HFMA e-learning lessons support hospitals' capital strategies: the typical hospital has so many capital needs. To keep up with patient demands, they need to invest in new technology. And many have aging facilities that have seen better days

Healthcare Financial Management, Annual, 2006

Many hospitals are experiencing difficulty in accessing capital to meet a glut of current and future needs. According to HFMA's Financing the Future series (Report 4, The Future of Capital Access, May 2004), cash from operations will play a key role in increasing hospitals' supply of capital in the future, both as a direct source of capital and as a reflection of operating efficiency. Credit rating agencies examine a hospital's operating efficiency to determine the hospital's rating, which in turn affects the hospital's ability to access capital from external sources.

It's not just hospital executives who make decisions that contribute to the organization's operating efficiency. It's staff at every level, starting with patient-access staff. In fact, patient-access staff can affect a hospital's ability to obtain capital to meet ongoing and future needs.

How? The answer is simple. These key staffers play an enormous role in maintaining and improving a hospital's cash position, which can affect your hospital's credit rating--and ultimately, its access to capital. The smallest actions that patient-access staff take can affect whether a hospital is paid, on time, for its services to patients. What happens if the staff person enters the wrong information in the master person index? What happens if he or she doesn't obtain the clinical documentation needed to support a claim?

What happens is that the hospital won't see the money. And the organization may need to spend even more time and money to rework claims in an effort to recover the payment that it should have received in the first place. A continuing pattern of claims denials can lead to great difficulty in achieving a hospital's capital projects.

Training with HFMA e-Learning

Hospital financial executives can address these problems by helping patient-access staff learn the best ways to achieve the goals of decreasing claims denials. Effective training is the key--and HFMA has developed its e-learning program to provide such training. HFMA's Avoiding Claims Denials e-learning series consists of 80 lessons that help patient-access staff understand their important role in ensuring the hospital's financial health--and, ultimately, its access to capital. Using scenarios that staff face in their daily encounters with patients and clinical staff, the lessons explain the actions staff members can take to improve your hospital's chances of being paid accurately and on time.

The Avoiding Claims Denials series includes 60 lessons focusing on avoiding denials and 20 lessons on claims denial management. The Claims Denial Management group of lessons is aimed at hillers and managers who rework, resubmit, or appeal claims denials.

The ultimate aim of the lessons in the Avoiding Claims Denials series is to help hospitals take every action necessary to ensure that they are paid for their services. But the series also instructs staff in other important areas, including:

* Introduction to the Business of Health Care

* EMTALA

* HIPAA privacy rules

* Customer service

* Uninsured and underinsured patients

* APCs

* Culture change to decrease denials

* Successful appeal letters

* Accuracy in charging

In late 2005, HFMA is planning to debut another set of lessons that can help improve hospitals' cash positions. The new lessons will focus on cost control. For information on all of HFMA's e-learning lessons, e-mail orglearning@hfma.org, or call Meg Flanagan at (800) 252-4362, ext. 310.