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Editor's E-Note
Payers and providers are typically viewed as being on opposite sides of the fence, competitors, each with their own goals. Here, Ritesh Ramesh, CEO of MDaudit, argues that this divide is unnecessary—that the two, in fact, share goals. When they work together, Ramesh explains, they can both improve patient satisfaction and reduce the risk of an audit.
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— Kate Jackson, editor |
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Revenue Integrity and Payment Integrity Goals Share More Than Meets the Eye
By Ritesh Ramesh
The payer/provider relationship is often seen as adversarial, with delays and denials by insurers taking the blame for falling hospital revenues. But these supposed antagonists are closer than they would initially appear.
For providers, the goal of revenue integrity is to take great care of patients, maximize the reimbursement to which they’re legitimately entitled, create operational efficiencies, and maintain regulatory compliance. Contrast that with payment integrity on the payer side, the goals of which include enabling a great beneficiary experience, member retention, payment accuracy, operational efficiencies, and maintaining compliance.
In each scenario, efficiency and regulatory compliance are directly shared. Both sides also want to empower patients/members while ensuring proper reimbursement. Accountability is key, so savvy payers and providers are looking to bridge the historical divide between them to create mutually beneficial partnerships.
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Battling an Infodemic
The World Health Organization (WHO) defines an infodemic as “too much information including false or misleading information in digital and physical environments during a disease outbreak.” To prevent confusion and risky behaviors, WHO highlights the need to monitor infodemics and calls for a systematic approach.
Website Tracking Transmits Information to Third Parties
The HIPAA Journal reports on a study published in Health Affairs demonstrating that most hospitals in the United States have transmitted health information to third parties that are typically not HIPAA-regulated entities through the use of tracking software on their websites that captures data pertaining to patient visits.
Clinician Reminders Help Treat Patients With Asthma
A study presented at the Pediatric Academic Societies Meeting demonstrated that prompting clinician awareness about guidelines and providing clinical decision support increasing the use of preventive medication for asthma and decreased caregivers concerns about medications.
Closing the Gaps
Forbes addresses compliance-related loopholes in HIPAA, citing, for example, the lack of regulations concerning medical health apps and websites and tracking services, and calling for what it calls more holistic remedies. |
Have a coding or documentation question? Get an expert answer by sending an email to edit@gvpub.com.
This month’s selection:
Question
Is it appropriate to report modifier 52 and modifier 22 on the same CPT when documentation supports? Is there an official reference that provides this direction?
For example:
CPT 44146 – 22, 52
52- A new stoma site was not created.
22- Patient had extensive adhesions and over five hours was used for adhesiolysis. He had extensive radiation affected bowel, over 60 cm of small bowel, and all of his colon from splenic flexure distally.
This case was substantially more difficult than usual because of significant effort and difficulty mobilizing and identifying anatomical structures due to altered surgical field secondary to distorted anatomy, previous surgery, radiation, inflammation, and tissue friability. This case was substantially more difficult than usual because of difficult location. This case was substantially more difficult than usual because of lysing adhesions/scar tissue for greater than 90 minutes.
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Interoperability Solutions
Consensus Cloud Solutions offers natural language processing and artificial intelligence solutions to address the industry’s growing need for technology that alleviates the burden of repetitive administrative processes, helping reduce staff frustration and improve document workflow through the continuum of care. Concensus’ Conductor is a powerful integration platform that supports the latest standards for connectivity while addressing a wide range of interoperability challenges. Learn more »
Revenue Integrity Symposium
The Revenue Integrity Symposium, presented by the National Association of Healthcare Revenue Integrity, takes place from September 18 to 19 in Charlotte, North Carolina, where experts will share strategies for ensuring compliance with regulatory challenges, maximizing revenue, and enhancing workflow and program design. Learn more » |
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