1. No category

January - February 2004
Mountain Views is the official newsletter of the
New Hampshire/Vermont Chapter of the
Healthcare Financial Management Association.
How to Develop Better Reports
to Influence Decision-Makers
By; Steven Berger,
Healthcare Insights
Over the years, it has become
apparent that there is a significant
variation in the level and quality of
reports and reporting that are being
presented to decision-makers within
the hospital and healthcare industry.
This observation comes from discussions with a variety of people
within the industry and the study
and teaching of the subject, through
the National HFMA class, Turning
Data into Useful Information, for
many years.
answered is, “Do what again?” Is
there really going to be any change
in the outcome if no additional
inputs are provided?” Very unlikely.
And yet, this dialogue is played out
over and over again in organization
after organization to no avail.
Why do we allow this dialogue to
repeat itself and...what can we do
to improve the outcomes so that the
decision makers become comfortable enough to make informed
decisions that have a better than
average chance of succeeding?
There are many good reporting
Good reports can always be produced. It is simply a matter
of asking the right questions and developing information
in the proper format to answer them.
Essentially, decision-makers (defined
as anyone that makes a decision
that will impact the financial, clinical
or operational outcomes of the
organization) are being provided
with reports by analysts that do not
generally provide the type and level
of information needed to make an
informed decision. This is not an
idle reflection but rather a commentary on the state of information
flow being delivered. Ask yourself
how many times you have heard this
statement...after giving (as the
analyst) or receiving (as the decisionmaker) a report, “Well, this is a nice
report, but it just does not give me
the kind of information I need to
make a decision in this case. Please
go back and do it again!” Now the
real question that needs to be
techniques that the analyst can use
to improve the quality of the reports
they are preparing and presenting
to decision-makers. However, these
reporting techniques have not been
effectively disseminated throughout
the industry, leaving many decisionmakers without the information
they require.
Good techniques include the use of
well organized and developed
processes and methods that make
for value-added and usable reports.
There are a number of elements
that should always be present in the
best reports. These elements are:
- Usefulness - as defined by the user
- Relevance - as defined by the user
- Simplicity
- Comprehensiveness
- Consistency
- Appeal
- Accuracy
- Timeliness
- Commentary inclusion
Importantly, the best way to ensure
that the reports will be useful and
relevant to the user is to ask a series
of questions that relate to the
report being developed. The
questions that the report creator
should ask, of the primary recipient,
after learning who that is, are:
- Who else will be receiving the
report?
- What is the purpose or objective
of the information being used?
- What time period will the report
cover?
- How often will the report need to
be generated?
Then, the report creator can
determine:
- What kind of information will
satisfy the objective?
Continued on page 3
INSIDE
WORDS FROM YOUR PRESIDENT
GREAT CARE, SMART BUSINESS
HOME HEALTH ISSUES AFFECTING
MEDICARE & MEDICAID
NEW MEMBER PROFILE
MEDICARE QUICKSTOP
LEARNING MENTALITY
MEMBER ORIENTATION
TECHNOLOGY CORNER
ELECTRONIC MEMBERSHIP DIRECTORY
OIG AUDITS COMPLIANCE
NAVIGATING CLAIMS GRIEVANCES
NEW MEMBERS
FOUNDER MERIT SERIES
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Officers &
Newsletter Policy
President
Kathryn T. Davila
603-569-7561
Email: [email protected]
President-Elect
Tina E. Naimie, CHFP, CPA
603-526-5339
Email:
[email protected]
Secretary
Steven J. McClafferty
802-447-5040
Email: [email protected]
Treasurer
Bruce H. LaPoint
802-888-8124
Email: [email protected]
Newsletter Editors
Ellen Gagnon
603-629-1112
Email: [email protected]
Kirsten Geoffrion
603-629-1171
Email: [email protected]
Newsletter Committee
Ellen Gagnon,Co-Chair
Kirsten Geoffrion, Co-Chair
Dartmouth-Hitchcock
Tara Durkee
Berry, Dunn, McNeil & Parker
Dave Ellis
CIGNA, NH
Janet Hodgdon
Baker, Newman & Noyes
Candi Smith
Blue Cross Blue Shield of VT
Diana Whitney, CHFP
IDX
MOUNTAIN VIEWS is published five times
a year.
Our objective is to provide members with
information regarding chapter activities as
well as ideas to help the individual in the
performance of his/her duties.
EDITORIAL POLICY-The editor strongly
encourages the submission of material for
publication. Articles should be typewritten
and double spaced. Letters should be neat
and legible and must be signed. The editor
reserves the right to edit material and
accept or reject contributions whether
solicited or not.
Send all correspondence, or materials for
publication, to:
Kirsten Geoffrion
Dartmouth-Hitchcock
1 Bedford Farms
Bedford, NH 03110
FAX: 603-629-1195
Opinions expressed in articles or features
are those of the author and do not necessarily reflect the views of the Healthcare
Financial Management Association, New
Hampshire/Vermont Chapter or the editor.
Page 2
Words From Your President
Working Smarter....
A Concept to Ponder
find a more solid solution.
Our contributions both large and
small help shape our future and the
future of those to follow. How well
we contribute will determine how
well those behind us will forge the
future. I’d love to hear from you
anytime - catch me at an education
session or drop me a line at
[email protected] or give
me a call at (603) 569-7561.
Sincerely,
Kathryn “Kasey” Davila
NH/VT HFMA Chapter President
We are all dealing with insurmountable task lists, pressing
schedules, complex issues and difficult
decisions. Due to this environment we
surely find ourselves presented with
the challenge of fixing or resolving a
situation “on-the-fly”. We apply a
band-aid as a temporary quick-fix to a
situation to allow for movement to
the next item or issue, and over time
that temporary solution becomes
locked into place.
The stickiness of the band-aid
dissolves, the situation resurfaces,
and you find yourself revisiting that
same thing attempting “yet again” to
resolve a problem that should have
been dealt with more efficiently
or effectively when first recognized.
You are still juggling the list, the
schedules, the issues, and the
old adage that hind-site is always
20-20. How much of that insight
would have been available if you had
allowed yourself to “work smarter”
not faster or harder when the issue
first appeared?
The concept of working smarter, and
not harder or faster, is often challenging to achieve and often not the
path of least resistance. I challenge
you in today’s hectic lifestyle and
workplace environment to press
forward and allow yourself the
latitude to breath and to use your
intelligence and expertise more fully.
Look at some of your past solutions
and what took you down that road.
Look to see if there are band-aids
ready to let loose or fall off. Engage
yourself; think about it, I bet you’ll
New
Ideas
Needed
What new topics would you
like to see addressed in this
newsletter? The newsletter
committee would love to
hear your ideas for articles.
We are interested in a variety
of topics that would appeal
to a broad scope of readers.
If you have an idea that you
would like to share, please
send it to Kirsten Geoffrion at
Kirsten.Geoffrion@hitchcock.
org. If you can suggest
someone who could write the
article, or if you can write it
yourself, please include that
information. Remember that
you receive 2 Founders points
for every article that gets
published in the chapter
newsletter. This can make a
significant contribution if you
are working towards earning
or maintaining certification.
The newsletter committee
will review all ideas submitted, and select those that
we think will interest our
members.
Mountain Views
How to Develop Better Reports to Influence Decision-Makers Continued from Page 1
Major Types of Accounts Receivable as a Percentage of Total Receivables
- What is the appropriate medium
for the report (Paper, Electronic)
- What design elements should be
utilized? (Words, Tables, Graphs,
Pictures)
If this process is used, the report that
is developed should always be
relevant and useful. The report
creator still has to incorporate
the other design elements into
the report to make it appealing,
comprehensive, simple, consistent
and clear.
Let’s take a look at a report that
meets all of these criteria and was
extremely effective in allowing the
decision-maker to make a decision.
The purpose of this chart was to
allow the hospital’s Chief Executive
Officer (CEO) to understand why
there had been a significant dropoff of cash over the previous six
months, so that action could be
taken to improve the cash receipts.
According to the narrative that
accompanies this chart, it indicates
that the discharged and not final
billed categories, both inpatient and
outpatient, have been the cause of
Mountain Views
the greatest increases in the
accounts receivable. In July of 1999,
these two categories made of about
12% of the outstanding receivables
($4.7 million). At December of 2000,
these same two categories made
up about 26% of the receivables
($9.7 million).
