AAHAM Q4 '21

IN THIS ISSUE
President’s Message …………………………………………………………………. 1
3 Updates from ABC for Health; November 2021 ........................................... 2
Measuring the Costs of Denials & the Impact of Prevention ......................... 4
Ask the Expert: Why Insurance Discovery Matters ....................................... 6
Preparing for the No Surprises Act: What you Need to Know Now ............... 8
Healthcare Staff Management in the New Normal ........................................ 10
SPRING CONFERENCE
FALL CONFERENCE
MAY 12-13, 2022
WILDERNESS RESORT
511 EAST ADAMS STREET
WISCONSIN DELLS, WI 53965
TBD
RED LION HOTEL PAPER VALLEY
333 W. COLLEGE AVENUE
APPLETON, WI 54911
ALSO REMEMBER TO MARK YOUR CALENDAR FOR
2022 ANI: 10/12 - 10/14 IN BALTIMORE, MD!!

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PRESIDENT’S MESSAGE
By: Marcy Marquis
It is that time of year where we start thinking about
the Holidays. Hopefully, this year we can all enjoy
gathering with friends and family. We also start to
think about the past year and wonder what the new
year will bring.
2022 also means new Board Members. We are looking
forward to several fresh faces and fresh ideas.
Please make sure when you watch for the email for
voting. If anyone is interested in participating on
committee in 2022, please reach out me.
AAHAM WI had an amazing year. We had our first
hybrid conference in the Spring. Our Fall Conference
was 100% virtual. Our education committee did an
amazing job planning both conferences and adjusted
to a hybrid and virtual formats. Thank you to our education
committee members: Curt Glaunert, Kaye
Preive, Glynis Evans, Beverly Pope, Chris Fisher,
Dustie Kline, Nicole Querio, Colleen Nolan and Mark
Herder.
The committees are Education, Newsletter / Marketing,
Certification, Membership and Government Relations.
Our board meetings are also open to our
membership. If you would like to learn more about
AAHAM and want to attend a board meeting, please
let me know and I will add to the meeting invite.
I hope everyone has an amazing holiday season. Enjoy
family and friends.
We all really missed seeing everyone in person.
However, the positive side of virtual is having so
many guests. People who normally cannot attend are
now able to participate. Our Education Committee is
busy working on several free webinars, so we can
continue to provide education between now and our
Spring 2022 conference.
I know many of you are busy with your year-end projects.
The board is busy with starting our 2022 membership
drive. Our membership fee of $30.00. We
currently have 81 members. Our goal for 2022 is to
hit 100 members. I would like to encourage everyone
to please renew your membership.
“An investment in knowledge pays the best
interest”
- Benjamin Franklin
Marcy Marquis
AAHAM WI Chapter President
If you are not a member, please join WI AAHAM.
Encourage your co-workers and associates from other
facilities to join. We also encourage our Corporate
Sponsors to renew their membership and encourage
current clients or potential clients to join WI
AAHAM.

3 Updates from ABC for Health; November 2021
From: ABC for Health
The pandemic continues to create ripples in the rules
and policies impacting health care coverage. We
continue to track policy developments, current
events, and rule changes in a changing landscape of
insurance coverage, and highlight three updates below:
National Public Health Emergency Extended -
Again
US Department of Health and Human Services Secretary
Becerra has officially renewed the public
health emergency declaration. It's effective October
18, 2021 for an additional 90 days which takes us
into January 2022. This is the 7th time HHS has extended
the emergency since it began on January 31,
2020. In our featured video, we explain the renewal
and what comes next.
ACA Open Enrollment
Open Enrollment opened November 1. This is the
annual enrollment window to purchase private
health insurance on the Affordable Care Act's private
health insurance marketplace HealthCare.Gov.
In our featured video, we review what information to
have handy to be ready to apply and key start dates
for coverage. Here is a look at what’s new for 2022:
have officially created a new "Special Enrollment Period"
opportunity for certain low-income consumers to
purchase private health insurance on HealthCare.Gov in
2022. The announcement came as the feds finalized
rules to improve the Affordable Care Act and Medicaid.
In our featured video, we explain who is eligible for the
new Special Enrollment Periods, what else is in the final
rule, and how to connect to coverage.
