Revenue integrity experts discuss recent CMS changes, denials management, and remote management at virtual education event

Revenue integrity experts shared advice and lessons learned over the past months during day one of Revenue Integrity and Reimbursement Strategies: A NAHRI Virtual Event.

The three-day virtual education event kicked off on October 6 with a special edition episode of The Revenue Integrity Show, NAHRI’s biweekly podcast. Sarah L. Goodman, MBA, CHCAF, COC, CCP, FCS, CHRI, president/CEO and principal consultant for SLG, Inc., in Raleigh, North Carolina, Valerie Rinkle, MPA, CHRI, lead regulatory specialist and instructor for HCPro, and Denise Wilson, MS, RN, RRT, senior vice president of Denial Research Group–Appeal Masters, discussed the impact the novel coronavirus (COVID-19) has had on revenue integrity functions and operations. With many offices closed and staff working from home to mitigate the spread of the COVID-19, staff working on appeals faced an unexpected hurdle: sending mass mailings or faxes from their homes, Wilson said. Setting staff up with the equipment necessary to complete those tasks at home is often impractical but these critical tasks can’t be sidelined. Hospitals can work around this obstacle by partnering with release of information or appeal vendors, Wilson recommended.

Next, Marc Hartstein, MA, Rinkle, and Jugna Shah, MPH, CHRI, president and founder of Nimitt Consulting, Inc., in Spicer, Minnesota, analyzed major proposals and themes in the 2021 Outpatient Prospective Payment System (OPPS) and 2021 Medicare Physician Fee Schedule (MPFS) proposed rules and the 2021 Inpatient Prospective Payment System final rule. With the public health emergency (PHE) and its related waivers and billing and coding instructions set to continue into next year, Hartstein, Rinkle, and Shah discussed how those rules could interact with changes proposed in the OPPS and MPFS. CMS temporarily waived a number of restrictions on provision of telehealth for the duration of the PHE, and some of those changes are likely to stick around, according to Rinkle.

“In the physician fee world, CMS wants to continue down this road of being more liberal, if you will,” she said.

However, the 2021 OPPS proposed rule was largely silent on hospital telehealth, Rinkle said. CMS might lack the statutory authority to make permanent changes to hospital telehealth coverage and reimbursement, she pointed out. Organizations may need to engage in advocacy work to encourage change at the legislative level, she advised.

Then, Tracey Tomak, RHIA, PMP, director of project management and client engagement at Intersect Health in Towson, Maryland, and Wilson explained how to recognize denials that have the best chance of being successfully appealed in “Appealability: Assessing and Rating a Denial for the Possibility of Overturn.” Tomak and Wilson walked through the hallmarks of a successful appeal and elements that may lead to a higher opportunity of overturn. They also demonstrated how organizations can create payer-specific appealability scoring tools.

All of the day one speakers joined a live Q&A video session where they answered attendees’ live and pre-submitted questions.

The day wrapped up with a virtual gala featuring a panel of NAHRI Conference Committee members discussing strategies for virtual hiring and team engagement. Tina Rosier, MS, PT, director of revenue integrity at Community Health Network in Indianapolis, Indiana, Stacie Smith, EMBA, RHIA, director of revenue integrity at Jennie Stuart Health in Hopkinsville, Kentucky, Jodi L. Stewart, RHIA, CCS, CDIP, CHRI, director of auditing services at TrustHCS in Springfield, Missouri, Diane Weiss, CPC, CPB, CCP, CHRI, vice president of revenue integrity at RestorixHealth in Metarie, Louisiana, and Caroline Znanciec, MBA, MS-HCA, managing director at CohnReznick Advisory in Baltimore, Maryland, shared their experiences navigating virtual job interviews, developing hybrid remote and onsite programs, and staying connected to colleagues.