Hayes' Healthcare Blog

Why External Audits are the Best Way to Ensure Revenue Integrity

Posted by Vasilios Nassiopoulos on December 20, 2018 at 11:30 AM

 

Healthcare organizations take pride in building and maintaining an effective internal auditing team. A robust internal audit program is crucial to avoid the perils of penalties and overpayments that can sabotage both top and bottom lines. Yet despite their best intentions, healthcare organizations that rely exclusively on internal monitoring and auditing functions – regardless of how effective they may be – can face significant pitfalls. 

To ensure that the organization's financial operations are performing to the required standards, it is essential that billing compliance programs go through periodic reviews from an independent, external entity.

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Topics: revenue integrity, compliance programs, Revenue, Audits

Ready for E&M Documentation Simplification? Not So Fast

Posted by Vasilios Nassiopoulos on November 29, 2018 at 1:00 PM

"The more things change, the more they remain the same." This French proverb is more relevant than ever when it comes to the proposed CMS changes for E&M documentation. Despite the exuberant celebration that greeted the announcement from CMS earlier this year that promised to reduce "documentation overload" for physicians, the reality is that the E&M documentation rules that have been around for over 20 years aren’t changing anytime soon.

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Topics: revenue integrity, cms

Time to Change the Conversation: Take the Next Step Forward in Revenue Integrity

Posted by Vasilios Nassiopoulos on November 8, 2018 at 9:00 AM

One of the common definitions of insanity is "doing the same thing over and over and expecting a different result." 

That definition came to mind after attending the National Association of Healthcare Revenue Integrity Symposium in Phoenix a few weeks ago. The event was well run, with expert speakers covering many critical revenue integrity issues, such as IPPS and OPPS annual updates, chargemaster maintenance, patient status, denials management, appeals and Medicare Fair Hearings, payer audits, value-based purchasing, utilization review (UR), and revenue cycle management strategies.

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Topics: revenue integrity

Trouble Ahead: The Unintended Consequences of the Proposed E/M Changes

The provider community has been begging for documentation reform for over 20 years, and there is no question that simplifying the complex requirements of clinical documentation is necessary. Unfortunately, the recent release of the proposed changes from CMS surrounding evaluation and management (E/M) is not the answer. The benefits of the modest reduction in documentation requirements are more than offset by the devastating impact the changes will have operationally, clinically, and financially.

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Topics: Hayes Thought Leadership Blog Series, cms, Revenue, revenue integrity, compliance risk, risk management, Medicare, reporting, clinical documentation, Coding and Documentation

From Simple Practices to Physician Conglomerates: The Burdensome Journey of the Practicing Physician

Posted by Vasilios Nassiopoulos on August 8, 2018 at 2:00 PM

This is the second in a series of four posts discussing how a revenue integrity program can help clinical, compliance and revenue cycle teams join forces to address the increasing challenges of compliance. In our first post, we discussed how a revenue integrity program can be a unifying force in the organization.

When it comes to medicine, many like to wax poetic over the simpler times of the 1990s. Although we have improved dramatically when it comes to medical advances and quality of care over the past several decades, clinicians sometimes long for a return to certain aspects of those “good old days” when practicing medicine was a much simpler pursuit.

Looking back at the evolution of the physician practice over the past quarter century, you can certainly understand that point of view. One thing is clear: the dramatic changes affecting the health care profession since the 1990s have contributed to a growing regulatory monster, which has negatively impacted the relationship between clinicians, compliance and revenue cycle teams.

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Topics: Revenue Cycle Health, revenue integrity

5 Benefits of a Common Revenue Integrity Backbone

Posted by Vasilios Nassiopoulos on May 17, 2018 at 9:00 AM

In today's challenging financial environment - plagued by shrinking revenue, narrowing margins and tightening regulatory constraints - many healthcare leaders are stepping back to take a more holistic view of their organization’s revenue stream. They understand that the traditional, silo'ed approach to revenue cycle and compliance - in which the two functions operate independently from one another - is not going to help them achieve their goal of optimizing their financial health.

These leaders are beginning to see the value of bringing these disparate groups together to effectively address their top- and bottom-line issues.  For many, that means implementing a comprehensive revenue integrity program that can serve as the “backbone” supporting such an effort.

