NAHRI news and revenue integrity insights on our latest quarterly call

On January 29, NAHRI presented its first members-only quarterly call of the year, where members heard from revenue integrity experts on engaging clinical staff, chargemaster updates, and addressing denials at their root cause.

NAHRI Director Jaclyn Fitzgerald opened the call with some announcements and reminders for upcoming opportunities within the NAHRI community, including the call for speakers for the 2019 Revenue Integrity Symposium (RIS), which will be held October 15–16, in Orlando and covers all aspects of revenue integrity, Medicare compliance, and the revenue cycle in acute care and long-term care settings. Get more information about the submission process and possible topics on the NAHRI website.

Additionally, Fitzgerald announced that the 2019 Revenue Integrity Leadership Exchange will be held just prior to RIS on October 13–14 in Orlando. The Revenue Integrity Leadership Exchange is an invitation-only event where approximately 25 of 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.

Also in NAHRI news is that the Certification in Healthcare Revenue Integrity (CHRI) credential exam is live, and we are taking applications for the first group of revenue integrity professionals to sit for it. For complete information, including prerequisites and the exam outline, download the CHRI Exam Handbook or visit the Certification page on the NAHRI website.

Following these announcements, four NAHRI Advisory Board members presented on the topics that are most pressing for them going into 2019.

• Many of us make personal New Year’s resolutions on January 1, but the start of a new year is a good time to look at professional changes you can make, too. Terri Rinker, MT (ASCP), MHA, revenue cycle director at Community Hospital Anderson in Anderson, Indiana, an affiliate of the Community Health Network, recognized that one area she could improve on is developing a stronger professional relationship with clinical access staff. Clinical access staff is critical to revenue integrity, but there is often a communication gap between departments, Rinker said. For the revenue integrity team, part of closing that gap is to be able to explain the “why” behind the requests they make of the clinical access staff, which may be something as simple as explaining the financial incentive. Rinker’s other resolutions include sitting for—and passing!—the CHRI exam and trying to stay more current with revenue integrity information.
• Price transparency is the biggest update for the chargemaster in 2019, but that’s not all. Sarah Goodman, MBA, CHCAF, COC, CCP, FCS, president/CEO and principal consultant for SLG, Inc., in Raleigh, North Carolina, and Kay Larsen, revenue integrity specialist at Adventist Health Glendale in Glendale, California, ran through some additional changes to look out for, including the following:
  • Functional reporting G-codes has been discontinued effective January 1, 2019, and you can find more information about the discontinued requirements .
  • Codes for MRI imaging have some changes you’ll want to pay attention to, said Goodman. New codes for breast MRI were added to differentiate breast MRI without contrast from breast MRI with/without contrast, and additionally, breast MRI with/without contrast to include computer-aided detection (CAD) when performed. These new codes have created some challenges, explained Goodman, as the C-codes for Medicare do not bundle CAD but allow for it to be added on with the new HCPCS code C8937. That code may be reported with any of the existing C-codes as well as the new “without contrast” CPT codes 77046 and 77047, so there is a way to add CAD to “without contrast” MRI of the breast in the HCPCS code set but not in CPT, Goodman said.
  • When dealing with charges, you might not usually look to the IPPS final rule, but there is an opportunity of add-on payments if specific ICD-10 codes (or in one case the NDC number) are present on the claim, Larsen said. To get more information, start with page 41274 of the Federal Register, and look for section
• Reducing denials is a common goal for any revenue integrity team. Elizabeth Lamkin, MHA, CEO of PACE Healthcare Consulting in Bluffton, South Carolina, walked through an example of how to reduce denials through analysis. Lamkin recommended looking at where denials occur at your facility. For example, on the inpatient side variations in internal staff assignment of RARC and CARC to denials can lead to inaccurate reporting of root denial reasons. Because of this variation, you must define how these codes will be assigned in your organization and train staff accordingly, Lamkin said. She also recommended auditing on a regular basis and using a categorization process for initial and final denials that is accurate. By focusing on initial denials and using categories to determine where denials are high, you can make targeted improvements that should ultimately improve final denials, said Lamkin.

A recording of the January quarterly call is available on the NAHRI website for members, who can now earn CHRI CEUs for listening to or presenting on quarterly calls. Register now for our upcoming quarterly members-only calls. If you would like to present during an upcoming quarterly call, please contact Associate Editor Heidi Samuelson at hsamuelson@hcpro.com.