This chart was designed to incorporate several helpful design
elements, including:
- Trending
- Stack bar
- Actual dollars (shown in the table)
- Percentage of actual dollars
(shown in the graph)
When this report was presented to
the CEO, he recognized that the
major cause for the lack of cash
receipts was the hospital’s inability
to bill out over 25% of its accounts
on a timely basis. At this hospital,
although the CFO was responsible
for the level of the accounts
receivable, the CEO had the VP of
Operations responsible for the
Medical Records coding. After
reviewing this report for less than a
minute, the CEO concluded that
henceforth, the coding operations
would report directly to the CFO.
In this case, there was no need for
the CFO to raise the issue of a
change in generic terms and argue
the case in opposition to the VP of
Operation. The report provided all
the relevant information for the
CEO to make an immediate and firm
decision. No addition information
was requested, nor was it required.
This was a successful, value-added
report.
Good reports can always be
produced. It is simply a matter of
asking the right questions and
developing information in the
proper format to answer them. It
will take a little time and some
practice, but your career and the
organization’s fortunes should
prosper from it.
Steven Berger is President of Healthcare
Insights, a firm specializing in healthcare
general and financial training, the
INSIGHTS management accountability
decision support software system. He
can be reached at [email protected] or
by phone at 847-362-122 or by website,
www.hcillc.com.
Page 3
Great Care, Smart Business:
How Mid-level Providers Enhance Medical Practice
By: The Physician Practice
Committee
Many hospitals and physician
offices employ Nurse Practitioners
and Physician Assistants in the
primary care, specialty, and surgical
practices. What is the best role for
them in these settings? How do
their productivity and expenses
compare to physicians? How do
you bill for these services and what
is the reimbursement?
What follows is an overview of an
upcoming conference co-sponsored
by NHVT HFMA and NH MGMA,
scheduled for Wednesday, March
10 at the Yard in Manchester. The
program will begin
with Kevin Stone,
giving an overview of
the roles of mid-level
providers in physician
practice-what works,
what works well. He
will present data from
the HFMA survey of
practices in northern
New England about
mid-level providers.
patients. In some practices with
busy walk-in traffic or high demand
for last minute visits, one clinician
sees all of the walk-in and same day
appointments, leaving all of the
other providers to see their regularly scheduled appointments
without double booking. This is
typical in a medium to large
practice. The role of the “acute”
provider may be rotated. In many
primary care practices, NP’s and
PA’s follow their own panel of
patients and provide a full range of
primary care services. Women clinicians often find their schedules
filled with adult care for female
patients. Many female patients
Join NHVT HFMA on March 10
at the Yard in Manchester
for an in-depth look at the roles,
economics and billing
for NP and PA services.
Three clinicians will discuss their
roles. A surgical PA will describe
the type of work he does. In
addition to assisting at surgery,
surgical PA’s often do pre-op visits
and follow patients post-operatively during the global period,
including managing complications,
responding to patient phone calls,
and doing post-op visits. In
addition, many PA’s in surgical
practices will do all or part of a
consult requested by another
health care provider. Economics
and reimbursement often influence
the role of the PA: assisting is reimbursed at a low level and so it
makes sense to have a PA perform
that task, freeing up another
surgeon to either operate or see
office patients. Also, the post
operative care is bundled into the
global payment. If the PA provides
that service, it also frees up the
surgeon for other tasks.
PA’s and NP’s in primary care
offices perform various roles and
responsibilities in caring for
Page 4
prefer to be seen by a woman
clinician, and whether the clinician
has expressed a particular interest
in this area or not, her schedule is
often filled up with these visits.
The role of the PA or the NP in a
non-surgical specialty practice
varies by the specialty practice and
its needs. Some perform all or part
of a consultation service. In some
practices, the clinician may perform
specific tests, such as stress tests, or
provide on-going follow up care of
chronically ill patients.
The billing rules for NP’s and PA’s
vary slightly by payer. Medicare,
and most third party insurance
companies, credential NP’s and PA’s
on their own. Medicare will pay for
services billed under the PA or NP’s
provider number at 85% of the
physician fee schedule rate. PA and
NP services can also be billed
incident-to the physician services
for Medicare patients.
The incident to requirements are:
• the service must be provided in
•
•
•
•
the physician office,
it must be part of the physician’s
plan of treatment,
the physician must remain
involved in some way in the
treatment,
it must be the kind of service
typically provided in a physician
office and
the physician must be in the
office at the time the service is
provided.
Effectively, that means that new
patients and established patients
presenting for new problems
cannot be billed incident to, but
must be billed using the PA’s or
NP’s own provider number. It is an
urban myth that the NP/PA can’t
bill consults or high level E&M
services–they can.
Join NHVT HFMA on March 10 at
the Yard in Manchester for an indepth look at the roles, economics
and billing for NP and PA services.
As an added bonus, you’ll hear the
results of the HFMA practice survey,
describing productivity and salaries
of mid-levels employed in northern
New England.
Did
You
Miss It?
For those of you who may have
missed it we ran a series of
articles featuring “Leadership”
that
began
with
the
September/October Issue. This
series will conclude with a 1/2
day workshop titled “Put Some
Learning Muscle into Your
Organization:
Practical
approaches to prioritizing,
developing and implementing
learning opportunities that
will make a difference”. This
workshop will be held on
March 25, 2004 at the Fireside
Inn, W. Lebanon, NH.
Mountain Views
Home Health Agencies Monitor Issues Affecting
Medicare and Medicaid Reimbursement
By Susan M. Young,
Executive Director, Home Care
Association of New Hampshire
MEDICARE.
With Medicare the source for about
70% of home health revenues in
New Hampshire and 50% in
Vermont, providers have closely
tracked the changes that the
Medicare Prescription Drug,
Improvement and Modernization
Act of 2003 will bring. Here’s a
quick rundown of the provisions
expected to have the greatest
impact on home health agencies:
Rural Add-On. A one-year 5% addon for home health services
provided in rural areas (six of NH’s
10 counties, 11 of Vermont’s 14) will
affect episodes or visits ending on or
after April 1, 2004, and before April
1, 2005. Ten of Vermont’s 12
agencies will benefit from the addon, while just over half of NH’s
Medicare-certified agencies are
eligible for the increase. Last year
Vermont lost about $3 million
(annualized) when the temporary
10% rural add-on expired.
Home Health Market Basket Index. The
annual inflation adjustment for home
health services will be reduced by .8%
for the last three quarters of calendar
year 2004, and all of calendar years
2005 and 2006; subsequent changes
to market basket updates will occur
at the beginning of calendar years
rather than fiscal years.
MedPAC Study on Home Health
M a r g i n s . The Medicare Payment
Advisory Commission (MedPAC) will
conduct a two-year study on home
health agencies’ payment margins
under PPS to determine if differences among agencies are due to
case-mix variations or other factors.
In December 2003 MedPAC staff
indicated that HHA margins are
quite healthy, leading some of the
members to question whether any
market basket update is needed at
all in the next year.
GAO Study on Medicare-Only CoPs.
The General Accounting Office
(GAO) is to report in six months the
Mountain Views
implication of applying home health
conditions of participation (CoPs)
only to Medicare beneficiaries. The
potential for a change here could be
helpful for agencies struggling with
Medicare-mandated costs in their
private duty and state-funded
programs.
Homebound Demonstration. CMS will
conduct a two-year demonstration
project to test whether exempting
individuals with severe and permanent chronic illnesses or disabilities from the homebound
restriction will increase utilization
and costs of the Medicare home
health benefit.
Medical Adult Day-Care Demonstration.
CMS will conduct a three-year, fivestate demonstration project on the
substitution of medical adult daycare services for a portion of services
that are prescribed in a home health
plan of care; payment will be 95%
of the PPS episode rate. HHAs may
provide these services directly or
under arrangement with a medical
adult day-care facility.
