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Summer 2017




Farewell President’s Message David Schweer, FACHE


Welcome President’s Message Marc Armstrong, CPA, CHFP


Membership Spotlight


Encore Events


Upcoming Events


8. Supreme Court Debt Ruling Could Have Healthcare Impact




Dana Lujan

Board of Directors

Contributing Editor

Marc Armstrong

Christine J. Carafelli Summerlin Hospital Med Ctr.

Contributing Writers

Rich Daly


Felipe S. Danglapin, MSA, PAHM Teachers Health Trust

Questions and Comments

Osmin A. Hernandez KPMG LLP

Tiffanie Fleming UMC of Southern Nevada

Dana Y. Lujan, MBA DYL Consulting Group

Board Chapter Officers President

David J. Schweer, FACHE Dignity Health Central CA Service Area


Marcus A. Armstrong, FHFMA Anthem Blue Cross & Blue Shield

Vice President

R. Keenan Underwood Kindred Healthcare Inc.


Joe Herman Fallon Paiute Shoshone Comm HC


Lawrence M. Preston, MBA, FHFMA Professional Medical Consultants, Inc


A Farewell President’s Message Thanks for being part of the HFMA Nevada Chapter. It has been my honor to serve as your chapter president over the last twelve months. I’ve had the opportunity to meet and work with many of you.

more programs, more finance-specific topics, and programs in northern and rural Nevada. Please join me in thanking our entire chapter board, including our outgoing members: Keenan Underwood, Kindred Healthcare; Tiffanie Fleming, UMC Southern Nevada, and Christine Carafelli, UHS/Valley Health System – Summerlin Hospital.

FY 16-17 Results We’ve had a great fiscal year. We accomplished many goals and came up short on a couple. We met our chapter targets for education, education quality / event surveys, innovative programs, networking, % members certified, and others, while we were slightly off target on membership growth and member satisfaction. We hosted new events including a Women’s Leadership Breakfast and a Diversity and Inclusion Summit. We continued to partner with other professional associations on the Nevada Health Care Forum, our popular Meet the CEO series, other education, joint charity golf tournaments and mixers.

Join us for upcoming education and networking events! Please see our list of upcoming events at in both northern and southern Nevada. We just had our 6th Annual Joint Association Charity Golf Tournament is on May 6th at the Red Rock County Club – Arroyo Course. It was a great event as usual thanks to Larry Preston and all our volunteers. We are planning our 1st Annual Northern Nevada Tournament on June 17th at Red Hawk Golf and Resort in Reno/Sparks. Go to: eckin.aspx?eventid=1983755. 100% of the proceeds of these events go to organizations supporting local veterans.

Our member satisfaction survey from last fall showed that we still have ample opportunity for improvement as it generally does. Members responding indicated an interest in


We are working on a full schedule of programs for the coming months. Some of our major events include those that follow. The 10th Annual Nevada Health Care Forum is scheduled for Oct. 10th at the new Enclave conference center in Las Vegas. HFMA’s Annual National Institute is in Orlando, FL from June 25-28. Region 11 joined with Region 10 for an expanded Western Region Symposium back in Las Vegas this year. It will be at the Paris Hotel next year in January 14-17, 2018. Please mark your calendar for all these events and plan on attending. Please also take advantage of other HFMA regional and national education events and webinars. Go to, and for more info.

Get more from HFMA Take advantage of all that HFMA has to offer. From education programs including virtual conferences and webinars to online resources and the hfma magazine, HFMA has resources to help you face the challenges of our industry. HFMA also has career resources and the HFMA Job Bank with current openings regionally and nationally. Support our sponsors We have a number of vendors who help sponsor the Nevada Chapter so that we can do all the things we do. Please see their ads and consider them for services that your organization may need. We need your help! Share your ideas The Nevada Chapter is a small chapter with no paid staff that relies on volunteers to offer programs, events, and services. If you have ideas on new programs or events, please volunteer to help make them happen. . You can reach me at or or Marc Armstrong, our President Elect, at

Now is the time to get certified! Limited number of chapter group purchase slots available. In case you have not heard, HFMA has revamped its certification program to become a Certified Healthcare Financial Professional (CHFP), which is a key requirement in becoming a Fellow in HFMA (FHFMA). The exam has been replaced by a two part self-study program with exam and case study, which includes retake options. To help members get certified and reduce the cost burden, the Chapter is doing a bulk discount purchase of the first part of the study program. In order to participate, you must successfully complete part one and its exam, and then also complete part two and its case study on your own. If you are interested or have questions, please contact Pete Sabal, our Certification Chair, at HFMA also offers a number of specialty certifications including revenue cycle, managed care, practice management, business intelligence, and accounting & finance. For more info, go to and see the certification links under education.

