A look back at NAHRI’s top stories of 2020
by Kevin Duffy
The 2020 calendar year was certainly challenging for revenue integrity professionals, as the novel coronavirus (COVID-19) pandemic stressed the workforce, necessitated new working environments, and led to frequent regulatory updates.
Through case studies, news, and analysis in the weekly Revenue Integrity Insider enewsletter and the quarterly NAHRI Journal, NAHRI worked to keep the revenue integrity community informed of all the changes.
Let’s take a look back at NAHRI’s most-read stories from 2020:
During a March 18 meeting, The ICD-10 Coordination and Maintenance Committee announced that it would adopt the World Health Organization (WHO) code, U07.1 (COVID-19), for the novel coronavirus effective April 1.
Previously, the panel had planned to implement the code beginning October 1 in the U.S. But the committee moved up the adoption date after the WHO declared COVID-19 a pandemic and President Trump declared the spread of the virus a national emergency, explained Donna Pickett, head of the diagnosis coding side of the ICD-10 Coordination and Maintenance Committee.
In this Q&A, industry experts clarify a reader’s question about billing anesthetic drugs with injection procedures. The reader provides two examples:
Example 1: The procedure was 20610. The drugs given were Ketorolac (J1885), Ropivacaine (J2795), and M-Pred Acet (J1040). The drugs were drawn into one syringe. The coder reversed J2795.
Example 2: The procedure was 20523. The drugs given were Ropivacaine (J2795) and Lidocaine. The coder reversed both charges.
On March 16, CMS announced blanket waivers of certain Medicare requirements to prevent gaps in care for beneficiaries affected by the COVID-19 public health emergency. SE20011 contains details of the waivers and billing instructions as well as links to related Q&As.
The methods for maximizing revenue capture have changed over the years. Revenue management has evolved from random chart audits to using data analytics and technology to find patterns. Tina Rosier, director of revenue integrity at Community Health Network in Indianapolis, shares how implementing predictive analytics has helped her team facilitate charge capture accuracy.
“In 2005, we did random chart audits, which was like looking for a needle in a haystack. Now we’ve leveraged our technology to help us find missing charges,” she says. For Rosier, that meant using EPIC and Revenue Guardian checks to find accounts with inaccurate charges. For example, a work queue in EPIC might flag a procedure that includes a 390 blood product charge but lacks a 391 blood administration charge. Rosier’s team would then review this account and add the missing charge.
CMS is automatically reprocessing 2019 hospital claims for certain services provided at grandfathered off-campus provider-based departments after a federal judge vacated portions of the 2019 outpatient prospective payment system final rule. However, the agency has filed an appeal and the same federal judge declined to strike down cuts for those services planned for 2020.