Bridging the Gaps in Vaccine & Lifeline Equity
The pandemic has exposed health equity and social justice
issues that include unequal access to vaccines and
telecommunications. As part of an extensive outreach,
education, and innovative in-reach campaign, ABC for
Health and ABC for Rural Health are helping to better
communicate information, resources, and support for
vulnerable populations.
Many families are looking for help at times of overstressed
budgets and rising concerns about staying connected
to work, school, or doctors. Many may not realize
telecommunications assistance – help paying phone
and internet bills - is an option. Access to "Lifeline" or
the "Emergency Broadband Benefit" provides an important
bridge to fill gaps created by a loss of income, a
loss of healthcare coverage, or loss of community-based
social supports.
More Time to Enroll:
CMS has officially extended the Open Enrollment
Period for people to purchase private health insurance
for 2022. Beginning this year, consumers will
have an additional 30 days to sign up for private
health insurance coverage on HealthCare.gov. Enrollment
runs November 1, 2021 – January 15, 2022.
In our featured video, we talk about this extension,
new initiatives to expand health coverage nationwide,
and other provisions of a finalized rule announced
in late September.
More Special Enrollment Periods for Low-I
ncome Consumers:
The Centers for Medicare and Medicaid Services
If families you work with have questions about finding a
vaccine or connecting to affordable internet, ABC for
Health has updated its popular fact sheets, available to
download and print. And remember to "Say it Forward!"
Share these materials and help spread the word
of useful resources across our state.
• Vaccine Fact Sheet – English
• Vaccine Fact Sheet – Spanish
• Lifeline Fact Sheet – English
• Lifeline Fact Sheet - Spanish
ABC for Health, Inc., is a Wisconsin-based, nonprofit, public
interest law firm dedicated to linking children and families, particularly
those with special health care needs, to health care
benefits and services. ABC for Health’s mission is to provide
information, advocacy tools, legal services, and expert support
needed to obtain, maintain, and finance health care coverage
and services.
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2022 SPONSORSHIP
OPPORTUNITIES
GOLD Sponsorship - $2,000 *Limited to five so act fast!
SILVER Sponsorship - $1,000
BRONZE Sponsorship - $600
To view tiered benefits & register for 2022 sponsorship
click here
2022 Membership Dues Renewal
Make sure to keep an eye out for your blue envelope!
The 2022 membership renewal invoices have been mailed.
As a thank you for your membership, we are continuing the “pandemic dues renewal discount” of
$188, payable in one lump sum by 12/31/21.
We are mindful of the times we are in and understand you may be struggling and wondering how to
pay for your dues.
If you are unable to take advantage of this discount, we also offer payment plans to help ease the
dues burden If you are unable to take advantage of this discount, we also offer payment plans to
help ease the dues burden. Remember, we also offer a one-time dues waiver as a member benefit as
well. If you have retired from healthcare, there is no longer a fee to renew. Click here to see if you
qualify.
Please contact the AAHAM National Office if you would like more information about these options.
If you need an electronic copy of your invoice, please contact Moayad Zahralddin at
moayad@aaham.org or 703.281.4043 ext 4.
CLICK HERE TO RENEW YOUR DUES

MEASURING THE COST OF DENIALS &
THE IMPACT OF PREVENTION
BY:
When it comes to denial management, there is no
“one-size-fits-all” approach.
Different organizations use different systems, departments,
metrics, third-party vendors, and technology
to guide and manage their approach to denials.
As technology and data-tracking capabilities have
advanced, however, denial prevention has risen to
the forefront as a strategy that not only addresses denials
but prevents them from happening in the first
place.
Unfortunately, however, far too many healthcare organizations
are still using the traditional “follow-up
method” of denial management, in which claims are
moved quickly through the process and onto the
payer as fast as possible.
measure and talk about denials, HFMA developed the
“Claim Integrity Task Force.” The group ultimately
identified and defined 6 key performance indicators
(KPIs) to be used for measuring the outcome of
denial management efforts.
• Initial denial rate (as a percentage of volume
and dollars)
• Primary denial rate
• Denial write-offs as a percentage of net patient
service revenue
• Time from initial denial to appeal
• Time from initial denial to claim resolution
• Percentage of initial denials overturned (with
reference to charges, volume, and inpatient
denials that converted to observation)
These providers zero in on their clean claim
rate (percent of claims not stopped by internal edits
before submission) as the most important indicator
of success and simply wait for the payer to tell them
what’s wrong with each claim.
