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Discover how our specialized services in Optical Revenue Cycle Management in New York can revolutionize your #healthcare financials. Learn about our expert Outsource Medical Coding Audit Services in the #US and Healthcare Provider Credentialing Services. Find out why healthcare providers selecting us for Revenue Cycle Management is the key to economic success.

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Overview: Hospital chargemasters are complex and represent a key component for the revenue cycle of hospitals. Chargemasters are intertwined with coding for services, billing for services, charging for services and even involve the cost reporting process. A myriad of decisions must be made concerning how the chargemaster is organized, impacts on coding and billing, charge structuring, cost accounting, and other processes within the revenue cycle. Whenever decisions are made, policies and procedures should be developed, approved and implemented. A proper system of billing and chargemaster policies and procedures can help to maintain an appropriate compliance stance in a world where ambiguous guidance is often the norm. The development of charges and charge structuring within the chargemaster is a major issue often referred to as transparent pricing. While even the Medicare program maintains that hospitals should charge for everything, the way in which charges are set and amalgamated at the claim level can vary significantly between hospitals. A key issue for the chargemaster is differentiating separately charging from separately reporting. The way in which hospitals make decisions about the bundling of charges at the line-item level within the chargemaster leads to many decisions, all of which need justification through proper policies and procedures. Due consideration must be given to departmental concerns about revenue generation, cost reporting implications, coding implications and any associate challenges with billing and claims filing. Why should you Attend: See Typical Questions - Here are some reworded marketing questions: Why are the chargemaster and hospital billing targets of compliance audits? How should we prioritize statutory and contractual compliance for the chargemaster and billing process? Will chargemaster and associated billing policies and procedures give us protection relative to compliance? How should we develop a system of chargemaster po

Overview: Many medical entities are increasingly struggling to manage revenue effectively. Self pay is on the rise due to high deductibles. Bad debt is increasing. What is your plan to manage these areas? Staff trained in denial management? Variances? Are they handling these areas in a timely manner? Payers have time limits in which dollars can be salvaged. Missing those strategic times mean dollars lost. Don't leave money on the table. We will discuss multiple avenues in which strong training and timely action can equal $$$. Why should you Attend: Don't lose hard earned revenue. Learn tips to strategic follow up, when and how to manage the appeal process. Is the claim appealable? Partial payments and why? Today's industry of high dollar deductibles create the necessity to expend additional efforts on self-pay accounts. There is a significant difference in collecting small co-pays and managing large balances. Bad debt creep? What is your plan for managing these areas? Areas Covered in the Session: Hire the right staff - Then engage in ongoing education Variances and denial management Billing compliance Coding for specificity, co-existing conditions and correct modifiers Supporting medical necessity CCI edits and unbundling Productivity Claims follow up Payer processing edits Additional development requests Handling problem claims and appeals Who Will Benefit: Coders Billers Revenue cycle Physicians, mid-level providers Nurses Claims follow-up Managers Speaker Profile Dorothy D. Steed is an Independent Healthcare Consultant and Educator in Atlanta. She was a Medicare specialist for a large hospital system and a physician coding audit supervisor for another hospital system, with 38 years of experience in healthcare. Additionally, she is an instructor at a state technical college in Atlanta, provides auditing & training in both facility and physician services, and has been a speaker at several healthcare conferences. Ms. Steed has written articles for

Are you a healthcare provider looking for affordable revenue cycle management services? Our expert team specializes in optimizing revenue cycles while reducing costs. Improve your financial performance today!

