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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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] => [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] => 2018-06-22 10:50:17 [post_modified_gmt] => 2018-06-22 10:50:17 [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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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 participating hospitals by nearly 30%. Some organizations are excluded from the payment cut, but all hospitals participating in the...
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How can pharmacy and financial teams improve pharmacy reimbursement by fixing common data gaps between the purchase history, the pharmacy formulary and the chargemaster?
This webinar will cover:
- Pharmacy revenue cycle and revenue integrity challenges and how the one health system addressed them
- Pharmacy Cost-to-charge analytics
- The health system’s approach to correcting missing and incorrect multipliers, invalid HCPCS and other common revenue cycle issues
- Pharmacy revenue integrity best practices in Cerner Pharmnet
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"]
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How can pharmacy and financial teams improve pharmacy reimbursement by fixing common data gaps between the purchase history, the pharmacy formulary and the chargemaster?
This webinar will cover:
- Pharmacy revenue cycle and revenue integrity challenges and how the one health system addressed them
- Pharmacy Cost-to-charge analytics
- The health system’s approach to correcting missing and incorrect multipliers, invalid HCPCS and other common revenue cycle issues
- Pharmacy revenue integrity best practices in Cerner Pharmnet
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"]
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Connecting Pharmacy Cost Management and Reimbursement in Cerner PharmNet
How can pharmacy and financial teams improve pharmacy reimbursement by fixing common data gaps between the purchase history, the pharmacy formulary and the chargemaster? This webinar will cover: Pharmacy revenue cycle and revenue integrity...
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[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/2018/05/2017-09-Preventing-Medical-Necessity-and-Prior-Authorization-Denials.mp4" image_src="https://craneware.wpengine.com/wp-content/uploads/2018/06/medical-necessity-denials-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"]
Develop a better understanding of how to manage the ever-changing payor requirements for outpatient Medical Necessity and Prior Authorization. Revenue Cycle expert Becky Kinsella will discuss the importance of communication and physician education in the development of Medical Necessity and Prior Authorization protocols, and share medical necessity best practices.
This webcast is being produced with the IL AAHAM and HFMA of Greater St. Louis, but registration is open to all. After this webinar you will be able to:
Recommended for:
Healthcare provider participants from the financial, clinical, and operational areas who want to understand better how to utilize the CDM in achieving best outcomes.
- Identify opportunities to reduce outpatient Medical Necessity and Prior Authorization denials
- Better understand the importance of utilizing Medical Necessity tools to ensure revenue integrity
- Learn how to develop and implement a best practice approach to Medical Necessity
- Understand the importance of accurate diagnosis coding and documentation
- Develop an understanding of the differences between Medical Necessity, Prior Authorization and Clinical Criteria requirements
- Learn how these requirements interact with Compliance
Share the Love!
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[/et_pb_button][/et_pb_column][/et_pb_row][/et_pb_section] [post_title] => Preventing Medical Necessity and Prior Authorization Denials [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => preventing-medical-necessity-and-prior-authorization-denials [to_ping] => [pinged] => [post_modified] => 2018-06-22 10:55:29 [post_modified_gmt] => 2018-06-22 10:55:29 [post_content_filtered] => [post_parent] => 0 [guid] => https://public.craneware.com/?p=29352 [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] => 29352 [post_author] => 2 [post_date] => 2017-09-21 20:10:32 [post_date_gmt] => 2017-09-21 20:10:32 [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/2018/05/2017-09-Preventing-Medical-Necessity-and-Prior-Authorization-Denials.mp4" image_src="https://craneware.wpengine.com/wp-content/uploads/2018/06/medical-necessity-denials-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"]
Develop a better understanding of how to manage the ever-changing payor requirements for outpatient Medical Necessity and Prior Authorization. Revenue Cycle expert Becky Kinsella will discuss the importance of communication and physician education in the development of Medical Necessity and Prior Authorization protocols, and share medical necessity best practices.
This webcast is being produced with the IL AAHAM and HFMA of Greater St. Louis, but registration is open to all. After this webinar you will be able to:
Recommended for:
Healthcare provider participants from the financial, clinical, and operational areas who want to understand better how to utilize the CDM in achieving best outcomes.
- Identify opportunities to reduce outpatient Medical Necessity and Prior Authorization denials
- Better understand the importance of utilizing Medical Necessity tools to ensure revenue integrity
- Learn how to develop and implement a best practice approach to Medical Necessity
- Understand the importance of accurate diagnosis coding and documentation
- Develop an understanding of the differences between Medical Necessity, Prior Authorization and Clinical Criteria requirements
- Learn how these requirements interact with Compliance
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Preventing Medical Necessity and Prior Authorization Denials
Develop a better understanding of how to manage the ever-changing payor requirements for outpatient Medical Necessity and Prior Authorization. Revenue Cycle expert Becky Kinsella will discuss the importance of communication and physician education...
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