Recap of our first NAHRI quarterly call

Tuesday, February 6, 2018

by Molly Cohen

NAHRI kicked off the new year by hosting its first quarterly members-only call, which featured insights from board members on hot topics revenue integrity professionals should keep on their radar this year.

Excitement was in the air as more than 100 NAHRI members dialed in for the live call on January 30. The call began with a series of announcements, including details about the 2018 Revenue Integrity Symposium to be held October 16–17, 2018, at The Wigwam Hotel in Litchfield Park. NAHRI is seeking speakers to present at the symposium and recently launched its call for speakers.

Other updates included the addition of physician practice and postacute care categories on the NAHRI Forums and the introduction of the NAHRI Member Justification Letter, which is intended to help non-members interested in joining NAHRI gain buy-in from program administrators.

Next, four NAHRI Advisory Board Members offered helpful tips and tricks for tackling some of today’s revenue integrity challenges. The following are some key takeaways:

  1. Disproportionate share hospitals (DSH) are eligible to buy their drugs from the 340B Drug Discount Program. Because these hospitals were receiving significant discounts on purchasing drugs, CMS set forth a payment reduction for separately payable outpatient drugs effective January 1. 2018. This payment reduction will impact on-campus outpatient locations as well as grandfathered off-site hospital-based locations. “If you didn’t use a 340B schedule, then you need to be careful, because those drugs are not subject to the reduction,” says Angela Simmons, CPA, vice president of revenue and reimbursement at Vanderbilt University Medical Center in Nashville, Tennessee. “You’ll want to notify CMS if there’s a certain drug for which you weren’t able to use the 340B pricing schedule.”
  2. When updating your chargemaster for 2018, bear in mind that the CPT® codes 74000-74020 for reporting abdomen imaging have been deleted, and there are three new codes to use in their place: 74018 (Radiologic examination, abdomen; 1 view), which replaces 74000; 74019 (Radiologic examination, abdomen; two views), which replaces 74010; and 74021 (Radiologic examination, abdomen; three or more views), which replaces 74010 and 74020. Chest imaging has been similarly overhauled for 2018. “Since the replacements are not always one-to-one, in addition to the chargemaster, look at your order sets or charge forms and see if you need to revise them to report the new codes appropriately,” says Sarah L Goodman, MBA, CHCAF, COC, CCP, FCS, president/CEO at SLG, Inc., in Raleigh, North Carolina.
  3. Elizabeth Lamkin, MHA, ACHE, CEO and partner at PACE Healthcare Consulting, LLC, in Bluffton, South Carolina, offered up some best practices for Part B rebilling. As a billing department, do not assume you will cost a patient more out of pocket when you rebill from Part A to Part B or from inpatient to outpatient and observation. Sometimes a short-stay inpatient will cost the patient more out of pocket than a rebill to outpatient, depending on deductibles and co-pays, says Lamkin. Have a prepared explanation to go out to patients. Also, make sure the patient understands this is a payer issue, not a hospital issue.
  4. DEX Z-Code™ identifiers are required for documenting certain Molecular Diagnostic (MolDX) laboratory tests ordered within 14 days of specimen collection. Facilities may face challenges when mapping lab test to the Z-code, because some payers are not ready to accept the codes at this time and instead request the test name on the claim. “I would encourage you to work with your labs to make sure they’re putting in the exact test name that’s being sent to an outside records lab or the test ID number,” advises Kay Larsen, CRCR, revenue Integrity specialist at Adventist Health Glendale in Glendale, California. To ensure compliance, Larsen identifies the test and puts the Z-code in the notes for the billers to document on the claim. Check with your outside reference labs to see if they bill Medicare directly or if they will bill your facility and have you bill Medicare, advises Larsen.

    Since the quarterly call, Larsen gleaned more insight about DEX Z-codes. “We received word from our other outside reference lab that they cannot provide the Z-codes to us directly and recommended that we access the DEX Diagnostics Exchange,” she says. “To use the website, your lab director will need to request a user ID for you. Be sure you’re listed as a lab administrator or you won’t be able to see the Z-codes.”


NAHRI members can download a recording of the January 30 call as well as the PowerPoint presentation on the NAHRI Resources page and can register for upcoming member calls online. If you’re a NAHRI member who is interested in presenting during an upcoming networking call, email Associate Editor Molly Cohen at



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