Commercial Audits: Managing Concurrent Review and Retrospective Denials
Provider systems are experiencing sharp increases in denials from commercial insurers and third-party payors. Commercial payors are using two primary tactics to identify claims to deny: concurrent denials and retrospective audits.
Watch this on-demand webinar recording for best practices on responding to audit requests, working across teams to facilitate appeals, and using data analytics to drive policy guidelines, process improvement, and management decisions.
- Understand common commercial payor audit practices and how to control and manage the process
- Coordinate your audit response team across departments and use audit and appeal data to help drive continuous process improvement
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Based on changes to the IPPS Final Rule, beginning in January 2019, hospitals will be required to publish a list of their standard charges online. This regulatory requirement presents an opportunity for healthcare finance teams to grow their market share and provide patients with accurate payment estimates. Trends indicate patients are “shopping” for providers with the best quality and cost, just as they do with any other commodity. This shift, along with changing reimbursement models and new regulatory requirements, motivates hospitals and health systems to adopt a consumerism-approach to healthcare which will attract and retain patients.
A Craneware customer will share their experience and the success that began with a thorough review of the hospital’s chargemaster. From the review, the customer achieved its strategic goal of creating a market based pricing strategy that keeps them competitive while also maximizing the changing payment methodologies impact rural hospitals.
In this session, presenters will share how they used the chargemaster as the foundation to build a competitive pricing strategy. Attendees will learn how to review and use their chargemaster to create a market-based pricing strategy while significantly improving patient loyalty and maximizing financial performance. The approach raised patient satisfaction, increased patient payment, and improved the hospital’s financial outcomes.
Topics Covered include:
- Engaging with key stakeholders early on in the chargemaster review initiative, communicating the project as a top-priority and ensuring ongoing participation in chargemaster processes
- Establishing a market-based pricing strategy using accurate charge data by comparing prices against competitors
- Implementing a process for pricing assessment, and establishing a timeline for continual reevaluation of charges using a 100% market-competitive chargemaster
- Identifying a strategic, multidisciplinary team comprised of clinical, non-clinical and IT professionals to champion a cross-department chargemaster review with pricing adjustments
- Making prices available to patients online to become fully transparent
Objectives:
- Identify common challenges that healthcare providers face to keep prices competitive and increase revenue
- Describe the importance of performing a thorough chargemaster review to identify areas of pricing variance
- Explain why healthcare organizations should spend a year focusing solely on chargemaster maintenance in order to see ROI
- Discuss how increased patient loyalty can significantly impact a healthcare organization’s bottom line
Share the Love!
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[/et_pb_button][/et_pb_column][/et_pb_row][/et_pb_section] [post_title] => Chargemaster & Price Transparency: Building Patient Loyalty while Improving Financial Performance [post_excerpt] => Based on changes to the IPPS Final Rule, beginning in Jan... [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => chargemaster-price-transparency-building-patient-loyalty-while-improving-financial-performance [to_ping] => [pinged] => [post_modified] => 2018-11-26 20:46:50 [post_modified_gmt] => 2018-11-26 20:46:50 [post_content_filtered] => [post_parent] => 0 [guid] => https://public.craneware.com/?p=205642 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 1 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 205642 [post_author] => 2 [post_date] => 2018-10-26 16:55:30 [post_date_gmt] => 2018-10-26 16:55:30 [post_content] => [et_pb_section bb_built="1" next_background_color="#000000" _builder_version="3.2.2"][et_pb_row _builder_version="3.2.2"][et_pb_column type="4_4"][et_pb_video _builder_version="3.2.2" src="https://public.craneware.com/wp-content/uploads/2018/11/2018-10-Chargemaster-and-Price-Transparency.mp4" image_src="https://public.craneware.com/wp-content/uploads/2018/11/chargemaster-and-price-transparency.jpg" play_icon_color="#0c71c3" max_width="65%" module_alignment="center" border_width_all="2px" box_shadow_style="preset3" border_color_all="#ecf0f1" /][/et_pb_column][/et_pb_row][et_pb_row _builder_version="3.0.106" use_custom_width="on" custom_width_px="750px" module_class="webinar-body-text"][et_pb_column type="4_4"][et_pb_text _builder_version="3.2.2"]
Based on changes to the IPPS Final Rule, beginning in January 2019, hospitals will be required to publish a list of their standard charges online. This regulatory requirement presents an opportunity for healthcare finance teams to grow their market share and provide patients with accurate payment estimates. Trends indicate patients are “shopping” for providers with the best quality and cost, just as they do with any other commodity. This shift, along with changing reimbursement models and new regulatory requirements, motivates hospitals and health systems to adopt a consumerism-approach to healthcare which will attract and retain patients.
