Debbie Hiraoka, Partner
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Debbie is a Partner and co-founder of SH Consulting LLC. Debbie has over 30 years of experience in assisting clients in healthcare revenue cycle, performance improvement, information systems planning, selection and implementation, financial analysis and modeling, accounting and finance related projects, and project management. Debbie has managed projects ranging from departmental systems to large-scale state-wide information systems and performance improvement projects. Former experience includes 13 years with Ernst & Young and 3 years with Cap Gemini Ernst & Young.
RELEVANT EXPERIENCE
Revenue Cycle
- Conducted a revenue cycle assessment for a large academic physician practice. Documented process flows, performed claim review and facilitated a session which resulted in identification of over 30 improvement ideas.
- Interim director of business office for multi-hospital health system. Achieved increase in cash collections in excess of 10% or $7.5M over cash targets. Implemented revenue cycle task force to improve communication with front, middle and back end components of revenue cycle. Achieved improvement of hospital net income exceeding $800,000.
- Implementation of a denial management and contract management system for a large multi-hospital health system. Achieved net revenue improvement of $2M annually.
- Project team leader to reengineer the admitting and patient accounting functions of a large academic institution. Reengineering effort included reorganization of department, redesign of processes to emphasize customer value-added and eliminate non-value-added functions and implementation of innovative information technologies. Anticipated cost savings and revenue enhancement opportunities in excess of $10M annually with an increase in customer satisfaction.
- Implementation of a claims processing system for the State of Hawaii Medicaid program. Applications include recipient tracking, provider registration, prior authorization approvals, claims processing, payment, and reporting. Included assistance with transitioning data and other information from the prior fiscal agent.
- Assisted the Medicaid fiscal agent to increase the accurate and timely processing of Medicaid provider claims from hospitals, nursing homes, physicians and other providers. Fiscal agent achieved a 100% report card as a result of these improvements.
- Cash acceleration project to increase cash receipts and reduce patient accounts receivable balance. Resulted in an immediate increase of 50% in monthly cash receipts.
- Implementation of the Revenue Management System module of TSI for a large academic institution. Included contract modeling, extract development, system testing, user training, and policies and procedures development. Anticipated revenue enhancement opportunities in excess of $3M annually.
Accounting, Finance and Cost Analysis
- Served as acting CFO for a large academic physician practice. Improved accuracy and timeliness of financial reporting, coordinated budget preparation and presentation of financial results and budget to the Board. Developed standard board reporting packet. Assisted Board with coordinating a forensic review of accounting practices.
- Provided interim supervision of accounting staff which included monthly financial statement preparation, budget preparation and presentation of financial results to the Board. Assisted with catch-up to close 6 months of financial statements and preparation of audit schedules in less than 30 days. Redesigned financial reporting package to align financial results with operations. Assisted with recruitment and training of a new controller.
- Developed financial models to determine the fully allocated cost of providing a hospital service, to analyze the cost of servicing a particular patient population for negotiation of a managed care contract, and to analyze projected revenues and expenses for several healthcare facilities including an acute care hospital for use in a real estate valuation.
- Reviewed the calculation of a hospital’s monthly contractual allowance reserves, including a review of the reserves schedules to support the net revenue and contractual allowance reserve calculations. Provided recommendations on monthly reserve amounts and assisted with calculation of third party liability estimates.
Corporate Compliance
- Development of compliance review checklists for the components of the professional revenue cycle, including admitting and registration, charge capture, documentation, billing and collection and follow-up. The checklists identify essential elements of an organization’s policies, procedures and other processes to ensure compliance with Federal and State requirements.
- Provided technical assistance related to a claim filed by a provider for failure to properly adjudicate and pay a hospital claim for services rendered. Work performed included preparation of a report describing the Medicaid payment systems, reimbursement methodologies and claims processing procedures. Result was a settlement in favor of the provider.
- Provided expert testimony and report related to a claim filed against a provider related to irregularities in the submission of a facility claim. Work performed included preparation of a report describing hospital claim billing requirements related to certain field locators. Result was a judgment in favor of the provider.
Information Systems
- Implementation of the first joint-state initiative nation-wide for information systems between the State of Hawaii and the State of Arizona. Applications included eligibility tracking, enrollment processing, health plan rosters, provider registry, and encounter processing. Assistance included development of a program management office, user requirements development, user acceptance testing, policies and procedures development, data conversion and system interfaces. Project was applauded by HCFA as “a model for other states to consider” and demonstrated its support by providing the maximum Federal participation levels of funding. Project encompassed nearly 70,000 man-hours and system went live just over a year after project kick-off.
- Implementation of a managed care information system for a health plan in less than 4 months to meet the requirements for a new line of business.
- Systems requirements and vendor selection for an integrated hospital information system.
- Project management and development of interim systems for the State of Hawaii Medicaid managed care waiver program.
- Development of a system for the State of Hawaii to track and bill premium share payments to clients. Assisted with development of an interface to allow for the automated transfer of information from the legacy system to a commercially off the shelf accounts receivable system.
- Development and maintenance of a college tuition tracking system.
- Implemented over 20 commercial off the shelf accounts systems, including Solomon, Great Plains and MAS-90. Modules include general ledger, accounts receivable, accounts payable, reporting and transaction import modules.
Performance Improvement
- Assisted the State of Hawaii Adult Mental Health Division with the implementation of the Medicaid Rehabilitation Option. Included development of processes and systems to support the timely and accurate payment of provider claims and the transfer of paid claims data with the Medicaid program using standard 837 and 835 transaction sets. Responsible for detail user acceptance testing that identified system issues. Developed interim systems to assist in monitoring the system issues which enabled the program to go-live despite these outstanding issues. Result has been $25 million of Federal funding to the State of Hawaii.
- Facilitation of discussions between various parties to identify issues and develop resolutions to improve the timely processing and adjudication of health care claims. The result was a significant reduction of pended claim volume by over 30%, increased communication between affected parties and increased customer satisfaction due to reduced time from claim submission until claim payment.
AFFILIATIONS/CERTIFICATIONS
Certified Public Accountant (not active)
Certified Management Accountant (not active)
Health Care Compliance Association
HIGHER EDUCATION
B.B.A., Accounting and Management Information Systems, University of Hawaii
M.B.A., University of Hawaii