Final IRCTC Webinar 5 23 17 - HTHU · HTH Iowa SHIP IRCTC Webinar 5‐23‐17 For more Information, please contact: [email protected] m 3 The End of the Road…

HTH Iowa SHIP IRCTC Webinar 5‐23‐17

For more Information, please contact: [email protected] 1

Welcome to the HOMETOWN HEALTH

A PORTION OF THESE MATERIALS WERE PRODUCED PURSUANT TO 2016-2017 IOWA SHIP GRANT.

IRCTC CLOSING WEBINAR

Webinar Agenda

Welcome & A Look Back Jennie Price

Managed Care & Contract Management Tips Sandy Sage

Deadlines & Upcoming Events Jennie Price

Webinar Etiquette• All attendees are in “Listen Only”

mode

• Questions or comments?- Open “Questions” pane in

dashboard- Type in comments or questions- Comments will be monitored

through out webinar. - Questions will be addressed at

end of the webinar.



Webinar Resources

• This webinar will be recorded and emailed to you to share with others on your team

• Handouts are available for download in the Handouts pane, and will also be emailed out to attendees after the webinar.

Roll Call!

Are you on this webinar with a group?

If so, please enter the list of first/last names and email addresses of those in attendance with you in

the Comments Pane.

IRCTC Program Goal

The goal of the Iowa Revenue Cycle Transformation Consortium (IRCTC) is to build a group of hospitals and other stakeholders that work together to strengthen the rural health infrastructure and increase access for small or rural Iowa hospitals. This will be accomplished by supporting Prospective Payment System (PPS) or Payment Bundling (PB) investment activities that improve hospital financial processes in areas such as:

▪ ICD-10 support and training

▪ Revenue Cycle Management training

▪ Reimbursement and Payment Updates



The End of the Road…

Looking Back at SHIP Year 2016-2017

At the beginning of the year, you gave us specific needs and requests for topics in the IRCTC Pre-Assessment

Reimbursement and Payment Updates ▪ Monthly Medicare Reimbursement Update Webinar to provide

reimbursement update on the most current Medicare policies and procedures, also hit topics such as:- MOON, - Prolonged Infusions and Coding Updates, - Part A Inpatient Billing & Coding, - Emergency Preparedness Rule- 2017 Radiology Changes- PPS Outpatient Final Rule- JW Modifier- Claims Holds and Observation Billing- BONUS Moon Webinar- Rural Health Clinic Billing- MIPS & RAC Update- Therapy Billing & Coding

• Quarterly CAH Reimbursement Training Webinars for reimbursement issues & updates specific to Critical Access Hospitals, including topics such as: - Swing Bed Billing, Chart and Cost Reporting- Outpatient Billing- Method II Elections, - 2017 General Billing Overview,

ICD-10 Support and Training

▪ Quarterly ICD-10/Coding Webinar led by HCCS - to help hospitals stay on top of the latest changes and ongoing challenges in coding requirements, hitting topics such as: - Conquering Colonoscopy CPT/ICD-10-CM Coding- EMS Coding Compliance in ICD-10 and Beyond - Preparing for the End of the Code Freeze: Oct. 1, 2016 - Unraveling Diabetes Coding in ICD-10-CM- Physician E/M and CPT Reporting in the ED Setting - Bonus Webinar! Coding for Injections & Infusions- In June: Hitting the Mark on Compliant OB coding in ICD-10

▪ Unlimited staff registrations Online Courses in the HTHU.net School of Documentation & Coding to support further staff development and education (For use through September 2017)



Revenue Cycle Management training▪ Quarterly Revenue Cycle Management Transformation Webinar

series/Quarterly Program Check-ins, providing accredited training for RCM leaders on top needs identified in the program Pre-Assessment, hitting topics such as: - Quarterly Iowa Medicaid/CMO Payor Updates- Business Office Team Development - Making the Most of your HTHU.net Education- The Importance of a Clinical Documentation Improvement Program- Business Office Leadership, Reporting, and Benchmarking for Improvement

▪ Unlimited staff registrations for the PFS/Business Office Certifications and Online Courses in the HTHU.net School of Revenue Cycle Management to support further staff development and education (For use through September 2017)

▪ Live Training & Networking at the Iowa Transformation Consortium Conference- A Transforming Industry: Industry Update- Transforming Strategy to Improve your Hospital’s Financials- The Transforming World of Coding and Audits- Using your DDE To Transform Focus: Reimbursement Practices that Look Forward- The Transformation of Denials through Contract Management- Transforming Swing Bed Programs for Revenue Improvement- Transforming Payment Models: Transitional Care Management- The Value of Telehealth: Telehealth Return on Investment

Other IRCTC Training

▪ Access to Cross-Training:- Quality Consortium: Quality Transformation and Patient Experience Transformation Series- Telemedicine Consortium Webinar Series, plus a Bonus Iowa Telemedicine Billing Webinar

▪ Other Bonus Webinars: - Post-Acute: How it Benefits the Hospital's ACA Triple Aim Objectives- OSHA Anti-Retaliation Training: Part of an Effective Compliance Program

▪ All Items, including recordings and resources can be found on theIRCTC Dashboard at www.hthu.net/irctc; password: revenue

That Brings Us To Today!