Although these providers may have a spectacular
clean claim rate, their rate of denials can still be astronomical
because their denial management efforts
happen on the back end once claims have already
been denied.
As a result, claim denials continue to increase along
with the cost to collect and the length of the payment
cycle.
This article aims to quantify the cost of denials and
give organizations an actionable roadmap for denial
management that is based on data and prevention
rather than follow-up and reactivity.
One Size Fits All?
In an effort to aid in denial management efforts and
help standardize the way healthcare organizations
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Notably Clean Claim Rate didn't make the list.
Instead, the task force included initial denial
rate (percent of claims denied upon first submission)
as the first metric on the list. Experts recognize that
claims paid on first submission save you money, time,
and resources spent on costly re-work and appeals.
This is precisely why we consistently measure our clients’
first pass yield. Similar to HFMA’s Initial denial
rate (% of claims denied upon first submission),
efficientC’s First Pass Yield rate measures the
percent of claims paid on first submission.
The Cost of Denials
Why is it so important to understand how many
claims are actually being paid upon first submission?
Because each denied claim is costing your organization
money. In fact, a 2017 Change Healthcare analysis
found that each denied claim costs on average
$117. Some other sources have estimated that this
number is closer to about $25 per claim, which may
be more realistic for professional claims in a smaller
practice setting.

Reduce its initial denial rate from 20% to 10%, what
would be the financial impact?
Image Source: Change Healthcare Infographic
Additionally, Change Healthcare states that 65% of
denied claims are never resubmitted, which indicates
that organizations are also experiencing large amounts
of lost revenue due to denials. Industry sources also
suggest that almost 60% of claims rebilled after a denial
will deny again.
Let’s take a look at an example. If the cost of denials
at XYZ Healthcare is around $75 per denied claim,
and they submit 20,000 claims per month, it is likely
that around 4,000 of those claims will deny (based on
a 20% initial denial rate).
This amounts to a cost of about $300,000 every
month or $3.6 million in a single year!
The organization’s total denied claims per month
would fall to 2,000, representing an estimated cost
savings of $150,000 each month. Said another way,
every additional claim that is paid upon first submission
becomes first pass reimbursement.
This improves the organization’s cash
flow, reduces revenue leakage, shortens the payment
cycle, and even boosts patient satisfaction.
Implementing a Successful Denial Prevention
Strategy
In an effective denial prevention program, every effort
is made to prevent denials prior to billing. For
example, edits built into the claim scrubber can stop
at-risk claims before they result in denials. While
this step does require a biller to clear the edit, stopping
to make the necessary changes prior to billing
keeps the payment cycle short.
If the claim is stopped on day 1, it can be fixed and
rebilled on day 2 and paid on day 16 or 17.
Another part of prevention is looking at data trends
and implementing process changes, edits, or change
routines:
Now if your organization has chosen to focus on prevention
over follow-up, there’s good news for
you. 90% of denials are preventable and occur most
often in categories like medical necessity, eligibility,
and demographic or technical errors.
Financial Impact of Denial Prevention
If XYZ Healthcare from the example above can implement
an effective denial prevention program and
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• If a large portion of total claim denials stem
from medical necessity issues, how can your
organization proactively address that? Is clinician
education needed to ensure clinical
documentation includes all necessary details?
• If denials stem from front-end errors related
to demographic information or eligibility,
how can processes be improved to ensure this
information is captured accurately and completely?
Is training needed for front-end staff?
Organizations who pay close attention to this type of
denial data can nimbly pivot to address the root
cause of denials in any area. Then, by continuing to
monitor performance, leaders can determine whether
the changes made are actually resulting in fewer denials.

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Bottom line: top-performing organizations are getting
claims paid in 20 days or less. That number indicates
many claims are being paid on first submission, which
hinges on a strong denial prevention strategy.
Start by getting on the same page as your claims management
partner. Denial prevention should be top of mind,
with the ultimate goal of stopping claims before they are
denied in order to shorten the payment cycle, improve
cash flow, reduce write-offs and revenue leakage, and
reallocate billing office resources that were previously
dedicated to denial follow-up.
Are you looking for a claims management partner who
can deliver in this area? We would love to talk with you.
efficientC is a denial prevention platform, designed to
STOP and FIX claims prior to billing. On average, our
clients see 90%-95% of claims paid within 20 days, a
15% overall improvement in cash flow, and a 40% reduction
in denials after just 60 days.
