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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 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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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
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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
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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/2018/05/2017-10-Connecting-Pharmacy-Cost-Management-and-Reimbursement.mp4" image_src="https://craneware.wpengine.com/wp-content/uploads/2018/06/pharmacy-cost-and-reimbursement-cerner-pharmnet-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"]

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
[/et_pb_text][/et_pb_column][/et_pb_row][et_pb_row][et_pb_column type="4_4"][et_pb_button _builder_version="3.2.2" button_alignment="center" custom_button="on" button_text_color="#ffffff" button_bg_color="#0066cc" button_border_width="0" button_border_radius="10" button_use_icon="off" button_text_color_hover="#ffffff" button_bg_color_hover="#66cc00" button_border_radius_hover="10" button_text="Download Pharmacy ChargeLink Fact Sheet" button_url="http://host.craneware.com/af2?LinkID=CH00096645eR00000038AD" url_new_window="on" /][/et_pb_column][/et_pb_row][/et_pb_section][et_pb_section bb_built="1" _builder_version="3.0.89" custom_padding="0px|||" prev_background_color="#000000" next_background_color="#e6eaee" global_module="25686"][et_pb_row global_parent="25686" module_class="social-share-blog" _builder_version="3.0.90" background_size="initial" background_position="top_left" background_repeat="repeat" module_alignment="center"][et_pb_column type="4_4"][et_pb_divider global_parent="25686" color="#d7d7d7" height="5px" _builder_version="3.2" max_width="80%" module_alignment="center" custom_padding="||40px|" /][et_pb_text global_parent="25686" _builder_version="3.0.106" module_alignment="center"]

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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[/et_pb_button][/et_pb_column][et_pb_column type="1_2"][et_pb_button admin_label="Desktop Phone" global_parent="20823" button_text="1-877-624-2792" background_layout="dark" module_class="footer-cta-btn desktop-phone" _builder_version="3.2.2" custom_button="on" button_text_size="17" button_text_color="#ffffff" button_bg_color="#66bf48" button_border_color="#66bf48" button_border_radius="5" button_use_icon="off" disabled="off" disabled_on="on|on|" button_bg_color_hover="#66bf48" button_border_color_hover="#66bf48" button_url="#"]

 

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[/et_pb_button][/et_pb_column][/et_pb_row][/et_pb_section] [post_title] => Connecting Pharmacy Cost Management and Reimbursement in Cerner PharmNet [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => connecting-pharmacy-cost-management-and-reimbursement-in-cerner-pharmnet [to_ping] => [pinged] => [post_modified] => 2018-06-22 10:52:42 [post_modified_gmt] => 2018-06-22 10:52:42 [post_content_filtered] => [post_parent] => 0 [guid] => https://public.craneware.com/?p=29364 [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] => 29364 [post_author] => 2 [post_date] => 2017-10-04 20:36:23 [post_date_gmt] => 2017-10-04 20:36:23 [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/2018/05/2017-10-Connecting-Pharmacy-Cost-Management-and-Reimbursement.mp4" image_src="https://craneware.wpengine.com/wp-content/uploads/2018/06/pharmacy-cost-and-reimbursement-cerner-pharmnet-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"]

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
[/et_pb_text][/et_pb_column][/et_pb_row][et_pb_row][et_pb_column type="4_4"][et_pb_button _builder_version="3.2.2" button_alignment="center" custom_button="on" button_text_color="#ffffff" button_bg_color="#0066cc" button_border_width="0" button_border_radius="10" button_use_icon="off" button_text_color_hover="#ffffff" button_bg_color_hover="#66cc00" button_border_radius_hover="10" button_text="Download Pharmacy ChargeLink Fact Sheet" button_url="http://host.craneware.com/af2?LinkID=CH00096645eR00000038AD" url_new_window="on" /][/et_pb_column][/et_pb_row][/et_pb_section][et_pb_section bb_built="1" _builder_version="3.0.89" custom_padding="0px|||" prev_background_color="#000000" next_background_color="#e6eaee" global_module="25686"][et_pb_row global_parent="25686" module_class="social-share-blog" _builder_version="3.0.90" background_size="initial" background_position="top_left" background_repeat="repeat" module_alignment="center"][et_pb_column type="4_4"][et_pb_divider global_parent="25686" color="#d7d7d7" height="5px" _builder_version="3.2" max_width="80%" module_alignment="center" custom_padding="||40px|" /][et_pb_text global_parent="25686" _builder_version="3.0.106" module_alignment="center"]

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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" image_src="https://craneware.wpengine.com/wp-content/uploads/2018/06/physician-charge-capture-for-hospitals-webinar.jpg" play_icon_color="#0c71c3" max_width="65%" module_alignment="center" border_width_all="2px" box_shadow_style="preset3" border_color_all="#ecf0f1" src="https://craneware.wpengine.com/wp-content/uploads/2018/06/2017-02-Incorporating-Physician-Charge-Capture-in-an-Integrated-Healthcare-System.mp4" /][/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"]

The US Healthcare system continues its drive towards improved quality of care and reduced healthcare costs by shifting patient care from independent, fragmented healthcare entities to integrated healthcare systems that align facility, physician, and ancillary services. The result is an increased push for hospitals to expand their physician networks through physician contracting and ownership. Hospital revenue integrity departments are now managing more professional services than ever. This complimentary educational webinar will cover the key differences hospital revenue cycle departments need to understand when managing physician charge capture. The webinar will include best practices for managing professional service charge capture and effective physician communication.

