AAHAM Inland Empire Spring Conference
April 14th – 15th, 2016
by Linda Corley, MBA, CPC, CRCR
(Click on the titles to download the presentations)
Blue Ribbon Hospital Reimbursement Presentation
Here we are in 2016 facing “payment reform” as never seen before in healthcare.
It’s not always billing that’s not getting claims paid! Let’s discuss the truths and myths about coverage, charge capture, coding and billing that lead to optimum payment.
Find out why the final bill (claim) does not originate in the “billing” office and what hospitals should be doing about the changing regulatory environment!
What are the current physician reporting programs? What do they mean and their impact?
Physician Quality Reporting System (PQRS), Electronic Health Record Reporting (EHR) Incentive Program or Meaninful Use (MU), The Value-based Payment-Modifier (VM)
Why “Change Management” is needed.
As CMS continues to “refine” Ambulatory Payment Classifications (APCs), 2016 has brought additional packaging of outpatient services payments; but the new year has also introduced several new reimbursement methodologies.
Join our discussion to understand how the OPPS Final Rule will affect the following outpatient services, and how you can prepare for optimizing compliant payment: APC restructuring, reorganization and consolidation of multiple clinical families, defining nine new Compliance APCs (including one for Observation), expansion of ancillary service packaging and further changes to Laboratory test payment, and a new data collection modifier and status indicators; along with a new comment indicator.
Medicare (CMS) has provided specific instructions for hospitals to follow when it is necessary to charge and bill Part B for services that were provided as “inpatient” but that were denied.
This session will review the required components for compliantly billing a Part A stay as a Part B outpatient service; and will explain the sequence of claims necessary to ensure accurate reimbursement.
As professional service (CMS-1500) claims have grown more complex, Front Office staff may require more explanation and clarification.
Now we describe our claim as a “mini-medical record” because of the amount of patient data and clinical information that is represented by codes on the claim.
This session will address—documentation that leads to clear charge capture, the importance of specific quality care decision-making , and how to be both “efficient” and “effective” in seeking professional reimbursement in 2016.