A Net With Many Holes: An Evidenced Based Assessment of Reimbursement Pitfalls

2.50
Hdl Handle:
http://hdl.handle.net/10755/151236
Type:
Presentation
Title:
A Net With Many Holes: An Evidenced Based Assessment of Reimbursement Pitfalls
Abstract:
A Net With Many Holes: An Evidenced Based Assessment of Reimbursement Pitfalls
Conference Sponsor:Sigma Theta Tau International
Conference Year:2007
Author:Brown, Michael, BSN, RN, CCA
P.I. Institution Name:The Methodist Hospital
Title:Cardiology Coder
[Research Presentation] Optimal revenue cycle health depends in part on effective eligibility and coverage verification, charge master maintenance, charge capture, documentation, and coding. Like a puzzle, all the pieces fit together to produce the total picture. This study addresses how those pieces can fall out of that picture and an approach to managing those issues. áMethod:á The study was performed over a two-year period. Each case (approximately 16,000) was audited for documentation of the services provided. In addition all inventory items were audited for appropriate documentation of usage.á Par levels of all inventory items were also addressed. Lastly, all case charges were checked for accuracy and postings of those charges were verified each day.áFindings: Documentation not precise nor clear. [Charge entry challenges; Charge master issues (including cdm, c-code, and mapping concerns; Quantity disbursement; Systems issues; and Inventory management accuracy] Action plan:áááááá Educate staff on proper documentation. [Educate billing staff; Perform through review of the charge master; Increase quantity issue availabilities;áá Correct c-codes; and Systems review]áThe evidenced based assessment demonstrated that for issues related to documentation alone there existed a potential loss of revenue of near $120,000 per quarter. All other identified areas totaled near $75,000 per quarter. Misrepresentation of the services provided can occur as a result of issues in any of these areas.á It is essential that an internal auditing of the documentation and charges entered be performed on a daily basis and that practitioners remain current with new requirements.ááááá
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleA Net With Many Holes: An Evidenced Based Assessment of Reimbursement Pitfallsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/151236-
dc.description.abstract<table><tr><td colspan="2" class="item-title">A Net With Many Holes: An Evidenced Based Assessment of Reimbursement Pitfalls</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Brown, Michael, BSN, RN, CCA</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">The Methodist Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Cardiology Coder</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">mebrown@tmh.tmc.edu</td></tr><tr><td colspan="2" class="item-abstract">[Research Presentation] Optimal revenue cycle health depends in part on effective eligibility and coverage verification, charge master maintenance, charge capture, documentation, and coding. Like a puzzle, all the pieces fit together to produce the total picture. This study addresses how those pieces can fall out of that picture and an approach to managing those issues. &aacute;Method:&aacute; The study was performed over a two-year period. Each case (approximately 16,000) was audited for documentation of the services provided. In addition all inventory items were audited for appropriate documentation of usage.&aacute; Par levels of all inventory items were also addressed. Lastly, all case charges were checked for accuracy and postings of those charges were verified each day.&aacute;Findings: Documentation not precise nor clear. [Charge entry challenges; Charge master issues (including cdm, c-code, and mapping concerns; Quantity disbursement; Systems issues; and Inventory management accuracy] Action plan:&aacute;&aacute;&aacute;&aacute;&aacute;&aacute; Educate staff on proper documentation. [Educate billing staff; Perform through review of the charge master; Increase quantity issue availabilities;&aacute;&aacute; Correct c-codes; and Systems review]&aacute;The evidenced based assessment demonstrated that for issues related to documentation alone there existed a potential loss of revenue of near $120,000 per quarter. All other identified areas totaled near $75,000 per quarter. Misrepresentation of the services provided can occur as a result of issues in any of these areas.&aacute; It is essential that an internal auditing of the documentation and charges entered be performed on a daily basis and that practitioners remain current with new requirements.&aacute;&aacute;&aacute;&aacute;&aacute;</td></tr></table>en_GB
dc.date.available2011-10-26T10:55:57Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T10:55:57Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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