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Get Proactive With Front-End Revenue Cycle Utilization Review

Product Code: YHHA082421A

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Get Proactive With Front-End Revenue Cycle Utilization Review

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Presented on: Tuesday, August 24, 2021 | 1–2:30 p.m. Eastern

Presented by: Tiffany Ferguson, LMSW, CMAC, ACM, and Marie Stinebuck, MBA, MSN, ACM

Program Synopsis

Ensuring appropriate patient status assignment is a complex process that has serious implications on patient care and hospital revenue. Utilization review (UR) professionals often address patient status issues after the patient is already at the hospital and an inappropriate status has been assigned. But the pressures and limitations of retrospectively reviewing patient status mean that not every case is caught before it affects discharge planning, patient billing, and hospital reimbursement.

UR professionals can get ahead of the game by proactively implementing processes and education that will make sure patients are placed in the correct status from the beginning. In this 90-minute webinar, speakers Tiffany Ferguson, LMSW, CMAC, ACM, and Marie Stinebuck, MBA, MSN, ACM, will explain how UR can work with front-end revenue cycle processes and staff to develop successful programs. The speakers will walk through Medicare’s rules for determining patient status and explain how patient status affects discharge planning and postacute placement, billing and reimbursement, and denials and audits. They’ll share tips for developing successful front-end UR programs and how to measure outcomes and use data to track performance. The presentation will conclude with a live Q&A during which attendees can submit questions.

At the conclusion of this program, participants will be able to:

  • Explain Medicare’s rules for determining patient status
  • Analyze the impact of patient status on denials and revenue
  • Demonstrate strategies involving UR in front-end revenue cycle processes to support appropriate patient status

 

Agenda

  • Overview of patient status and the role of utilization review (UR)
    • Inpatient admission
      • 2-midnight rule
    • Observation services
    • Three-day transfer rule and postacute placement
  • Impact of patient status determinations
    • Patient status and denials
      • Medical necessity denials
      • Current denial trends
      • Short-stay audits
    • Patient billing and communication
      • Financial responsibility and patient status
      • Patient notices and communication
      • Care planning and discharge planning
    • Downstream impacts of patient status determinations
  • Front-end revenue cycle and UR
    • Understanding front-end revenue cycle
      • Remote UR
      • Identifying admission points
      • Education
    • UR strategies
      • Concurrent process
      • Tips for successful programs
  • Outcomes and data analysis
    • Defining and measuring outcomes
    • Tracking performance

Who Should Listen?

  • UR management managers/directors
  • UR professionals
  • UR staff
  • UR nurses
  • Physician advisors
  • UR committee members
  • Case management managers/directors
  • Case managers
  • Revenue cycle managers/directors
  • Revenue integrity managers/directors
  • HIM directors/managers
  • Compliance officers
  • Patient access managers/directors

Meet the Speaker

Tiffany FergusonTiffany Ferguson, LMSW, CMAC, ACM, is the CEO of Phoenix Medical Management Inc., a hospital case management company. Ferguson is a graduate of Northern Arizona University and received her MSW at UCLA. After practicing as a hospital social worker, she was tapped by administration at Northern Arizona Healthcare to serve as director of community case management and quickly assumed leadership responsibility as system director of health and care management, later becoming top administrator for the employed medical group. She is ACM certified, serves on the board for the Northern Arizona Gerontology Association, contributes regularly to RACmonitor and the Journal of Case Management, and is a commentator for Finally Friday.

Marie StinebuckMarie Stinebuck, MBA, MSN, ACM, has been a nurse for 25 years with 13 years in case management and more than a decade in hospital case management leadership. Her roles have included leadership of teams in case management, utilization review, denials management, clinical documentation integrity, and medical record integrity. She holds an MBA from the University of Phoenix and an MSN in Nursing Leadership from Grand Canyon University and currently holds an active role on the AMCA Arizona Board.

Continuing Education

American Health Information Management Association (AHIMA)

This program has been approved for 1.5 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

Ability to claim credits for this webinar expires on: 8/23/2022

National Association of Healthcare Revenue Integrity (NAHRI)

This program has been approved for 1.5 continuing education units towards fulfilling the requirements of the Certification in Healthcare Revenue Integrity (CHRI), offered as a service of the National Association of Healthcare Revenue Integrity (NAHRI).

Instructions

Webinar system requirements and program materials: 
To fully benefit from the webinar experience, please note you will need a computer equipped with the following:

Browser: Microsoft Internet Explorer or Edge, Firefox, Chrome, or Safari, with JavaScript enabled 
Internet: Internet connection (high-speed connection recommended) 
Streaming: Access audio/video streaming from any browser on a computer, mobile, or tablet device

Prior to the webinar, you will receive an email with detailed system requirements, your login information, presentation slides, and other materials that you can print and distribute to all attendees at your location. 

CAN'T LISTEN LIVE? 
No problem. The On-Demand version will be available. Use it as a training tool at your convenience—whenever your new or existing staff need a refresher or need to understand a new concept. Play it once or dozens of times. A $259 value! 

PLEASE NOTE 
Participation in the webinar is just $259 per site. All materials must be retrieved from the Internet. 

Call your customer service representative toll-free 800-650-6787 or email customerservice@hcpro.com if you have questions.