Review the reimbursement tracking as part of the revenue cycle, and understand the basics of DRGs, APCs and MPFS in this audio session with Duane Abbey.

1. © 2002-2014 Abbey & Abbey, Consultants, Inc. Slide # 1Slide # 1
Revenue Cycle: Tracking Reimbursement forDRGs
, APCs and MPFS
Presenter
Duane C. Abbey
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OASIS is the foundation of the patient homecare episode. It is the major factor to
determine both outcomes and reimbursement.

2. © 2002-2014 Abbey & Abbey, Consultants, Inc. Slide # 2Slide # 2
This workshop and other material provided are designed to provide accurate and
authoritative information. The authors, presenters and sponsors have made every
reasonable effort to ensure the accuracy of the information provided in this
workshop material. However, all appropriate sources should be verified for the
correct ICD-9-CM Codes, ICD-10-CM diagnosis codes, ICD-10-PCS procedure
codes, CPT/HCPCS Codes and Revenue Center Codes. The user is ultimately
responsible for correct coding and billing.
The author and presenters are not liable and make no guarantee or warranty;
either expressed or implied, that the information compiled or presented is error-
free. All users need to verify information with the Fiscal Intermediary, Carriers,
other third party payers, and the various directives and memorandums issued by
CMS, DOJ, OIG and associated state and federal governmental agencies. The
user assumes all risk and liability with the use and/or misuse of this information.
Disclaimer

3. © 2002-2014 Abbey & Abbey, Consultants, Inc. Slide # 3Slide # 3
Presentation Faculty
Duane C. Abbey, Ph.D. – Dr. Abbey is a healthcare consultant and educator with over 20 years
of experience. He has worked with hospitals, clinics,
physicians in various specialties, home health agencies and other health care providers.
His primary work is with optimizing reimbursement under various Prospective Payment
Systems. He also works extensively with various compliance issues and performs
chargemaster reviews along with coding and billing audits.
Dr. Abbey is the President of Abbey & Abbey, Consultants, Inc. A wide range of consulting
services is provided across the country including charge master reviews, APC compliance
reviews, in-service training, physician training, and coding and billing reviews.
Dr. Abbey is the author of fourteen books on health care, including:
•“Non-Physician Providers: Guide to Coding, Billing, and Reimbursement”
•“Emergency Department: Coding, Billing and Reimbursement”, and
•“Chargemasters: Strategies to Ensure Accurate Reimbursement and Compliance”.
Recent books include: “Compliance for Coding, Billing & Reimbursement A Systematic
Approach to Developing a Comprehensive Program”, “Introduction to Healthcare Payment
Systems”, “Fee Schedule Payment Systems” and “Prospective Payment Systems” from
Taylor and Francis. He has just finished the fourth book in the Healthcare Payment System
Series; “Cost-Based, Charge-Based and Contractual Payment Systems”.

4. © 2002-2014 Abbey & Abbey, Consultants, Inc. Slide # 4Slide # 4
 Revenue Cycle versus Reimbursement Cycle
 Generation of Claim That Is Adjudicated with Payment Made
 Itemized Statement versus Claim Generation
 Overall Process Optimization versus Detailed Process Suboptimization
 Big Picture versus Individual Small Pictures
 Yes, This Involves Teams, Six Sigma Techniques, Supply Chain and
Various Metrics
 Systems Approach
 Break Reimbursement Cycle Process Into Parts
 Improve a Given Part - Suboptimization
 Put Back Together
 Look At The Interfaces
 Need a Metric To Measure Overall Quality
 Work Backwards In Order to Improve  Systems Approach
 Efficiency versus Effectiveness
 Hospital Silo Effect – Intra-Department vs. Inter-Department
 Resistance to crossing departmental boundaries.
 Example: Coding personnel refusing to review charges when coding.
 Identifying How You Can Help!
 “Be a part of the solution, not a part of the problem.”
Revenue Cycle: Tracking Reimbursement
Introduction

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Revenue Cycle: Tracking Reimbursement
Introduction
 Frequently Asked Questions
 What is the revenue cycle?
 How does the reimbursement cycle relate to the revenue cycle?
 How can we improve the reimbursement cycle?
• Cost-Benefit
• Suboptimization
• Systems Approach & Tools (See 6-Sigma)
• Financial Impacts
• Efficiency vs. Effectiveness
 Why track reimbursement?
 How to track reimbursement?
• Automated vs. Manual
 Who really tracks reimbursement?
• Hospitals? Clinics? Physicians? Others?
• Is it difficult to track reimbursement?

6. © 2002-2014 Abbey & Abbey, Consultants, Inc. Slide # 6Slide # 6
To see the complete presentation check the
below link:
http://www.audioeducator.com/hospitals-and-health-systems/reimbursement-
tracking-08-12-14.html

7. © 2002-2014 Abbey & Abbey, Consultants, Inc. Slide # 6Slide # 6
To see the complete presentation check the
below link:
http://www.audioeducator.com/hospitals-and-health-systems/reimbursement-
tracking-08-12-14.html