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NAHRI Members-Only Quarterly Call
PRESENTED ON July 30, 2019
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Hosted By
• Jaclyn Fitzgerald, CHRI
• Director, NAHRI
– Fitzgerald is the director of NAHRI and is responsible for the strategic planning of the association. She ensures NAHRI meets the needs of members and serves as the voice of the revenue integrity profession.
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Agenda
• Update on regional chapters and workgroups
• Revenue Integrity Week re-cap
• Revenue Integrity Symposium
• Presentation by Jugna Shah, MPH, CHRI, president, Nimitt Consulting Inc., on the 2020 OPPS proposed rule
• Presentation by Valerie Rinkle, MPA, CHRI, regulatory specialist, HCPro, on administrative simplification.
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NAHRI Local Chapters
• NAHRI endorses the formation of regional, state, local, and subject-specific networking organizations. NAHRI encourages the collaboration of such groups with the national body and supports the alliance of the local and national groups for mutually favorable principles. Each chapter must choose three officers who must be from different healthcare organizations and who are current NAHRI national members to act as liaisons between the parties. Visit https://nahri.org/local-chapters for more information.
• Interested? Visit nahri.org/local-chapters or email NAHRI Director Jaclyn Fitzgerald at [email protected]
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NAHRI Regional Chapters
• Michigan, Ohio, Indiana Regional Chapter– This chapter is currently seeking Chapter Members
– Please contact one of the following Chapter Leaders if you are a current NAHRI member looking to join this regional chapter
• Rebecca Moore, MSA, CHRI, Director Revenue Enhancement & Aquistions, Michigan Medicine, [email protected]
• Meagen Windler, CHRI, Corporate Director, Beaumont Service Center, [email protected]
• Julie Cowher, MA, RHIA, CHC, Director, Revenue Management, Ohio State University Wexner Medical Center, [email protected]
• South Dakota, North Dakota, Montana, Wyoming, Nebraska Regional Chapter– This chapter is currently seeking interested Chapter Members
– Please contact one of the following Chapter Leaders if you are a current NAHRI member looking to join this regional chapter
• Paula Twiss, Supervisor, Revenue Integrity, Regional Health, [email protected]
• Roger Hettinger, Senior Revenue Cycle Advisor, Axea Solutions, [email protected]
• Sherry Deaver, Revenue Cycle Services Officer, Avera Health, [email protected]
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NAHRI Regional Chapters
• Minnesota and Wisconsin Regional Chapter– This chapter is currently seeking two additional Chapter Leaders as well as interested Chapter
Members
– Current Chapter Leaders
• Lisa Kanivetsky, BA, CPC, CHRI, Revenue Integrity Manager, Hennepin Healthcare, [email protected]
• Kristina Howey, MBA, Revenue Integrity Business Analysis Manager, Marshfield Clinic Health System, [email protected]
• New England Regional Chapter– This chapter is currently seeking two additional Chapter Leaders as well as interested Chapter
Members
– Current Chapter Leaders
• George Boulger, RHIA, Revenue Integrity Manager, South Shore Hospital, South Weymouth, MA– [email protected]
• Laura Clifford, CPC, Revenue Integrity Analyst, Central Maine Healthcare, Lewiston, ME– [email protected]
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NAHRI Local Chapters
• Michigan, Ohio, Indiana Regional Chapter Meeting
– Inaugural meeting is open to NAHRI members and non-members to help professionals understand the national and regional benefits of NAHRI
– Register for free at https://attendee.gotowebinar.com/register/7509528477920674572
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NAHRI Workgroups
• NAHRI also supports the formation of Member Workgroups. Each group agrees on its own focus and meeting frequency/duration. Workgroups are typically formed based on area of interest or job title. NAHRI Leadership assists by connecting members, scheduling calls, and providing a means of group notetaking.
• The following NAHRI Member Workgroup is accepting new members:– NAHRI Revenue Integrity Collaboration Workgroup
• Meeting frequency: Monthly
• Meeting duration: One hour
• Current member count: Six
• For questions, contact NAHRI Director Jaclyn Fitzgerald at [email protected].
