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.
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 2
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
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 3
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)
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 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 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?
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 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!
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 6
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
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 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)
▪ Watch for trends in denial reasons
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 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.
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 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
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 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.
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 11
What is a Payer Matrix?
A way to track and monitor contract terms, rates, reimbursement and other important contract information
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 12
Bottom Line
KNOW YOUR CONTRACTS!
Monitor your reimbursement!
Share information with staff!
CONTACT
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 13
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
Continue the Transformation!
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
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 14
Continue the Transformation!
Improve Quality of Care & Data Reporting
Improve Financial Processes &
Payment
Utilize Technology &Telehealth Tools
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
Continue the Transformation!
Improve Quality of Care & Data Reporting
Improve Financial Processes &
Payment
Utilize Technology &Telehealth Tools
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)
Continue the Transformation!
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!
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 15
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”
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 16
Step Three:Complete the Survey
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 17
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
HTH Iowa SHIP IRCTC Webinar 5‐23‐17
For more Information, please contact: [email protected] 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!