MEDICAID and
STATE PROGRAMS
While Medicare contributes the
most to the income statement,
Medicaid is the major source of
operating losses for many agencies
in New Hampshire. Although
providers were spared rate cuts in
the state budget for 2004-05, they
won’t see rate increases either. NH
home health reimbursement rates
were last adjusted in 1999. For
some providers, this may force
decisions on whether they can
continue to serve Medicaid or other
state-funded clients. Early in 2004
the Home Care Association of New
Hampshire will be providing a cost
analysis to NH DHHS, which is
required by statute to review rates
for home health services annually
and revise rates to reflect the
average cost to deliver care. The
report will also go to legislative
leaders, along with a reminder of
the statutory requirements to adjust
rates.
In Vermont, Medicaid payments for
most home health services are
adequate, according to Peter Cobb,
Executive Director of the Vermont
Assembly of Home Health Agencies.
However, the VNAs do subsidize a
number of state-funded programs,
including homemaker and Healthy
Babies, Kids and Families.
So, What
Do You
Think?
This is our first electronic version of
Mountain Views, which
is an exciting opportunity for us to take
advantage of technology that
many of us use every day. This allows us
to reduce chapter expenses while still delivering a high quality
newsletter to our members. We would like to hear your feedback. If
you have any comments you would like to share with the committee
please email them to [email protected]. or to your
Chapter President at [email protected].
Page 5
New Member Profile -
Peter Callahan
We’d like to welcome Peter Callahan
as a new member to our Chapter.
Peter is an attorney, currently in his
fifth year as a Health Care Associate
with Hinckley, Allen & Snyder, LLP, a
full service law firm with offices in
Concord,
NH,
Boston
and
Providence. Peter has worked at the
firm’s Concord office since
September, 2003.
On a day-to-day basis, Peter deals
with a variety of health law issues,
including compliance, fraud and
abuse, corporate transactions, tax
exempt planning, Certificate of
Need applications, HIPAA, EMTALA,
Medicare/Medicaid issues, and
equity transactions for health care
facilities. He works with hospitals,
physician group practices, CCRCs,
and long term care facilities.
Prior to working at Hinckley Allen,
Peter was a corporate and health
care attorney at Hill & Barlow, PC in
Boston. While at Hill & Barlow, he
practiced in many different areas of
the law, including the acquisition of
an OB/GYN clinic, the sale of a $400
million investment firm, and the
construction of a new high school.
When asked about which areas of
the health care business interests
him the most, Peter replied, “I truly
enjoy handling all of our client’s
issues, but my favorite area is counseling early-stage health care businesses. It makes me feel as though I
had something to do with their
success.”
Peter joined HFMA because,
“Financing of health care is a crucial
element that a health care attorney
needs to be trained in.” He feels
that HFMA provides the resources a
lawyer needs to stay on top of the
issues his clients will face. He first
learned about HFMA from Neil
Castaldo, a colleague at Hinckly
Allen.
After graduating from high school,
Peter began a career as a carpenter.
When he was in his mid-twenties, he
lost his sight due to an eye disease.
After this, he attended classes at
Keene State College before entering
and graduating from Boston
College, Magna Cum Laude, and
then Boston College Law School.
Peter lives in Concord, NH with his
guide dog, Rye.
2004 National Spring Seminar Series Register Today!
The 2004 Spring Seminar Series is offering twenty-three seminars
at four great locations:
San Antonio 2/23 - 2/26 • New Orleans 3/15 - 3/18
Alexandria 4/21 - 4/22 • San Diego 5/17 - 5/20
Six new seminar topics have been added for this year:
• Six Sigma in Health-care Finance: A Simulation Session
• Essential Issues of Revenue and Reimbursement Strategies
• Patient Access: Strengthening the Weakest Link
• Step by Step Process for Negotiating, Monitoring and Auditing
Your Managed Care Contracts
• Coordination of Benefits Agreements and the COB Contractor’s Role in
Collecting MSP Data and Handling Unsolicited Checks
• Cost Management: Key Functions to Improved Budget Control
Register online at www.hfma.org/spring and save $75 off your registration total!
Page 6
Mountain Views
More Ideas on How to Foster a Learning
Mentality in Your Organization
By Cynthia Low Johnson, FHFMA,
Director, Knowledge and
Education Technology
IDX Systems Corporation,
Burlington, VT
more exposure to the customer will
increase the employee’s true understanding of customer needs and
improve the service they
offer.
In the past issues of this column, we
focused on the definition of a
learning organization and a few
ideas on how to provide your staff
with learning opportunities. While
training classes can often provide a
foundation to learning, they are not
the end but rather, they are just the
beginning. Learning should take
place continuously and it is those
organizations that support and
foster
ongoing
knowledge
gathering and creation that truly
succeed. Here are some additional
ideas on how to broadly encourage
and foster learning and a learning
mentality, which will ultimately lead
to higher employee satisfaction,
empowerment, and business results.
2) Expose employees
to other organizations. Allow and
encourage
employees to attend
education sessions
that will get them
networking with
other organizations.
Even organize “field
trips” to companies
outside of your
industry; the “out of
the box” thinking this
can instigate has astonished
many!
1) Give employees an opportunity to
meet the customer directly. The
3) Work aggressively on individual
development plans for each
employee. Focus on 1-2 areas a
year, and use the 70/20/10 rule in
coming up with development plans
• For all acute care hospitals, the occupational mix survey has been
released. It is due to the fiscal intermediary by February 15, 2004.
• The final rule for outpatient services effective January 1, 2004 was
published on November 7, 2003.
• The proposed rule for inpatient psychiatric PPS was published in the
federal register on November 28, 2003. Comments on this proposed
rule will be accepted by CMS until January 27, 2004.
• The annual inflation update for ambulance services was published on
December 5, 2003.
• The Medicare Prescription Drug, Improvement and Modernization
Act was signed into law on December 8, 2003. The provisions and
effects are far-reaching and should be carefully considered.
• The final rule for rural health clinics was published on December 24,
2003. The effective date is February 23, 2004.
• CMS has announced a new on-line manual system and it is located at
www.cms.hhs.gov/manuals. It is expected to significantly reduce
redundancy and is expected to streamline the updating process.
• In keeping with the season, a reminder that the Medicare Part B
payment allowance for the influenza virus vaccine (CPT code 90658) is
currently $9.95. Part B deductibles and coinsurance do not apply.
The ICD-9-CM diagnosis code V04.81 must be used for claims with
dates of service on or after October 1, 2003.
For more information visit http://www.cms.hhs.gov/.
Mountain Views
(Create explicit activities to provide
development opportunities for
employees based upon a
70/20/10 split - - 70%
learning based on specific
work assignments, 20%
learning activities using
coaching, mentoring,
shadowing, or learning
from others, and 10%
on courses and self
study).
4) Have “open houses”
in
your
different
departments or even
sections within a single
department. Include
mini presentations,
displays, and learning
activities/games. This will allow
the person to have fun learning
something new plus see how their
work impacts the bigger picture.
5) When you have a business
problem, hold brainstorming
sessions that include people from
outside your area as well as those
familiar with the problem. This can
bring forward thinking and ideas
that are difficult with only the
limited experience of the known.
These scenarios often bring breakthrough thinking and solutions.
6) Rotate jobs. A healthy dose of
“walking in the others’ shoes” can
expand the minds of even the most
seasoned employee. Plus, it will
provide a wider scope of knowledge
about the business, which will ultimately improve understanding of
purpose and thus performance of
the job.
For more ideas and specifics on how
to create a learning organization,
attend the 1/2 day workshop, “Put
some “learning muscle” into your
organization: Practical approaches
to prioritizing, developing and
implementing learning opportunities that will make a difference”,
March 25, 2004, at the Fireside Inn,
W. Lebanon, NH. For more information, contact Cindy Johnson at
[email protected] or Kasey
Davila
at
kdavila@huggins
hospital.org.
Page 7
HFMA Member Orientation
The HFMA Member Orientation
Session was held on December 3,
2003 at Berry, Dunn, McNeil &
Parker. The purpose of the session
was to familiarize new HFMA
members with all the programs and
opportunities available through
HFMA. The program was also open
to any NH/VT member that would
like a refresher course. Many
thanks to all the board members
and committee chairs that attended
and shared their experiences with
the group.
Tracy King from MVP
HealthCare and Tom Bullis
from CBA attended to gain
knowledge of what healthcare
resources were available to
them through their local
chapter.