An up-to-date and accurate CDM is vitally important to the financial stability and success of a healthcare organization. Regardless of the payment methodology, the CDM remains the linchpin of the revenue cycle. Healthcare leaders within the financial, clinical, and operational realms benefit from solid understanding of the CDM in the fast-changing value cycle for healthcare.

Learning Objectives:

  • Identify charge capture variances between facility and professional services
  • Comprehend key differences in professional and facility coding and regulatory reference data
  • Effectively manage professional service charge capture in an integrated health system
  • Understand how to engage professional service providers in improving health system revenue integrity
[/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section][et_pb_section bb_built="1" _builder_version="3.0.89" custom_padding="0px|||" prev_background_color="#000000" next_background_color="#e6eaee" global_module="25686"][et_pb_row global_parent="25686" module_class="social-share-blog" _builder_version="3.0.90" background_size="initial" background_position="top_left" background_repeat="repeat" module_alignment="center"][et_pb_column type="4_4"][et_pb_divider global_parent="25686" color="#d7d7d7" height="5px" _builder_version="3.2" max_width="80%" module_alignment="center" custom_padding="||40px|" /][et_pb_text global_parent="25686" _builder_version="3.0.106" module_alignment="center"]

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[/et_pb_button][/et_pb_column][/et_pb_row][/et_pb_section] [post_title] => Incorporating Physician Charge Capture in an Integrated Healthcare System [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => incorporating-physician-charge-capture-in-an-integrated-healthcare-system [to_ping] => [pinged] => [post_modified] => 2018-06-22 10:56:38 [post_modified_gmt] => 2018-06-22 10:56:38 [post_content_filtered] => [post_parent] => 0 [guid] => https://public.craneware.com/?p=29355 [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] => 29355 [post_author] => 2 [post_date] => 2017-02-10 20:15:50 [post_date_gmt] => 2017-02-10 20:15:50 [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" image_src="https://craneware.wpengine.com/wp-content/uploads/2018/06/physician-charge-capture-for-hospitals-webinar.jpg" play_icon_color="#0c71c3" max_width="65%" module_alignment="center" border_width_all="2px" box_shadow_style="preset3" border_color_all="#ecf0f1" src="https://craneware.wpengine.com/wp-content/uploads/2018/06/2017-02-Incorporating-Physician-Charge-Capture-in-an-Integrated-Healthcare-System.mp4" /][/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"]

The US Healthcare system continues its drive towards improved quality of care and reduced healthcare costs by shifting patient care from independent, fragmented healthcare entities to integrated healthcare systems that align facility, physician, and ancillary services. The result is an increased push for hospitals to expand their physician networks through physician contracting and ownership. Hospital revenue integrity departments are now managing more professional services than ever. This complimentary educational webinar will cover the key differences hospital revenue cycle departments need to understand when managing physician charge capture. The webinar will include best practices for managing professional service charge capture and effective physician communication.

An up-to-date and accurate CDM is vitally important to the financial stability and success of a healthcare organization. Regardless of the payment methodology, the CDM remains the linchpin of the revenue cycle. Healthcare leaders within the financial, clinical, and operational realms benefit from solid understanding of the CDM in the fast-changing value cycle for healthcare.

Learning Objectives:

  • Identify charge capture variances between facility and professional services
  • Comprehend key differences in professional and facility coding and regulatory reference data
  • Effectively manage professional service charge capture in an integrated health system
  • Understand how to engage professional service providers in improving health system revenue integrity
[/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section][et_pb_section bb_built="1" _builder_version="3.0.89" custom_padding="0px|||" prev_background_color="#000000" next_background_color="#e6eaee" global_module="25686"][et_pb_row global_parent="25686" module_class="social-share-blog" _builder_version="3.0.90" background_size="initial" background_position="top_left" background_repeat="repeat" module_alignment="center"][et_pb_column type="4_4"][et_pb_divider global_parent="25686" color="#d7d7d7" height="5px" _builder_version="3.2" max_width="80%" module_alignment="center" custom_padding="||40px|" /][et_pb_text global_parent="25686" _builder_version="3.0.106" module_alignment="center"]

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