Revenue Roundtable

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Bedside Procedures Charges – A lot of education and planning is involved when/ if a facility decides to capture bedside procedures, particularly when no additional net reimbursement is gained. Then why do it? New Code Updates for July 2017- Learn about the new laboratory, blood bank, surgery, clinic and pharmacy codes that must be implemented in July 2017. Is the chargemaster ready and staff prepared? Read more

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Booming Demand: How Urgent Care Centers are Impacting Hospital Operations

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The construction and use of urgent care centers in the health care industry has steadily increased over recent years. The growing popularity of urgent care centers presents an opportunity for hospitals to extend networks or expand partnerships in order to reach new clientele. Further, it offers an opportunity to enhance brand recognition in new and existing markets. According to the Urgent Care Association of America (UCAOA), urgent care dates back to the late 1970s and was created with the intention of meeting a community’s immediate health care needs. It was a slow but steady start for urgent care in the beginning, but the concept of seeing a physician without an appointment eventually began to gain popularity among patients. Over the past 20 years, the urgent care industry has continued to expand and earn the trust of those seeking a safe and affordable place to receive medical attention. Today, urgent care centers are physician-staffed and typically offer extended hours (evenings and weekends), providing quality care without the costs and wait times associated with the average emergency room (ER) visit. Urgent care centers are best suited for situations that require more immediate attention; often times, this serves to be more practical than seeing a primary care provider, who can be challenged with offering consumers the hours or immediacy an illness or accident can demand. Why the Increase in Popularity? There are various drivers behind the recent growth of urgent care. The UCAOA estimates that growth has been steady the last several years,…

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Medicare Certification Process – Setting the Stage for Success

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According to a 2015 Comprehensive Error Rate Testing (CERT) Report recently released by the Centers for Medicare and Medicaid Services (CMS), “the denial rate for Skilled Nursing Facilities (SNFs) increased from 6.9% to 11% due to missing or incomplete certification/recertification.” A certification that the beneficiary requires daily skilled care that can only be provided in a SNF/swing bed setting is key to Medicare Part A coverage and claim approval. The SNF must obtain and retain the certification and recertification statements as Medicare Administrative Contractors or other Medicare contractors may request them as part of a medical review to determine if SNF services were reasonable and necessary. CMS does not require a specific format for the certification or recertification process but does have a list of requirements that need to be met for the resident’s stay to be deemed valid. The certification process is not the same as an order to admit to the SNF or an order for a skilled level of care. A separate statement indicating the resident will require on a daily basis SNF covered skilled care is required. The initial certification must be obtained at the time of admission, or as soon thereafter as reasonable and practicable. BKD recommends the physician certification be signed within the first two days of admission. Faxed signatures are acceptable. The initial certification must clearly indicate that; Skilled nursing or rehabilitation services are required on a daily basis, The services can only be provided in the SNF or swing bed hospital on…

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Embracing Change: Issues regarding the potential re-designation of Critical Access Hospitals to Free-standing Rural Emergency Centers

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While an estimated 19% of the US population lives in rural areas, 54% of all traffic fatalities occur in these geographic areas as opposed to urban areas1. For persons living in rural areas, a closed hospital means farther travel, even hours, for care. This is simply not an option for cardiac issues, workplace injuries, or automobile accidents. Today, critical access hospitals face a three-pronged challenge of high volumes of uninsured and underinsured patients, declining reimbursements from government payers, and a sharp decline in census for inpatient services. While Rural Health providers face continual challenges, the same cannot be said for the nation’s free-standing emergency departments than now number at over 500 sites. Most are affiliated with a large hospital system and serve as a feeder for patients needing inpatient care. Also, these EDs are usually located within 20 miles of a full-service hospital, typically located in more affluent suburban areas to target privately insured patients2. The same can be said of Urgent Care Centers that cherry-pick locations based on socio-economic factors such as rates of commercially insured residents. So, the prospect of a large for profit ED or Urgent care center opening in a rural community to compete with the local CAH is near non-existent. As a result, Critical Access Hospitals are the only option for persons seeking both emergency and urgent care. Nearly twenty years have passed since the Critical Access Hospital designation was created as part of the Balanced Budget Act of 1997 in response to a string…

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