NAHRI’s second Quarterly Call shares expert advice and revenue integrity news

Wednesday, May 2, 2018

More than 100 NAHRI members tuned in to hear expert advice on revenue integrity hot topics and get the scoop about exciting new NAHRI initiatives during our second members-only quarterly call on April 24.

The call kicked off with updates on several major NAHRI projects, including the latest on the 2018 Revenue Integrity Symposium to be held October 16–17, 2018, at the Wigwam Hotel in Litchfield Park, Arizona. The symposium will be preceded by the Revenue Integrity Leadership Exchange, to held October 14–15, 2018, also at the Wigwam Hotel. The Exchange is a free, invitation-only event that brings together revenue integrity senior leadership for ideas-sharing sessions built around cutting-edge revenue integrity topics. If you are interested in learning about the event and opportunities to attend, contact NAHRI Director Andrea Kraynak, CPC, at

Next up on the agenda was Revenue Integrity Week, which will be held June 3–9, will put a spotlight on the critical work done by revenue integrity professionals. Visit the Revenue Integrity Week page to check out the FAQs, download your toolkit, and add your voice to the first-ever State of the Revenue Integrity Industry survey.

And, by popular request, NAHRI announced the creation of two new topics on the Forums: physician practice and postacute. Visit the Forums to get feedback on a range of revenue integrity challenges, share ideas, and network with peers.

Following the announcements, three NAHRI Advisory Board Members offered insights and tips on some of the most recent revenue integrity challenges.

  1. Putting a solid process in place to handle Medically Unlikely Edits (MUE) is one of the biggest hurdles to efficient edit management. Anna Santoro, MBA, CCS, CCS-P, RCC, system director revenue integrity/CDM at Hartford Healthcare in Newington, Connecticut, offered insight on how establishing clear communication between stakeholders in the edit process will keep claims moving. Identify who receives claims with MUEs and at what point in the revenue cycle. Each hospital may find that these edits are routed to a different department such as revenue integrity or HIM. “The key here is to first identify who is performing these functions,” Santoro said. “You want to make sure that it’s someone, regardless of the location, who does have a coding background and fully understands what this means.”
  2. Provider-based departments continue to throw up fresh confusion despite CMS’ attempts to clarify the regulations. MLN Matters SE 18002 reminded organizations of existing enforcement edit requirements but may have muddied the waters regarding reporting location, said Denise Williams, COC, senior vice president of revenue integrity services at REVANT Solutions in Trussville, Alabama. Reporting location can be confusing because many hospitals have multiple off-campus provider based departments, and a patient might visit several different of these facilities. The main provider billing address—the address of the parent hospital—is always reported in form locator 1 of the UB-04. The off-campus provider based department address is reported as the service facility location in form locator 79 on the UB-04. “If no services were provided at the main provider, but services were provided at multiple off-campus provider-based departments, and there were multiple physical locations, then wherever the patient presents and registers first is the address that’s going to go in that service loop in form locator 79,” Williams said.
  3. Total knee arthroplasty (TKA) was removed from CMS’ inpatient-only list in January. However, that left many organizations questioning how to determine when to perform this procedure on an outpatient versus an inpatient basis. Several factors come into play when making that call, said Ronald Hirsch, MD, FACP, CHCQM, vice president of R1 RCM in Chicago. TKA can continue to be performed on an inpatient basis because some patients will require an inpatient admission based upon the medical predictability of something adverse happening. And although organizations must review the pricing and payment differential of the TKA diagnosis-related group versus ambulatory payment classification, that can’t drive policy, he points out. “If you develop your own medical guidelines and it’s approved by your medical staff, you’re going to have something to fall back on if you get audited,” Hirsch said.

NAHRI members can download a recording of the April 24 call and the PowerPoint presentation on the Resources page and are encouraged to register for the next quarterly call scheduled for Tuesday, July 31. If you’re a NAHRI member and are interested in presenting on an upcoming NAHRI members-only call, please contact Associate Director Jaclyn Fitzgerald at