Learn how to use enhanced workflows and utilize pre-bill auditing in this one-hour webinar, presented by Laura Legg, HRG Executive Director of Revenue Integrity and Compliance.
See full webinar at www.hrgpros.com/webinars.
Sustaining Revenue Cycle Excellence: Top Performing PFSKrista Andrews
In reading all the former “best practices for the revenue cycle” information I was left a little dismayed of how one team could possibly achieve all the recommended processes and still deal with the ever present day-to-day fires and challenges. I set out to get real life examples from individuals and revenue cycle teams who have achieved sustained success. This presentation chronicles the first 12 facilities I visited and researched.
Learn how to use enhanced workflows and utilize pre-bill auditing in this one-hour webinar, presented by Laura Legg, HRG Executive Director of Revenue Integrity and Compliance.
See full webinar at www.hrgpros.com/webinars.
Sustaining Revenue Cycle Excellence: Top Performing PFSKrista Andrews
In reading all the former “best practices for the revenue cycle” information I was left a little dismayed of how one team could possibly achieve all the recommended processes and still deal with the ever present day-to-day fires and challenges. I set out to get real life examples from individuals and revenue cycle teams who have achieved sustained success. This presentation chronicles the first 12 facilities I visited and researched.
The Top 9 Questions Every Medical Coder Asks about Risk Adjustment and the CR...Laureen Jandroep
The Top 9 Questions Every Medical Coder Asks About Risk Adjustment and the CRC™ Certification was presented in a webinar by Certification Coaching Org (CCO), www.cco.us. A wealth of information was covered including: what Risk Adjustment (RA) entails, how this field is growing, and RA career opportunities. Also discussed was what to look for in a Risk Adjustment course. Attendees’ questions on careers in RA or preparing for the Certified Risk Adjustment Coder (CRC™) credentialing examination were answered. Presenters were Alicia Scott, CPC, CPC-I, CRC, and Chandra Stephenson, CPC, CIC, COC, CPB, CPCO, CPMA, CPC-I, CCS, CANPC, CEMC, CFPC, CIMC, CGSC, COSC, CRC, CCC. The host for the webinar was Boyd Staszewski.
The OIG Fraud Alert warns providers against overpaying physician in medical director positions. However, even if you have checked the payment rates on every medical director contract, you may still be paying too many medical directors.
Speaking before the Georgia Pediatric Practice Managers Association, PYA Consultant and ICD-10-CM Trainer Kim-Marie Walker addressed recent ICD-10 developments along with basic guidance for the transition, including:
• Comparison of ICD-9 and ICD-10
• ICD-10 organizational and structural differences
• Vendor recommendations and available resources
• Transition planning and roles
Compliance Pitfalls of Hospital-Based ContractsMD Ranger, Inc.
We will consider the most common compliance issues in hospital-based agreements. We discuss:
--Defining hospital-based services
--Trends and components of hospital-based contracts and types of payments (such as coverage payments, overall stipends, and income guarantees)
--Compliance pitfalls to avoid
--FMV and documentation options
Guide Preview: The importance of using an accredited enterprise image-viewing...Calgary Scientific Inc.
The Healthcare industry is more dynamic than ever before. Innovative technologies have significantly enhanced the way medical practitioners diagnose patients, review images, seek second opinions, communicate results and generally approach the care they give. According to the Government Accountability Office, 75% of all imaging procedures are performed outside of the hospital setting. Because images are now being accessed remotely, it has become crucial to understand if the technology has been accredited. If it has not, diagnosis or treatment decisions using that technology should never be made.
This guide describes how to decipher between an accredited and non-accredited enterprise image-viewing solutions and the risks of not understanding the differences. http://offers.calgaryscientific.com/resolutionmd4-guides
Optimizing revenue in the healthcare acute care setting goes beyond traditional revenue cycle activities. Beyond revenue cycle emphasizes the focus on departmental operations of managing through put and acuity that can significantly impact revenue.
Real-Time Surveillance for Rapid Correction of Clinical Decision Support Fail...Allison McCoy
The utilization of clinical decision support (CDS) is increasing among healthcare facilities which have implemented computerized physician order entry or electronic medical records. Formal prospective evaluation of CDS implementations occurs rarely, and misuse or flaws in system design are often unrecognized. Retrospective review can identify failures but is too late to make critical corrections or initiate redesign efforts. Real-time surveillance of user responses and patient outcomes comprises one approach to give immediate feedback to CDS designers and help operate a safety net which intercepts CDS failures. We outline four types of CDS (passive alerts, interruptive alerts, order sets, and complex ordering advisors) and describe common failures with surveillance applications for high-alert medications such as aminoglycosides, anticoagulants, and insulin. We then present a computerized tool for high-alert medication prescriptions which serves developers, clinical pharmacists, and institutional physician leaders. The tool has two views: the surveillance view allows users to scan all CDS failures and prioritize high-risk scenarios, and the patient detail view provides context for understanding CDS failures. Entries on the surveillance tool populate automatically when CDS is used or ignored, allowing verification of prescription safety and accuracy.
