27. June 2014 12:42
We enjoyed catching up with clients, media and healthcare finance professionals at the 2014 HFMA ANI Conference held in Las Vegas, NV. During the conference, we were honored to have 5 products receive HFMA’s Peer Review Designation for the tenth consecutive year. Craneware was also selected to present alongside our client Centura Health to share Centura’s revenue integrity journey and best practices for charge capture standardization. Below are a few trends/topics that we heard on the show floor this week.
The Importance of Healthcare Data – On Monday, Atul Gawande, MD shared his keynote presentation, “Leading the Change: Healthcare in Transition,” and discussed the importance of leveraging data in a smart and useful manner to reduce costs. Atul explained that “success requires making data the most important resources to clinicians and patients for improving care.” Health systems and hospitals should leverage data to improve quality outcomes and reduce revenue leakage. He also emphasized the importance of collaboration, “Why Doctors and CFOs Need to Talk.”
Outpatient Services as a Promising Opportunity –Hospitals and health systems are exploring new opportunities in outpatient services to increase referrals to core patient services and to position their organization within their perspective communities. As hospitals continue to compete for market share in clinical areas, outpatient services will be a beneficial method to reach new patients and generate revenue.
Pricing Transparency in Hospitals - Finally, we heard a lot about the industry’s increasing need for pricing transparency. A Transunion Healthcare survey released Monday found that 62 percent of patients are either sometimes or always surprised by their out-of-pocket costs, while only one-quarter are given pre-treatment cost estimates from their providers. With this increasing trend, it is vital for healthcare organizations to implement strategic processes that enable consumers to access defensible, market-appropriate service pricing.
Did you attend HFMA ANI 2014? If so, we look forward to hearing your thoughts on the most discussed trends.
18. June 2014 10:19
Let’s face it. RACs are viewed as problematic across all stakeholder audiences – even among the recovery auditors themselves as some RACs are talking about not renewing their contracts. Amazingly, this has many people questioning whether Recovery Audit program (RAC) will be back. These people point to the following facts:
- CMS’ announcement that the RACs are officially paused:
- Feb. 21, 2014 was the last day that a Recovery Auditor could send an Additional Documentation Request (ADR)
- June 1 will be the last day a Recovery Auditor can send an improper payment file to the MACs for adjustment.
- Numerous complaints & lawsuits filed about the Recovery Audit program by groups ranging from the American Hospital Association, to the Auditors themselves;
- The backlog is more than two years before an Administrative Law Judge (ALJ) can possibly hear appeal cases.
Just because the RACs are paused, don’t let your compliance and audit preparedness slip! Claims submitted during the RAC pause still need to be compliant to avoid denials & audits.
Whether the RACs resume; or throw in the towel; or even if a new program is introduced under a different name; hospitals and health systems still must prepare for an escalating volume of audits from both government and commercial payers.
And, with the wide range of new payer plans in healthcare, each with their own set of rules, being proactive & prepared is quite a big job for hospitals. Tell us your thoughts.
And, attend the Craneware Benchmark Series: Key Indicators of Revenue Integrity Excellence to learn more about recovery audits, understand how well your organization is performing against Craneware standards and, equally importantly, gather step-by-step best practices to minimize compliance risk and optimize financial performance.
16. June 2014 09:44
Last we talked about the critical need for hospitals to have a medical necessity program in place to ensure they’re prepared for any regulatory change that’s coming down the pike next.
An effective medical necessity program needs to begin with Patient Access checking coverage, validating payer rules and Local Coverage Determination (LCD) changes. Lack of pre-authorization is the #1 Patient Access-related reason cited for claim denials. So, a successful medical necessity program should have tools that:
- Flag prior-authorization warnings
- Offer timely access to medical necessity requirements for most major U.S. payers
- Provide reports that help assist physicians in understanding payer requirements for proper documentation
- Provide guidance on relevant reimbursement data to support appropriate upfront collections
What do you think are the keys to a successful medical necessity program?