The results speak for themselves. If your organization
makes the move to efficientC, your total cost of denials
will go down. Whether this is through a reduction in A/R
days or an improved overall payment rate, the difference
is significant.
You can get in touch with a member of the efficientC
here.
Exhibitor & Sponsorship
Registration is now open!!!
Click to view:
The Brochure The Agreement
Links to:
Sponsor Registration
Exhibitor Registration
Conference Website
We’d appreciate if you indicate you’re with AAHAM
when signing up - we can’t wait to see you!

ASK THE EXPERT: WHY INSURANCE
DISCOVERY MATTERS
BY:
We’re putting insurance discovery software under the
microscope to help you get the full picture, from every
angle, about this topic. Since we’ve been helping
health care organizations with their financial challenges
for many years, we have a handle on the most
common questions about insurance discovery. We’re
answering some of them below, but feel free to send a
question you might have about Insurance Discovery
here, and we’ll be happy to answer it in one of our
upcoming posts.
To kick the series off, let’s define insurance discovery
as the search to locate previously unknown commercial,
government, or exchange plan coverage missed
during registration or retro approved post-service.
Now let’s get to the root of the matter.
Why should healthcare providers care about insurance
discovery?
Healthcare is a service business. And like all businesses—even
not-for-profits—to stay viable and fiscally
healthy, revenue must exceed expenses. If we
think about both sides of this equation, we can say
that the past 18 months has been like none other.
On the revenue side, COVID has been a huge roadblock
as access to healthcare initially waned while
providers instituted safety protocols and states mandated
holds on elective procedures. In addition, fearful
patients skipped wellness visits and screenings. At
the same time, the increase in uninsured patients continued,
driving an unprecedented growth in uncompensated
care.
These two converging circumstances—deficits in
both earned revenue and a deluge of uncompensated
care—combined to create a hyper-focus on expense
control. Healthcare organizations have become more
cost conscious, with management considering ways to
cut potential fat, including:
• They’re revisiting vendor costs to determine
where they can renegotiate contract terms.
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• They’re assessing workflow to determine how
to streamline internal processes for greater efficiency
and reduction in overhead.
How does insurance discovery help boost revenue
and trim costs?
On the revenue side, it’s indispensable for uncovering
previously unknown commercial, government, and
exchange plan coverage. Including primary, secondary,
and tertiary coverage. In addition to commercial
insurance, perhaps they are eligible for Medicare or
Medicaid, or are covered under COBRA. Maybe the
front desk forgot to ask insured patients to update
their current health insurance coverage, and it
changed. There are so many reasons to adopt insurance
discovery, and they all point to the need for insurance
discovery to increase revenue and decrease
uncompensated care.
Regarding expense reduction, providers are looking
for every penny in light of increased supply and labor
costs due to a pool that continues to shrink. When it
comes to staff, time is money. Software that easily
locates previously unknown coverage in self-pay primary
and secondary accounts can add up to significant
time savings and exceptional ROI.
How can we identify an insurance discovery solution
that yields best ROI?
That is literally the million-dollar question. The first
place to look is at software provider fee structures,
which vary greatly. Is there a limit on transactions?
Are there fees for duplicating inquiries per patient
visit/treatment that constrain searches? Are there contingency
fees applied to remits received on insurance
discoveries found? Or are transactions unlimited for a
flat monthly fee that’s budget friendly and could result
in savings up to 70% depending on patient volume?
Still have questions? Contact us for a web demo,
or set up a test file so you can see insurance discovery
in action for yourself.

Preparing for the No Surprises Act: What you need
to know now on the new surprise billing law
By: Jennifer Boese, (CliftonLarsonAllen, LLP)
In early 2019 we wrote a CLA blog on the issue of
surprise billing where said we thought there was a
better than likely chance something would be enacted
in the 116th Congress (2019-2020). Flash forward
to 2020 and no one would have expected a
global pandemic whose dynamics would lead to enactment
of the No Surprises Act under the Consolidated
Appropriations Act of 2021 (Public Law 116-
260). While the years-long legislative debate is over
(for now), the regulatory efforts of deciphering and
implementing the law are underway. The new policies
take effect on January 1, 2022. That is right
around the corner and a trio of agencies released
multiple implementation regulations. Here’s what
you need to know.
