Benchmarking for Medical Practices

Benchmarking for Medical Practices

 

LUTZ BUSINESS INSIGHTS

 

benchmarking for medical practices

 

Lutz Healthcare Consulting Director, Tara Wisdom, was recently featured in the May/June 2019 Physicians Bulletin, a publication of the Metro Omaha Medical Society.

“Our life begins and ends with measurement. What was the baby’s length and weight at birth? How old was the man when he passed away? At every step in our life we are measured against something or someone.

If a pediatric patient’s weight is off the age-height-weight scale at his preventive visit, the patient’s parents are counseled in an attempt to bring the child to a healthy weight. If an HbA1c result is high compared to norms, the diabetic patient’s medications and diet are more closely managed.

As a physician, you are responsible for monitoring not just the health of your patients bt also the health of the clinic, practice or facility in which you work. You may also be responsible for mentoring peers or managing other physicians.”

Read the full article on page 17.

 

ABOUT THE AUTHOR

402.827.2076

twisdom@lutz.us

LINKEDIN

TARA WISDOM + HEALTHCARE CONSULTING DIRECTOR 

Tara Wisdom is a Healthcare Consulting Director at Lutz with over 18 years of experience. She assists clients with physician and hospital practice management, business plan development and new practice set-up to make sure healthcare practices are effectively managing operational costs and properly capturing revenue while staying compliant.

AREAS OF FOCUS
  • Healthcare Consulting
  • Physician Services
  • Compensation Structures
  • Data mining and Analysis
  • Medicare and Insurance Reimbursement
  • Merger/Reorganization Planning
  • Internal Control and Systems Reviews
  • Strategic Planning & Feasibility Studies
AFFILIATIONS AND CREDENTIALS
  • Medical Group Management Association, Member
  • Nebraska and Iowa Medical Group Management Associations, Member
  • Metropolitan Omaha Medical Society, Strategic Partner
EDUCATIONAL BACKGROUND
  • BA in Accounting, University of Nebraska, Lincoln, NE
COMMUNITY SERVICE
  • Community Alliance, Executive Board Member
  • Children’s Hospital, Friend’s Board
  • Quality Living Inc, Ambassador
  • Omaha Opera Guild, Cotillion Representative
  • Nebraska Children’s Home, Gift Coordinator Volunteer
  • Aldrich Elementary PTO, Executive Board Member

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VIEW MODIFIED SUMMER HOURS HERE

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND

3320 James Road, Suite 100

Grand Island, NE 68803

P: 308.382.7850

Denial Management: Are You Doing Enough?

Denial Management: Are You Doing Enough?

 

LUTZ BUSINESS INSIGHTS

 

denial management: are you doing enough?

cathy bojanski, healthcare manager

 

“There’s tremendous pressure to reduce denials. According to CMS, 20% of all claims are denied, 60% of lost or denied claims will never be resubmitted, and 18% of claims will never be collected.”1

Are you doing all you can to identify, manage or prevent claim rejections and denials? Here are some helpful hints and suggestions that you can easily implement to make your office more efficient and accelerate your collections.

 

POST payments, and more importantly denials, daily (or as soon as possible); Have a process.

  • Are the payments correct per your payer contract?

 

MANAGE the reports – Do you have access and are you receiving the reports required?

  • There are reports from your vendor, the clearinghouse and finally the payers themselves to facilitate this process.
  • If a claim is rejected how long does it take to resubmit a rejected claim?
  • Does your system have built-in screening edits, pre-submission?
  • Who works these?
  • How often?

 

TRACK the types of denials – Are you doing this?

  • Categorize the denials
  • By payer, by code with description; Know your payor mix to prioritize
  • What actions are needed to correct the claim?
  • Educate and inform – Make this information available to all staff.  Chances are several staff members are dealing with the same denial issues.

 

RECOGNIZE trends

  • Ask the right questions of the billers and coders. Do you see this often?  Is this all payers or a specific payer denial?

 

FIX

  • System corrections – work with your vendor to identify and correct issues up-front, saving time and money
  • Corrected claims – simple corrections (CPT code/modifiers/units) by adjustment
  • Appeal – medical necessity denials (NCD and LCDs)
  • Know the payer-specific time limits for submitting corrections/appeals
  • Process for tracking corrected claims and appeals to ensure they are processed and paid?

 

1 http://healthyhospital.changehealthcare.com/ten-steps-reduce-denials-win-appeals-improve-hospital-performance/

 

ABOUT THE AUTHOR

402.827.2366

cbojanski@lutz.us

CATHY BOJANSKI + HEALTHCARE MANAGER

Cathy Bojanski is a Healthcare Manager at Lutz with over 25 years of experience. Her primary responsibilities include preparation and review of Hospital and Clinic Chargemaster (CDM) reviews for healthcare clients, as well as assisting with coding and billing services.