Welcome to our new Chapter President and Board! Marc Armstrong is our incoming president and has a number of new volunteers, including some with experience serving in other chapters. I look forward to seeing you at an upcoming chapter event. David Schweer Outgoing President HFMA – Nevada Chapter


A Welcome Message From the Incoming President

Thank you for your commitment to the HFMA Nevada Chapter. We are just about to wrap-up a very successful and productive fiscal year 2016-17 under Dave Schweer’s leadership and guidance. Dave is very astute and has a keen eye for quality as he helped the chapter meet its targets for education, education quality, networking, member certification percentage, board composition, and the relatively new innovation metric. Two new and successful programs this year included the Women’s Leadership Breakfast and the Diversity and Inclusion Summit. Thank you, Dave, for your leadership and for serving as a mentor to me as I take the reins. FY17-18 Board of Directors Please welcome our incoming Board slate comprised of the following new and returning volunteers: President Marc Armstrong FY17-18 Director Felipe Danglapin President-Elect Dana Lujan FY17-18 Director Osmin Hernandez Vice President Glenda Hill FY17-18 Director Tim Myers Secretary Joe Herman FY17-19 Director Bonnie Barnett Treasurer Larry Preston FY17-19 Director Karla Gebo Past President Dave Schweer FY17-19 Director George Wiley Ex Officio Christy Johnson, NHA Leadership Training Conference (LTC) A team of seven leaders from the incoming Board traveled to Phoenix for the annual LTC at the Arizona Grand Hotel in April. During the conference, the leaders received training and learned best practices in the President, President-Elect, Programs and Communications leadership tracks with additional sessions pertaining to driving membership, increasing volunteerism and providing 6

fun and engaging social programs. The team is preparing for an exciting year by using this training as a springboard to provide an even higher quality service to each of you. New and Improved Website Coming Soon The chapter has engaged StarChapter to help transform our website into a multifunctional platform for news, recognition and event registration. We hope to have our user-friendly and appealing HFMA Nevada Chapter website up and running by mid-June. Our site address will remain Education and Networking For those of you living in Northern Nevada, or who would like to travel to Reno, please join us at our 1st Annual Northern Nevada Tournament on June 17th at Red Hawk Golf and Resort in Reno/Sparks benefitting the Sierra Nevada Horses and Heroes. To register, please go to Plan on combining some education and recreation as HFMA’s Annual National Institute (ANI) returns to Orlando this year from June 25th thru 28th. To learn more and to register, please visit: The 10th Annual Nevada Health Care Forum is scheduled for Oct. 10th at the new Enclave conference center in Las Vegas. To learn more and to register, please visit The Western Symposium returns to Las Vegas early next year, this time at the Paris Hotel & Casino on January 14th thru 17th. Event updates will be posted at Get involved by Volunteering Each of you are quite accomplished in your respective roles within health care finance. Your unique experience and ideas can prove invaluable in helping the chapter provide excellent educational programs and events to the membership. Please consider helping us by serving on one or more of our committees, such as Programs, Communications, Membership, Sponsorship, and Social. To learn more about how you can help, please reach out to me at I look forward to serving you this year. Thank you, Marc Marc Armstrong Incoming President HFMA – Nevada Chapter


Supreme Court Debt Ruling Could Have Healthcare Impacts By : Rich Daly Justice John Roberts, Jr. and Justices Anthony Kennedy, Clarence Thomas, and Samuel Alito, Jr.


The dissenting opinion was authored by Justice Sonia Sotomayor. May 18—The U.S. Supreme Court ruled that debt collectors and debt buyers don’t violate federal law when they pursue debts in bankruptcy that exceed state time limits on collection.

