
CAROLINA CHAPTER
AAHAM needs support and involvement from its members.
No matter how much or how little time you can contribute, your colleagues will appreciate your efforts. If you are not involved, there is no time like NOW to get involved. It is often said, the more time you contribute to an organization, the more you gain from your membership.
Getting involved in the Carolina Chapter of AAHAM is as simple as contacting Steve Duncan or Wanda Welch and letting them know of your interest.
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