Diane Maheau, Certification
Committee Chair brings along
Marjorie Moulton, a coworker at Lakes Region
HealthCare, in hopes that she
will join HFMA.
New Member Frank Shipman from Kreg Information Systems gains additional knowledge of HFMA from our chapter President, Kasey Davila.
Program Calendar
2004
Date
Topic
Anticipated Location
02/11/04
Annual Meeting The Future of Healthcare
Fireside Inn, Lebanon, NH
03/10/04
Physician Practice Management
Executive Court, Manchester, NH
03/25/04
How to Develop an Ongoing
Employee Development program
Fireside Inn, Lebanon, NH
Watch your mail for registration materials regarding these workshops. Register Early!
Page 8
Mountain Views
Technology Corner
E-Visit Pilot Launches
By Deb Barnard,
Project Manager - Patient Online,
Dartmouth-Hitchcock
lining the medical issue and credit
card information that may be used
for billing purposes.
In 2001, Dartmouth-Hitchcock (DH),
launched Patient Online®, IDX
Corporations’ 24x7 communications
product. Patient Online (POL) is a
HIPAA compliant, secure product
that replaces nonsecure e-mail messaging. With the
POL module and its
full integration to
IDXtend, (a practice
management
system) patients
access stored data to
create and send
messages to their
providers, view and
update
demographic and insurance information,
pay account balances online
and
request
appointments,
medication renewals, medical
record forms, and referrals. DH
staff and providers use the same
POL application to process the
requests/ messages and respond to
the patients.
Once a provider and patient both
agree to hold an E-Visit, a series of
information exchanges occur.
Medical information provided by
the patient, combined with the
provider’s
knowledge of
the patient’s
history
and
symptoms, and
any
needed
research is used
to complete an
assessment of
the issue. The
provider uses
POL to communicate medical
care and/or questions back to the
patient. The patient receives notification in a personal e-mail account
that a POL response is available and
then uses POL to respond back to
the provider. These exchanges
occur just as if the patient had
come into the office. If an office
visit is needed to further assess the
issue, the E-Visit is ended, and
neither the patient nor carrier is
billed for the interaction.
Through this feature,
patients request
online “visits” with
their medical
providers.
A one-year pilot for the newest
Patient Online feature, E-Visits, was
launched in December 2003.
Currently the feature is available to
any DH Manchester and Nashua
patient with a POL account and a
few health plans have agreed to
participate in the pilot by covering
these services.
Through this feature, patients
request online “visits” with their
medical providers. Patients eligible
for E-Visits are those with a chronic
condition that previously required
face-to-face interactions.
The POL web site provides information regarding the definition
and proper use of E-Visits and
outlines patient financial obligations. Through the system, a
patient provides the initial information, including a message out-
Mountain Views
All POL exchanges are automatically documented in
the system.
At the conclusion of an
E-Visit,
the
provider
selects
the
reason why
the E-Visit has
ended, enters
a CPT and ICD-9
code into POL,
and files the EVisit.
A POL
charge entry task is
automatically generated to the billing
department, where a staff
member processes the task and
enters the charge into IDXtend. All
carriers are billed the same E-Visit
fee and the patient is responsible,
via the stored credit card information, for any non-covered
services and applicable co-pays.
In addition to charge capture, the
provider is responsible for documenting the patient/provider
message exchanges, subjective and/
or objective data, previous medical
history, and assessment and plan
into the electronic medical record
(EMR). This is completed through
copy and paste functionality and
once pasted into the EMR, E-Visit
information is readily available to
providers and staff throughout the
organization.
Response time and the quality of
responses are critical to Patient
Online’s success.
A team of
POL
operations
staff
and
department members throughout
the organization closely monitor
each of these areas. E-Visits, like all
POL requests, are responded to
within twenty-four (24) hours
of the request. Support staff
monitors E-Visit requests on behalf
of providers to ensure that patients
receive an initial response
within the established timeframe.
EMR and coding
analysts review EVisits for clinical
quality
and
coding compliance and
feedback is
given to each
provider. Since
appointments are
scheduled for these
interactions, missing
charges
are
captured through
standard missing
charges reports.
Page 9
The Membership
Directory at
Your Fingertips!
How many times have you turned
the pages of our membership
directory to get a member’s phone
number or email address? Is your
directory dogged eared and falling
apart? Better yet, you are on a trip
without the directory but you need
to
contact a
member who is
the expert and
can answer your
questions in a
flash. But you do
not remember
their
phone
number or email
address. What do
you do?
Before I explain this new technology, let us briefly take a walk
through “Membership Directory
History.” Back in the 1980’s when
people were not as mobile as they
are now, these documents were
your normal 8 x 11 book on your
shelf. We thumbed through it routinely and it was dogged eared.
During the early 1990’s as we
became more mobile, these books
became smaller to pack into our
briefcases. With the age of the
internet and increase use of
computer software, we kept a
“select” list in our contact file. In
the late 1990’s and early 2000’s, the
technology was to have it on a CD.
With the newer technology you can
have the membership directory at
your fingertips. It can reside on your
PDA. We all have one that we carry
with us to meetings or when we are
travelling. Do you, or our mystery
member Joyce Bluhm, have to enter
all those names as contacts? No,
because our directory is saved as a
Word document.
With PDA
software from a company like
Page 10
By Diane Maheux, CHFP
Dataviz, you can open Word, Excel,
PDF and PowerPoint documents.
The software is relatively inexpensive under $ 80 for the premium
version and very simple to install. I
would strongly suggest that you
have your IS department purchase
and install the software for you. In
a matter of minutes, you too will
have these documents on your PDA.
Also, make sure there is sufficient
memory on your PDA to handle the
software and the Word document.
If you have any questions, do not
hesitate to contact me at (802) 4475040 or send me an email at
[email protected]. I will be more than
happy to share this with you!
?
MYST?ERY
? MEM? BER
?
?
Congratulations to Dennis
Brodeur, our Mystery Member for
the November/December issue.
Dennis found his name in the
newsletter and called the editor in
time. In case you are still looking,
his name was hidden in the Patient
Friendly Billing 2003 Update article
on Page 3, second column, last
paragraph. Dennis is a Business
Services Manager at Southwestern
Vermont Medical Center in
Bennington, VT. For calling in on
time, Dennis received an HFMA
sweatshirt with the local chapter
name and national logo.
Can you find your name in this
newsletter? If you see your name
identified as the mystery member,
please call Kirsten Geoffrion at
603-629-1171 or email her at
[email protected] by
February 15, 2004 to claim your
HFMA related prize.
We are always trying to promote
certification and preparing all HFMA
members to take the certification
exams. In that attempt to entice
you to pursue certification, here are
a few questions for you to see how
much you know. The following
could appear on an Accounting and
Finance exam.
1) Which of the following should
NOT be considered when evaluating
a capital investment proposal:
a) cash outflow
c) cash inflow
e) opportunity cost
of funds
b) economic life
d) debt
restructuring
2) If fixed costs are equal to $40,000
and the contribution margin per
unit is $5.00, what is the break even
volume?
a) 4,000 units
c) 8,000 units
b) 6,000 units
d) 10,000 units
3) What type of costs do not change
in volume (in the short run)?
a) variable costs
b) semi-variable
c) fixed costs
costs
d) semi-fixed or stepped variable costs
4) Which of the following is not part
of the operating budget?
a) Capital budget
c) expense budget
d) revenue budget
b) statistical
budget
5) Given the following information,
what is the current ratio for this
facility?
Cash
$100,000
Marketable securities
$150,000
Accounts Receivable
$725,000
Other current assets
$ 30,000
Accounts Payable
$220,000
Other current liabilities
$ 75,000
a) 3.31
c) 3.61
b) 3.41
d) 4.51
So how did you do? If there are
questions on any of the answers,
please drop me an email at
[email protected].
Answers: 1) D; 2) C; 3) C; 4) A; 5) B
By Steve McClafferty, FHFMA
Comptroller, Southwestern Vermont
Medical Center
Test Your
Knowledge Certification
Time
Mountain Views
OIG Audits Compliance for
Outpatient Cardiac Rehab Services
This OIG audit was part of a
nationwide analysis of Medicare
reimbursement for outpatient
cardiac rehabilitation services
requested by the
Centers
for
Medicare
and
Medicaid Services
to determine the
level of provider compliance with national
Medicare outpatient
cardiac rehabilitation
policies. The objective
of this review was to
determine whether
Medicare properly
reimbursed the subject
hospital for outpatient
cardiac rehabilitation services.
