2. April 2014 13:07
As you know, on Monday March 31, the Senate voted 64-35 to pass a House-approved measure (HR 4302) that would delay a scheduled 24% cut to Medicare physician reimbursement rates and push the ICD-10 compliance deadline to 2015. President Obama then signed the bill into law on Tuesday, April 1.
In the healthcare finance community there is relief and aggravation depending on whom you talk to, along with questions about how CMS and congress are going to proceed. Will Oct. 1, 2015, in fact become the new deadline for transitioning to ICD-10? Can organizations that are ready to implement ICD-10 do so voluntarily? And a big question: will CMS just wait for ICD-11, due to be released in 2017?
Based on the timeframe required to Americanize ICD-10, it would take until almost 2020 to implement ICD-11. Regardless of the code set, efficient business processes that accurately capture and validate that data are correct and complete will remain vital to optimize reimbursement, compliance and overall financial performance.
What is your hospital’s reaction to this turn of events? How are you adjusting and planning? We’d love to hear your thoughts.
6. March 2014 09:48
Any processes involving business data collected before a claim is submitted are especially valuable for today’s healthcare organizations. Inaccurate data is not an asset but instead is just “dirty” data that can lead to more problems than it solves.
If you suspect dirty data is causing problems, you’re not alone. For your hospital to achieve optimal efficiency, reimbursement and compliance it is vital to understand that:
- Data validation is key to your hospital not just surviving, but thriving
- It is possible to meet the challenges of healthcare charge validation
- Automation tools are vital to meeting those challenges
- Accurate data is essential to successfully managing audits and optimizing reimbursement
Want to develop a strategy to clean up your data? Craneware’s Revenue Integrity Survival Guide has tips to help you start your journey to better data validation and revenue integrity.
3. February 2014 09:04
In a recent Modern Healthcare article, “RAC Appeals Backlog Cause for Frustration,” it is cited that HHS’ Office of Medicare Hearings and Appeals began notifying hospitals around the country with high numbers of appeals that they would not be able to submit new cases until the existing backlog clears – which could take two years or more.
With an average of 15,000 appeals being submitted per week and over 70% of all appealed claims still sitting in the appeals process, it is no surprise that this RAC backlog is causing unrest in the healthcare community. This issue will only continue as RAC activity continues increasing at a significant rate.
While this is definitely frustrating for hospitals, and negatively affects their cash flow, it is not quite as hopeless as it sounds. By improving their documentation, hospitals will be able to manage appeals through the earlier levels, before it even gets through to the level-three ALJ appeal.
The following improvements to hospitals’ documentation and appeals will enable the real long-term answer to this problem:
- Implement management tools to help ensure important deadlines are not missed before you get to the third level of appeal, which requires an administrative law judge (ALJ).
- Learn from the appeal process. Review the entire claim, denial, and appeal to ensure that all issues related to the case can and will be prevented in the future.
- Have a system or process in place to track and monitor denials and appeals in order to prioritize the cases that are worth pursuing.
- Develop hospital-specific leveling criteria to define complex patients and/or complex procedures to delineate inpatient/outpatient status for grey area procedures.
- Self-audit to identify risks and internally track any and all RAC activity to minimize your financial risk.
What proactive RAC best practices have your hospital implemented to improve documentation and reduce appeals?