15. August 2014 13:25
The July 2014 GAO highlight report on Medicare Program Integrity entitled, “Increased Oversight and Guidance Could Improve Effectiveness and Efficiency of Postpayment Claims Reviews,” can be read online here: http://www.gao.gov/assets/670/664880.pdf
This report essentially says that CMS, “…has taken steps to prevent its contractors from conducting certain duplicative post-payment claims reviews—reviews of the same claims that are not permitted by the agency—but CMS neither has reliable data nor provides sufficient oversight and guidance to measure and fully prevent duplication.”
So, since the administrative cost-pressure from duplicative audits won’t lessen any time soon, getting optimal processes and tools in place for managing duplicative audits - both efficiently and effectively - is essential. Remember - even an error is considered fraud today.
Check out 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.
If your organization is “seeing double” with duplicative audits, what approaches are helpful and what insights would you share with others on the Journey to Revenue Integrity?
8. August 2014 13:41
By Kathy Schwartz, Product Manager, Craneware
Most hospitals aren’t receiving all the reimbursement for chargeable supplies that’s rightfully theirs & struggle to reduce related compliance and data governance risks for the hospital. Hospitals know this. At the same time, they know the practical difficulties of identifying & correcting the situation. After all, the enabling data systems reside in different sectors of the hospital. Worse still, these systems were never designed to share information with each other.
Confronting this issue requires attention from both revenue cycle and supply teams. It requires breaking down silos between the major components of the current process: across purchasing history; item master; clinical arena; chargemaster and reimbursement. Data inconsistencies and breakdowns typically occur as data moves between these sectors.
- Isolate the types of supplies that you should address first, in order to get a faster return on efforts to improve your reimbursement for chargeable supplies.
- Identify where you should look for common errors that prevent optimal reimbursement for supplies.
- Establish a communications framework that will get the necessary information to the parties who can improve your current reimbursement situation.
- Ascertain how accurate data allows administrators to strategically assess pricing methodologies & focus on quality of care not only cost containment.
- Explore methods for bridging procurement facts with revenue information to assist both teams in achieving strategic goals while mitigating risks.
- Discover best practices for supplies data management to balance the investment in supplies with optimal return on that investment.
Hospitals that accomplish these aims have a lot to show for their efforts, often in terms of significantly reduced compliance risk, increased annualized reimbursement, greater collaboration across their organization, and supply data that is aligned for ongoing success.
What are your thoughts about aligning supply chain and revenue cycle to ensure revenue integrity
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.