OIG’s review disclosed that the
hospital did not designate a
physician to directly supervise the
services provided by its cardiac reha-
bilitation program. In
addition, contrary to
current
Medicare
requirements, OIG could
not identify the physician
professional services to
which the cardiac rehabilitation services were
provided “incident
to.” Also, the hospital
claimed and received
Medicare
reimbursement for outpatient
cardiac
rehabilitation
services which did
not meet Medicare
coverage
requirements, which may not have
been supported by medical record
documentation, or which were otherwise unallowable.
OIG recommended that the hospital:
(1) work with its fiscal intermediary
to ensure that its outpatient cardiac
rehabilitation program is being conducted in accordance with the
Medicare coverage requirements for
direct physician supervision and for
services provided “incident to” a
physician’s professional service; (2)
work with its intermediary to
establish the amount of repayment
liability for services provided to beneficiaries where medical documentation may not have supported
Medicare covered diagnoses and for
services not otherwise allowable; (3)
bill evaluation and orientation visits
only when performed by physician
personnel in accordance with local
medical review policy; and (4)
implement controls to ensure that
medical record documentation is
maintained to support Medicare
outpatient cardiac rehabilitation
services.
We Asked Around...
What is Your
New Year’s Resolution?
“Improve safety in the healthcare delivery process while maintaining
state-of-the-art facilities and equipment and, sound fiscal performance.”
- Thomas Lenkowski, CFO, Vice President of Finance, Southwestern Vermont Health Care
“Successful expansion into the New Hampshire Market.”
- Jim Hester, Vice President for Vermont, MVP HealthCare
“To continue to contribute to keeping the healthcare system in Nashua,
NH running smoothly”
- Emily Blatt, Director, Advantage Network PHO
“Maintain a strong partnership with healthcare providers in New England.”
- Richard M. White, Cigna HealthCare, Assistant Vice President, Provider Contracting and
Provider Relations in New England
Mountain Views
Page 11
Navigating Managed Care
Medical Claims Grievances
By: Richard Scheinblum, Controller,
Monadnock Community Hospital
As financial professionals, it is
imperative that we understand the
definitions and regulations covering
managed care plans, so that we can
be more informed advocates for our
patients.
Health care decisions for managed
care plans in New Hampshire can be
appealed for three reasons:
1. Denials based
necessity.
on
medical
2. Denials based on pre-existing conditions.
3. Denials based on disallowing
On June 22, 2002 in a major victory
access to out-of-network care.
for states, the Supreme Court
affirmed in the Moran Case a 5-4
Vermont’s formal definition is a
decision that the savings clause of
little broader including adverse
the Employee Retirement Income
determinations, claims payments,
Security Act (ERISA) of 1974 that
handling or reimbursement for
gives states the power to regulate
services, or any other matter perinsurance issues of ERISA plans does
taining to their contractual relanot pre-empt the
tionship with the
Illinois independent
insurer.
“This case is important
review statute. This
Typically, plans
case is important
because it clarifies the
covered by this
because it clarifies the
state’s authority in
law are referred
state’s authority in
as fully insured
regulating insurance
regulating insurance issues to
health
plans, such
issues related to ERISA
as
HMO’s
(Health
r
e
l
a
t
e
d
t
o
E
R
I
S
A
p
l
a
n
s
.
”
plans. The decision
Maintenance Orlays down a comganization), P.O.S.
monsense line of difPlans
(Point
of
Service),
or gateferentiation between HMO’s as
keeper
type
products,
where
choices
Healthcare providers governed by
are limited. On the other hand, subERISA strictures, and as insurance
scribers are not eligible for external
providers subject to the strictures of
review under self-insured P.P.O.
state insurance regulation.
(Preferred Provider Organizations)
While 42 states including New
plans and traditional indemnity
Hampshire and Vermont had
products, whereby plans do not conenacted legislation for independent
siderably limit a member’s choices of
review under a managed care plan
care. In short, a key factor to deterat the time of this case, the Supreme
mining eligibility is identifying if
Court’s decision is important
one’s plan is covered under ERISA.
because it paves the way to provide
It’s important for consumers to ask
care givers another option to
their insurance plan administrator if
advocate on behalf of their patients.
the coverage provided is governed
Furthermore, this case provides a
by ERISA. This can make the difprecedent to uphold the state legisference between being eligible for
lation that has already been enacted
an external review and seeking
to protect the subscriber.
remedy via legal or other means.
The decision clarifies that states are
allowed to regulate insurance as a
way to regulate the practice of
medicine, to impose professional
standards for the quality of care
offered by HMO’s and to require
coverage of medically necessary care
as a mandated benefit.
Page 12
Effective September 3, 2000, the
process for navigating the managed
care health care review system is
contained in the following New
Hampshire State Statutes: RSA
420:J5 (XXXVII), RSA 420:J5-A
(XXXVII), and RSA 420:J5-B (XXXVII),
RSA 420:J5-C (XXXVII).
Effective July 1, 1999, Vermont’s
rules are contained in Regulation H99-1: Independent External Review
of Health Care Service Decisions.
Navigating New
Hampshire and Vermont
Managed Care Plan
External Review Laws
Step 1 - Internal Policy and
Procedure Navigation
In general, New Hampshire and
Vermont requires each managed
care plan operating in their state to
maintain written policies and procedures for the claim appeal process
and establishes minimum guidelines
for such issues as claim dollar limits,
reviewer requirements, timing or
process,
and
notification
requirements. The law states that
the first level of appeal should be
completed within 15 days and the
second level of appeal should be
completed within a 30-day time
period beginning from the initial
filing date of the appeal or
grievance. A company’s specific
review process should meet the
state law and can be found in the
subscriber manual.
Step 2 - External Review
The New Hampshire Department of
Insurance (DOI) administers the
external review process. The DOI
publishes the Managed Care
Consumer Guide to External Appeal,
which
can
be
found
at
http://webster.state.nh.us/insurance/
News/External%20Review%20-%20
Consumer%20Guide+.pdf .
The Vermont Department of
Banking, Insurance, Securities, and
Health Care Administration (BISCHA)
administer the external review
process in Vermont. Information
regarding the process can be found
at http://www.bishca.state.vt.us
/RegsBulls/hcaregs/REG_H-99-1.htm
(Section 6 and Section 7).
Mountain Views
All grievances that are deemed to
have merit will be performed by an
independent review organization
(IRO). The standard review process
may take up to 45 days from initial
request to final determination.
Unfortunately, the extended length
of the standard review process does
not meet the needs of individuals
who require an urgent health care
decision because of the acuity of the
presenting problem. As a result,
New Hampshire and Vermont law
does provide for an expedited
review process within 72-hours of
appeal.
New Hampshire and Vermont
versus Nationally
Conclusion
Nationally, subscribers that seek
independent reviews are successful
about 45% of the time in overturning the managed care plan’s
decision. This ranges from a low of
21% in Arizona and Minnesota to a
high of 72% in Connecticut. In this
same study, New Hampshire was
below the national average,
reporting 43% for the period
September 2000 - September 2001.
In addition, plan decisions get
modified another 6% of the time
for those states reporting. New
Hampshire reported above the
national average at 10%.
It’s important that medical providers
in New Hampshire and Vermont
understand their patient’s rights
under the medical grievance procedure. Overall, knowing the law
makes a provider better prepared to
advocate on a patient’s behalf
should a managed care plan deny
care that the physician and patient
deem necessary.
Richard Scheinblum is Controller at
Monadnock Community Hospital in
Peterborough, New Hampshire.
Questions or comments about this
can be sent to richard.schein
[email protected].
The following table depicts the statistics for New Hampshire’s first two year’s
that this law has been in place.