Issue
Surprise bills stem from when a patient seeks medical
care at a hospital, free-standing emergency department
or from providers he/she believes are innetwork
only to receive a “surprise” bill for the balance
(i.e.: balance billing) of the cost because
somewhere along the line a provider was out-ofnetwork.
In these situations, the patient is left with a
surprise bill. This can frequently happen in emergency
situations but in non-emergencies as well.
The No Surprises Act addresses both situations and
will impact health care providers (including air ambulances),
insurers (individual, group, and selffunded/sponsored)
and patients.
Emergencies
In emergency care situations a health insurer must
cover the patient as in-network regardless of whether
the facility or provider(s) are participating providers
in the patient’s insurance plan. The requirement
to treat as in-network during emergencies extends
to other hospital departments that are used
and services provided after the patient is stabilized
unless certain criteria can be met. Emergency facilities
include hospitals and freestanding emergency
departments. Providers include physic-
ians or other health care providers acting within
their scope of practice. Emergency services include
medical screening and other ancillary services used
to evaluate and treat the patient. Air ambulances are
also covered.
Generally, the provider or facility is prohibited from
“balance billing” the patient for the remainder of the
uncovered amount during the emergency. In some
cases, the facility/provider may be allowed to balance
bill and use out-of-network cost-sharing after a
patient has been stabilized. However, this is available
only if a series of requirements (with many underlying
criteria) are met.
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• The patient can travel using nonmedical and
nonemergency transportation
• Specific notice and consent criteria are met
• A patient is able to receive information and
give an informed consent
In emergency situations, the insurer is prohibited
from using prior authorization or waiting periods and
patients are to be treated as if they are covered innetwork
(assuming their insurance covers any emergency
service) by the group or individual health plan
for co-pays or cost-sharing. There are also specific
requirements for how insurers determine any costsharing
for patients in these situations.
The cost-sharing amount will be governed by any
state-mandated rates that apply, a state all-payor
model rate, or the median in-network rate under the
plan for like services by a similar provider in the
same geographic region provided on January 31,
2019. This latter option is called the “qualifying payment
amount” (QPA). The amount used for patient
cost-sharing is based off whichever one of these
three options is applicable and is referred to as the
“recognized amount.”
With respect to payment to providers, an insurer

either sends a notice of denial or a payment to the respective
facility/providers within 30 days. A policy in
the regulations that providers will like is that insurers
may not deny coverage of certain services provided in
the emergency department by determining whether an
episode of care involves an emergency medical condition
based solely on final diagnosis codes or automatically
deny coverage based on a list of diagnosis
codes initially, without regard to the individual’s presenting
symptoms or any additional review.
The provider may accept the insurer’s payment or
may begin a 30-day negotiation period. If no payment
resolution can be reached during those 30 days, the
parties may initiate a new independent dispute resolution
process.
Non-Emergencies
In non-emergency situations, unless notice and consent
are given, the patient is also held harmless from
out-of-network bills when at an in-network facility. A
health care facility in a non-emergency situation includes
a hospital, hospital outpatient department, critical
access hospital or an ambulatory surgical center
and the ban on surprise billing would include those
that provide items or services at or to those.
A few of the criteria for notice and consent in these
non-emergency situations are:
1. Notice and consent are provided to the patient
at least 72 hours prior (if scheduled within at
least 72 hours) or at time of service if less than
72 hours, but not less than three hours
2. The notice and consent form clearly states consent
is optional or the patient may seek care
from a participating provider. The form is
signed, maintained by the provider and given
to the patient (email or mail, patient preference)
3. Information on prior authorization or other
care management requirements
4. A good faith estimate of the cost is given
5. A list of in-network providers is given
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Notice & Consent
With respect to both emergency and non-emergency
situations, it is important to note that the No Surprises
Act and regulations specifically exclude certain services
and items from the notice and consent procedures
altogether. In other words, patients may not
provide consent nor may certain providers request
consent (to balance bill) under various circumstances
for the following ancillary services and situations:
• Items and services related to emergency medicine,
anesthesiology, pathology, radiology, and
neonatology, whether or not provided by a
physician or non-physician practitioner, and
items and services provided by assistant surgeons,
hospitalists, and intensivists,
• Diagnostic services (including radiology and
laboratory services),
• Items and services provided by other specialty
practitioners, as provided by HHS,
• Items and services provided by a nonparticipating
provider if there is no participating provider
who can furnish such item or service at
such facility,
• Unforeseen medical needs arising at the time
of the service
Independent Dispute Resolution (IDR)
If there are disputes between the health care provider
and insurer related to reimbursement, a newly created
IDR process may be utilized. There are various timelines
that must be followed during this process. If after
30 days of open negotiation the two sides cannot
come to a resolution, either side may initiate the IDR
process. Once the IDR entity is selected each entity
submits their best and final offer. The provider and
insurer may submit additional information to support
its offer.
