Making the practice plan perfect

General Article

Practice plan administrator Sheila Kirkegaard oversees billing, reimbursement and budgeting in 19 diverse areas of medical service

Sheila Kirkegaard works in partnership with Dr. Marc Stewart, medical director for the Seattle Cancer Care Alliance, and with oncologists, pathologists, psychiatrists and many other specialists. Photo by Todd McNaught

It didn't take long for Sheila Kirkegaard to appreciate working at the Hutchinson Center. While the practice-plan administrator had expected to encounter all sorts of scientific innovation when she arrived last July, she was excited to find that the spirit of discovery does not stop at the laboratory door. "The whole culture lends itself to creative problem solving," she said.

Energized by the Hutchinson Center's environment, Kirkegaard is continually striving to strengthen the center's practice plan, which guides physicians, physician assistants and nurse practitioners from the Clinical Research Division — most of whom work in the bone-marrow transplant program — as they manage the patient billing, reimbursement and budgeting aspects of their work.

Opportunities and challenges

"Sheila very quickly identified areas of opportunity and potential improvement in our practice plan," said Dr. Marc Stewart, medical director for the Seattle Cancer Care Alliance (SCCA) and a member of the Clinical Research Division. "Opportunities to improve our legitimate professional fee collections are high on her list. Thanks to Sheila, our practice plan is very well-organized."

Kirkegaard's job requires that she work closely with the SCCA. The partnership among three institutions — the Hutchinson Center, UW Medicine and Children's Hospital and Regional Medical Center — adds an additional layer of complexity to the billing process. So does the fact that most Center doctors belong to the UW Physicians practice group and divide their time between research and patient care.

"This is a very complicated practice because there are so many players involved," Kirkegaard said. "Hutchinson Center practitioners see patients at the SCCA outpatient clinic as well as at SCCA inpatient units at Children's Hospital and the UW Medical Center. The practice is also very diverse. I've identified 19 areas of service. We have oncologists, pathologists, psychiatrists and many other specialists, so it's a big job to get to know each of them."

Background of success

Kirkegaard oversees the billing, reimbursement and budgeting process from start to finish, but believes the more energy she spends upstream, the better the results will be downstream. "What I like to do is look at the first step — when the practitioner is providing the service," Kirkegaard said. "The more clearly I understand their practice and their services, the better all of the rest of the steps — billing the insurance company, collecting the appropriate fees and analyzing the financial results — will go."

As part of her effort to learn more about the work of Center practitioners, Kirkegaard recently joined the American Society of Blood and Marrow Transplantation and was chosen to serve on a working group that is developing financial benchmarks for bone-marrow transplantation.

Although Kirkegaard is not responsible for actually processing or sending out bills, she is responsible for advising providers on how best to complete the fee sheets that generate the coding that drives billing. That's no small task considering how "ambiguous and voluminous" the ever-changing rules and regulations governing the process can be, but it is vital as inaccurate or incomplete fee sheets can cause reimbursements to be delayed or denied, she said.

With that in mind, Stewart is happy to have Kirkegaard onboard. "In the last few years, we have been held to higher standards of practice with regard to documentation and billing and much work remains to be done," he said. "Sheila's strong background in accounting, consulting and medical-practice management — including the success of actually changing two Medicare regulations — speaks to her success to date and our potential success in the future."

Medicare regulations, which also drive most insurance-company policies, are often at odds with medical practice. However, it's typically the provider that must adjust, not the insurer. Nevertheless, in her previous job, Kirkegaard twice succeeded in reversing objectionable regulations.

A certified public accountant, Kirkegaard is the former administrator for Physicians Anesthesia Service, a group of 75 anesthesiologists that practices at Swedish Hospital and Medical Center. Before that, she worked as a consultant managing physician practices.

"I like health care as an industry because it's helping to save and improve people's lives," she said. "I especially like the not-for-profit culture at the Hutchinson Center."

Kirkegaard recently completed the first in a series of reviews intended to clarify and simplify the billing process in each of the Hutchinson Center's 19 areas of service. "The idea is to bring providers together to talk about their practices, the services they perform and the billing regulations, and then develop procedures that ensure everything correlates and that the system runs smoothly and accurately," she said. "We want to look at everything in the regulations and hone them down to what's relevant to us."

Help for researchers

The first review, which examined outpatient bone-marrow transplant services, resulted in a rule of thumb for practitioners trying to code various types of patient visits, Kirkegaard said. Next up are reviews of Consults and Inpatient Critical Care services. Kirkegaard said the Center's practitioners have welcomed being able to meet with someone to resolve questions about billing and other practice-management issues. She also is available to help researchers who are preparing grant applications obtain pricing for clinical services funded by the grants. Kirkegaard encourages providers with questions to contact her at skikrega@fhcrc.org.

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