Final Revenue Cycle Consortium Training:

▪ Based on everything this year, what’s next for YOUR hospital?

▪ What is your next focus area for Coding, Revenue Cycle, or other Financial Processes?

▪ What goals should you be setting now to move forward?



What’s down the road?

▪ COST CONTROL: Uncertainty about the direction health care priority to maintain tight control over expenses - This means focusing on the relationship between cost and quality- For Staff: “Even with unknowns, we do know we will not compromise quality, safety and service

▪ EXPANSION OF YOUR MARKET: Seek new sources of revenue --- Enhance revenue sources by looking at partnerships that rely on your expertise, your personalized care, your special programs

▪ BIG ISSUES on the horizon: online care, consumer care and wellness

▪ RISING PATIENT EXPECTATIONS, DROPPING REIMBURSEMENT

▪ REGULATORY (& PAYMENT) CHANGES

▪ STATE PAYOR CHANGES

SHARE YOUR THOUGHTS:

When it comes to Financial Processes,

what are some areas you see on the horizon as focus areas or needs for

your hospital?

Enter yours in the question pane! (*We won’t share names…)

Education: Managed Care Contract Management Tips

▪ One of the areas of need requested this year

▪ Talked about at Iowa Conference (a little!)

▪ We’ll be focusing heavily on Payors and Contracts in next year’s Iowa Medicaid CMO Quarterly Calls

▪ We’ll be providing 6 new Online Support Courses/ Certification Next Year

▪ Purpose of Today’s Education: Provide a foundation of education and a “checkpoint” to see where you are managing contracts to get us ready for next year!



Managed Care Contract Management TipsSandy Sage, RN – Revenue Analyst

What is contract compliance or contract management?

Executing and monitoring contract performance to maximize revenue and

minimize risk.

Why?

▪ Hospitals are responsible for monitoring contract performance

▪ Managed Care companies are not monitoring your contracts for you!

▪ Success will positively impact your financial bottom line



Contract Issues

▪ Incorrect calculations leading to underpayments

▪ Missing contracted increases

▪ Inappropriate claims denials

▪ Complex terms incorrectly applied

▪ Missing outlier or carve out payments

Missing Increases▪ Multi-year contracts will often have annual

percentage increases included

▪ Do you know which of your contracts are single year and which are multi-year?

▪ Audits should be done within 30 days of contracted percentage increase

▪ Any underpayments should immediately be reported

Claims Denials▪ Claim denials should be monitored and

tracked by payer

▪ Denials for the same reason over and over should be evaluated

▪ Successful appeals may signal inappropriate denials (Medical Necessity)

▪ Watch for trends in denial reasons



Underpayments

4 main causes for underpayments

1. Incorrect billing

2. Pricing errors by payer

3. Incorrect payment calculations

4. Difference in contract term interpretation

Incorrect Billing

▪ Missing modifiers

▪ Missing occurrence or value codes

▪ Missing ID numbers

▪ Incorrect demographic data

▪ Missing authorization or referral

▪ Records requested not sent

▪ Missing invoice for implants

▪ More……

Payer Pricing Errors

▪ Do you know what you should be getting paid?

▪ When working remits it is important to know what to look for and to understand what you are looking at.

▪ Have your billers divided by payer so that they become familiar with accurate payment rates.

▪ This will allow them to more easily notice if an incorrect calculation or pricing error has caused an underpayment.



Payer Pricing Errors

▪ Complicated and complex contracts

▪ Each payer has their own negotiated contracts and rates

▪ A managed care insurance may not have your rates accurately entered into their system

▪ Payments that are not accurate according to the contracted rates are pricing errors and should immediately be brought to the attention of the payer

Contract Confusion

▪ Do you understand the terminology used in the contract?

▪ Does the payer understand it the same way?

▪ Have you read the definitions in your contract?

▪ It is easy to create confusion with miscommunication of contract terms.

▪ Know your terminology and definitions!

Missing Payments?▪ Make sure that you are being paid what you are

owed!

▪ Audit your claims to ensure all payments are received

▪ Outliers –– Payment addition for cases that incur

extraordinarily high costs.– Threshold amounts – Dollar amounts that the

cost must exceed in order to get the outlier payment.

