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Editor's e-Note
When it comes to most anything, being prepared is key. Whether it’s heading out on a hike or studying for an exam, the best strategy is to have everything in order before the event.

The same can be said of submitting bills. Why not get a jump on the revenue cycle by examining claims immediately following discharge? This month’s exclusive examines the critical components of this strategy.

Lee DeOrio, editor
e-News Exclusive
The Prebill Review: An Important Step for Revenue Recovery
By Mary McNerney

Health care organizations continue to face financial challenges during COVID-19. With decreased revenue, increased costs, and lower operating margins, savvy leaders need to look for innovative ways to ensure revenue integrity and financial sustainability. One proven method is a proactive approach via a prebill review—a review of documentation and coding within 24 hours of discharge and prior to the final bill (to avoid impact on discharged, not final billed). Organizations that invest in this approach ensure physician documentation supports coding compliance, Medicare severity diagnosis-related group (MS-DRG) accuracy, and quality performance data prior to claims submission. Ultimately, a prebill review promotes revenue recovery prior to claims submission.

While this is not new to many organizations, there are integral elements that define a successful framework and distinguish a prebill audit from a prebill review inclusive of a comprehensive clinical documentation improvement (CDI) program.

Prebill Audit vs Prebill Program

Is there a difference? Absolutely! A best practice prebill program incorporates an “assess, build, and sustain” approach designed to unite and align the review with data insights including impact on case mix index, education, and process improvement. Woven with physician intervention, these insights ensure optimization of revenue opportunities and risk mitigation.

Full story »
Products & Services
3M Analytics Platform Integrates Social and Clinical Risk Data
3M Health Information Systems introduces a new technology platform that allows health care providers and payers to prioritize care and allocate resources for high-risk individuals and patient populations. 3M Social Determinants of Health Analytics (3M SDoH Analytics) combines clinical, social, and population health data to create a complete picture of patient health. The new platform builds on the power of 3M Clinical Risk Groups (3M CRGs), a population classification system, and includes social risk intelligence from Socially Determined, a social risk analytics company, to promote program design and management in collaboration with community-based organizations. 3M SDoH Analytics uses 3M CRGs to describe the health status, severity, and total disease burden in an identified population. 3M CRGs help identify medically complex individuals and can be used to understand health care utilization and cost. When integrated with Socially Determined’s social risk metrics, 3M SDoH Analytics quantifies social risk factors and analyzes the impact of these factors on population health. Learn more »

RWJ Foundation Advances Guidance to Address Social Inequities
A policy brief series, Federal Policy Recommendations to Advance Health Equity from the Robert Wood Johnson Foundation, includes evidence-based recommendations to help people through the immediate health and economic crises and longer-term recommendations to ensure all people in the United States have a fair and just opportunity to be as healthy as possible. “Improving Housing Affordability and Stability to Advance Health Equity” focuses on how millions of families in America—particularly families of color—are denied shelter, security, and access to opportunity. “Increasing Access to Supplemental Nutrition Assistance Program (SNAP) to Advance Health Equity” focuses on SNAP, the nation’s largest food assistance program which serves as a critical lifeline for millions of families in America who have trouble affording food. “Increasing Access to Affordable and Comprehensive Health Insurance” focuses on the inability of many people to afford health insurance—particularly people of color or those in low-wage jobs—which has uncovered one of the nation’s clearest vulnerabilities during the COVID-19 pandemic. Learn more »

AKASA Publishes Report on Revenue Cycle Automation in Health Care
AKASA has published its “Annual Report on Revenue Cycle Automation,” a complimentary 17-page booklet that provides insight into the state of revenue cycle automation in hospitals and health systems across the United States. The report includes the results of a national survey that was designed to shed light on the state of automation in health care revenue cycle operations, dynamics driving automation initiatives, and plans regarding future automation strategies within health care organizations. The “Annual Report on Revenue Cycle Automation” includes discussion and insights on automation as a future-state mandate, challenges of deploying new technologies in a pandemic, why the type of automation matters, how automation can elevate employees, and what to expect in 2021 and beyond.  Learn more »
Other News
Kentucky Mom Alleges Hospital Workers Missed Her Cancer — Then Covered Up Their Mistake in the EHR
Fleming County Hospital allegedly sent a patient the wrong letter, saying there was no evidence of cancer, instead of telling her to return for a follow-up exam, and after the patient filed a lawsuit, hospital employees edited her EHR to delete evidence of the error, according to NBC News.

Texas Health Care Worker Accused of Copying, Pasting Doctor Signatures as Part of Medicare Fraud Scheme
The owner of Opnet Healthcare Services was charged with multiple counts of making false health care statements, reports KPRC 2.
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In this e-Newsletter
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The Logic Behind Computer-Assisted Coding
Want to make better sense of coding rules? Let some artificial intelligence be your guide, and it may start to become clear. Read more »

Feds Go Postal to Address Patient-Matching Shortcomings
In an effort to avoid mix-ups and mash-ups of medical records, a new initiative wants to standardize how patient addresses are recorded. Read more »

Busy ED Environment Breeds Documentation Lapses
A significant chunk of change can be lost when health care organizations fail to capture the care being provided in the emergency department.  Read more »

Locked & Loaded Against COVID-19
By gathering and organizing data, health care systems are creating an extra weapon in their fight against COVID-19. Read more »
Industry Insight
EHR Vendor to Share Data With Large Life Insurance Company

New York Life, America’s largest mutual life insurer, announces an innovative collaboration with Cerner Corporation, a global health care technology company, to facilitate and simplify EHR retrieval. The two companies have worked together to minimize friction in the life insurance application process for consumers and accelerate underwriting decisions.

This collaboration supports New York Life, with patient consent, in safely and securely accessing hospitals’ EHRs in near-real time. New York Life and Cerner refined the solution to meet the needs of both consumers and insurance companies as well as to ease the administrative burden on health care providers.

“These efforts are an important part of New York Life’s ongoing drive to leverage digital health data to accelerate life insurance underwriting,” says Alex Cook, head of strategic capabilities at New York Life. “With the support of these innovations, New York Life has reduced application processing time and streamlined the process for consumers to meet their life insurance coverage needs.”

— Source: New York Life

Read more »
Ask the Expert
Have a coding or documentation question? Get an expert answer by sending an email to

This month’s selection:
A question has come to light in our coding department, and we are trying to get a little more clarification on ICD-10 codes for CKD stage 3. Does the provider specifically have to document stage 3a or 3b for the coder to pick up, or can the coder determine this with the eGFR documented by the provider?

Tricia Keller, CCS
Delta Health

Yes, the provider has to document the stage for the coder to code it. If it’s not documented, the coder has to query physician or code default code for stage 3, but they cannot code a or b based on any other information.

— Suhas Nair is product manager at EZDI.
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