“It takes only the common sense to conclude that one should not be able to profit on the inadvertent inattention of others,” Sotomayor wrote in her dissent, joined by Justices Ruth Bader Ginsburg and Elena Kagan. “It is said that the law should not be a trap for the unwary. Today’s decision sets just such a trap.”

On May 15, the high court issued a 5-3 decision in Midland Funding, LLC v. Johnson that filing of a proof of claim that is obviously time-barred “is not a false, deceptive, misleading, unfair, or unconscionable debt collection practice within the meaning of the Fair Debt Collection Practices Act,” as Justice Stephen Breyer wrote in the majority opinion.

Several industry experts anticipated that the decision will boost collection efforts on old healthcare debts.

Edgars (Edz) Sturans, president and CEO of BillingTree, said in a written statement to

Breyer was joined in his decision by Chief


HFMA,, “We can certainly see there being some increased litigation specifically involving debt buyers that purchase old healthcare debt portfolios.”

represents debt buyers and debt collection firms. “If anything, it will deter plaintiff’s lawyers who are bringing more cases, but it may be that it just makes them be more creative,” Bartholow said in an interview.

Karen Scheibe Eliason, corporate counsel for ACA International, an association of credit and collection professionals, agreed that more cases in all areas of unsecured debt—including in health care—are likely.

Increasing Significance in Health Care The temptation to offload bad debt is increasing in health care, industry advisers say.

“In an abundance of caution, particularly now having this ruling, I would think that debt collectors and creditors would file these proofs of claim on debt that is owed because they may or may not be time-barred,” Eliason said.

“There certainly is more pressure to collect the patient liability—no doubt about it,” said Terry Allison Rappuhn, formerly leader of HFMA’s Patient Friendly Billing project. “The highdeductible plans [HDHPs] are creating a huge amount of pressure on patients and also on the hospitals and the physicians.”

A proof of claim is a court filing that states the amount owed by a debtor to a creditor. Eliason hailed the court decision as “driven by the rule of law” because it was consistent with statutory definitions of claims as simply “the right to payment.”

In 2006, just 5 percent of employer health plans had members enrolled in HDHPs. Last year, nearly one out of three covered employees was in an HDHP, according to the Kaiser Family Foundation.

“It’s still owed, even if it is beyond the statute of limitations,” Eliason said in an interview.

The $55.8 billion in hospital bad debt expenses in 2015 ranged from 1.63 percent of revenue for not-for-profit hospitals to 3.78 percent of revenue for low-volume hospitals, according to a recent Medicare S-10 cost report analysis (HFMA member login required) by American Hospital Directory Inc., Louisville, Ky.

In the 48 states where debt does not expire after the time limit on enforceable collections, the collection limit is generally six years, she said. Attorneys for debtors were even more adamant about its impact. “This opinion blows a hole wide open for debt buyers to use the bankruptcy process in a completely unique way,” Thad Bartholow, a partner with Kellett & Bartholow, PLLC in Dallas, said in a webinar on the decision. “We could see some very old debt reappearing for people in bankruptcies.”

A Moody’s Investors Service outlook issued in March concluded that for-profit hospitals’ bad debt expenses as a percentage of revenue will continue to increase over the next 12 to 18 months. If hospitals move to sell more of the uncollected portions of their total patient debt, they should use caution.

Among those who thought the decision could reduce claims on old debt was Stephen Sather, an attorney at Barron & Newburger, where he

“Patient satisfaction is a top priority with a lot


of hospitals because they lose revenue if they get poor scores on patient satisfaction with Medicare,” said Tom Brekka, CEO of VestaCare. “So they are going to be very concerned with chasing patients with bad debt aggressively.” Hospitals looking to pursue increasing amounts of older debt should first ensure they have a board-approved policy and a comprehensive set of predefined circumstances in which such actions are appropriate, said Chad Mulvany, director of healthcare finance policy, strategy and development, HFMA. Such steps may prevent potentially adverse publicity from unpopular debt collection cases.

Other Impacts The ruling could have an unintended benefit for healthcare providers targeted over unintentionally disclosing identifiable personal information or unredacted healthcare records as part of court filings, according to Sather. “While this decision doesn’t directly speak to that, it could have some encouraging language to try to beat back some of those lawsuits,” Sather said. The case also may bring attention to the need to change hospital billing from a chase model to more of a prearranged payment agreement, Brekka said.