– Normally addressed in your contracts



Missing Payments?

▪ Add On or Carve Out Payments

▪ Payments that are usually negotiated in contracts for high cost procedures or supplies

▪ Implants, Cardiac procedures

▪ High cost drugs

Recoveries

▪ Not only do hospitals have a responsibility to monitor claims payments but you also have a financial need.

▪ Recovery of money from underpayments may vary depending on the complexity of the contract and the effort expended to challenge the underpayment.

▪ Recoveries can vary from 2-6% of your payment amounts.

▪ It is worth the effort!

What to Do

▪ Take time to educate your staff

▪ If you don’t take the time to educate you will begin to see a decrease in your net revenue

▪ Meet with staff regularly to discuss what they are seeing and identify important issues

▪ Stay up to date with any contract changes or adjustments

▪ Use contract software or a payer matrix to use as a training and reference tool.



What is a Payer Matrix?

A way to track and monitor contract terms, rates, reimbursement and other important contract information



Bottom Line

KNOW YOUR CONTRACTS!

Monitor your reimbursement!

Share information with staff!

CONTACT

[email protected]



Announcements & Deadlines

Continue the Transformation!

SHIP Year 2017-18 Information Webinar: Tuesday, June 20 at Noon Central

▪ Register here: https://attendee.gotowebinar.com/register/2813848549990725378


Improve Quality of Care & Data Reporting

Improve Financial Processes &

Payment

Utilize Technology &Telehealth Tools

CONSORTIUM RESOURCES:Financial ProcessesClinical Documentation Improvement Series and ongoing Coding/ICD‐10 Updates

Cost Reports Training Series, including S‐10 Cost Reports and Uncompensated Care

Pricing Transparency and ChargemasterTraining Series

Ongoing Medicare Reimbursement Updates

Ongoing Iowa Medicaid/CMO Updates/ Payor Contracting Training






Payment


CONSORTIUM RESOURCES:Quality Improvement

Quality Transformation Series: • New HCAHPS series – Using HCAHPS to your

Hospital’s Advantage• Rural Health Center Clinical Quality Measures• Quality Leaders ‐ Building a Robust Quality

Department/Evaluating your Quality Department

MIPS Training Program• Roadmap for Physician Performance Based Measures

Swing Bed Compliance & Efficiency Program with other Skilled Nursing Compliance Resources




Payment


CONSORTIUM RESOURCES:Tech & Telemedicine

Community Care: Paramedicine & Telemedicine Series of Education and Staff “Remote Community Health Worker” Certification

Technology Transformation Series: HIT and Value Based Care, eCQM, CPOE, Disease Registry, and System Performance Training from EHR Vendors (Staff Training on inputting the correct data, and Quality Leader training on extracting the necessary data)


Telemedicine Transformation Project

Individual funds for equipment, one‐on‐one strategic planning and consultations with experts for your hospitals, Certifications for staff

Coding Audits & Benchmarking Project

Individual Retrospective Audits and benchmarking against others, individual hospital consultations

Care Coordination & Transitional Care Management Project

Training & Preparation for CCM & TCM, certification for staff, manuals and resources

Choose One Project!



Don’t Forget…

Course Recordings & Continuing EducationAll Recordings from this year are on your IRCTC Dashboard at www.hthu.net/irctc

NO EXPIRATION DATE FOR THESE!

Very Important Deadline!

SHIP Post-Assessment

SHIP Year 16-17 Post-Assessments & Evaluation Due: Friday, May 26th (Mandatory!)

Step One: Click on link to IQTC Post-Program Assessment:http://www.surveygizmo.com/s3/3570437/Iowa-Revenue-Cycle-Transformation-Consortium-IRCTC-Post-Assessment-and-Evaluation

Step Two: Fill out the “Completer Information” and Click “Next”



Step Three:Complete the Survey



15 Questions – Some are Mandatory (*), some are optionalHit “Submit” at bottom

Post-Assessment: By May 26http://www.surveygizmo.com/s3/3570437/Iowa-Revenue-Cycle-Transformation-Consortium-IRCTC-Post-

Assessment-and-Evaluation

SHIP 17-18 Kickoff: June 20https://attendee.gotowebinar.com/register/2813848549990725378

Utilize your IRCTC Resources: Dashboard at www.hthu.net/irctc

Utilize your HTHU Courses & Certifications: through September, 2017



Thank you for your participation this year!

Questions?

Thank you for attending!Please take a moment to fill out the webinar evaluation that will launch once the webinar closes to give us your feedback, and tell us how to better help your hospital!

Documents

Final IRCTC Webinar 5 23 17 - HTHU · HTH Iowa SHIP IRCTC Webinar 5‐23‐17 For more Information, please contact: [email protected] m 3 The End of the Road…