Revenue Cycle Operations

Instituting Quality Focused Report Packages: 60 min

Does your organization deliver comprehensive revenue information daily? Weekly? Monthly? How is this data acted upon, and who tracks improvement? Healthcare Informatix and data-driven management have become the focus of many organizations, but many times there is a gap between analyzing the data and acting upon it. In this presentation we discuss the risk of data overload, choosing the most actionable information, the proper timing of data delivery, and the most effective tools to convey information.

Best Practice Revenue Cycle Functionality for Specific Departments: 60 min

Every department has different revenue cycle components. These components apply to chargemaster creation, revenue recognition, coding involvement and business office understanding. Presentations are provided for each of the departments listed below. Each presentation provides strategies specific to the listed department or modality. Participants receive information to implement best practice revenue cycle components, improve departmental ownership and accountability while maximizing gross revenue and net reimbursement. Particular attention is paid to ensure that the process mitigates compliance concerns while improving patient experiences.

Chargemaster Functionality for Business Managers: 60 min

The facility chargemaster controls the flow of departmental revenue to respective payors. Common chargemaster errors drive reimbursement and compliance issues errors that ultimately impact the profitability, reputation and customer service perceptions of performing departments. Many department leaders have little or no understanding of the chargemaster data elements, or the importance of proper CDM structure to reimbursement and compliance. Departmental Business Managers and coders must have a roll in chargemaster creation, maintenance, audits and updates to ensure a complete compliant billing practice. This presentation provides a step by step explanation of chargemaster elements, and the impact of Chargemaster decisions on reimbursement. Common errors are identified, and suggested proven audit methods provided to mitigate risk. Processes suggested allow for clear understanding throughout the revenue cycle of chargemaster elements ensuring that servicing departments, coding and the business office all share the same understanding of the complex choices required in the chargemaster.

Effective Practice Management for Physician Offices: 60 min

Does your practice operate under a specific set of operational policies and procedures? If not, there is inherent variability in your operations. Variability impacts productivity and increases expenses. Practice staff must clearly understand their roles and the importance of quality controls and customer satisfaction. Participants receive guidelines, policies and strategies to ensure total revenue capture, maximum reimbursement, compliance mitigation, improved quality scores and patient satisfaction. Participants can quickly incorporate presentation components to facilitate improved operational parameters.

Navigating Modifiers – How to ensure the compliant placement of modifiers within the revenue cycle: 60 min

Modifier assignment is critical to proper reimbursement. Failure to append required modifiers results in costly rework or decreased reimbursement. Increasing attention to modifier placement has resulted in millions of dollars of reported audit take backs in the past few years. Improper modifier assignment,even unintentional, can trigger fraud investigations, costly fines and damage to professional reputations. New modifier guidelines have been established to combat over-reimbursement due to modifier assignment. Improper modifier assignment, even unintentional, can trigger fraud investigations, costly fines and damage to professional reputations. Modifier assignment is often considered a “billing function.” Most billers lack access to the medical record information required for proper modifier decisions, or do not have coding certification, training and/or tools necessary to understand the nuanced guidelines that must be applied for proper modifier assignment. This presentation provides an overview of requirements and research to evaluate proper modifier assignment as well as providing the tools necessary for determination. The most common modifiers required for reimbursement are discussed and evaluated. Where multiple modifiers may be appropriate, the hierarchy for modifier determination is reviewed. Identification of the code requiring a modifier in any code pair is determined, and rules for proper modifier assignment and research are outlined.

Pricing Policies: How to create a defensible pricing strategies: 60 min

Transparency in pricing requirements and expectations are on the rise. Large deductibles and coinsurance responsibilities have driven dramatic increases in patient inquiries into internal pricing methodologies. “Lesser of” language in payor contracts provide risks of underpayments where fees are not routinely evaluated. Chargemasters are routinely updated inconsistently without a thorough process. Few organizations develop policies to govern pricing, or implement checks and balances to ensure accurate and consistent pricing methodology. This presentation examines the importance of routine and thorough analysis of chargemaster pricing. Effective and consistent processes to establish fees are suggested. Policies and Procedures guidelines to ensure accurate and consistent pricing are offered. Routine audit schedules and suggested audit tools will assist in validation and adherence to published guidelines while evaluating risk of underpayments.