Revenue Integrity Symposium: A NAHRI Virtual Event

Revenue leakage costs hospitals 1%–3% of revenue annually, and this figure has likely increased in the past year. In addition to new codes and changing regulations, revenue cycle management teams face tighter margins, furloughs and layoffs, and evolving work environments. This presentation will cover four components that serve as a foundation for successful revenue integrity programs in the post-COVID-19 world—helping to maximize reimbursement, ensure a streamlined workflow, and close ever-present gaps among revenue integrity analysts, billers, coders, and clinicians. Attendees will learn how to develop a comprehensive revenue integrity program that includes strategies for minimizing leakage, optimizing reimbursement, identifying COVID-19 revenue opportunities, and mitigating risk from compliance violations and external audits. The presentation will outline case studies with practical applications, offering tactics that have yielded significant ROI for hospitals and health systems.

This session will review the three types of NCCI edits: procedure-to-procedure edits, Medically Unlikely Edits, and add-on code edits. Learn how to find resource tables and manuals to research your edit and modifier questions. Understand appropriate use of modifiers for procedure-to-procedure edits. Medically Unlikely Edit rationale and applicability of add-on code edits will also be discussed.

Gain a better understanding of the structure of a CDM and common reimbursement methodologies. This session will offer tips for maintaining an up‐to‐date and compliant CDM, provide guidance on identifying charge capture strategies for typical ancillary services, and describe best-practice methods for managing COVID-19 changes related to the chargemaster.

With the recent release of the anticipated CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule (CMS-1753-P), CMS is reverting to its previous approach on the inpatient-only list. Join this session to learn about the proposed rule, understand the implications of this reversal, and the proposed changes to medical review audits.

Sponsored by: 3M Information Systems

Medical necessity now accounts for 20% of all denials—a 66% increase over two years—and commercial payer appeal success has dropped to 45%. At the same time, regulatory pressure is increasing. This changing payer landscape has made effective utilization review more important than ever. Defensible patient status determinations can help prevent denials and raise the chances of successful appeals. During this session, Dr. Kurt Hopfensperger will discuss patterns in payer behavior, the consequences of regulatory changes, and how artificial intelligence (AI) can help hospitals keep ahead of these trends to maintain their revenue integrity.

Authorization and claims denials are one of the largest threats to revenue integrity. Hospitals must present a coordinated response and utilize all available tools to effectively combat denials. This session will cover how to monitor key performance indicators, establish a peer-to-peer process, coordinate and track denials, and highlight opportunities to improve communication among hospital departments including utilization management, case management, patient financial services, and contracting.

Whether they realize it or not, hospital medical staff play a crucial role in revenue integrity. They hold the power in their pen and keyboard. Yet, no physician ever went into medicine with the goal of understanding the regulatory history of the 2-midnight rule, dissecting the inpatient-only list, delivering patient notices, or ensuring that hospital claims are submitted accurately. In this session, a veteran revenue integrity leader will moderate a discussion with two leading physicians in the regulatory realm to discuss keys to working with physicians to ensure compliance with regulations and documentation, touching on issues such as the compliant use of observation, the admission order, the 2-midnight presumption, medical necessity, and more.

Get an inside look at best-practice strategies for maintaining an up-to-date and accurate charge description master (CDM) and promoting collaboration among CDM professionals, financial leadership, and consulting experts. This panel session will use case studies and real-life examples to explain the role of the CDM coordinator, CFO, and outside consultants and vendors. Attendees will take away key tips for promoting revenue integrity in the facility setting.