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Revenue Integrity Week
• June 3–7, 2019
• This year’s theme was Scale New Heights: Elevate Your Profession and Career
• More information: https://nahri.org/ri-week/revenue-integrity-week
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Revenue Integrity Week
• Peer Recognition Program—see the July NAHRI Journal for more information
• Katie Boykin, BSN, RN, manager of CDM and charge capture at WakeMed in Raleigh, North Carolina, nominated by Kim Yelton, RHIA, CCS, CDIP, CHRI, director of revenue integrity at WakeMed
• Niah Cortez, MA, BS, CHC, revenue integrity manager at WhidbeyHealth in Coupeville, Washington, nominated by Beth Stout, revenue cycle director at WhidbeyHealth
• Julie Cowher, director of revenue management at Ohio State University Wexner Medical Center in Columbus, Ohio, nominated by Tate Batson, senior director of facility reimbursement at Novant Health in Charlotte, North Carolina
• Tami Felix, supervisor of RHIT coding at Legacy Health in Portland, Oregon, nominated by Robin L. Baxter, revenue cycle specialist at Legacy Health
• William Franquet, AVP of revenue cycle at Evangelical Community Hospital in Lewisburg, Pennsylvania, nominated by Carol Waughen, director of compliance at Evangelical Community Hospital
• Elizabeth Freeze, clinical charge audit analyst at Lafayette General Health System (LGH) in Lafayette, Louisiana, nominated by Rebecca Flugence, contract management specialist at LGH
• Amanda Ray, revenue integrity manager at WakeMed in Raleigh, North Carolina, nominated by Kim Daughtry, revenue integrity analyst at WakeMed
• Interested in recognizing a member of your team? NAHRI’s Peer Recognition Program doesn’t have to end with Revenue Integrity Week. Let us know why your peers deserve recognition: www.surveymonkey.com/r/GMKH693
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Revenue Integrity Week
• As part of Revenue Integrity Week, all members who nominated a peer or were nominated were entered into a drawing to a win a cake for their Revenue Integrity Week celebrations. NAHRI is happy to announce that Katie and Kim won the drawing and shared pictures of the WakeMed revenue integrity teams’ celebration.
NAHRI Peer Recognition Program drawing winners celebrate Revenue Integrity Week with complimentary cake from NAHRI at WakeMed Business Center (top) and WakeMed Raleigh Campus (bottom).
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Revenue Integrity Week
• Five Duke University Health System revenue integrity teams entered a friendly food-collection competition to benefit Durham Rescue Mission. The Patient Revenue Management Organization teams collectively donated 8,337 food items to people in need in the Durham community.
• The health system awarded prizes to the teams that collected the most food– In 1st place winning a cheesecake party: Revenue integrity-
CDM teams
– In 2nd place winning a pizza party: Charge integrity –PRMO revenue managers
• Garland Goins, MBA, director of revenue and documentation integrity at Duke University Health System, spearheaded the collection of the food.
• In addition to the food drive, guest speakers from AHIMA, AAPC, HFMA, and compliance discussed the benefits of certification and how recognized/coveted it is in the industry.
• Read more in the July issue of the NAHRI Journal
NAHRI Peer Recognition Program drawing winners celebrate Revenue Integrity Week with complimentary cake from NAHRI at WakeMed Business Center (top) and WakeMed Raleigh Campus (bottom).
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Revenue Integrity Symposium
• October 15–16, 2019, at The Renaissance SeaWorld in Orlando
• Pre-con options:
– Leader As Coach: Leadership Development Master Class (October 13–14)
– Medicare Boot Camp - Utilization Review (October 13–14)
• Post-con options:
– Medicare Boot Camp - Audits, Appeals, and Denials Version (October 17–18)
– Medicare Boot Camp - Provider-Based Departments Version (October 17–18)
• NAHRI member reception October 14
• NEW LTC track
• More information: https://nahri.org/network/ris
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Revenue Integrity Symposium
• Renaissance Orlando– 6677 Sea Harbor Drive– Orlando, FL 32381– $219/night – September 20 cut-off
date
• Our resort is just minutes from Walt Disney World® and other attractions. RIS 2019 attendees will receive special discounted rates to attend Disney Parks, Universal Studios, and SeaWorld, and more.
• Attendees must purchase discounted tickets to the Disney parks by October 12, 2019.
