A One-Day Course Designed to Improve Reimbursement and Reduce Claims Denials
What We Will Cover
- The nature, origin and scope of payer denials.
- To re-thinking the definition of denials.
- Understanding the root causes of denials and where they typically occur
- To use reports from operations to identify denials, improve cash flow and spot compliance problems.
- To proactively avoid payer denials.
- To implement a program to monitor and audit success, both in cash flow and in compliance.
- Best practice case studies from physicians, ancillary providers, hospitals and health systems.
Who Should Attend
Hospital and healthcare provider CFOs, VPs of reimbursement; VPs of finance, directors and/or managers of patient accounts, managed care, health information systems, and operations professionals responsible for managing the receivables process.
Hospitals, Physicians, Dentists and other providers have seen a decline in fee schedules and an increase in managed care plan reimbursements complexity. At the same time, the cost of collecting all that the provider is entitled to has skyrocketed. To further complicate matters, denials erode the bottom line due to missed revenue opportunities, and increasing collection costs associated with those accounts.
The process of properly submitting claims, collecting payment and meeting coding and documentation compliance requires an intense and sophisticated approach in order to achieve financial survival. You need a workable strategy to develop, implement and maintain an integrated compliance and denials management systems that will improve your cash flow process. This course will show you how!
1. Reimbursement Today
- Recognize how the reimbursement environment and prompt payment issues have changed the game
- Identify various implications of the revenue cycle on denials and how denials impact that cycle
- Define essential concepts of denials management and develop techniques to deal with them
2. Defining Denials and Denials Triggers
- How to categorize denials - from zero payments to inaccurate payments and write-offs
- How and where you typically find your first denials clues
- Common reasons for denials and inappropriate write-offs
- The importance of accurate management reporting on financial success.
3. Process Analysis: Form and Function
- Payers’ denials reasons and Root Cause Analysis: what’s really causing your denials and how to fix it.
- Identifying data flow in denials management - How does your data flow? Let''s Graph it!
- Finding and fixing the breakdowns for prospective prevention
- Start with a clean house: the importance of accurate coding and documentation on denials management
4. The Denials Management Team - Who to Involve, How to Direct Them
- Roles and responsibilities
- Members and meetings
- Reports and reporting
5. Ongoing Process Improvement
- The parallel approach: prospective prevention and retrospective review
- Managing medical reviews: requests, reconsiderations and appeals
6. Monitoring System Effectiveness
- Performance indicators, tools and techniques
- Monitoring your progress: process improvement
- Best practices
Basic knowledge of the billing and collections process in healthcare is assumed.
Type of Program
Specialized Knowledge and Application
Maria K Todd, MHA, PhD, Vice President, HealthPro Consulting, Inc. Brooklyn, NY. Dr. Todd worked as a provider relations coordinator with a large national HMO before venturing out on her own as a consultant. She often acts as a certified mediator serving on dispute resolution cases between payors and providers. Prior to that, she worked on the provider side, where she maintained a minimum 92% of net collectibles in many settings, and single-handedly reduced days in AR by double digits, performing clean up of old files that required specialized attention. Through her training sessions, she has shared her techniques with hundreds of clients and seminar attendees across the nation. In one recent case, upon audit of zero-balance claims for a three hospital system, she identified and recovered more than $3 million dollars on inaccurately posted write-offs and/or claims paid incorrectly according to the contract. Dr. Todd is an Advanced Member of HealthCare Financial Management Association (HFMA) and a recipient of their 1999 Follmer Bronze Award.
She is the author of: The Managed Care Contracting Handbook (1996, McGraw Hill and the HFMA, Chicago) IPA, PHO, MSO Development Strategies (1997, McGraw Hill and the HFMA, Chicago), and The Physician Employment Contract Handbook (1999, McGraw Hill and the MGMA, Chicago).
With clinical, administrative, health plan and paralegal professional work experience, she assists hospitals, physicians and other healthcare professionals on a national basis with managed care contract review (operational/activity-based cost analyses), and specializes in analysis and negotiation of complex, healthcare provider agreements, regulatory compliance (HIPAA), disease management programs, integrated delivery system development, managed care contractual revenue audits and recovery projects.
Dr. Todd often serves the legal community on a national basis as an expert witness. A prolific author, she has had regular columns in Decisions in Imaging Economics, Orthopedics Technology Review and Practice Pointers, a special publication of the American Osteopathic Association. She also serves as an editorial resource to the Managed Care Contracting and Reimbursement Advisor (Brownstone)
$229 Single Person
$219 2-4 Registering from Same Organization
$199 5+ Registrants
|Registration includes: |
CD of Interactive Tools for After Class Implementation
|Audio CD, MANUAL and Interactive Tools CD||Those who cannot attend are welcome to order a digital audio CD, manual and accompanying Tools CD from the program for $229. If you attend the program, a 50% discount will apply to the additional materials. These will be shipped to you after the program has concluded. In order to receive the 50% discount, the materials must be ordered at the same time as registration.|