Webinar Agenda. Webinar Etiquette. HTH Iowa SHIP IRCTC Webinar For more Information, please contact:

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1 Welcome to the HOMETOWN HEALTH IRCTC CLOSING WEBINAR A PORTION OF THESE MATERIALS WERE PRODUCED PURSUANT TO IOWA SHIP GRANT. 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. m 1

2 Webinar Resources This webinar will be recorded and ed to you to share with others on your team Handouts are available for download in the Handouts pane, and will also be ed 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 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 m 2

3 The End of the Road Looking Back at SHIP Year 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 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, 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, 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) m 3

4 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 the IRCTC Dashboard at 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? m 4

5 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! m 5

6 Managed Care Contract Management Tips Sandy 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 m 6

7 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) Watchfor trends in denial reasons m 7

8 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. m 8

9 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 m 9

10 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. m 10

11 What is a Payer Matrix? A way to track and monitor contract terms, rates, reimbursement and other important contract information m 11

12 Bottom Line KNOW YOUR CONTRACTS! Monitor your reimbursement! Share information with staff! CONTACT m 12

13 Announcements & Deadlines Continue the Transformation! SHIP Year Information Webinar: Tuesday, June 20 at Noon Central Register here: r/ Continue the Transformation! CONSORTIUM RESOURCES: Financial Processes Clinical Documentation Improvement Series and ongoing Coding/ICD 10 Updates Cost Reports Training Series, including S 10 Cost Reports and Uncompensated Care Improve Quality of Care & Data Reporting Improve Financial Processes & Payment Pricing Transparency and Chargemaster Training Series Ongoing Medicare Reimbursement Updates Utilize Technology & Telehealth Tools Ongoing Iowa Medicaid/CMO Updates/ Payor Contracting Training m 13

14 Continue the Transformation! 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 Improve Quality of Care & Data Reporting Improve Financial Processes & Payment MIPS Training Program Roadmap for Physician Performance Based Measures Swing Bed Compliance & Efficiency Program with other Skilled Nursing Compliance Resources Utilize Technology & Telehealth Tools Continue the Transformation! CONSORTIUM RESOURCES: Tech & Telemedicine Community Care: Paramedicine & Telemedicine Series of Education and Staff Remote Community Health Worker Certification Improve Quality of Care & Data Reporting Improve Financial Processes & Payment 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) Utilize Technology & Telehealth Tools Continue the Transformation! Choose One Project! 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 m 14

15 Don t Forget Course Recordings & Continuing Education All Recordings from this year are on your IRCTC Dashboard at NO EXPIRATION DATE FOR THESE! Very Important Deadline! SHIP Post-Assessment SHIP Year Post- Assessments & Evaluation Due: Friday, May 26th (Mandatory!) Step One: Click on link to IQTC Post- Program Assessment: Cycle-Transformation-Consortium-IRCTC-Post-Assessmentand-Evaluation Step Two: Fill out the Completer Information and Click Next m 15

16 Step Three: Complete the Survey m 16

17 15 Questions Some are Mandatory (*), some are optional Hit Submit at bottom Post-Assessment: By May 26 Assessment-and-Evaluation SHIP Kickoff: June 20 Utilize your IRCTC Resources: Dashboard at Utilize your HTHU Courses & Certifications: through September, 2017 m 17

18 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! m 18