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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.

HFMA MAP Event 2015 - A quick recap and thoughts

by Craneware19. November 2015 14:42

By Kathy Schwartz

My Craneware colleagues and I recently returned from sunny Ft. Lauderdale, Florida. If you have never been to an HFMA MAP revenue cycle event, I can’t recommend them enough. Compared to the big shows like HIMSS and ANI, it was less crowded and more focused on revenue cycle. There was a great balance of downtime to make friends with people from provider systems and with vendors, and the educational sessions were filled with useful takeaways. I was honored to be invited to speak at one of the educational sessions with Kathy Lytal from Parkview Health on Enterprise Pharmacy and Supply Chain Revenue Integrity (click the link to download a copy of the slides).

The general consensus among attendees on ICD-10 was “so far, so good.” We also heard the phrase “Y2K” used more than once. In one session, the speaker remarked that they hadn’t seen a dramatic loss of coder productivity like CMS and others had predicted.

There was, however, serious concern and speculation about what will happen when the first 835 remittances start coming back from payors. Will denials increase as payors move from doing ICD-9 crosswalks to actually processing claims in ICD-10? A session that Presbyterian Health held, titled Reducing Denials Through Collaboration detailed how they had tackled denial management by working across departments as well as with their hospital’s health plan. The session was so full that many people in the back had to stand!

We saw denial management come up as a top issue again in one of the large general sessions. HFMA live-polled the entire conference with the following question:

At a strategic level, if you could only monitor one benchmark, it would be:

  1. Denials as a % of total claims remitted
  2. Aged A/R > 90 days
  3. Net days in A/R
  4. Cash as a % of net patient service revenue

Interestingly, 34% of the audience voted for option 1 – Denials as a % of total claims remitted. Options 2, 3, and 4 were 17%, 24%, and 25% respectively.

If you were there, what did you take way from HFMA MAP? And if you were not, what do you think? If you could monitor just one benchmark, which would it be? And was ICD-10 another Y2K or is there more to come? Feel free to write me at k.schwartz (at)


2016 HCPCS Update: G6030 through G6058 Missing from Addendum B?

by Craneware16. November 2015 13:02

There appears to be an unidentified CMS issue with the recent HCPCS file deletions. Addendum B lists G6030 through G6058 as deleted. At the time of this writing (Nov 16, 2015), the CMS file does not show these codes as deleted.

Based on the Clinical Laboratory Fee Schedule Public Meeting minutes, Craneware coding researchers were able to find the following:

After further consideration of this issue, several meetings with the public, and in consultation with the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of National Drug Control Policy, we are proposing to modify that policy as follows:

  1. Delete the following G- codes:
    • G0431
    • G0434
    • G6030 through G6058 (28 codes)
  2. Continue to not recognize the following CPT codes:
    • 80300 through 80377 (64 codes)
  3. Create two G-codes to be priced at this meeting: GXXX1, GXXX2
    • GXXX1, GXXX2

The two new G codes are currently nowhere to be found in Addendum B or the 2016 HCPCS file which makes replacements a little tough, and we aren’t finding anything in the final rules (OPPS or Physician) that provides the two new G codes.


Notes From the Craneware Financial Performance Summit

by Craneware2. November 2015 14:50

October 20 through 22, Craneware hosted its second annual Summit at Red Rock Resort outside of Las Vegas. From the very name of the event it was a little different from 2014, as while last year’s event was called the Revenue Integrity Summit, this one was the Financial Performance Summit.

There was a reason for that. While revenue integrity is critical for any provider organization, success is increasingly about managing revenue, cost and outcomes in a more integrated way. It’s why the concept of the value cycle came about, and conversations at the Summit touched on all these factors for provider organization success.

The 100 or so attendees had a wide range of interests in addition to a common goal of financial excellence in their organizations. The sessions looking at proposed OPPS rules and the overview and early analysis of 2016 CPT updates were standing-room only. There was also a great session by David Johnson, CEO of 4Sight Health, titled Value Rules: Playbook for Post-Reform Healthcare that left attendees talking. Todd Nelson, Vice President of Education and Organizational Solutions at HFMA gave a spirited presentation on The Mind of a CFO that provoked several thoughtful Tweets from John Lynn of

During the roundtable sessions, there was a lot of interest in discussing best practices for pricing, as consumerism, media coverage and competition are heating up the need for sound strategies. And throughout the event, pharmacy and supplies came up in conversation as attendees shared ways to be sure that supplies and administered medications are accurately coded, billed, and reimbursed.

Were you at the Summit? Do you want to go next year? What would you like to be able to learn at an event like this? Let us know, and in the meantime here are some useful links associated with the event.

Hospital CFO Insights from Craneware Summit

( by John Lynn, 10/22/2015)

Blog post detailing Craneware Financial Performance Summit presentation, ‘The Mind of a CFO and the Value Cycle,’ from speaker Todd Nelson of HFMA.

Value Rules: Playbook for Post-Reform Healthcare

(4Sight Health, by David W. Johnson, 10/21/2015)

David Johnson, CEO of 4Sight Health, talks about the market forces dictating the industry shifting to a value cycle approach in a post-reform world.


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