The Top 9 Questions Every Medical Coder Asks about Risk Adjustment and the CR...Laureen Jandroep
The Top 9 Questions Every Medical Coder Asks About Risk Adjustment and the CRC™ Certification was presented in a webinar by Certification Coaching Org (CCO), www.cco.us. A wealth of information was covered including: what Risk Adjustment (RA) entails, how this field is growing, and RA career opportunities. Also discussed was what to look for in a Risk Adjustment course. Attendees’ questions on careers in RA or preparing for the Certified Risk Adjustment Coder (CRC™) credentialing examination were answered. Presenters were Alicia Scott, CPC, CPC-I, CRC, and Chandra Stephenson, CPC, CIC, COC, CPB, CPCO, CPMA, CPC-I, CCS, CANPC, CEMC, CFPC, CIMC, CGSC, COSC, CRC, CCC. The host for the webinar was Boyd Staszewski.
The OIG Fraud Alert warns providers against overpaying physician in medical director positions. However, even if you have checked the payment rates on every medical director contract, you may still be paying too many medical directors.
Speaking before the Georgia Pediatric Practice Managers Association, PYA Consultant and ICD-10-CM Trainer Kim-Marie Walker addressed recent ICD-10 developments along with basic guidance for the transition, including:
• Comparison of ICD-9 and ICD-10
• ICD-10 organizational and structural differences
• Vendor recommendations and available resources
• Transition planning and roles
Compliance Pitfalls of Hospital-Based ContractsMD Ranger, Inc.
We will consider the most common compliance issues in hospital-based agreements. We discuss:
--Defining hospital-based services
--Trends and components of hospital-based contracts and types of payments (such as coverage payments, overall stipends, and income guarantees)
--Compliance pitfalls to avoid
--FMV and documentation options
Guide Preview: The importance of using an accredited enterprise image-viewing...Calgary Scientific Inc.
The Healthcare industry is more dynamic than ever before. Innovative technologies have significantly enhanced the way medical practitioners diagnose patients, review images, seek second opinions, communicate results and generally approach the care they give. According to the Government Accountability Office, 75% of all imaging procedures are performed outside of the hospital setting. Because images are now being accessed remotely, it has become crucial to understand if the technology has been accredited. If it has not, diagnosis or treatment decisions using that technology should never be made.
This guide describes how to decipher between an accredited and non-accredited enterprise image-viewing solutions and the risks of not understanding the differences. http://offers.calgaryscientific.com/resolutionmd4-guides
Optimizing revenue in the healthcare acute care setting goes beyond traditional revenue cycle activities. Beyond revenue cycle emphasizes the focus on departmental operations of managing through put and acuity that can significantly impact revenue.
Real-Time Surveillance for Rapid Correction of Clinical Decision Support Fail...Allison McCoy
The utilization of clinical decision support (CDS) is increasing among healthcare facilities which have implemented computerized physician order entry or electronic medical records. Formal prospective evaluation of CDS implementations occurs rarely, and misuse or flaws in system design are often unrecognized. Retrospective review can identify failures but is too late to make critical corrections or initiate redesign efforts. Real-time surveillance of user responses and patient outcomes comprises one approach to give immediate feedback to CDS designers and help operate a safety net which intercepts CDS failures. We outline four types of CDS (passive alerts, interruptive alerts, order sets, and complex ordering advisors) and describe common failures with surveillance applications for high-alert medications such as aminoglycosides, anticoagulants, and insulin. We then present a computerized tool for high-alert medication prescriptions which serves developers, clinical pharmacists, and institutional physician leaders. The tool has two views: the surveillance view allows users to scan all CDS failures and prioritize high-risk scenarios, and the patient detail view provides context for understanding CDS failures. Entries on the surveillance tool populate automatically when CDS is used or ignored, allowing verification of prescription safety and accuracy.
http://cpc.certifiedcodertraining.com/index.php/what-is-medical-coding | Curious about the field of Medical Coding? Certified Coder presents a brief overview of Medical Coding and why it is important.
Even if you’re not the world’s greatest writer, you should still learn how to write effective emails. It’s absolutely essential if you want people to take you seriously. Here are few guidelines that you should follow for better communication.
Practical and Succinct Solutions to Coding - Select Data, Inc. RachelBuckleySelect
Discussing increasing numbers of Complexities in Home Health that challenge reimbursement and the financial and quality outcomes bottom line;
Exploring Regulatory Issues and Agency Finances
Making Connections Between Coding, the POC, and Keeping Your Reimbursement;
Looking at Potential Impending Audits and Queries and their Impact;
and ICD-10…Will you be ready or will you be one of the agencies expected to have significant delays in payment?
