Robert M. La Follette School of Public Affairs
Monday, February 4, 2013

Lefkow manages medical billing, claims systems

Helena Lefkow and her family

Helena Lefkow helps smooth billing and claims processes for hospitals and their patients. The La Follette School alum is project manager of patient financial services with the Metropolitan Chicago Healthcare Council, an association of more than 150 hospitals and health-care organizations.

"I work with hospital management staff across the revenue cycle, from patient registration, billing and collection of payments, clinical case management, medical records and regulatory compliance," says Lefkow, who graduated in 2008 with a Master of Public Affairs degree.

Lefkow came to La Follette several years after completing a bachelor's degree in history at Northwestern University. She worked as a market analyst for a consulting firm, as executive director of the National Association of Women Lawyers and as a research assistant to a law professor at Northwestern, studying the long-term effect of the Fair Housing Act of 1968 and the effectiveness of poverty law litigation initiatives.

At the Metropolitan Chicago Healthcare Council, Lefkow helps her department provide technical assistance with claims processing and billing. She also helps manage the unit's collaboration with the federal Centers for Medicare and Medicaid Services, the Illinois Department of Healthcare and Family Services, and private payers to address hospitals' collective revenue cycle concerns. "Patient Financial Services provides reliable and timely information on complex rules and regulations to help hospitals ensure they are billing accurately and complying with federal, state and private payer requirements," Lefkow says. "I also research and write a weekly government relations newsletter on health-care policy that is distributed to hospital executives."

One project she led to facilitate smoother processes brought together Illinois and federal officials to help them better understand federal and state requirements for hospitals to verify whether their employees, physicians and contractors were allowed to participate in Medicare and Medicaid programs.

"I brought in the U.S. Department of Health and Human Services Office of Inspector General exclusions director, Illinois' HFS inspector general and the deputy director of statewide enforcement for the Illinois Department of Financial and Professional Regulation to offer guidance on how frequently hospitals should check the program exclusion status of clinicians who order or refer services," Lefkow says. "We also discussed resources hospitals can tap to ensure compliance with federal and state regulations, as well as the penalties for noncompliance."

Workshop report available online

Helena Lefkow prepared the workshop report Fee-for-Service Medicaid in Wisconsin: An Evaluation of Quality Improvement Initiatives for the Aged, Blind and Disabled with Alexis MacDonald, Michael Porter and Krista Willing for the Office of Policy Initiatives and Budget, Wisconsin Department of Health and Family Services.

The report examines alternatives for improving the quality of health care provided to the aged, blind and disabled population in fee-for-service Medicaid in Wisconsin. Options the authors considered include maintaining the status quo, implementing a pay-for-performance system, adopting a primary care case management program, operating a chronic disease management program, and pursuing a combination of primary care and chronic disease management.

The job had a steep learning curve, Lefkow notes, because billing and claims processing is very specific and not necessarily something one learns in school. "However, I did have some experience with Medicaid policy through my La Follette workshop report for Wisconsin's Department of Health and Family Services," she says. "I also did a clinical program at the Center for Patient Partnerships at the University of Wisconsin Law School, which gave me an invaluable understanding of how to navigate health insurance and the health-care system in general."

The position of the La Follette school on a large research campus facilitates opportunities like these. "The education I received was very good and prepared me well for policy work," says Lefkow, who had a fellowship her first year and a project assistantship her second. "The small size of the program really allows students to develop relations with faculty. I met a lot of very smart and interesting people."

Lefkow's experience at La Follette inspired her husband to change careers. "The year after I graduated, he started at the Harris School of Public Policy at the University of Chicago," she says. "We are both a couple of wonks now — in addition to being parents of our son, who was born in 2011."

After Lefkow graduated, she and her husband headed back to Chicago with their yellow Labrador, and Lefkow started her job search. She found her job through 1991 La Follette alum Theresa Mintle, then chief of staff for the Chicago Transit Board and now chief of staff to Chicago's mayor. Mintle put Lefkow in touch with someone she knew at the Metropolitan Chicago Healthcare Council. "I can't thank her enough for her help," Lefkow says, adding that she is happy to do the same for La Follette alumni.

When Lefkow started at La Follette, she planned to focus on health policy, thinking she would be a patient advocate. "I don't work with patients now, but being in Chicago, we work with a number of safety-net hospitals that serve uninsured people and others covered by Medicaid," Lefkow says. "I feel like my work helps them remain financially viable so they can continue providing care to their communities."