A Craneware customer will share their experience and the success that began with a thorough review of the hospital’s chargemaster. From the review, the customer achieved its strategic goal of creating a market based pricing strategy that keeps them competitive while also maximizing the changing payment methodologies impact rural hospitals.
In this session, presenters will share how they used the chargemaster as the foundation to build a competitive pricing strategy. Attendees will learn how to review and use their chargemaster to create a market-based pricing strategy while significantly improving patient loyalty and maximizing financial performance. The approach raised patient satisfaction, increased patient payment, and improved the hospital’s financial outcomes.
Topics Covered include:
- Engaging with key stakeholders early on in the chargemaster review initiative, communicating the project as a top-priority and ensuring ongoing participation in chargemaster processes
- Establishing a market-based pricing strategy using accurate charge data by comparing prices against competitors
- Implementing a process for pricing assessment, and establishing a timeline for continual reevaluation of charges using a 100% market-competitive chargemaster
- Identifying a strategic, multidisciplinary team comprised of clinical, non-clinical and IT professionals to champion a cross-department chargemaster review with pricing adjustments
- Making prices available to patients online to become fully transparent
Objectives:
- Identify common challenges that healthcare providers face to keep prices competitive and increase revenue
- Describe the importance of performing a thorough chargemaster review to identify areas of pricing variance
- Explain why healthcare organizations should spend a year focusing solely on chargemaster maintenance in order to see ROI
- Discuss how increased patient loyalty can significantly impact a healthcare organization’s bottom line
Share the Love!
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[/et_pb_button][/et_pb_column][/et_pb_row][/et_pb_section] [post_title] => Chargemaster & Price Transparency: Building Patient Loyalty while Improving Financial Performance [post_excerpt] => Based on changes to the IPPS Final Rule, beginning in Jan... [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => chargemaster-price-transparency-building-patient-loyalty-while-improving-financial-performance [to_ping] => [pinged] => [post_modified] => 2018-11-26 20:46:50 [post_modified_gmt] => 2018-11-26 20:46:50 [post_content_filtered] => [post_parent] => 0 [guid] => https://public.craneware.com/?p=205642 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 16 [max_num_pages] => 16 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => 1 [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => 1 [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => [is_404] => [is_embed] => [is_paged] => [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => 64ab7dca56e1642e54ce1feebc030700 [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) )
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Chargemaster & Price Transparency: Building Patient Loyalty while Improving Financial Performance
Based on changes to the IPPS Final Rule, beginning in Jan… read more
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This complimentary webinar will cover best practices for chargemaster management policies and procedures for hospitals and health systems.
Craneware has implemented new chargemaster processes and tools in nearly 1/3 of US hospitals, and often we find teams operating without clear chargemaster policies and procedures. This presentation will provide a step-by-step guide to help your team define your CDM policies and procedures, as well as ways to improve upon existing written policies.
The following topics will be covered:
- Policies and Procedures – why they are important, critical elements
- How to create or update your CDM Policies and use a policy approval checklist
An overview of standard CDM policies:
- CDM Maintenance
- Charge Reconciliation
- Room and Bed Charging
Recommended for:
- Chargemaster Managers and Coordinators
- Revenue Cycle and Revenue Integrity Leadership
Share the Love!
[/et_pb_text][et_pb_image global_parent="25686" src="https://craneware.wpengine.com/wp-content/uploads/2018/03/twitter-share.png" url="https://twitter.com/home?status=" align="center" module_class="share-icon twitter" _builder_version="3.2.2" /][et_pb_image global_parent="25686" src="https://craneware.wpengine.com/wp-content/uploads/2018/06/linkedin_share.png" url="https://www.linkedin.com/shareArticle?mini=true&url=" align="center" module_class="share-icon linkedin" _builder_version="3.2.2" /][/et_pb_column][/et_pb_row][/et_pb_section][et_pb_section bb_built="1" fullwidth="off" specialty="off" _builder_version="3.0.106" background_color="#e6eaee" prev_background_color="#ffffff" next_background_color="#2d79c2" global_module="26920"][et_pb_row global_parent="26920" background_position="top_left" background_repeat="repeat" background_size="initial"][et_pb_column type="4_4"][et_pb_text global_parent="26920" _builder_version="3.0.90" background_layout="light"]You might also like...