“If a hospital is going to have someone else contact their patient about their debt, they should have a process in place on how they treat the patient, [ensuring] that there is respect and that if the patient contests the bill, they have some sort of recourse—which frankly is not going to happen with a 10-year-old debt,” Rappuhn said in an interview.

“If you shift the focus with patients from chasing them to engaging them on the financial question and getting them enrolled in some type of financial program when they are being treated, they are much less likely to avoid paying their bill and force you into a position to have to go after them in collections,” Brekka said.

She urged hospital CFOs considering turning over old debt to collection agencies to first read the industry guidance and recommendations for protecting their patients.

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

An HFMA and ACA International medical debt task force developed consensus practices, updated in April 2016, to “bring clarity, fairness, and consistency to medical account resolution.”



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In your opinion, what is the most important issue facing Healthcare/Healthcare Finance today? Patient Education. On the revenue side of healthcare most patients tend to think they simply have to walk in, provide insurance and be done. Patients need to be better informed of their insurance coverage and personal obligations. We need to help patients understand that they are ultimately responsible for the charges they incur and the more proactive they can be with their insurance company, the quicker issues can be resolved.

Membership Spotlight

How long have you've been a member of HFMA? Clark County Collection Service has been a member for several years. I have increased the participation level over the last two years. We have a strong mutual interest in the future healthcare concerns that face our community.

Tim Myers Clark County Collection Service, LLC Business Development Manager What are you doing now? I am the Business Development Manager for Clark County Collection Service LLC. In addition, I serve as the President of Nevada Collectors Association, Treasurer of Nevada Bass Nation (past president), Board Member of Healthcare Financial Management Association and I am an active member of the Southern Nevada Apartment Association.

Why is being a member important to you? Healthcare is essential to quality of life. It is our responsibility to be actively informed and help shape the future of the medical industry. It is imperative that we build strong relationships across industries so that we can speak with a louder voice. Healthcare is a majority of our business and what effects our clients, effects our business and our families. It is an honor to serve on the HFMA board as a vendor member.


What advice would you give to early careerists or those considering membership? Get educated and get involved and put your talents to work for one of the most important industries that drives 17.8% of GDP and 100% of your personal well-being. Health is wealth. You can contribute on every level from learning to partnering with the industry for the good of all patients.

Glenda R. Hill, MBA President & CEO Fore-ward Healthcare Solutions, Inc.

Tell us one thing that people don't know about you? When I am not working with a team to support the agenda of the medical or collection communities, I enjoy hands on work where I have a tangible end product. “Do it yourself� projects are especially rewarding because you can see the progress as a project comes together and know what you contributed to that project.

What are you doing now? I am doing revenue cycle work for healthcare organizations as well as helping organizations adopt telemedicine. My company offers a b2b telemedicine platform that is robust and comprehensive and allows providers to set their own fee schedules and we can bill insurance for qualified visits. In your opinion, what is the most important issue facing Healthcare/Healthcare Finance today? In my opinion, unpredictable changes due to political influences makes it extremely difficult for healthcare executives to plan and strategize. It is a precarious time and healthcare finance professionals have to navigate a myriad of changing reimbursement models, regulatory pressures, and


demands from a variety of stakeholders.

oldest living survivor of the Oregon Trail, was honored by the President of the United States and a monument erected in her honor. I have a photo of her standing next to it and at the ripe old age of 80-something, she looked like a rugged and tough woman.