The arbitrator does not have the discretion to change
either offer, so will select one or the other as is. However,
in its deliberations, the law allows arbitrator
may consider other factors, such as the level of training,
experience, quality and outcomes, market share
held in that geographic region, patient acuity, complexity
of services, teaching status, case mix, and
scope of services among others. The arbitrator may

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not consider a provider’s charges or the payment rates
from government programs, such as Medicare or
Medicaid.
One of the biggest issues for providers under the regulations
is the requirement that the IDR entity presumes
that the offer closest to the QPA is the appropriate
offer unless “rebutted by presentation of credible
information about additional circumstances that
clearly demonstrate that the QPA is materially different
from the appropriate out-of-network rate.” Provider
groups believe this tilts the IDR process in favor of
the insurer and argue such a presumption is not found
in the actual law itself.
Other Provisions
There are many other provisions in this law, a few of
which include:
• Good faith estimates required
• Dispute resolution procedures between uninsured
or self-pay patients and providers.
• Air ambulances are required to submit a variety of
information such as costs, number and location of
air ambulances, disaggregated data by payer
• Health plans must be able to provide advanced explanation
of benefits (EOB) to patients when a service
or item is scheduled.
• Health insurers must also have up-to-date directories,
price comparison tools and ensure continuity
of care with any provider changes
• Enforcement generally falls to the states, but the
federal government may step in
• Various reports and studies are required
Finally, an area of complexity will be the interplay
between state surprise billing laws and the No Surprises
Act and which one supersedes. In some situations,
state laws will apply with respect to payment
rates. In other instances, the federal law will govern,
such as with self-funded plans, air ambulances, states
without surprise billing laws or where the surprise
billing law is less robust.
What are a few steps to take now?
1. Be educated on the new law and implementing
regulations, know your state(s) law
2. Review current contracts with respect to emergency
and ancillary providers to determine potential
areas of concern/exposure
3. Review your revenue cycle and workflow processes
(i.e.: necessary notices, consent form, good
faith estimate, balance billing)
4. Consider or review price transparency tools with
this law in mind
5. Establish an internal work team to oversee planning
and implementation
6. Watch state legislatures for surprise billing activities
Jennifer Boese, MS, is the director of health care policy
and innovation at CLA. She may be reached at
Jennifer.Boese@CLAConnect.com

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Certified Recovery, Inc.

A A H A M CERTIFICATIONS
AAHAM Certified Revenue Cycle Executive
AAHAM Certified Revenue Cycle Professional
AAHAM Certified Revenue Integrity Professional
AAHAM Certified Revenue Cycle Specialist
AAHAM Certified Compliance Technician
Healthcare patient financial services professionals across the nation and around the globe are looking for an edge...a way to work
smarter, build a career, stay informed and make the right contacts; an AAHAM certification helps you achieve all of these goals.
What is the AAHAM CRCE (Executive) certification?
Executive Certification is an extensive online proctored exam directed to all senior and executive leaders within the healthcare revenue
cycle industry, to help equip them for strategic management of the business. This certification possesses the highest level of difficulty
combining content knowledge of the business with critical thinking and communication skills. AAHAM offers two types of Executive
certification; one focused on the revenue cycle within an institutional (hospital, health system) environment and the other focused on
the revenue cycle in a professional (physician, clinic) environment. Dual certification is available for those interested in obtaining certification
in both specialties.
What is the AAHAM CRCP (Professional) certification?
Professional Certification is an online proctored exam directed to supervisors and managers in the revenue cycle industry, to validate
their knowledge and skills. This certification is for the individual who desires confirmation and recognition of their expertise and/or
for those who aspire to the executive level certification. AAHAM offers two types of Professional certification; one focused on the
revenue cycle within an institutional (hospital, health system) environment and the other focused on the revenue cycle in a professional
(physician, clinic) environment. Dual certification is available for those interested in obtaining certification in both specialties.