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[/et_pb_button][/et_pb_column][/et_pb_row][/et_pb_section] [post_title] => Chargemaster (CDM) Policies 101 [post_excerpt] => This complimentary webinar will cover best practices for chargemaster management policies and procedures for hospitals and health system... [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => 340b-opps-changes-and-improving-pharmacy-revenue-integrity-2 [to_ping] => [pinged] => [post_modified] => 2018-11-26 17:48:55 [post_modified_gmt] => 2018-11-26 17:48:55 [post_content_filtered] => [post_parent] => 0 [guid] => https://public.craneware.com/?p=31290 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 1 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 31290 [post_author] => 2 [post_date] => 2018-07-02 18:58:43 [post_date_gmt] => 2018-07-02 18:58:43 [post_content] => [et_pb_section bb_built="1" next_background_color="#000000" _builder_version="3.2.2"][et_pb_row _builder_version="3.2.2"][et_pb_column type="4_4"][et_pb_video _builder_version="3.2.2" src="https://public.craneware.com/wp-content/uploads/2018/07/2018-06-Chargemaster-Policies-101.mp4" image_src="https://public.craneware.com/wp-content/uploads/2018/07/cdm-policies.png" play_icon_color="#0c71c3" max_width="65%" module_alignment="center" border_width_all="2px" box_shadow_style="preset3" border_color_all="#ecf0f1" /][/et_pb_column][/et_pb_row][et_pb_row _builder_version="3.0.106" use_custom_width="on" custom_width_px="750px" module_class="webinar-body-text"][et_pb_column type="4_4"][et_pb_text _builder_version="3.2.2"]
This complimentary webinar will cover best practices for chargemaster management policies and procedures for hospitals and health systems.
Craneware has implemented new chargemaster processes and tools in nearly 1/3 of US hospitals, and often we find teams operating without clear chargemaster policies and procedures. This presentation will provide a step-by-step guide to help your team define your CDM policies and procedures, as well as ways to improve upon existing written policies.
The following topics will be covered:
- Policies and Procedures – why they are important, critical elements
- How to create or update your CDM Policies and use a policy approval checklist
An overview of standard CDM policies:
- CDM Maintenance
- Charge Reconciliation
- Room and Bed Charging
Recommended for:
- Chargemaster Managers and Coordinators
- Revenue Cycle and Revenue Integrity Leadership
Share the Love!
[/et_pb_text][et_pb_image global_parent="25686" src="https://craneware.wpengine.com/wp-content/uploads/2018/03/twitter-share.png" url="https://twitter.com/home?status=" align="center" module_class="share-icon twitter" _builder_version="3.2.2" /][et_pb_image global_parent="25686" src="https://craneware.wpengine.com/wp-content/uploads/2018/06/linkedin_share.png" url="https://www.linkedin.com/shareArticle?mini=true&url=" align="center" module_class="share-icon linkedin" _builder_version="3.2.2" /][/et_pb_column][/et_pb_row][/et_pb_section][et_pb_section bb_built="1" fullwidth="off" specialty="off" _builder_version="3.0.106" background_color="#e6eaee" prev_background_color="#ffffff" next_background_color="#2d79c2" global_module="26920"][et_pb_row global_parent="26920" background_position="top_left" background_repeat="repeat" background_size="initial"][et_pb_column type="4_4"][et_pb_text global_parent="26920" _builder_version="3.0.90" background_layout="light"]You might also like...
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Chargemaster (CDM) Policies 101
This complimentary webinar will cover best practices for chargemaster management policies and procedures for hospitals and health system… read more
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[post_date] => 2018-01-03 20:31:56
[post_date_gmt] => 2018-01-03 20:31:56
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In 2018, CMS reduced payment for some outpatient drugs used in OPPS settings, cutting reimbursement at many 340B participating hospitals by nearly 30%. Some organizations are excluded from the payment cut, but all hospitals participating in the 340B program will have new requirements to report an additional modifier on drugs acquired under the 340B program.
