24. April 2014 15:28
Auditors need to be more aware & competent than ever before. No longer can healthcare organizations live on just Medicare: Medicaid & commercial payor awareness is necessary.
Commercials are tough. The ever–changing rules from commercial payors make it very difficult. Plus, unlike Medicare, commercial payors don’t typically provide solid rules - healthcare organizations have to piece the rules together themselves. And commercial payors generally have a poor way of communicating their rules to auditors
Auditor tip: When reviewing claims make sure that you review them from the perspective of the payor on the claim.
What are your experiences with meeting commercial payors’ requirements for reimbursable claims?
(The above was written by Bill Malm, N.D. R.N. CMAS... and Craneware Senior Data Product Manager. Bill was recently voted Auditor of the Year by the American Association of Medical Audit Specialists (AAMAS). Congratulations, Bill!)
17. April 2014 11:18
What would you do if a huge sum of money you’d earned was sitting in someone else’s bank account, and there was no way for you to get your money in the near term? We’ve been hearing from many hospitals that are worried about the Recovery Audit (RAC) appeals process being placed on hold. Hospitals are asking what will happen if the RAC audits begin before the appeals process is available again. This week H&HN posted a video interview titled, “Financial Planning in the Wake of RAC.” In the video, University of Kansas Hospital CEO Bob Page details how his organization has $22 million wrapped up in the RAC process. We encourage you to watch the video and learn more about the impact this can have on hospital operations. Is this issue a top concern for your organization?
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.