Articles-Thought Leadership Reimbursements at Risk Article | Page 4

“For example, a patient comes in with an order for a
unilateral ultrasound of the breast for a suspicious
lump. The ultrasound is performed, but the technician
chooses a code from the charge master that was
deleted in 2015. She was trained the year before by an
expert in the department who created a cheat sheet of
commonly used codes for popular procedures,” says
Gurzynski-Wells.
“If this error is not caught at the time of service, then a
claim scrubber will flag the error and put the bill on
hold. A report with all the failed claims will be
generated and either a biller or an auditor will identify
the error and correct it. But it shouldn’t end there: a
critical next step is educating the department technician
on the proper code,” believes Gurzynski-Wells.
Payer contracts are also a source of concern. More
than 7% of claims are not paid correctly the first time
or even subsequent times. An entire sector of the
industry has evolved to examine claims retrospectively.
They identify inaccurate payments and reconcile over-
and underpayments. This results in an increase in
administrative resolution time and an acceleration in
the cost to collect.
Payer-provider contracts and member relationships have
grown even more complex under value-based care and
alternative payment models. Instead of one schedule
applying to every provider, contracts can contain a
myriad of nuances tailored to specific providers.
In the opinion of Gurzynski-Wells, “Organizations can
shift from rework to proactive correction. By training
revenue cycle personnel to recognize and identify the
origin of these patterns and providing education in the
areas where those patterns originated, errors can be
corrected before claims are submitted.”
Training for Revenue Cycle Success
No one comes to work wanting to mess up. Employees
want to be successful and do a good job. With the right
training tools, the staff will feel supported and will have
the confidence to engage patients and become
effective members of the revenue cycle team.
“Education regarding revenue cycle and CPT codes will
aid clinical and billing staff in their understanding of the
charge entry process and why specific steps are
necessary. The goal is to eliminate the problem at the
point of charge entry before it causes failed claim
rework,” says Gurzynski-Wells.
“It’s important to create a hands-on environment
where staff can practice what they’ve learned.
HealthStream offers e-learning courses, simulators, and
social gaming to make the training experience fun,
showing folks it’s okay to enjoy what they do. Webinars
include 2018 code updates and CPT changes. We offer
standardized transitioning and onboarding of patient
access staff, including moving someone from an ED
coder to an inpatient coder, or someone who’s great
with CPT codes in the billing department to the ED.
We also offer performance analytics to measure
success,” offers Gurzynski-Wells.
What could happen if organizations could find a way to
hire the right candidate, onboard them successfully, and
invest in them professionally for everyone’s benefit?
They could improve efficiency, reduce duplication of
effort, increase productivity, and increase teamwork
and process improvement. Ultimately, organizations can
reduce operational cost and retain those dollars that
may be slipping away.
Susan Gurzynski-Wells is a Senior Product Manager at HealthStream. She has worked with healthcare
organizations for over 25 years to ensure data integrity during periods of transition. Susan is an
expert in coding and revenue cycle management. For more guidance on improving reimbursement,
visit: http://www.healthstream.com/reimbursements.
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