Charge errors, observation, and membership updates on April’s quarterly call

Wednesday, May 8, 2019

On April 30, NAHRI presented its second members-only quarterly call of 2019, where members heard from revenue integrity experts on charge error correction and observation, as well as received some updates on what’s new at NAHRI.

The call opened with NAHRI Director Jaclyn Fitzgerald giving some announcements and reminders for upcoming events and opportunities, including Revenue Integrity Week, which will be held June 3–7. This year’s theme is Scale New Heights: Elevate Your Profession and Career, and it marks the launch of our Peer Recognition Program. If you know a fellow NAHRI member who has gone above and beyond in their role—be it a promotion, great idea, or helping hand—we want to help you give them a shout out. Through the Peer Recognition Program, NAHRI will distribute certificates of recognition to all who are nominated by peers leading up to and throughout the week. Complete our simple form to let us know why your peers deserve recognition. All nominees and nominators will be entered into a Revenue Integrity Week prize drawing. More resources to help you plan your Revenue Integrity Week celebration can be found on the NAHRI website.

Fitzgerald also announced that NAHRI is also beginning the formation of local and regional chapters, so you can network and connect with fellow NAHRI members in your geographic area. You can find out more information on our Local Chapter page.

The Revenue Integrity Symposium will be here before you know it! Held October 15–16 at the Renaissance SeaWorld in Orlando, this year’s symposium will feature a highly requested long-term care track. Fitzgerald highlighted the 2019 pre-conference and post-conference opportunities, including a pre-conference Utilization Review boot camp and two post-conference Medicare boot camps—Audits, Appeals, and Denials and Provider-Based Departments Once again, we will also host the Revenue Integrity Leadership Exchange, an invitation-only event where the most forward-thinking revenue integrity leaders from across the country network and learn from each other in peer-to-peer roundtable discussions. Please email NAHRI Director Jaclyn Fitzgerald at jfitzgerald@hcpro.com if you would like to be considered for this invitation-only event. For more information, check out our Revenue Integrity Symposium page.

Finally, Fitzgerald introduced our three newest NAHRI Advisory Board members:

  • Tracy Cahoon, MBA, CHRI, director of revenue integrity at Southwest General Health Center in Brecksville, Ohio
  • Lisa Kanivetsky, BA, CPC, CHRI, revenue integrity manager at Hennepin Healthcare in Minneapolis, Minnesota
  • Kathryn J. Noorbakhsh, RN, BSN, CPC, CPC-H, director of corporate compliance and revenue analysis at University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania

You can find their bios and contact information on our Advisory Board page.

Following these announcements, three NAHRI members, including two of our NAHRI Advisory Board members, presented on topics that are relevant to anyone working in revenue integrity today.

Charge errors are usually not purposeful and often occur because of a breakdown in another process. Debra May, NAHRI advisory board member and vice president of revenue cycle at Renown Health in Reno, Nevada, and her colleague and fellow NAHRI member Jennifer Grayson, manager of revenue integrity at Renown Health, walked through how to create a formal charge error correction process. There are multiple ways to find errors, including regular reviews of revenue by revenue integrity departments, coders reaching out for clarification when a department has an unusual charge, and scheduled or unscheduled audits. Because there are many paths that lead to finding errors, your facility may benefit from a task force that will review all potential charge errors. This process is aided by creating and maintaining a single location to document potential charge errors to allow for ease of review. The revenue integrity team can validate the data via revenue and usage reporting. It also helps to have regular task force meetings to review the data collected.

Although observation is meant to be a well-defined set of specific, clinically appropriate services, those well-defined services aren’t defined anywhere. Ronald Hirsch, MD, FACP, CHCQM, vice president at R1 Physician Advisory Solutions in Chicago, gave an overview of the problems revenue integrity professionals encounter with the ambiguous definition of observation. Observation comes down to whether it is clinically appropriate to keep a patient at the hospital to receive services and reduce risk, and revenue integrity professionals need to be up on this distinction because commercial insurers are reviewing and denying observation if hospital care is not medically necessary. There are also some interesting nuances to observation payment where doing more could mean getting paid less. Hirsch will be speaking more on this topic at the 2019 Revenue Integrity Symposium.

A recording of the April quarterly call is available on the NAHRI website for members, who can now earn CHRI CEUs for listening to or presenting on quarterly calls. More information can be found on the downloadable presentation. Register now for upcoming quarterly members-only calls, which occur on the last Tuesday of the month in January, April, July, and October. If you would like to present during an upcoming quarterly call, please contact Associate Editor Heidi Samuelson at hsamuelson@hcpro.com.

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