What is the AAHAM CRIP (Revenue Integrity Professional) certification?
The Revenue Integrity Professional (CRIP) is an online proctored exam directed to anyone in the revenue cycle industry to help ensure
that facilities effectively manage their charge master, and bill and document appropriately for all services rendered to a patient. This
certification requires an in-depth, working knowledge of various revenue cycle areas and proper skill sets needed to increase revenue
and reimbursement for facilities. It also ensures that proper charging takes place to maintain compliance within the insurance payer
programs.
What is the AAHAM CRCS (Specialist) certification?
Specialist certification is an online proctored exam that tests the proficiency of staff involved in the processing of patient accounts and
to prepare them for the many details needed to perform their daily job duties. AAHAM offers two types of Specialist Certification; one
focused on the revenue cycle within an institutional (hospital, health system) environment, the other focused on the revenue cycle in a
professional (physician, clinic) environment. Dual certification is available for those interested in obtaining certification in the institutional
and professional specialties.
What is the AAHAM CCT (Compliance) certification?
Compliance certification is an online proctored exam that thoroughly tests competencies in healthcare compliance for all staff involved
in the processing of patient accounts. It is intended to meet the annual employee compliance training requirements and to support individuals
with professional compliance responsibilities in both institutional (hospital, health system) and professional (physician, clinic)
settings.
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WHY EARN AN AAHAM
CERTIFICATION?
AAHAM certification states you are an expert
in the field. It is an investment in your
personal growth and your professional future.
For over forty years, AAHAM’s elite
certification program has set the standard of
excellence in patient financial services and
the revenue cycle.
It doesn’t matter whether you are new to the
healthcare revenue cycle or are a seasoned
veteran, our family of AAHAM certification
examinations offer a complete career ladder
beginning with the Certified Revenue Cycle
Specialist and culminating with the Certified
Revenue Cycle Executive. We have a certification
that will help advance your career.
Wisconsin Chapter Membership
ONLY $30 per year!
Unique benefits include:
• Professional development & networking
with peers
• Notification of National Monthly
Webinars (Cost: Free-$199)
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Spring/Fall/Winter Conferences
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Plus the learning doesn’t stop once you have
obtained certification. Our certifications are
maintained through a continuous education
process. This assures you stay abreast of the
important changes and updates that continually
occur in our rapidly changing healthcare
environment.
AAHAM certification options include:
• AAHAM Certified Revenue Cycle Executive
• AAHAM Certified Revenue Cycle Professional
• AAHAM Certified Revenue Integrity Professional
• AAHAM Certified Revenue Cycle Specialist
• AAHAM Certified Compliance Technician
To learn more about certification visit our
website or contact AAHAM WI Certification
Chair, Nicole Querio at
nquerio@os-healthcare.com
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Become a member now at aaham-wi.org!
This quarterly newsletter is published four times yearly
by the Wisconsin Chapter of AAHAM. It is intended to
update members of organizational activities and to provide
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of AAHAM, National AAHAM or the editor. Reproduction
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Healthcare Staff Management in the New Normal
From the RevCycle, Inc. Blog
The role of a manager is to support employees—and
that includes supporting their mental health. As we
move into the new normal following the COVID-19
pandemic, that will be especially true for healthcare
staff management.
Not only were healthcare staff on the front lines of
the pandemic, they had to adapt to the rapid adoption
of new modalities and technologies, such as automated
workflows, digital communication, and telehealth.
The fallout of those stressful months could include
anxiety, depression, burnout,
trauma and even PTSD. Some
experts even posit a
“behavioral health disaster”
among healthcare workers if
steps are not taken to identify,
prevent, mitigate and manage
PTSD symptoms.
What can leaders do to manage
healthcare staff in the
new normal?
1. Implement Stress Management Training &
Mental Health Support Programs
That is, if you have not already. Healthcare staff will
need mental health, stress management and wellbeing
programs more than ever as they deal with the fallout
of the pandemic and rebalancing their lives after
months of intense stress. Healthcare leadership
should consult with mental health experts on the best
programs for their staff.
