Idea exchange: NAHRI’s most buzzworthy stories

NAHRI is proud to serve the revenue integrity community by providing a place to network and share ideas and experiences. One way we support that goal is by providing you with case studies, news, and analysis from your peers and industry experts in the Revenue Integrity Insider and the NAHRI Journal.

Let’s take a look at the stories that have generated the most buzz in the first half of 2018.

1. A look into KPIs: Hospital late charges
   This case study takes a look at how to maximize the foundation key performance indicator (KPI): hospital late charges. The timing of posting charges has a ripple effect. The longer you wait to post a charge, the more likely it is you will miss something. Bruce Preston, CPC, director of revenue integrity at Grady Health System in Atlanta, explains how to late charges can be used to compare how an organization stacks up in terms of the amount of charges posted on time versus late. “Timely charge capture is so important because it dictates your reimbursement and the true revenue you get back as a healthcare system,” says Preston. “This specifically relates to timely filing denials, as well as our state Medicaid late charge policy.”
2. Set teams up for charge capture success by refining roles
   Managing charge capture in a multi-hospital system that spans a variety of service lines and charges can prove to be a daunting task both in terms of ensuring claims are accurate and ensuring team members are well versed in each service line and charge type. While some health systems may train staff across all areas of charge capture, Karen Taylor, RN, BSN, MHA, director of revenue integrity at Saint Luke's Health System in Kansas City, Missouri, shares how her organization opted to assign each team member a role in which they could become experts. “We found that having that many people across a big system, and trying to keep them educated and current didn’t make a whole lot of sense from an efficiency and revenue maintenance standpoint,” says Taylor. “We found it was more successful to have a small cluster of staff where this was their specialty.”
3. Build bridges to solve charge capture and reconciliation issues before they hit denials
   Accurate charge capture is the foundation of revenue integrity. Sophisticated tools allow revenue integrity staff to sift through data, track trends, and pinpoint missing or inaccurate charges. But a revenue integrity department that simply focuses on identifying and addressing charge capture failures on the back end will find themselves trapped in a Sisyphean cycle. This case study offers a look at how Barbara Fisher, CHC, corporate director of revenue integrity and denials management at Shiners Hospitals for Children in Tampa, Florida, applied lessons learned from data analytics and back-end processes to help clinical staff capture the correct charges from the start.
4. Ring in the new year with these chargemaster updates
   Chargemaster matters are always at the forefront of revenue integrity. Experts including NAHRI Board Member Sarah L. Goodman, MBA, CHCAF, COC, CCP, FCS, president and CEO of SLG, Inc., in Raleigh, North Carolina, analyzed the impact of 2018 code changes on the chargemaster. “One thing that needs to be very clear is that you must change both your chargemaster and order sets to capture these new CPT codes,” says Goodman. “While the new adds seem fairly straightforward, there are a few caveats that must be considered.”
5. Translating revenue integrity principles to a small organization
   Revenue integrity at a smaller organization looks much different than revenue integrity at a multi-hospital system. Fewer resources mean it’s an all-hands-on-deck operation with everyone taking on multiple roles. Sondra Hess, CCS, CRC, documentation specialist at the Levy-Kime Clinic, Los Angeles Jewish Home in Reseda, California, shares how her small but diverse facility has made revenue integrity work for them. To meet her organization’s needs, Hess wears many hats—a concept familiar to most smaller organizations. She’s the coder, CDI specialist, and medical records auditor. She works closely with the providers and clinic staff and the facility’s biller.

If you have a topic you’d like to see covered in 2018 or a project you’d like to be interviewed about, email Editor Nicole Votta at nvotta@hcpro.com. We look forward to hearing from you!