Association updates, the revenue integrity value of physician advisors, and wound care coding tips on April’s Quarterly Call

NAHRI’s April 27 Quarterly Call explored the impact of physician advisors on revenue integrity, wound care coding tips, and the latest association updates.

NAHRI Director Jaclyn Fitzgerald, CHRI, kicked off the call with a look at recent education and networking opportunities.

NAHRI’s virtual education events ensure revenue integrity professionals keep up with the latest changes, learn new strategies for addressing common problems, and earn valuable CEUs. The following virtual education events are currently available on-demand:

• Critical Access Hospital and Rural Health Clinics Reimbursement Virtual Symposium
• Mastering Utilization Review and Patient Status: A NAHRI Virtual Event

On-demand participants can view educational session recordings at their convenience for 60 days after the date of purchase.

The 2021 Revenue Integrity Symposium (RIS) is going virtual, Fitzgerald announced. The event, scheduled to take place August 17–18, features two tracks of the quality content and trusted experts attendees have come to expect from RIS. Sessions will begin around noon Eastern, or 9 a.m. Pacific. There will be a live Q&A session with speakers each day, a virtual cocktail hour, and live-stream discussion strings that allow attendees to participate in valuable networking experiences. Pricing is $479 for NAHRI members and $499 for non-members, and discounts are available for group purchases.

In addition, every RIS registration comes with a free seat at two regulatory update webinars this fall to ensure you stay up to date with major rules. Details, including dates, are still to be announced, but all RIS registrants will automatically receive email instructions to join the following webinars:

• 2022 IPPS final rule webinar
• 2022 OPPS final rule webinar

NAHRI’s biweekly podcast, The Revenue Integrity Show, is currently booking guests for upcoming programs. If you’re interested in being a guest, email nahri@hcpro.com. You can register for free to join us for our next episode and stream past episodes.

NAHRI Local Chapters are growing. New chapters include the Pacific Northwest Regional Chapter (AK, OR, WA) and the NAHRI Illinois Local Chapter. NAHRI Local Chapters are a great way to connect with peers locally and share ideas and solutions. To join or start a new chapter, visit NAHRI’s Local Chapter page.

After the association updates, Adriane K. Martin, CO, FACOS, CCDS, vice president of physician services at Enjoin, discussed how physician advisors can play a key role in helping hospitals pull through the financial impact of the COVID-19 pandemic and set the stage for future success. Hospitals are in a precarious position, with revenue decreasing as cost skyrocket, Martin said. Physician advisors have typically worked in utilization review (UR), but their unique skills could be a boon to revenue integrity—where physician advisors are often underused.

“From a revenue integrity perspective, it really does hit on that short-term need for revenue recovery and [recovery from COVID-19] by impacting your financial accuracy through DRG optimization, denials prevention and management, and optimizing revenue integrity under alternate payment models,” Martin explained.

The real-world value of bringing physician advisors’ unique skills to revenue integrity was explored through several case studies. Martin also discussed how to select and train physician advisors, how to develop and implement a physician advisor program that includes revenue integrity, and how to measure and report on the success of the program.

Next, Crystal Tobin, COC, CHRI, revenue integrity service line specialist/subject matter expert at Sutter Health in Roseville, California, discussed wound care codes for procedures performed in outpatient clinics and some of the most frequently seen coding errors for those procedures. Coders must have a nuanced grasp of the difference between non-selective and selective debridement and between debridement and active wound care management, she said. Coders must be familiar with documentation requirements and should be prepared to query if documentation is missing or incomplete.

Tobin also addressed common questions about charging for an evaluation and management (E/M) service on the same day as a wound care procedure. Although generally it isn’t appropriate, it may be under specific conditions—the key to knowing whether an E/M service is separately chargeable is in the documentation.

“The documentation clearly has to state that something separate is going on. An example of this would be a new patient visit,” Tobin said. “A new patient coming to the clinic needs to be evaluated, needs to be assessed, before doing anything. So, an E/M level is going to be appropriate based on that evaluation if there’s a decision made to do a procedure.”

A recording of the April Quarterly Call is available for NAHRI members. Listening to or presenting on quarterly calls awards one CHRI CEU. Register now for upcoming quarterly calls. If you would like to present on an upcoming quarterly call, please contact NAHRI at nahri@hcpro.com.