Symposium spotlight: Garner tips about how to work best with physicians

Editor’s note: Ronald L. Hirsch, MD, FACP, CHCQM, CHRI, vice president of physician advisory services with R1 RCM, will present “Revenue Integrity and Your Medical Staff: Updates, Controversies, Keys to Success” with Kay Larsen, CRCR, and Joseph Zebrowitz, MD, on Day One of the Revenue Integrity Symposium: A NAHRI Virtual Event, which takes place August 17‒18. Hirsch is a general internist and HIV specialist. He is certified in healthcare quality and management by the American Board of Quality Assurance and Utilization Review Physicians.

Q: What are you most excited about for your session this year?
Hirsch: During my session, I will present with another physician and a hospital revenue integrity expert, and that will be unlike any before. Kay Larsen will be asking Dr. Zebrowitz and me common questions revenue integrity professionals face when dealing with physicians, and we will do our best to provide answers. It will be more of a conversation as opposed to a scripted session. I am excited to try this format and be “on stage” with two distinguished people.

Q: What piece of advice would you like to give people about revenue integrity?
Hirsch: Prevention is so much easier in the long run. Revenue integrity professionals should analyze denials for patterns, then perform a root cause analysis when they find them to determine how to stop them. In some cases, it is a minor issue, such as making sure a modifier is applied properly, but in other cases, such as status determination denials, there is a multi-step process revenue integrity professionals need to review to find and fix the root cause. That effort will pay off significantly over time.  

Q: What’s the biggest challenge in revenue integrity right now? How does your session help tackle this?
Hirsch: Healthcare is like no other industry. Haven (a company formed by Amazon), Berkshire Hathaway, and JPMorgan Chase couldn’t fix it, and if those three could not do it, it may be permanently broken. Each payer has its own set of rules for paying providers for the same service. It makes no sense at all. Our session won’t fix it, but the audience will know that they are not alone in dealing with a dysfunctional system with competing priorities and incentives and confusing rules and guidelines.