Overview: As the healthcare industry moves toward a value based reimbursement model rather than fee for service, it is crucial that the provider and ancillary staff understand how ineffective reporting can lead to dollars lost. We will review the 3 critical areas that require skilled management. Understand that patients are more educated about their healthcare and are increasingly responsible for more out of pocket costs. High dollar deductibles may result in self pay realities and bad debt increases. Learn areas that increase your chances for an audit. Are you ready for the challenge? Why should you Attend: Revenue is dependent upon proficiency in multiple areas. In today's environment, it is risky to maintain the status quo and increasingly important to obtain and maintain skilled business staff. The granularity of the ICD-10 code set requires understanding of the official coding conventions and guidelines, the ability to apply those guidelines, and the ability to recognize when reporting may lead to revenue delay, reduction or loss. Additionally, other factors affect your revenue stream. This includes patients with high deductible plans, collection of much more than a small co-pay, and staff understanding of regulations that govern telephone collection activity. Don't leave money on the table or invite an audit into your practice. Audits are often the result of weak billing and coding skills. This program will review several areas that will cost you money if poorly handled. Areas Covered in the Session: Required specificity in coding Documentation necessary for ICD-10 reporting Why coders must frequently query for clarification How ambiguous diagnosis reporting affects you r bottom line Internal collections versus outsourcing. What should you consider Staff effective in handling problem claims? Developing appeals? Who Will Benefit: Coders Billers Revenue cycle Physicians Mid-level providers Nurses Claims follow-up Managers Managers Speaker Profil

Overview: Become knowledgeable and understand the False Claims Act, Anti-Kickback Statute, Physician Self-Referral Law, Excluded Individuals and additional criminal/civil laws that may worsen the punishment if these laws are violated. Understand the criteria of each law, exceptions and how to identify an issue that requires mitigation. Why should you Attend: Are you able to distinguish with certainty an agreement, contract or activity that is permissible versus one that is not under our current healthcare laws and regulations? Do you have a contract organization system where reviews are done regularly and retained centrally? Do you conduct auditing and monitoring of potential high risk compliance areas related to fraud, waste and abuse? If you are uncertain or need additional guidance on recognizing potential violations of healthcare fraud, waste and abuse regulations and how to audit and monitor for non-compliance, this training is for you. Areas Covered in the Session: Define and describe elements of the Anti-kickback Statute, False Claims Act, Exclusionary Rule, Physician Self-Referral Law and potential penalties for violations Discuss exceptions and related criteria to the Physician Self-Referral Law and the Anti-Kickback Statute Identify common potential issues that may result in violations and how to avoid or mitigate them Provide examples on how to comply with the regulations Describe areas to audit, monitor and implement policies/procedures for compliance Who Will Benefit: Health care providers Revenue cycle management employees Coders, Billers Compliance officers Contract management Compliance and Internal Audit professionals Healthcare administrators Speaker Profile Gail Madison Brown is a registered nurse and an attorney with over 25 years of experience in health care. For the last 15 years she has focused on health care compliance and revenue cycle management operations. Gail's experience ranges from starting new compliance programs and making impr

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Attention Optometrists! Are you struggling to juggle patient care and billing tasks?

Overview:   Review 6 points of high quality evidence based clinical documentation Review of 7 criteria that all entries in a patient record should include Impact of documentation on coding and claims Impact on audits and ability to defend an audit When an audit is initiated, the completeness of documentation becomes critical in the ability to support what you have reported. Let's take a look at areas in which weaknesses are often found.  Why should you Attend:  The granularity and accuracy of the ICD-10 code set is supported by quality clinical documentation. It is anticipated that payers will increasingly become less flexible in allowing non-specific codes. The use of unspecified codes will likely lead to rejected claims if it is possible to report the more definitive condition. In most cases, unspecified should not be reported unless there is clear evidence to support the inability to report the detailed option.  Is your E & M level supported in the documentation? If you have never experienced scrutiny of your billing patterns by payers and other entities, you may not be aware of weaknesses that lead to recovery of funds or other costly consequences. Your documentation will be key in supporting diagnoses, service codes and acuity of the patient. It is not just payers who engage in audits. Others include State medical boards, Qui Tam and possible reporting of questionable practices by patients. Do your billing patterns and documentation stand up under reporting scrutiny? This presentation will review areas in which you may not be as strong as you think!  Areas Covered in the Session: Significance of abnormal lab results Measurement of lesions, when taken and inclusion of margins Start & stop times & methodology for infusions & discrepancies in billing Diagnostic testing and medications should be supported in a diagnosis Depth of wounds and cause should be clear Severity of illness Diagnosis present on admission? Who Will Benefit: Coders Billers Rev