Invest in Training
Mental health training topics for healthcare staff may
include:
• Debunking common myths & stigmas about
mental health
• Coping with high stress demands & environments
14
• Maintaining a healthy work-life balance
• Substance abuse and other addictions
• Healthy stress reduction and relaxation techniques
• Who to go to for mental health concerns
• Self-monitoring and pacing
• Identifying actual threats/fears vs anxiety
• Helpful vs negative self-talk
• Setting healthy boundaries
• Focusing on what they can change vs what is
outside their locus of control
Make Sure Staff is Aware
of the Resources
In the 2019 Mental Health at
Work Report, issued by SAP
and Qualtrics, nearly 46% of
all workers said that their
company had not proactively
shared the mental health resources
available to them.
Make sure your staff knows
about the resources and are
actively encouraged to use
them. Make time available to attend trainings and
make the training mandatory or incentivized in order
to allay fears. Managers should set the example by
participating themselves.
Employee health plans should include robust coverage
for mental health treatment, including virtual options
that might work better for busy schedules. Allow
for flexible scheduling whenever possible to attend
appointments.
2. Don’t Wait Until Your People Ask For
Help...Because They Probably Won’t
Healthcare staff must deal daily with strong emotions
from patients and their loved ones. Most must make
do with a lack of time and/or resources. They may
fear getting a side-eye from their colleagues if they

need a “mental health day” to recuperate or are seen
taking a sorely needed break. They may fear losing their
jobs, being passed over for a promotion, or letting down
their team if they don’t work continual overtime, even
when they’re exhausted.
There are also personality factors at play. Many
healthcare workers go into the field out of a desire to
help people. They are service-oriented individuals who
are seen—and who may see themselves—as strong, capable,
giving, and tireless. They may downplay their
own needs or see asking for help as weakness. After
all, they are the ones who are supposed to be doing the
helping.
All these factors make self-care for healthcare workers
a particular challenge. You cannot wait for them to ask
for support, no matter how stressed they are. Rather,
you must be proactive in offering support and codifying
mental health best practices. Otherwise, you may end
up losing a valuable employee to burnout.
3. Build a Culture of Self-Care, Backed Up with Real
Policies & Procedures
It is important to teach and encourage self-care, but
without procedures and policies, staff may forgo selfcare
due to pressure, stigma, or fear of negative consequences.
Actively enforced policies take the burden off
staff by giving them “permission” to take care of themselves.
These policies can include:
• Mandatory PTO days
• Mandatory rest/relaxation/stress management
breaks
• Required limits on work hours
Practices can include:
• Assigning mentors, work partners or teams to
encourage peer support
• Scheduling regular check-ins between supervisors
and direct reports
• Providing healthy, energizing food options in the
breakroom to reduce reliance on sugary snacks
and caffeine
• Providing at-work options for yoga, exercise,
meditation, and other stress reduction techniques
15
• Providing regular mental health and wellness
training, as described above
The cost of these policies and practices is made up
for in recaptured productivity and in preventing the
loss of good employees to burnout.
Building a culture of self-care starts with leadership.
Managers should set the example by prioritizing
self-care themselves. If employees see their
managers making use of resources, taking rest
breaks and utilizing PTO, they are more likely to
feel comfortable and safe doing the same.
4. Support Your Healthcare Staff by Being Flexible
COVID-19 will have a long shadow as individuals
and families try to rebalance their lives. Staff members
may be dealing with childcare or other scheduling
challenges as a laid-off spouse returns to the
workforce, for example. Some staff members may
need more hours to make up for lingering unemployment
in the family, while others must work less
to accommodate family needs.
Whenever possible, allow for more scheduling flexibility
for employees. Show compassion and understanding.
Not only will this help employees stay
more productive in the present, they will likely respond
to your compassion with dedication and loyalty
in the long term.
5. Communicate, Communicate, Communicate
Uncertainty breeds anxiety. When the world feels
shaky on its foundation, even a small procedural or
staffing change can feel like an earthquake.
Be transparent about the state of the practice and
any organizational changes or updates. If you do
not address it, the rumor mill will—and even if
there’s nothing wrong, the uncertainty will make it
so. Set clear expectations about working hours,
workloads, and priorities.
Reduce the burden on your staff with Revenue
Cycle Management Solutions
Your staff will thank you (and feel stronger, too). With
the burden of patient billing and collections lifted, they
will have the muscle for what they do best.