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Revenue Integrity Symposium
• Pricing– Standard: $1,199
– Early bird: $1,099
– Early bird plus NAHRI or AMBR member discount: $999
• Early bird pricing ends August 17
• Groups—send five for the price of four– Early bird group pricing with
membership discounts: $3,996
– Early bird group pricing: $4,396
– Compare to standard full price for five non-member attendees: $5,995
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Revenue Integrity Symposium
• Strong focus on revenue integrity programs and hot topics, including sessions on revenue integrity workplans and ensuring success with chargemaster and claim edits
• Learn from peers and industry experts about key changes expected to impact your outpatient and inpatient services next year
• Educate newer staff on a wide variety of revenue cycle topics presented by expert consultants as well as hospital leaders
• Stronger focus on professional development—new track—and introduction of long-term c are content
• From a large health system? Send your acute and long-term care professionals as a group to ensure everyone is on the same page when they return to their facilities
• Learn how to focus and educate a revenue integrity program or department
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Revenue Integrity Symposium
• NAHRI members get free admission to a special members-only networking reception on October 14, the night before RIS officially kicks off. It’s a great chance to plan to meet face-to-face with NAHRI members and leadership you may have connected with on the NAHRI forums, heard speak on members-only quarterly calls, or through other NAHRI initiatives. NAHRI members attending this reception should RSVP online as soon as possible to reserve their space.
• Professionals wishing to earn support from program administrators to attend the 2019 Revenue Integrity Symposium may adapt our justification letter proposal.
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Live CHRI exam at RIS
• The mission of the CHRI credential is to ensure healthcare revenue integrity professionals are recognized for their due diligence in their field and dedication to professional growth. The CHRI credential can help new and veteran revenue integrity professionals demonstrate knowledge of revenue integrity core competencies. Professionals who earn the CHRI credential have proven their proficiency in rules and regulations, compliance, revenue management, and internal reporting strategies.
• When: October 16—live pencil-and-paper exam– Also available online
• The exam consists of 140 questions, of which 120 are scored and 20 are pre-test questions. The passing score is 86 correct out of 120 scored questions.
• Timed exam—2.5 hours
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NAHRI Annual Salary Survey Report
• NAHRI is conducting its second annual Revenue Integrity Salary Survey and we want to hear from you. Click here to take the survey and enter for a chance to win to a free on-demand webinar. All respondents will receive a complimentary copy of the survey report.
• Full URL: https://www.surveymonkey.com/r/JYQHSFW
• In the 2018 Revenue Integrity Salary Survey report, we learned that most respondents earned $60,000–$69,999 annually but almost as many earned $70,000–$79,999. We also discovered that salary goes up when you work at a health system as does it does after completing a master’s degree. Will these trends hold steady for 2019 or will other factors tip the balance? Take advantage of the opportunity to weigh in and gain valuable information for your career and department.
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Board Member Presentation: 2020 Proposed Rules: OPPS and MPFS
Jugna Shah, MPH, CHRIPresident of Nimitt Consulting, Inc.
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Introducing…
• Jugna Shah, MPH, CHRI, President and Founder Nimitt Consulting Inc. – Shah is the president and founder of Nimitt Consulting, Inc., a firm
specializing in case-mix payment system design, development, and implementation. She has over 20 years of experience working with providers on the ongoing clinical, operational, financial, and compliance implications of Medicare’s payment systems, specifically OPPS, IPPS, and the MPFS. Shah has educated and audited numerous hospitals on their drug administration coding and billing practices and most recently has been on the forefront of coverage, coding, billing, and reimbursement advocacy for cell and gene therapies. She has contributed to several books and numerous OPPS/APC articles and is a contributing editor of HCPro’s Briefings on APCs.
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Overview of CY 2020 Proposed Rules
• Both OPPS and MPFS out VERY late
– OPPS: https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-16107.pdf
– MPFS: https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-16041.pdf
• It hasn’t even been 24 hours since the rules were released, but we can tell they both already pack a punch and will require careful review
• Comments due September 27, 2019, and hopefully NAHRI members will advocate for what they support and suggest alternatives for what they don’t
• Final rules expected on or around November 1, 2019, so that hospitals have 60 days to prepare for the January 1, 2020, implementation
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Highlights from the 2020 OPPS Proposed Rule: The Big Ones
• Price transparency
• Continuation of last year’s site neutral cuts to clinic visits
• Continuation of 340B payment reductions, with request for comments on what CMS should do if it loses the court battle (appeal in progress)
• Physician supervision
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2020 OPPS proposed rule: Price Transparency
• Proposed definitions and penalties for price transparency
– Proposed rule defines “hospitals,” “items and services,” and “standard charges”
• Standard charges would include “gross charges” and “payer-specific negotiated charges”
– Providers required to create public list of “shoppable” services
– CMS will rely predominately on complaints made to CMS by individuals or entities regarding noncompliance
– CMS would notify hospitals of deficiencies and allow a corrective action plan submission before imposing civil monetary penalties
• Penalties proposed to be $300 per day capped at $100,000 per year
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2020 OPPS proposed rule: 340B payment policy
• District Court ruled 2018 and 2019 reduction in payment from ASP plus 6% to minus 22.5% was unlawful. CMS currently appealing.