Description
Total number of grievances received
Total number not eligible under statute
Total number eligible
Wholly resolved in favor of covered person
Partially resolved in favor of covered person
Wholly resolved in favor of insurance carrier
Partially resolved in favor of insurance carrier
Pending resolution
Termination as a result of reversal by insurance carrier
Termination requested by consumer
Percent in favor of covered person / eligible
9/3/2000 9/30/2001
10/1/200110/30/2002
29
0
29
11
2
15
0
1
0
0
38%
56
44
12
4
0
6
0
1
0
1
33%
Information from BISCHA was not available for Vermont. Rule 10 requires the healthplan to
maintain these records versus the commissioner.
Welcome New Members of
The NH/VT Chapter of HFMA
Name
Title
Employer
Location
Hillary Halleck
Vicky MacKay
John Morris
Peter Callahan
Thomas Bullis
Sandy Pardus
Ann Gilbert
Stephen LeBlanc
Robin Fisk
Accountant
PFS Supervisor
CFO
Attorney
Accountant
CFO/CIO
Director, Patient Financial Services
Sr. Vice President
Attorney
New London Hospital
Littleton Reg. Hospital
Androscoggin Valley Hospital
Hinckley, Allen & Snyder LLP
CBA/EBPA, Inc.
Lamprey Health Care, Inc.
Speare Memorial Hospital
Dartmouth-Hitchcock
Fisk Law Office
New London, NH
Littleton, NH
Berlin, NH
Concord, NH
So. Burlington VT
Newmarket, NH
Plymouth, NH
Lebanon, NH
Plymouth, NH
Mountain Views
Page 13
New Hampshire/
Vermont Chapter
Sponsors
Because of the generosity
of the organizations listed
below, we are able to offer
quality services, such as this
newsletter, to our members.
To these organizations, we say
thank you.
PLATINUM SPONSORS
Berry, Dunn, McNeil & Parker
New Hampshire/Northeast
Credit Services, Inc.
GOLD SPONSORS
Allied Creditor Service, Inc.
CBA/EBPA
ClaimAssist
Devine, Millimet & Branch, PA
Gragil Associates, Inc.
Kreg Information Systems
Marcam Associates
ProMutual Group
Siemens Health Services
TIAA-CREF
Tyler, Simms & St.Sauveur,
CPA’s, P.C.
SILVER SPONSORS
A Fireside Inn & Suites
Bittel Financial Advisors
Blue Cross / Blue Shield of
Vermont
Comprehensive Healthcare
Solutions
Credit Bureau Services of NH, VT
and ME
Dinse, Knapp & McAndrew, PC
Discover and Recover
Eggleston & Cramer, Ltd.
Hackett, Valine & MacDonald
Harvard Pilgrim Health Care of
New England
Helms & Company
IDX Systems Corporation
KPMG LLP
Legg Mason Wood Walker, Inc.
Medical Bureau/ROI
MVP Health Care
PricewaterhouseCoopers, LLP
Ryan Smith & Carbine, Ltd.
USI Consulting Group Executive
& Professional Benefits
Division
Page 14
Founders Merit
Award Series
HFMA recognizes that its strength
lies in volunteers, who contribute
their time, ideas, and energy to
serve the healthcare industry, their
profession, and one another. Active
participation in HFMA at the
national and/or chapter levels
provides members with numerous
opportunities for professional development, information, networking,
and advocacy.
Established in 1960, the Founders
Merit Award Series acknowledges
the contributions made by HFMA
members at four award levels:
The Follmer Bronze Award
• Named after William G. Follmer,
who is credited with the creation
of the American Association of
Hospital Accountants (now HFMA).
• Is awarded to an individual who
had earned 100 member points.
The Reeves Silver Award
• Named after Robert H.Reeves, an
organizing member of the AAHA,
was elected president of AAHA in
1956 and was instrumental in
creating the structure of AAHA.
• Is awarded to an individual who
had earned 200 member points.
The Muncie Gold Award
• The award honors Fredrick T.
Muncie, an organizing member of
the AAHA, and the first president
of the association (1947-49).
Muncie also assisted in the organization of the first AAHA chapter
(First Illinois).
• Is awarded to an individual who
had earned 300 member points.
The Founders Medal of Honor
The award was added in 1986 and is
conferred by nomination of the
Chapter Board of Directors. This
award recognizes individuals who
have been actively involved in HFMA
for at least three years, have earned
the Muncie Gold Award, have
provided significant service at the
chapter and/or national level in at
least two of those years, and remains
to be a member in good standing.
Points earned by members during
2002-03 are reported by the
chapter's Founders Contact to HFMA
National by August 10 each year.
Member points are totaled and an
award list is generated for each
chapter. The chapter's Founders
Contact verifies the list, and the
awards are then ordered. Although
HFMA National and the chapters
track most member points, it is ultimately the responsibility of the individual member to report points
earned to the chapter's Founders
Contact, who serves as a liaison to
HFMA National.
Founders points are accumulated for
the following:
• Chapter Membership (1 - 4 pts)
• Certification
(FHFMA-6 pts, CHFP-3 pts)
• National-level leadership
(12 - 30 points)
• Chapter-level leadership
(12 - 25 points)
• Chapter involvement
(3 - 12 points)
• Literary contributions (2 points - Note
that articles in HFMA are tracked
by National, others need to be
reported to the Founders Contact
by the individual)
• Educational programs such as ANI, Selfstudy programs or Chapter educational programs (3-day event - 3
points, 2-day event - 2 points, 1-day
event - 1 point)
Member points are automatically
transferred from one chapter to
another. Retroactive scoring of
points for all categories is permissible if appropriate documentation is provided. However, no
points are earned for services for
terms of office of less than one-half
of a chapter’s fiscal year for any
category; services a member is paid
to perform; or for chapter participation prior to HFMA membership.
You can review your current
Founders points on line, by going to
HFMA’s Member Directory at
http://www.hfma.org/mem
bers/memdirect.htm and drill down
to your Founders information. If you
have any questions about the
Founders Merit Award Program,
please direct them to Steve
McClafferty, NH-VT Chapter
Founders Contact at (802) 447-5040
or [email protected]. The following
schedule reports accomplishments as
of the year ending May 31, 2003.
Mountain Views
Founders Award Points as of May 31, 2003
Name
Professional
Designation
ADAMS, SCOTT
ALDRICH, PEGGY
ALEXANDER, STACY
ALLEN, GEORGE
FHFMA
ALLEN, THERRIN
AMAN, DENNIS
AMIDON, GORDON
ANDERSON, GAIL
ANGWIN, KATHY
ANTONINO, JAMES
ARNOLD, SANDRA
AVERY, DAVID
AYRES, ALICE
BAILLARGEON, RUTH
BAKER, JANET
BARKER, LISA
BATRA, VARSHA
BAYES, NOLA
BEANE, DANA
CPA
BECK, CRAIG
BEGIN, CARL
BEGNOCHE, ANN
BELANGER, NORMAN
BELIVEAU, ALBERT
CHFP,CPA
BENOIT, DONALD
BERGERON, KATHRYN
CPA
BERLENBACH, JOHN
BERRY, CLEMENT
BITTEL, STEVEN
BLAHA, DIANE
BLAIR, SCOTT
BLAISDELL, LINDA
BLATT, EMILY
BLUHM, JOYCE
BONENFANT, SUSAN
BOSELA, CARRIE
BOUCHARD, JUDITH
BOUDEWYNS, MARY KAY FHFMA
BOUDREAU, MARILYN
BOWEN, REBECCA MBA,MHA,FHFMA
BRADLEY, LAWRENCE
BRETCHES, GEOFF
BREWER, DEBORAH
RN
BRINES, DUNCAN
BROCHU, MICHAEL
BRODEUR, DENNIS
BROWN, KAREN
BROWN, STEPHEN
BUGBEE, DAWN
CPA
BURGESS, DORIS
BURNS, BRUCE
FHFMA
BYCER, ROBERT
CANADY, CAROLYN
FHFMA
CARDINAL, CARRIE
CAREY, RENEE
CASASSA, ALLISON
CPA
CATE, VIRGINIA
CHAPDELAINE, GUY
CPA
CHARBENEAU, JOHN
CHARMAN, CHRISTINE
CHASE, KAREN
CHENEY, SIBYL
CHEVERIE, W.