In this educational webinar, Bonnie Kirschenbaum and Craneware’s Kathy Schwartz will provide a detailed overview of the 2018 OPPS changes, steps hospital pharmacy, revenue cycle, and revenue integrity teams can take to ensure compliance with the new requirements, and recommendations on improving pharmacy revenue integrity at your organization to help offset this unprecedented payment cut.
After watching this educational webinar, attendees will have an understanding of
- The payment cuts and which hospitals and drugs will be affected
- New “JG” and “TB” modifiers and other requirements
- Steps hospital teams can take to ensure compliance
- Steps hospital teams can take to improve pharmacy charge capture and revenue integrity
Share the Love!
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[/et_pb_button][/et_pb_column][/et_pb_row][/et_pb_section] [post_title] => 340B OPPS Changes and Improving Pharmacy Revenue Integrity [post_excerpt] => In 2018, CMS reduced payment for some outpatient drugs used in OPPS settings, cutting reimbursement at many 340B... [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => 340b-opps-changes-and-improving-pharmacy-revenue-integrity [to_ping] => [pinged] => [post_modified] => 2018-11-26 20:48:09 [post_modified_gmt] => 2018-11-26 20:48:09 [post_content_filtered] => [post_parent] => 0 [guid] => https://public.craneware.com/?p=29362 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 1 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 29362 [post_author] => 2 [post_date] => 2018-01-03 20:31:56 [post_date_gmt] => 2018-01-03 20:31:56 [post_content] => [et_pb_section bb_built="1" next_background_color="#000000" _builder_version="3.2.2"][et_pb_row _builder_version="3.2.2"][et_pb_column type="4_4"][et_pb_video _builder_version="3.2.2" src="https://craneware.wpengine.com/wp-content/uploads/2018/05/2018-01-340B-OPPS-Changes-and-Improving-Pharmacy-Revenue-Integrity.mp4" image_src="https://craneware.wpengine.com/wp-content/uploads/2018/06/340B-pharmacy-revenue-integrity-webinar.jpg" play_icon_color="#0c71c3" max_width="65%" module_alignment="center" border_width_all="2px" box_shadow_style="preset3" border_color_all="#ecf0f1" /][/et_pb_column][/et_pb_row][et_pb_row _builder_version="3.0.106" use_custom_width="on" custom_width_px="750px" module_class="webinar-body-text"][et_pb_column type="4_4"][et_pb_text _builder_version="3.2.2"]
In 2018, CMS reduced payment for some outpatient drugs used in OPPS settings, cutting reimbursement at many 340B participating hospitals by nearly 30%. Some organizations are excluded from the payment cut, but all hospitals participating in the 340B program will have new requirements to report an additional modifier on drugs acquired under the 340B program.
In this educational webinar, Bonnie Kirschenbaum and Craneware’s Kathy Schwartz will provide a detailed overview of the 2018 OPPS changes, steps hospital pharmacy, revenue cycle, and revenue integrity teams can take to ensure compliance with the new requirements, and recommendations on improving pharmacy revenue integrity at your organization to help offset this unprecedented payment cut.
After watching this educational webinar, attendees will have an understanding of
- The payment cuts and which hospitals and drugs will be affected
- New “JG” and “TB” modifiers and other requirements
- Steps hospital teams can take to ensure compliance
- Steps hospital teams can take to improve pharmacy charge capture and revenue integrity
Share the Love!
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[/et_pb_button][/et_pb_column][/et_pb_row][/et_pb_section] [post_title] => 340B OPPS Changes and Improving Pharmacy Revenue Integrity [post_excerpt] => In 2018, CMS reduced payment for some outpatient drugs used in OPPS settings, cutting reimbursement at many 340B... [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => 340b-opps-changes-and-improving-pharmacy-revenue-integrity [to_ping] => [pinged] => [post_modified] => 2018-11-26 20:48:09 [post_modified_gmt] => 2018-11-26 20:48:09 [post_content_filtered] => [post_parent] => 0 [guid] => https://public.craneware.com/?p=29362 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 16 [max_num_pages] => 16 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => 1 [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => 1 [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => [is_404] => [is_embed] => [is_paged] => [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => 3c6f4ca88e0661e0ec99a75868330857 [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) )
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340B OPPS Changes and Improving Pharmacy Revenue Integrity
In 2018, CMS reduced payment for some outpatient drugs used in OPPS settings, cutting reimbursement at many 340B… read more