Are denials and payer audits still impacting your bottom line?Matt Moneypenny
If you are a healthcare provider, it is almost inevitable that you will have to navigate through denials and payer audits. However, there are certain practices that can be implemented to better manage your denials, improve your claim quality, help you manage and track the challenges of audits, and reduce the overall chances of an audit and manage those you must undergo. If you don't know these best practices already, how could you?
On Thursday, June 7th at 11 AM EST, Etactics and Medical Record Associates hosted the webinar, Are Denials and Payer Audits still impacting your bottom line? It featured host Ray Dalessandro, Etactics' Regional Sales Manager, and special guest, Charlie Saponaro, the CEO of Medical Record Associates.
2 Best Practices to Improve Emergency Department CodingManish Jain
Emergency Department Coding Best Practices - Read First part of the article published by AAPC Healthcare Business Monthly Magazine - the article has been authored by Gayathri Natarajan, head of Coding for Access Healthcare
Cardiology Coding Got You Down? Use These 5 Tips for Success!Manny Oliverez
Struggling with billing for your cardiology practice? In this presentation, we discuss 5 challenges to proper documentation and coding in a cardiology practice. These challenges include human errors, lack of knowledge regarding current coding and documentation standards, working and charting in multiple care environments, and/or not coding to the highest degree of specificity.
Visit Our Website: http://www.CaptureBilling.com/
Learn how to be a RAC Survivor with Laura Legg, HRG Executive Director of Revenue Integrity and Compliance, in this thirty-three slide presentation. Get updated on the 2017 RAC Audit changes and what you can do to prevent a RAC attack.
For more info visit: http://www.hrgpros.com/rac-audit-optimization
hrgpros.com
@hrgpros
800.695.8171
9. “ How is it a write-off?” “ They just write it off.” “ Write it off what?” “ Jerry, all these big companies …they write off everything.” “ You don’t even know what a write-off is.” “ Do you?” “ No, I don’t.” “ But they do, and they’re the ones writing it off.” “ It’s a write-off for them.”
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18. Non-Specific Finding Guideline to Improve Specific Clinical Indications MVA Document the clinical indication in addition to MVA Where does it hurt? List all OR What part(s) of body rcvd trauma? Date of accident Check for Dates Specify the reason a size-date discrepancy is suspected Large for date OR Small for date Complications of pregnancy - specify R/O Pneumonia Specify the reason pneumonia is suspected SOB, difficulty breathing, Cough, Fever Abnormal test results Pre-Op Specify the operation to be performed Fever, Back Pain Abnormal test results Smoker Document the clinical indication SOB, difficulty breathing, Cough Abnormal test results Follow-up Specify what is suspected and why Where does it hurt? Swelling, Abnormal weight loss Abnormal test results Cancer List specific primary/secondary site Where does it hurt? Swelling, Abnormal weight loss Abnormal test results DEXA Screen Once every 365 days Is patient post-menopausal? Suspect XX or Rule out XX or Evaluate for XX Document the reason XX is suspected Where does it hurt? Swelling, Abnormal weight loss Abnormal test results History of XX Do NOT use if condition still exists Be specific about the disease Document clinical indications that disease has returned
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21. 2009 Denial Rates by Payer * Source: athenahealth Coventry Healthcare 9.3% Medicare-B 8.7% Champus/Tricare 7.7% Wellpoint 7.3% United Health Group 7.2% Cigna 5.9% Aetna 5.6%
Show of hands – how many certified coders do we have in the room?
AAPC Interventional coder CACs by MedLearn and others
Managed staff costs means being able to manage the allocation of staff – forecast for new/loss of procedures No loss of throughput for illness, vacations
Throughput = total procedures coded, total docs/hour Output = coded docs per coder per hour
Show of hands You can’t improve what you can’t measure Measure -- yardstick vs. computer Increase throughput -- by increasing the number of procedures that go directly to billing without coder review Increase output – if you’re trying to manage without data. “when coders count, they aren’t coding”, Linda Weideman Identify errors -- most CACs flag coding errors somewhere in the coding process, allowing for corrections before the charge is posted and runs through a claim scrubber and allows for a certified coder to make corrections
Beat their personal and practice best
Can anyone suggest other variables?
Facility interface – usually happens after facility changes their RIS
Rad-stats from OIG Eliminate the bottom 20% of infrequently performed procedures from routine audits, but these should be audited at least once a year
DOING an audit is not enough, DO something with the results! Area of concern example: outliers like higher rate for a certain procedure, downcoding due to lack of documentation
Meet with facility to eliminate them from the RIS
Industry benchmark – two days, show of hands Another TAT that is usually tracked by the RIS is from the exam completion to when the report is finalized Another TAT is the time from completion to receipt You could also track by facility – what might drive that variance?
Aetna and Champus are at the top of the heap for not correctly applying the CCI rules Other types of incorrect denials Wellpoint tops the list of payers that require documentation
Discrepancy rate – 98% of the time the physician is right