• CMS is requesting comment on how to pay for 340B drugs in 2020 and beyond. Proposal is to continue paying ASP minus 22.5%, but would consider ASP plus 3% going forward as a potential remedy.
• Since CMS redistributed $1.65 billion into OPPS in 2018 alone as result of policy, it expects a significant economic impact on providers and beneficiaries as it relates to their cost-sharing.
• CMS seeking many comments including:– Should the remedy be retrospective (e.g., made on claim-by-claim basis)?
– Should it be prospective (e.g., upward adjustment on future 340B claims)?
– Should some other method be used?
– Impact on hospitals that received more payment as a result of the budget neutral implementation?
– Impact on beneficiaries if CMS unwinds the policy?
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2020 OPPS proposed rule: Site Neutral Payment Around G0463
• CMS proposing to complete two-year phase-in of site-neutral payment reduction regarding HCPCS code G0463 (hospital outpatient clinic visit)
– Providers currently receiving 70% of the OPPS rate
– In CY 2020, providers will receive 40% of the OPPS rate
– Not likely much that can be done about this
• No additional services on the site-neutral chopping block … at least not yet but we could see drug administration coming under fire in 2021 or 2022
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Additional Highlights from the 2020 OPPS Proposed Rule
• Physician supervision proposed to change from direct to general
• Separately payable drugs proposed to remain at ASP + 6%
• Packaging threshold to increase slightly to $130
• Inpatient-only list – remains intact but one procedure proposed to come off the list and additional ones discussed
• Proposal to enact a one-year exemption for the QIOs to refer to the RACs for review so providers have time to gain experience with application of the 2-midnight rule
• Prior authorization proposed for five services that are appear most cosmetic/elective
• Clinical lab fee schedule
• Comment solicitation on cost reporting, CDM, and related payment issues
• Seven new tech applications and some are very interesting new technologies
• Much more…
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Highlights from the 2020 MPFS Proposed Rule
• Payment for evaluation and management (E/M) services
• Medicare telehealth services
• Physician supervision requirements for physician assistants
• Review and verification of medical record documentation
• Care management services
• Transformation of MIPS/creation of MIPS value pathways
• Comment solicitation on opportunities for bundled payments under the PFS
• Therapy services
• And much more…
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Board Member Presentation:Administrative simplification
Valerie Rinkle, MPA, CHRIRegulatory specialist for HCPro
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Introducing…
• Valerie Rinkle, MPA, CHRI, Regulatory Specialist, HCPro
– Rinkle is a lead regulatory specialist and instructor in Middleton, Massachusetts, for HCPro's Revenue Integrity and Chargemaster Boot Camp as well as instructor for the Medicare Boot Camp®—Hospital Version, Medicare Boot Camp®—Utilization Review Version, and Medicare Boot Camp®—Critical Access Hospital Version. Rinkle is a former hospital revenue cycle director and has over 30 years of experience in the healthcare industry, including over 12 years of consulting experience in which she has spoken and advised on effective operational solutions for compliance with Medicare coverage, payment, and coding regulations.
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Administrative Simplification: Anything but Simple
www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html
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Administrative Simplification: Applies to All Payers & Providers
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Administrative Simplification: Follow the Authorities
Chapter 25, Medicare Claims Processing Manual
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Follow Enforcement Procedures When Applicable
www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Enforcements/Downloads/ASComplaintProcessIG20190702.pdf
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• Questions?
• To volunteer to present on an upcoming NAHRI Quarterly Call, please contact NAHRI Director Jaclyn Fitzgerald at [email protected]
• To receive your CHRI continuing education credits, complete the survey at https://app.keysurvey.com/f/1417788/711d/
In Closing