AREAS OF FOCUS
AFFILIATIONS AND CREDENTIALS
  • Association for Rural Health Professional Coding, Member
  • Certified Billing Specialist

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Toll-Free: 866.577.0780  |  Privacy Policy

All content © Lutz & Company, PC

VIEW MODIFIED SUMMER HOURS HERE

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND

3320 James Road, Suite 100

Grand Island, NE 68803

P: 308.382.7850

CMS Survey & Certification Emergency Preparedness Initiative

CMS Survey & Certification Emergency Preparedness Initiative

 

LUTZ BUSINESS INSIGHTS

 

cms survey & certification emergency preparedness initiative

kirk delperdang, healthcare manager

 

Following the devastating experiences by health care facilities during Hurricanes Katrina and Rita, the Centers for Medicare & Medicaid Services (CMS) Survey and Certification (S&C) Group established a series of internal working groups, with representatives from the CMS Central and Regional Offices, to develop updated emergency preparedness policies and procedures that effectively address S&C essential functions. The recommendations from the working groups are being integrated into the larger CMS and HHS national plans to provide preparation guidance for S&C essential business functions.

The emergency preparedness rule for Medicare Participating Providers and Suppliers was published September 16, 2016, and the implementation date was November 15, 2017. It applies to all Hospitals, Long Term Care Facilities, Critical Access Hospitals, and Rural Health Clinics.

*Compliance is required for Medicare participation.

There are four core elements of the Emergency Preparedness Program and element of the plan must be reviewed and updated annually.

RISK ASSESSMENT AND PLANNING – All providers must develop an emergency plan using all hazards approach, and plan and identify in advance essential functions and who is responsible in a crisis.

POLICIES AND PROCEDURES – These are developed based on the plan (e.g. medical documentation, evacuation or shelter and place).

COMMUNICATION PLAN – Establish alternate means of communication, provide information to local authorities sharing medical information, and provide occupancy information and assistance to other facilities in the community.

TRAINING AND TESTING PROGRAM – Train staff and test the plan through drills.

NOTICE ON TRAINING & EXERCISES

If a facility activates their emergency plan due to a disaster, the facility is exempt from one full-scale/individual based exercise for that year. However, the secondary requirement for a table-top exercise or exercise of choice still applies. Facilities must demonstrate completion of two exercises per annual year.

HAVE YOU TESTED?

The testing requirements include:

Participation in a full-scale exercise that is community-based, or when a community-based exercise is not accessible, an individual, facility-based exercise.

AND

Conduct an additional exercise that may include, but is not limited to the following:

  • A second full-scale exercise that is individual, facility-based.
  • A tabletop exercise that includes a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan.

IS THERE AN AFTER ACTION REPORT (AAR)? 

The AAR should document the exercise and next steps. Make it stand out with clear diagrams, lists of best practices, opportunities for improvement, and lists of resources. Make it readable and, most importantly, know where it is.

CMS wants you to “Demonstrate staff knowledge of emergency procedures.”

 

 

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Emergency-Prep-Rule.html

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Templates-Checklists.html

https://narhc.org/resources/rhc-rules-and-guidelines/#emergency

ABOUT THE AUTHOR

402.496.8800

kdelperdang@lutz.us

LINKEDIN

KIRK DELPERDANG + HEALTHCARE MANAGER

Kirk Delperdang is a Healthcare Manager at Lutz with over 25 years of experience. He provides accounting and consulting services to healthcare and related organizations.

AREAS OF FOCUS
AFFILIATIONS AND CREDENTIALS
  • Healthcare Financial Management Association - Nebraska Chapter, Member
  • Nebraska Society of Certified Public Accountants, Member
EDUCATIONAL BACKGROUND
  • BA in Accounting, University of Northern Iowa, Cedar Falls, IA
COMMUNITY SERVICE
  • St. Vincent de Paul, Knights of Columbus, Member
  • Active in various youth sports leagues: Aldrich Elementary, Millard Athletic Association, Millard North Schools, Omaha FC, Skutt Catholic High School and YMCA

SIGN UP FOR OUR NEWSLETTERS!

We tap into the vast knowledge and experience within our organization to provide you with monthly content on topics and ideas that drive and challenge your company every day.

Toll-Free: 866.577.0780  |  Privacy Policy

All content © Lutz & Company, PC

VIEW MODIFIED SUMMER HOURS HERE

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND

3320 James Road, Suite 100

Grand Island, NE 68803

P: 308.382.7850

Why Do a Chargemaster Review?