Mountain Views
Total Net
Current
Points
Total
Prior Points
Total
Accumulated
Points
3
3
5
17
2
2
6
4
5
2
2
7
2
8
9
2
5
5
2
4
4
5
6
6
5
4
4
3
2
5
5
9
5
5
3
15
7
44
5
29
6
3
7
11
4
7
6
6
5
3
10
3
9
7
3
5
5
2
4
3
2
4
6
100
41
45
228
1
2
0
3
31
8
4
4
4
47
146
4
2
4
0
0
345
4
27
76
0
13
2
64
2
50
8
26
0
14
9
5
0
417
6
378
106
20
30
241
0
134
20
32
63
80
113
86
86
2
0
44
80
16
178
32
4
323
59
103
44
50
245
3
4
6
7
36
10
6
11
6
55
155
6
7
9
2
4
349
9
33
82
5
17
6
67
4
55
13
35
5
19
12
20
7
461
11
407
112
23
37
252
4
141
26
38
68
83
123
89
95
9
3
49
85
18
182
35
6
327
65
Name
Professional
Designation
Total Net
Current
Points
CHMIELEWSKI, LINDA
CHFP
31
CHOWINS, RICHARD
3
CHURCH, PAMELA
4
CLARK, DONALD
4
COLBY, SCOTT
8
COMEAU, SCOTT
6
CONBOY, MARY
12
CORDNER, GLENN
5
COTNER, JEAN
4
COWAN, LARRY
4
CRAMER, ANNE
12
CRAWFORD, THOMAS
6
CROSBY, EVALIE
CPA
4
CULLEROT, MARC
4
CURROTTO, EUGENE
4
DABRODY, PAUL
3
DANIELS, GARY
CHE
7
DAVILA, KATHRYN
55
DAVIS, MICHAEL
5
DAY, MARY
2
DEL TRECCO, MICHAEL
4
DELANEY, DEBORAH
CPA
9
DEMERS, PAUL
13
DENTON, CHRIS
4
DERRICK, FRANCIS
4
DESRANLEAU, MARY
2
DETTRE, THOMAS
CPA
4
DINDA-WILKINSON, REBECCA
2
DIONNE, KELLY
3
DONADIO, CLAUDIA
4
DONAGHEY, JANE
3
DOWLING, THOMAS
2
DUNIGAN, JACK
2
DUNLAP, LEONARD
4
DUNLAP, NANCY
2
DURETT, CAROL
3
DURKEE, TARA
CPA
17
DYER, DANIEL
6
EDSON, LINDA
4
ELLIS, DAVID
7
ELMORE, RICHARD
2
ELWELL, RICHARD
CPA
15
ENGLAND, NANCY
3
EPPLY, MARK
CPA
0
ERICKSON, WILLIAM
2
FAIRALL, MARIANNE
4
FERNANDEZ, IDA
FHFMA
10
FISHER, CYNTHIA
4
FOLLAND, CHEYENNE
CPA
2
FORD, RICHARD
FHFMA, CPA” 13
FOSS, LINDA
2
FOTTER, ROBERT
8
FOWLER, WM.
4
FOX, JUDI
3
FOX, RICHARD
5
FREY, SCOTT
4
FRIZZELL, PAMELA
4
FULLER, SUSAN
4
GAGNE, MARK
6
GAGNON, ELLEN
5
GALIN, ROBERT
3
GALLICANO, MARY
3
Total
Prior Points
Total
Accumulated
Points
85
2
0
16
6
20
0
78
0
19
4
8
4
58
8
86
14
123
21
4
18
176
133
6
374
4
13
6
60
17
51
5
0
339
10
19
14
0
2
7
8
150
47
23
8
342
312
0
7
139
16
104
14
8
297
13
64
18
21
7
20
0
116
5
4
20
14
26
12
83
4
23
16
14
8
62
12
89
21
178
26
6
22
185
146
10
378
6
17
8
63
21
54
7
2
343
12
22
31
6
6
14
10
165
50
23
10
346
322
4
9
152
18
112
18
11
302
17
68
22
27
12
23
3
Continued on Page 16
Page 15
Founders Award Points 2003
Name
GARDENT, PAUL
GASNER, MARY
GENDRON, GEORGE
GENT, KATHERINE
GEOFFRION, KIRSTEN
GEORGE, DON
GIBSON, LYNN
GLYNN, ELIZABETH
GOODELL, JILL
GREGOIRE, JAMES
GRILL, ROBBIN
GROLEAU, COLETTE
GUILLETTE, LYNN
GUSTAFSON, LINDA
GUTH, JAMIE
GUZMAN, NATALIE
HADDY, LESLIE
HALE, FREDERICK
HALE, KENNETH
HANLON, CHARLES
HARRIS, KATHY
HARVIE, JANET
HAYES, LORI
HEALY, CHRISTOPHER
HEBERT, ALICEN
HEBERT, JEFF
HEBERT, PAUL
HELD, DEBRALEE
HELLMANN, BERNARD
HEMMING, STUART
HEPBURN, TIMOTHY
HERGET, DENISE
HERSEY, ROBERT
HILL, MICHAEL
HODGDON, JANET
HOFFMAN, LINDA
HOLLIDAY, MARY
HOLLNER, JANET
HOOKER, CARL
HOWE, SCOTT
HUGHES, MELANIE
HUMPHREY, NICOLE
HUNT, KEVIN
HUSBAND, GARY
IRELAND, PETER
JANTZEN, DANIEL
JESSOP, JOHN
JOHNSON, CYNTHIA
JOHNSON, PAUL
JUDD, MARJORIE
KALINEN, GAIL
KARTASZEWICZ, CORINNE
KEANE, JOHN
KEEFE, THOMAS
KEELER, DUANE
KEENE, RUSSELL
KELLEHER, JOHN
KELSEY, ELLA
KEMP, MARJORIE
KIBBIE, JEFFREY
KIMBALL, BARBARA
KING, BRUCE
KIRIAKOUTSOS, PETER
KLEINER, RONALD
Page 16
Professional
Designation
CPA
CPA
CPA
CPA
RN,BSN
FHFMA
CPA
CHFP
FHFMA
CPA
MHA
FHFMA
CHFP
FHFMA
FHFMA
CPA
Continued from Page 15
Total Net
Current
Points
Total
Prior Points
Total
Accumulated
Points
3
3
3
2
11
3
3
2
2
2
10
3
22
7
2
3
5
4
3
9
4
3
3
4
5
2
3
7
3
6
2
5
15
2
32
3
3
8
6
3
4
7
15
3
9
4
4
28
4
16
3
2
2
3
4
2
9
24
2
2
3
25
2
3
141
0
9
2
12
32
17
4
4
28
478
4
67
44
4
6
0
328
76
77
10
0
42
17
31
14
23
0
56
45
8
32
164
14
75
3
14
2
24
60
17
0
127
31
452
83
49
194
7
185
3
4
15
95
339
6
170
13
18
0
6
438
12
28
144
3
12
4
23
35
20
6
6
30
488
7
89
51
6
9
5
332
79
86
14
3
45
21
36
16
26
7
59
51
10
37
179
16
107
6
17
10
30
63
21
7
142
34
461
87
53
222
11
201
6
6
17
98
343
8
179
37
20
2
9
463
14
31
Name
KOEHLER, THERESA
KUHMAN, DAVID
KURIGER, FREDERICK
KURRLE, LINDSAY
L’HUILLIER, RENELLE
LA ROCHELLE, ALBERT
LACHENAL, LEON
LAMOUREUX, DAVID
LANGE, DAVID
LAPOINT, BRUCE
LAROCHELLE, DARLENE
LAROUSSI, CATHY
LAUER, CHRIS
LAWRENCE, PHILIP
LEMIRE, SHARON
LEMNAH, DEBORAH
LENKOWSKI, THOMAS
LEWIS, RICHARD
LILLIE, CLAIRE
LINDAMOOD, LAVERNE
LIPMAN, HENRY
LONG, MICHAEL
LORING, JOSEPH
LOTT, ANDREA
LUCIUS, RICHARD
LUSSIER, MICHAEL
LYDON, PAMELA
LYNCH, BARBARA
MACCALLUM, TRACY
MACKEY, ROBIN
MAHEUX, DIANE
MANAHAN, JAMES
MARLOW, GARY
MARQUIS, BRIAN
MARTEL, EVA
MARTIN, PETER
MARZINZIK, JOHN
MAXWELL, RICHARD
MCAULIFFE, HANIA
MCCLAFFERTY, STEVEN
MCCUTCHEON, MELISSA
MCDONNELL, KIM
MCDOWELL, SAMUEL
MCEWEN, MICHELLE
MCGAHEY, CINDY
MCGEE, MARIE
MCGUNNIGLE, LISA
MCNALLY, WALTER
MCNAMARA, ERICA
MEAD, ROSELYN
MELBY, LESLIE
MENDER, KIMBERLY
MILLER, MICHAEL
MILLER-WENDELL, GALE
MINNEHAN, PAULA
MINOLI, BECKI
MOCKLER, CHARMAINE
MOONEY, BRIAN
MORRILL, BETH”
MORRISON, SARAH
MOSS, STEPHEN
MUCHEMORE, LINDA
NAIMIE, TINA
NEWTON, JOHN
Professional
Designation
CPA
CPA
Total Net
Current
Points
8
3
4
CPA
5
4
4
2
7
13
23
CPA
0
2
3
4
5
5
16
FACHE
3
CPA
3
9
5
FHFMA, CPA 22
11
5
4
CPA
4
9
3
RN,BSN
6
FHFMA,CPA 12
CHFP
20
3
FHFMA
11
3
10
4
7
CPA
5
18
FHFMA
40
3
3
PH.D.
