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- Current staffing levels prevented therapists from seeing patients long enough
- The quality of documentation suffered because of the volume of patients in relation to staffing
- Therapists were not adequately trained in CPT selection on their charge ticket
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).
A 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:- Improved compliance
- Improved cash flow
- Improved revenue capture
- Decrease in days in accounts receivable
- Decreased financial denials
- Improved documentation
- APC analysis
- Charge master reviews
- Charge process analysis
- Compliance and corporate integrity
- Documentation audits
- DRG benchmarking
- Independent review organization services
- Payment & denial management
- Rate analysis
- Revenue cycle operations reviews
For More Information
Contact your BKD advisor or:R. Scott Vaughn
800.581.4290
