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Welcome to Craneware's blog.

This blog is the place to go for discussions related to the many facets of healthcare revenue integrity. Here, Craneware experts share their thoughts and report on industry trends… and encourage you join the conversation with your own unique experiences and opinions. Craneware client or not, there's something for everyone to learn and discuss.

CY 2016 OPPS Final Rule-Post Implementation Challenges

by Craneware29. January 2016 11:36

By: Joan Hoover, Healthcare Consultant, Data Development

Another January 1 has come and gone, and we continue to address the challenges in our revenue cycle operations resulting from the implementation of the CY 2016 OPPS Final Rule.

One of those changes is that the L1 modifier will be used to report only the lab tests that are performed on the same day as other services but for a different reason (and ordered by a different physician) while stand-alone lab tests will no longer require the L1 modifier. Are you still struggling to find a way to report this modifier correctly?

Another change is in the billing and coding of services concerning stereotactic radiosurgery: CMS is pulling the costs for planning and preparation services related to SRS treatment delivery (CPT® codes 77371-77372) and will pay planning and preparation services according to their assigned status indicator when furnished 30 days prior to or 30 days post SRS treatment delivery.

Our challenge with this change is the implementation of the new modifier: “CP” (Adjunctive service related to a procedure assigned to a comprehensive ambulatory payment classification [C-APC] procedure). CMS clarified how to use this modifier during this week’s CMS Hospital Open Door Forum. They said the modifier is NOT needed on the CPT codes for planning and preparation but is required for ALL OTHER adjunct services furnished 30 days before and 30 days after the date of the SRS delivery.

Another challenge: In late December, CMS released new HCPCS codes (G-codes) for lab tests used for drug testing. During this week’s Hospital ODF, CMS stated that the policy took longer than intended; therefore, the codes were not finalized in time for the January 2016 OPPS CR that includes all payment rates. CMS has instructed the MACS to HOLD claims containing the new G-codes until the April 2016 update can be implemented.

Lastly, CMS also discussed the “PO” modifier which became mandatory for January 1, 2016. They have received many questions regarding the upcoming changes to off-campus provider based departments for which they have posted an FAQ document.

Anyone who’s worked in revenue cycle has by now gotten used to these sorts of challenges. How do you and your team prepare and address each year’s changes?  Have you run across other post-implementation challenges resulting from the CY 2016 OPPS Final Rule? We’d love to hear from you!

Part Two: From revenue cycle to value cycle

by Craneware8. January 2016 09:57

In part one of our value cycle series, we looked at the factors driving the growth of healthcare spending as it approaches 20% of our gross domestic product. The next question is: who’s spending this money? Businesses are hit by increased expense, but increasingly it’s the healthcare consumer bearing the heaviest load.

Both CMS and private payors realize that costs can’t rise forever. Thus the rise of new reimbursement models rewarding value over volume. In these models, providers failing to meet quality and cost outcomes will be penalized while those delivering to defined measurements of value rewarded.

Revenue is of course still vital to success, and a well-managed revenue cycle will always be a critical part of a provider’s ability to care for their community. But the relationship between revenue, cost and quality – always important in the past - must now be coordinated even more closely. They cannot be addressed as separate concerns but instead managed as components of a single larger process.

Managing this process means first identifying risks all across the value cycle. Without visibility into – and understanding of – cost, revenue and quality, a provider system risks their patients’ satisfaction, their own profitability, and their regulatory compliance. Once risks are discovered, a value cycle approach means converting those risks into opportunities for improvement in cost, revenue and quality. Finally, the value cycle means optimizing these improvements, turning them into sustainable processes.  

Discover, convert and optimize. The value cycle connects cost, reimbursement and outcomes, helping providers meet their mission and margin in a world linking reimbursement  to value.

How are you aligning your clinical, operational and financial data? How is the drive to deliver value affecting different departments in your system? We’d love to hear from you at thevaluecycle@craneware.com.

Happy Holidays from Craneware!

by Craneware16. December 2015 09:22

By Mark Montgomery, Chief Marketing Officer

At a recent event I heard the speaker answer a self-imposed question: what is the difference between success and significance? As I sat and pondered my own answer, the speaker provided his.

“Success,” he stated, “is about me. Significance is about my impact on others.”

As we are in the 2015 holiday season, it’s a good time for us to pause, reflect, and look to the future. The holidays allow many of us to, at least for a few days, step away from work and engage with our family and loved ones. Perhaps it is here that many of us see our greatest success, and even our greatest significance.

Our industry is primarily focused on significance: the ability of our organizations, and of our individual contributions, to positively affect others. So I would like to pause and thank the countless professionals that make the healthcare industry “significant” to my family and community.

First, to the clinicians, caregivers and healthcare professionals who are on the front line of patient and community care, I say thank you. Your significance is greatly appreciated.

And to the professionals that make the provider network work: financial, administrative, facility, suppliers, and others, I also say thank you. It is your behind-the-scenes work that keeps hospitals and other care centers open, solvent and safe.

Have a great 2015 holiday season, and a very successful 2016. Enjoy your success. Yet even more, enjoy sharing time with the significant people in your life.

Cheers,

 

Mark Montgomery

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