There’s plenty to do until the dust settles
There’s plenty to do until the dust settles
Providers can still thrive under the new system
Many providers wonder what they can do during this time of software glitches and program memorandums to smooth their own transition to the outpatient prospective payment system (PPS). There’s plenty to keep you occupied, analysts say.
• Get complete information.
Much information is available on the Health Care Financing Administration’s (HCFA) Web site (www.hcfa.gov), says Rita Scichilone, MHSA, RHIA, CCS, CCS-P, coding practice manager at the American Health Information Management Association in Chicago. "The transmittals spell it out as clearly as anyone knows. You can also submit questions directly to HCFA, and HCFA is posting the questions directly on its Web site."
Providers should also attend seminars or read publications about the new payment system. "The challenge is to wade through all the information and take time to understand all of the rules and regulations," she says.
Make your problems known
• Stay in touch with your fiscal intermediaries.
"Let them know what your problems are, so the problems can be worked out from both sides," Scichilone says.
• Be involved directly with any department that is affected by a new communication.
Outpatient service delivery is so complex that providers could have registration, service delivery, and charge entry occurring in a department unknown to the rest of the facility until the visit shows up on a bill that is about to be transmitted, says Laura Frazier, RHIT, manager of APC Solutions for QuadraMed Corp., San Rafael, CA, a health care information systems company.
Because of the complexity, providers need to work together, not in isolation, she advises. "If problems with condition codes and modifiers don’t get to all the parties that input outpatient data within an organization, then someone is missing that information. That will leave the organization in damage control and they will need to fix the damage quickly."
If the communication remains solely within the billing or patient accounting department, the facility will continue to work with damage control, she says, though she adds that it will never get rid of the problem. She admits that some facilities will struggle to keep everyone up-to-date because of turnover and understaffing in some departments.
Proceed with caution
• Track your payments.
"When patient accounts or the billing office get the remittance advice, they should be able to track if HCFA sequenced the relative weight and reimbursed correctly," Frazier says. "There are some real problems if they are not policing the remittance advice and making sure the bill is clean before it is dropped to the [fiscal intermediary]."
Deborah Williams of the American Hospital Association in Washington, DC, agrees. "Providers need to continue to be cautious, even if things seem to be going well. They need to make sure that they double-check the payment amount due and do random audits on the claims that are getting paid." They need to make sure they are receiving the correct amount, says the senior associate director of policy development.
• Try to thrive.
Providers have a lot of opportunities to thrive under the new payment system, if they learn it like the back of their hand, Frazier says. "You have to be current with the information, and have a good communication with your fiscal intermediary."
Thriving under the outpatient PPS is differ-ent from just existing and getting by, she says. "Thriving means actually succeeding and doing well. That means getting data input the first time, and making sure that there is a prebill drop review to ensure that the entire encounter is captured, all the charges are included, that there aren’t any late charges, and that modifiers are appended where necessary and are reflected in the medical record." This is the most proactive strategy that an organization can put in place now, she says, but "many are so understaffed that they can’t afford to do that."
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