Perioperative Revenue Cycle Improvement Program |
| Purpose: |
| This document provides a service overview of the ISH Revenue Cycle Improvement services. |
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| INTRODUCTION: |
| Organizations are facing the need to both improve reimbursement for their current surgical volume and prepare for future regulatory and competitive pressures. Organizational charge deficiencies typical come from broken charge capture processes, inaccurate CDM price, or outdated interpretations of CMS guidelines. The ISH program addresses these by: |
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- Improving the accuracy in the charge capture process to increase the number of charges for chargeable lines as defined by organizational policy (time, implants, supplies, etc).
- Correcting the charge price by ensuring the price is calculated from an accurate cost basis.
- Changing charging policies to increase the number of line items as allowed by CMS to include equipment and instrument sets.
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| The ISH programs can be self-funding from cash recovery and applying a percentage of future reimbursement improvements to implement an infrastructure of that delivers an understanding of their true cost of delivering case (Cost Transparency). By implementing a documentation and information capture process that yield access to this information, organizations are also positioned to publicly market Procedure Price and automate business processes such as the Supply Chain. |
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how we begin: |
Every project begins with a no cost, no commitment process. We begin with an initial high level comparison of your charge capture and reimbursement indicators we collect from your Cost Report against our target metrics for the OR, Recovery Room, and Anesthesia. We use these indicators to identify organizational effectiveness of the charge capture process and understanding of CMS guidelines. This step also provides a range of potential cash recovery and reimbursement increase for the current surgical volume.
Based upon the outcome of the indicator step and mutual agreement, we will conduct a no cost, no commitment detailed audit of 8 surgical and end of procedures. The nurse auditors will review what constitutes the time charge, the implant and supply charge capture accuracy, and the gross amount charged. We will present our findings to you in conjunction with an education workshop on the OR Revenue Cycle Best Practice model. During this process we will seek to get approval to implement our charge policy and procedure recommendations. |
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| IMPLEMENTATION – RISK SHARING: |
Based upon the outcome of the audit, we are prepared to enter into a risk share engagement. The risk share engagement has two aspects. The organization can choose either or both of the programs:
Cash Recovery and Nursing Education – This program is funded purely from cash recovered from previously billed cases. We will assume responsibility for auditing previously billed cases and submitting bills for unbilled or incorrectly billed eligible line items. We will be paid 50% of the cash recovered. We will also provide internal education on the new, go forward charging policies.
Infrastructure Implementation – Infrastructure is defined as accurate data files, accurate links and correlation between master files, use of clinical documentation to initiate charge capture / case costing / supply replenishment, and systems optimization and integration. 50% of the first year’s reimbursement increase or a mutually agreed to percentage will be applied to the Infrastructure Implementation and be applied to an hourly basis reimbursement. |
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