3
CPA
4
2
FHFMA, CPA 60
RN,Esq.
5
CPA
2
CPA
37
6
4
7
2
3
5
CPA
3
4
12
4
4
CPA
6
4
CHFP, CPA 39
5
Total
Prior Points
Total
Accumulated
Points
86
18
45
28
0
23
11
4
20
132
0
17
87
73
136
8
458
54
33
93
83
506
37
12
0
82
118
226
0
117
10
45
211
0
120
49
81
57
14
135
4
12
23
163
4
276
10
23
219
20
18
36
16
11
3
25
10
8
16
0
124
0
184
82
94
21
49
33
4
27
13
11
33
155
0
19
90
77
141
13
474
57
36
102
88
528
48
17
4
86
127
229
6
129
30
48
222
3
130
53
88
62
32
175
7
15
26
167
6
336
15
25
256
26
22
43
18
14
8
28
14
20
20
4
130
4
223
87
Mountain Views
Name
NICHOLS, ARTHUR
NISUN, KATHY
NOLAN, F.E. WARD
NOLTE, CARMEN
O’CONNOR, JAMES
O’NEILL, DANIEL
OBRYAN, PATRICK
OGORZALEK, EDWARD
OLSON, JON
ONTHANK, PAUL
ORR, KAREN
OSULLIVAN, MICHAEL
OUELLETTE, CONNIE
PAGE, ANNE
PAGNIUCCI, DAVID
PAQUETTE, BONNIE
PARK, JAMES
PATNAUDE, KIMBERLY
PATTERSON, ANDREW
PATTERSON, LOUISE
PAUL, SUZANNE
PAUL, TRACEY
PETERSON, KATHY
PETERSON, SUZANNE
PILLING, DEB
PIOTROWSKI, JANE
PLAMONDON, RICHARD
PLANT, STEVEN
PRATT, KATHLEEN
PROVOST, GERALDINE
PURDY, GARY
QUEALY, BARBARA
RANDALL, BEATA
RANDALL, EDWARD
RANGAVIZ, RASSOUL
RANSOM, GAIL
REHM, JUDITH
REILLY, JOHN
RENAUDETTE, LINDA
RESCOTT, EUNICE
RHODES, KATHERINE
RICHARDSON, WILLIAM
RIDER, WILLIAM
RIZZA, RICHARD
ROBBINS, DEB
ROBERGE, DENNY
ROBERGE, JEREMY
ROBERTS, NEAL
ROCKLISS, SIDNEY
ROGERS, EVELYN
ROGERS, MICHAEL
ROSIEN, DOUGLAS
ROUNDS, VIOLET
ROVELLA, ROBERT
ROY, JAMES
SANVILLE, DAVID
SCHEINBLUM, RICHARD
SCHNEIDER, CHARLES
SCHUETZKOWSKI, RALPH
SCHWARTZ, JOHN
SCIONTI, JEFFREY
SENGER, RICHARD
SHAW, BERNICE
SHELMANDINE, LAUREL
Mountain Views
Professional
Designation
CPA
CHFP,CPA
CPA
FHFMA
CPA
“RN,MBA”
CPA
FHFMA
FHFMA
FHFMA
Total Net
Current
Points
Total
Prior Points
Total
Accumulated
Points
7
8
7
7
8
8
7
7
7
3
3
3
30
5
26
5
5
3
10
3
2
2
39
4
4
5
4
3
5
3
8
2
6
6
4
8
4
8
7
4
2
2
3
24
5
2
7
3
3
7
15
6
4
5
3
9
13
5
3
4
3
23
3
6
126
69
78
2
12
102
91
406
37
21
4
5
111
160
159
8
83
122
28
32
10
11
78
4
0
47
68
24
14
28
0
7
1
0
25
19
13
2
55
11
3
5
43
270
0
3
13
36
105
5
261
0
17
47
23
52
18
63
8
112
21
197
72
0
133
77
85
9
20
110
98
413
44
24
7
8
141
165
185
13
88
125
38
35
12
13
117
8
4
52
72
27
19
31
8
9
7
6
29
27
17
10
62
15
5
7
46
294
5
5
20
39
108
12
276
6
21
52
26
61
31
68
11
116
24
220
75
6
Professional
Designation
Name
SHERWIN, MARY
SHIPMAN, DEBORAH
SHOWALTER, RICHARD
SHUTAK, JEFFREY
SIMMONS, DAVID
SIMMS, WILLIAM
SIMPSON, STEPHEN
SINCLAIR, SANDRA
SLOANE, SCOTT
SMITH, LORA
SMITH, PETER
ST. GEORGE, JOHN
STANISLAS, MARC
STONE, KEVIN
STOVER, KATHLEEN
STRINGER, CHARLES
SYMONDS, ANDREA
TALBOTT, DIANE
TATRO, JEFFREY
THERIAULT, ANNE
THERRIEN, ANDRE
THOMAS, CHARLES
THOMAS, PETER
THOMPSON, LORI
TOLL, SIDNEY
TOLZMANN, GEOFFREY
TRAINOR, PAUL
UNDERWOOD, CHERRY
VANDERSALL, SCOTT
VANINI, MARIO
VAUGHAN, AMY
VINCENT, RICHARD
VIZVARIE, JANE
WALCEK, PETER
WALKER, DANA
WALKER, LESLIE
WALLA, JEFFREY
WALLIN, CINDRA
WALSH, MICHAEL
WALTZ, MARTHA
WARD, KELLY
WEEKS, WILLIAM
WELLS, SUSANNAH
WENNERS, DOUGLAS
WESTMAN, MARK
WEYL, STEPHEN
WHITNEY, DIANA
WHITNEY, MAUREEN
WHITNEY, SUSAN
WILLIS, JANET
WILSON, NANCY”
WINAGLE, AMY
WINN, SHARON
ZIMMERMAN, RON
Total Net
Current
Points
9
23
CPA
4
CHFP
19
3
CPA
3
0
3
CPA
5
3
9
FHFMA
24
2
2
6
9
CPA
7
2
2
5
3
CPA
4
CHFP
23
2
FHFMA
9
7
2
CPA
3
2
2
4
2
13
FHFMA
22
2
8
FHFMA, CPA 55
6
2
MBA
9
4
91
2
3
4
2
CHFP
24
3
2
4
9
2
3
5
Total
Prior Points
Total
Accumulated
Points
53
66
269
515
243
153
0
71
46
16
18
570
19
10
26
12
11
2
8
19
84
27
28
7
384
59
0
29
8
4
2
12
76
125
6
34
416
31
2
6
8
0
5
0
60
4
63
4
8
5
53
12
6
26
62
89
273
534
246
156
0
74
51
19
27
594
21
12
32
21
18
4
10
24
87
31
51
9
393
66
2
32
10
6
6
14
89
147
8
42
471
37
4
15
12
91
7
3
64
6
87
7
10
9
62
14
9
31
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