Price transparency, elimination of inpatient-only list take centerstage at January Quarterly Call

Wednesday, February 3, 2021

by Kevin Duffy

NAHRI’s January 26 Quarterly Call featured important association updates, as well as presentations on the new price transparency requirements and the 2021 OPPS final rule.

Association updates and opportunities

To lead off the call, NAHRI Director Jaclyn Fitzgerald, CHRI, provided a look back at 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.

Fitzgerald also provided a look ahead at Mastering Utilization Review and Patient Status: A NAHRI Virtual Event, which will be held March 30–31. Bring your team to learn the latest strategies for concurrent and retrospective UR, Part A to B rebilling, inpatient-only list management, and prior authorization so you can protect your bottom line. Attendees can earn valuable CEUs and take advantage of our easy-to-use virtual platform for unique networking opportunities. NAHRI members receive $20 off the registration fee of $399, and group pricing discounts are also available. For more information, visit the event page.

Fitzgerald highlighted the Critical Access Hospital and Rural Health Clinics Reimbursement Virtual Symposium, which will be held April 27–28. Throughout the two-day event, experts will cover topics including emergency department documentation and billing, how to receive proper reimbursement for telehealth services, and quality/HCC reporting, as well as offering live Q&As where you can get feedback on your most pressing questions. NAHRI members receive $20 off the $399 registration fee.

Finally, Fitzgerald provided information on the 2021 Revenue Integrity Symposium, which is scheduled to be held in-person at the Gaylord Palms Resort & Convention Center in Kissimmee, Florida on October 19–20. Pricing information and information about social distancing and precautionary measures taken during the event can be found on the event page.

“This is a great way to network with your peers and learn from folks in the industry,” Fitzgerald said. “It’s really a fun event with a nice range of revenue integrity topics for everyone.”

In addition, Fitzgerald discussed NAHRI’s 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.

To wrap up the opening portion of the program, 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. NAHRI is excited to see its Local Chapters continue to grow in 2021. 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.

Price transparency: Preparing for patient inquiries and government oversight

Following Fitzgerald’s announcements, Ogi C. Kwon, JD, MHA, manager, regulatory compliance at R1 RCM in Chicago delivered an in-depth look at the new price transparency requirements. Kwon discussed how to anticipate patient needs, explaining government oversight of price transparency, and offered major takeaways for hospitals.

Kwon started his presentation by examining two requirements of price transparency—the machine-readable file of standard charges and the shoppable services requirement. He recommended putting a link on the banner of the hospital’s website to direct patients to the list of shoppable services.

“If you’re part of a healthcare system and you have a single website that talks about price transparency, having breakout links to the specific hospitals that discuss the pricing information for those specific hospitals, I think it would be very helpful to help orient patients to where this information is,” said Kwon.

The hospitals that are going be in the best position to differentiate themselves from their competitors will be those that treat healthcare price transparency as not so much a check-the-box requirement, but as a evolving phenomenon that is constantly incorporating industry best practices and listening to patient concerns, according to Kwon.

Kwon also noted that organizations should be on the lookout for any changes by the Biden administration.

“I believe price transparency is here to stay, but it still sort of remains to be seen exactly the way the new administration will be interpreting the nuances as it relates to price transparency, especially auditing and enforcement,” Kwon said.

CY 2021 OPPS: The phasing out of the inpatient-only (IPO) list

The Quarterly Call wrapped up with a presentation on the 2021 OPPS final rule from Jerilyn P. Morrissey, MD, vice president, client performance and revenue integrity, Versalus Health in Newtown Square, Pennsylvania. Morrisey focused her presentation on the elimination of the inpatient-only (IPO) list, diving into the compliance and regulatory implications for hospitals.

Effective January 1, 2021, CMS removed nearly 300 procedures from the IPO list, a change that will impact operations at healthcare organizations everywhere. Morrisey stressed that when a procedure is removed from the IPO list, it does not automatically become an outpatient procedure. Instead, the procedure can be classified as either an inpatient or outpatient procedure, Morrisey explained.

“That means there is no default status one way or the other,” she said.

Morrisey recommends that organizations create a dynamic performance scorecard to help with their determinations.

“Ultimately, at the end of the day, you need a multi-faceted approach that monitors and educates your team on how to choose status correctly using the 2-midnight rule, otherwise any of your modeling will be incorrect and lead you down a bad path,” Morrisey said.

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 NAHRI Associate Editor Kevin Duffy at kduffy@hcpro.com.

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