Why Do a Chargemaster Review?

 

LUTZ BUSINESS INSIGHTS

 

why do a chargemaster review?

paul baumert, healthcare consulting shareholder

 

How pricing is set for a healthcare organization can have a significant impact on its financial performance. If individual charge items in the chargemaster file contain errors, payment for services could be wrong or denials can occur. These are two critical reasons why it’s important to routinely review the chargemaster file.

The chargemaster file is a main component in any third party compliance review, since the healthcare organizations’ reimbursement originates from individual charge items. Ensuring accurate code descriptions and pricing for individual service items is paramount for price transparency. Below are additional reasons to conduct a chargemaster review:

  • Keep up-to-date CPT/HCPCS Codes
  • Correct Revenue Code assignment
  • General Ledger/Department assignment and mapping accuracy for proper cost report preparation
  • Remain compliant with billing and coding for services
  • Ensure accurate Charge Capture for services performed

Maintaining an accurate and compliant chargemaster file is an on-going process. Periodic internal and external comprehensive reviews are essential duties of the revenue cycle team. Additionally, to properly monitor and update a healthcare organizations chargemaster file, policies and procedures are critical to ensure on-going changes are made. This will help prevent errors in payment and compliance related issues that can arise with incorrect/outdated chargemaster files.

ABOUT THE AUTHOR

Paul Baumert

402.827.2315

pbaumert@lutz.us

LINKEDIN

PAUL BAUMERT + HEALTHCARE CONSULTING SHAREHOLDER 

Paul Baumert is a Consulting Shareholder at Lutz with over 20 years of experience in accounting and consulting for healthcare and nonprofit industries. He specializes in the areas of financial management support services and reimbursement analysis.

AFFILIATIONS AND CREDENTIALS
  • Nebraska Society of Certified Public Accountants, Member
  • American Institute of Certified Public Accountants, Member
  • Healthcare Financial Management Association, Member
  • Certified Public Accountant
  • Fellow of the Healthcare Financial Management Association
EDUCATIONAL BACKGROUND
  • BSBA, Creighton University, Omaha, NE
COMMUNITY SERVICE
  • Elkhorn Public School Foundation, President
  • Iowa Healthcare Financial Management Association, Past President
  • Nebraska Society of Certified Public Accountants Legislation Committee, Chairman

SIGN UP FOR OUR NEWSLETTERS!

We tap into the vast knowledge and experience within our organization to provide you with monthly content on topics and ideas that drive and challenge your company every day.

Toll-Free: 866.577.0780  |  Privacy Policy

All content © Lutz & Company, PC

VIEW MODIFIED SUMMER HOURS HERE

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND

3320 James Road, Suite 100

Grand Island, NE 68803

P: 308.382.7850

Financial Compliance Check-Up

Financial Compliance Check-Up

 

LUTZ BUSINESS INSIGHTS

 

financial compliance check-up

Now that winter is here, what better way to spend some additional time indoors than doing a winter healthcare financial compliance checkup. In this webinar, we take a step back and look at the overarching financial infrastructure vital to a facility’s long-term success and stability. Reviewing each major section of healthcare finance, we discuss key policies, internal controls, contracts, and other best practices to help organize the financial compliance aspects for healthcare providers.

 

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SIGN UP FOR OUR NEWSLETTERS!

We tap into the vast knowledge and experience within our organization to provide you with monthly content on topics and ideas that drive and challenge your company every day.

Toll-Free: 866.577.0780  |  Privacy Policy

All content © Lutz & Company, PC

VIEW MODIFIED SUMMER HOURS HERE

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND

3320 James Road, Suite 100

Grand Island, NE 68803

P: 308.382.7850

Revenue Cycle

Revenue Cycle

 

LUTZ BUSINESS INSIGHTS

 

revenue cycle

As Healthcare institutions, we hear a lot of talk surrounding the Revenue Cycle. This presentation, led by Amy Evanich and Claire Thelen, will discuss helpful hints to help ensure your revenue cycle is operating efficiently and effectively.
 
Every employee plays a role in the impact of the revenue cycle, and this webinar is tailored to cover each area. If there are inadequacies or an opportunity for improvement in the revenue cycle process in a certain department, please consider having the direct staff in this area listen in.

 

RECENT POSTS

SIGN UP FOR OUR NEWSLETTERS!

We tap into the vast knowledge and experience within our organization to provide you with monthly content on topics and ideas that drive and challenge your company every day.

Toll-Free: 866.577.0780  |  Privacy Policy

All content © Lutz & Company, PC

VIEW MODIFIED SUMMER HOURS HERE

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND

3320 James Road, Suite 100

Grand Island, NE 68803

P: 308.382.7850