October Quarterly Call features association updates, tips for optimizing reimbursement in post-COVID world

Wednesday, November 4, 2020

NAHRI’s October 27 Quarterly Call featured important association updates, an in-depth presentation on optimizing post-COVID-19 reimbursements through a revenue integrity program, and a detailed look at revenue integrity in the age of value-based purchasing and the patient-centered revenue cycle.

To lead off the call, NAHRI Director Jaclyn Fitzgerald, CHRI, provided an overview of Revenue Integrity and Reimbursement Strategies: A NAHRI Virtual Event, which is now available on-demand. The event was held from October 6-8, but 60-day on-demand access is available for $179. Attendees will receive access to 12 educational sessions as well as the daily moderated Q&A. The event’s expert speakers provide analysis of the latest CMS regulations and their impact on reimbursement. Attendees can receive CEUs for their attendance.

Fitzgerald also highlighted the recently launched NAHRI Leadership Council, a free program that is designed for NAHRI members and nonmembers in revenue integrity or revenue cycle leadership positions. The Council will perform regular surveys for research reports to help revenue integrity leaders stay on the cutting edge of the industry. Though the Council launched in September, NAHRI is still accepting applications. To be considered for the Council and to review the benefits of joining, visit the NAHRI Leadership Council page.

In addition, Fitzgerald discussed NAHRI’s new podcast, The Revenue Integrity Show, which airs live every other Thursday at 3 p.m. Eastern. The podcast is available to stream on iTunes, Spotify, Google Play, and a host of other podcast apps. A library of past episodes can be found here. If you are a seasoned speaker interested in making an appearance, or if you are less experienced and would like to start out in an informal setting, the podcast is the perfect opportunity. Please contact nahri@hcpro.com if you are interested in being a guest on a future podcast or have topic suggestions.

Fitzgerald noted the recent release of the CHRI Exam Study Guide. The Study Guide is an essential tool for anyone preparing to sit for the CHRI Exam. It includes access to the 80-question CHRI Practice Exam and can accommodate different study strategies, from taking notes to highlighting sections to creating flash cards. The CHRI Exam Study Guide is available for order here.

Finally, Fitzgerald discussed the growth of the NAHRI Local and Regional Chapters. Recently established chapters include the Pacific Northwest Regional Chapter (AK, OR, WA) and the Illinois Local Chapter. If you are interested in joining or starting a new chapter, visit the NAHRI Local Chapter map and contact Associate Editor Kevin Duffy at kduffy@hcpro.com.

Optimizing reimbursement revenue in the post-COVID world

Following Fitzgerald’s announcements, Andrew Stieve, vice president of revenue integrity solutions at R1 RCM in Chicago and Johnny Pezzuto, senior director of revenue integrity services at R1 RCM, presented strategies for navigating COVID-19 reimbursement nuances, understanding patient responsibility for COVID-19 cases, and developing price strategies to keep you organization competitive.

Stieve and Pezzuto identified four key components to optimizing reimbursement:

  1. Identify blind spots
  2. Control the controllable (know revenue impact on changes to insurance contracts, charges, codes, and pricing)
  3. Make the CDM your friend
  4. Understand COVID-19 revenue integrity opportunities

The burden is on each individual hospital and hospital system to be aware of what each payer will cover, Steive said.

“That’s really led to a lot of nuance and complexity hospital to hospital, and even within a hospital system,” said Stieve. “Certainly, this makes it complex when a claim is getting paid and a patient responsibility is left over.”

Stieve stressed the importance of setting up workflow rules and algorithms to capture COVID-19-related errors and opportunities.

Stieve and Pezzuto also offered a checklist for proper coding, telehealth visits, prior authorization waivers, patient cost sharing, and CMS reimbursement.

Finally, Stieve shared a case study from a large healthcare system that R1 RCM worked with in the initial months of the COVID-19 pandemic.

“We really established what the standards were related to COVID patients, what payers and CMS said they would versus would not cover, and we really built out a complex and detailed matrix across the entire 120-hospital system,” Stieve said.

Revenue integrity in the age of value-based purchasing

The Quarterly Call wrapped up with a presentation from Virginia Gleason, CPHRM, CCM, CDIP, senior manager, advisory services, for nThrive in Alpharetta, Georgia, on revenue integrity in the age of value-based purchasing and the patient-centered revenue cycle.

Gleason reviewed the need for quality documentation, noting that the diagnosis should be documented “as demonstrated by” followed by clinical indicators. A description of the treatment plan should also be included.

In addition, Gleason went into detail on readmission documentation.

“What we are not doing well within this middle revenue cycle space—and I say that because it’s pretty much what I’ve seen industry-wide—is that we are not effectively documenting to show that the readmission was not avoidable,” Gleason said.

The key in building the proper documentation, according to Gleason, is ensuring that utilization review and clinical documentation integrity (CDI) programs are not siloed.

“The CDI program can get all of the CCs and MCCs in the world, but if the inpatient level of care is denied for medical necessity, it doesn’t matter how many CCs and MCCs we have,” Gleason explained. “So, combining and making sure that we don’t have a silo between these two clinical areas of the middle revenue cycle becomes key.”

A recording of the October 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 NAHRI Associate Editor Kevin Duffy at kduffy@hcpro.com.