The US healthcare system is made up of complexities. A system in which people with disabilities and above the age of 65 are covered by Medicare and Medicaid programs, clinicians ought to make their financial cycles a priority. When it is the first thing on your to-do lists, medical claims approve at a much faster rate without having to worry about denials.

Revenue cycle management (RCM) is the backbone of the healthcare industry. It manages the finances of the providers and keeps them going on a daily basis. Several organizations involved in the process to make it a success. The role of medical billing services in the US and the front-desk staff is undeniable.

Overview: Participants will understand the importance of responding to the OCR pre-audit requests and how to respond. Our discussion will cover how to prepare for an anticipated OCR HIPAA privacy audit, by discussing how to conduct an internal self-assessment of your privacy program. We will discuss how to conduct the self-assessment, whether it be the need for policies, procedures or obtaining all of your business associates information. Why should you Attend: If you have received a request from the OCR to provide the name of your entities privacy official and additional criteria, you are already aware that you are on the OCR's radar and may be the focus of an audit. If you haven't received a request yet, anticipate receiving one soon. In addition to ensuring that your HIPAA program is audit ready, you also need to ensure that you know all of your business associates and have their information readily available to provide to the OCR. Your entity needs to be ready now, as the OCR will either conduct focused desk audits, on-site audits or both in effort to review documentation of evidence of your compliance with the HIPAA regulation. Areas Covered in the Session: Office of Civil Rights "OCR" requests for privacy official and additional information and timeline for response Internal assessment criteria of privacy program in anticipation of an OCR audit Conducting the assessment using the template based upon HIPAA regulations Discuss methods to address any found deficiencies Workforce training Who Will Benefit: Healthcare providers Compliance and Internal Audit professionals or office staff responsible for ensuring patient privacy Healthcare Administrators Business Associates and all HIPAA Covered Entities Speaker Profile Gail Madison Brown is a registered nurse and an attorney with over 25 years of experience in health care. For the last 15 years she has focused on health care compliance and revenue cycle management operations. Gail's experience ranges

Overview: Participants will learn how to conduct an investigation of allegations of patient privacy violations using a privacy "risk analysis" tool and steps that should be taken when a breach has been determined. Why should you Attend: You must conduct a prompt and thorough investigation of all allegations of privacy violations. A violation of a patient's privacy may result in monetary penalties, harm to your reputation and especially harm to a patient. You need to make certain your organization has the expertise to conduct a thorough privacy investigation, analyze the results and take all necessary action to mitigate and report violations when required. Areas Covered in the Session: Best practices for conducting a privacy investigation Use of the risk analysis tool Interpretation of your results Reporting requirements if necessary Recommendations of continued privacy monitoring Workforce training Who Will Benefit: Healthcare providers Compliance and Internal Audit professionals or office staff responsible for ensuring patient privacy Healthcare Administrators Business Associates and all HIPAA Covered Entities Speaker Profile : Gail Madison Brown is a registered nurse and an attorney with over 25 years of experience in health care. For the last 15 years she has focused on health care compliance and revenue cycle management operations. Gail's experience ranges from starting new compliance programs and making improvements to existing programs for physician practices to large health care organizations. Gail also has provided numerous lectures to healthcare providers, executives and professional colleagues. Gail Madison Brown will develop, implement, and oversee processes, systems, educational programs, and other activities necessary to support and grow clinical trials activities at the UT Health Science Center. The Chief Clinical Trails Officer (CCTO) provides overall strategic leadership in this area including planning, goal setting, and monitoring organ

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