How long have you've been a member of HFMA? Just over ten years Why is being a member important to you? This is a very complex industry and HFMA is my go-to source for information and education. Also, I have met many other healthcare finance executives that have resulted in great friendships as well as resources. What advice would you give to early careerists or those considering membership? Do not hesitate. Join. HFMA not only provides current industry information, but the relationships you will develop via other HFMA members are priceless for your career. You will find top notch professionals who will embrace you and your quest for knowledge to make this industry better. Tell us one thing that people don't know about you? I am a native Oregonian. My greatgreat-great grandfather was a captain on the Oregon Trail and settled in Oregon. My family still has the original spinning wheel they brought over on the trail and my great-great grandmother, who at the time was the


EVENT ENCORE 1st Collaborated Annual Women’s Leadership Breakfast – Las Vegas December 8th, 2016 On “International Women’s Day” marked the 1st Collaborated Annual Women’s Leadership Breakfast “Leading Change...By Changing the Way YOU Lead.,” that consists of the following stellar panel; Moderator: Teressa Conley | President & CEO| Dignity Health (St. Rose Dominican) Panelists: Linn Billingsley, RN | Division Vice President | Kindred Healthcare Debra Fox, RN, MSN | Chief Nursing Officer | UMC Debra March | Councilperson | City of Henderson Melissa Walker, MBA | Chief Financial Officer | Dignity Health (St. Rose Dominican) We would like to express my gratitude who so generously helped make this event come together smoothly (Dana Lujan, Christine Carafelli, Tiffanie Flemings, Bonnie Barnett, Rosie Saenz, Jennifer Hussein, Dave Schweer, Pete Sabal, and Marc Armstrong) and also express gratitude to Dignity Health, Valley Health Systems, CCCN, Nevada National Guard and Anthem for donating items for the gift bags. Last but not least, to UMC for graciously hosting and sponsoring the event.


EVENT ENCORE Annual Leadership Training Conference – Phoenix, AZ –April 2017

Marc Armstrong presenting Dave Schweer with an “Outstanding Leadership” award – April 2017


For more info and to register… ventid=1983755 June 20th 8:00 am, Post Legislative Session Update (Reno) - Details for an identical update in Las Vegas to be announced. (Tentatively July 14th 11:30) In conjunction with MGMA Speakers: Caterine O’Mara, Executive Director, Nevada State Medical Association Bill Welch, President, Nevada Hospital Association No RSVP required June 23rd 11:00-1:00, Meet the CEO / Meet the ACHE Board Speaker: Jeremy Bradshaw, CEO, MountainView Hospital, President – ACHE – Nevada Chapter Lunch will be provided.

June 16th, 7:30-9:30, Women’s Event – Meet the CEO - A Micro Hospital’s Role in Population Health In conjunction with Nevada Executive Women in Healthcare

MountainView Hospital 1st Floor Auditorium 2880 N. Tenaya Way Las Vegas, NV 89128

Speaker: Laura Hennum, Market CEO Dignity Health – St. Rose Dominican Neighborhood Hospitals, Emerus - Las Vegas

RSVP to: Crystal Reardon at June 25-28, HFMA Annual National Institute Orlando, FL For more info and to register, go to:

RSVP to: June 17th, Inaugural Nevada Health Care Forum Northern Nevada Joint Association Charity Golf Tournament (Reno/Sparks) A joint event of the Nevada Chapters of ACHE (American College of Healthcare Executives), HFMA (Healthcare Financial Management Association), HIMSS (Healthcare Information and Management Systems Society), and MGMA (Medical Group Management Association) 7:00 am – Registration 8:30 am – Shotgun start – Best ball format with opportunity to purchase mulligans

July 14th, 11:30-1:00, Post Legislative Session Update (Las Vegas) - TENTATIVE Location & Details TBA Sept. 7th, 2:30-3:30, ACHE / HFMA Update at Nevada Hospital Association (Lake Tahoe / Incline Village) Hyatt Regency Lake Tahoe 111 Country Club Dr, Incline Village, NV 89451 Sept. 21-22, HFMA Northern California / Nevada Fall Conference (Lake Tahoe / Squaw Valley) Resort at Squaw Creek 400 Squaw Creek Rd Olympic Valley, CA 96146

Red Hawk Golf and Resort 6600 N Wingfield Pkwy Spanish Springs Sparks, NV 89436


Sept. 29th, 7:30-9:30 am, Women’s Leadership Breakfast (Reno) Speakers TBA Renown Regional Medical Center Mack Auditorium 1155 Mill St. Reno, NV 89502 October 10 (Tentative), 10th Annual Nevada Health Care Forum Stay tuned for more information.


HFMANV Healthcare Financial Partner: 2017 Summer Edition  
HFMANV Healthcare Financial Partner: 2017 Summer Edition