Jill Hammond, Manager |
Potential RPM Benefits
experience insight
A hospital was experiencing difficulties with financial denials in the outpatient therapy department. During an onsite review, BKD discovered a high rate of turnover in the therapy department. Our evaluation revealed that:
BKD found a unique relationship between the inadequate level of staff and the denials related to poor documentation. In fact, the therapists were not capturing all their services on the charge ticket. The result: BKD recommended an alternate staffing pattern, trained the staff on documentation and CPT selection. In eight months, denials had ceased, volume was up by 29% and net revenue was up by 12% ($400,000 per year). Revenue & Performance ManagementA significant challenge for hospitals today is understanding the operational, billing and coding requirements under Medicare’s various prospective payment systems (PPS). The complexity of APCs, DRGs, inpatient rehab PPS, psych PPS and the incomplete guidance from CMS in critical areas makes it extremely difficult for hospitals to be certain they are billing for the payment to which they are entitled while remaining in compliance. Yet it is important for hospital financial leaders to master the complexity of these PPS systems and understand CMS’s guidance to help ensure their organizations receive appropriate payment for services rendered.BKD’s revenue and performance management team offers various techniques for gaining proper payment and managing claims denials under Medicare PPS. Revenue and performance management staff can address the concerns of all personnel involved in APCs, DRGs and psych PPS, including financial personnel such as CFOs and controllers; coding, billing and reimbursement personnel; compliance personnel; and charge description master coordinators. Our recommendations are based on CMS and fiscal intermediary communications to keep hospitals in compliance with current requirements. BKD’s revenue and performance management staff are individuals who have served in the hospital trenches and bring this valuable experience to clients needing guidance or objective feedback. Staff credentials include registered health information administrator (RHIA), registered health information technician (RHIT), credentialed professional coder (CPC) and certified coding specialist (CCS). Our RPM solutions include:
For More InformationContact your BKD advisor or:R. Scott Vaughn 800.581.4290 |