The dictionary defines a “backbone” as “the chief support of a system or organization.” A well-developed revenue integrity program can be the “chief support” that links together revenue cycle and compliance, resulting in a more robust revenue stream, decreased risk of costly non-compliance, and enhanced bottom-line performance.

Here are five benefits that can be achieved by instituting a common revenue integrity backbone in your organization.

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Topics: revenue integrity, revenue cycle management, healthcare compliance

Developing a Revenue Integrity Program? Get Help with the Right Partner

Posted by Vasilios Nassiopoulos on May 10, 2018 at 9:00 AM

You’ve been struggling with the need to improve your bottom line while reducing organizational costs. New financial models, increased cost shifts to patients and continued merger and acquisition activity are leading to an increased focus on your organization’s overall financial health. Up until now, you’ve likely relied on revenue cycle management (RCM) which has served you well, but you now recognize that RCM doesn’t go far enough. You need something more, so you’ve decided to implement a more holistic revenue integrity program.

Revenue Integrity – getting paid for everything you do, and keeping it – takes a broader view of the organization’s revenue stream. A revenue integrity program evaluates many of the same people, processes and technology as RCM, but goes a step further by understanding how these various disparate processes can be connected to optimize the entire revenue cycle.

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Topics: revenue integrity, vendor selection, Change management

Revenue Integrity Leaders Gather to Find Solutions to Healthcare’s Financial Challenges

Posted by Peter J. Butler on May 2, 2018 at 3:00 PM

By Peter Butler, President and CEO, Hayes Management Consulting

As part of our commitment to helping healthcare organizations optimize their business processes to achieve greater revenue integrity, Hayes has recently formed a Revenue Integrity Advisory Council (RIAC), a small group of revenue cycle and compliance executives who understand the real-world financial challenges associated with running a large, complex organization. We held our first meeting on March 20th in Chicago, where leaders from some of the nation’s most prestigious healthcare organizations gathered for an afternoon to discuss issues, exchange ideas and develop new solutions for overcoming some of their most pressing concerns.

So what was on their minds? Not surprisingly, the topics covered a range of issues including telehealth, quality-based reimbursement, and high-cost drug reimbursement, as well how to organize the coding function and managing compliance issues.

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Topics: Revenue, revenue integrity, Hayes Thought Leadership Blog Series, Thought Leaders

Forgotten A/R: 3 Steps to Getting Beyond “Low Hanging Fruit”

Posted by Paul Allen on March 21, 2018 at 10:34 AM

Low hanging fruit. You likely hear the term nearly every day in the business world. It refers to something easy to reach and therefore should be “picked” first. It has also come to mean an area where you can concentrate your efforts to get the most results.

In healthcare finance, low hanging fruit is often used as a descriptor of the easiest money to collect on outstanding accounts receivable. Revenue Cycle teams focus on Medicare, Medicaid, and specific major payers that make up the majority of their revenue.

Working the payers that will yield 80 percent of your revenue – Medicare, Medicaid, and two or three of your major commercial plans - makes sense and should be the first line of attack when looking to collect outstanding revenue. But what about the “fruit” that is further back and higher up in the “trees?” What about that other 20 percent of your revenue?

You shouldn’t be content with disregarding 20 cents of every dollar. With improvements in automation and technology, it’s time to take another look at this still-very-valuable component of your receivables and begin mapping out a new attack plan to collect it.

 

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Topics: revenue integrity, A/R management, Revenue Cycle Health

3 Keys to Staying on Top of Your Underpayments

Posted by Aaron Wall on February 14, 2018 at 3:29 PM

Research from the Medical Group Management Association (MGMA) estimates that payers underpay practices in the U.S. by an average of 7% – 11%. In a time when budgets are tightening and reimbursements are shrinking, it’s more important than ever to make sure your organization is being paid correctly. Some organizations take this seriously but many don’t spend nearly enough time focusing on underpayments and their bottom lines suffer as a result.

Forward looking healthcare systems that are committed to a robust revenue integrity program, take the time to analyze their revenue and reimbursement details. Based on their success, it is clear that it’s worth the time and effort each year to make sure your contracts are up to date and that that you are monitoring your underpayments on a regular basis.

Staying on top of your underpayment activity is not as difficult as it may seem. There’s a good chance someone at your organization already has the information needed to get this ball rolling.

Here are three key things you need to implement an effective reimbursement analysis program.

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Topics: revenue integrity, Revenue Cycle Health, Data Analysis

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