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AAHIM | 2020 Virtual Annual Meeting – Integrating Clinical and Financial Process and Data to Drive Revenue Integrity

The integration of clinical and financials processes and data is critical to a sustainable provider organization. This new era of revenue integrity requires close monitoring of clinicians’ ordering, documentation practices, and clinical significance, in order to ensure appropriate reimbursement, avoid denials and improve public quality reporting. Clinical documentation has never been more vital since performance-based payments are not directly linked to quality measures that required data and information. This session is intended to discuss data driven CDI for continuous improvement through internal auditing and feedback mechanisms, collaboration with coding and providers in order to solve issues related to more efficiently merge clinical and financial processes. Session Objectives: To improve patient care, revenue and compliance, a clinical documentation chain requires collaboration throughout the organization. Weak links anywhere along the chain will contribute to poor data quality. This presentation will describe: -Regulatory Issues impacting healthcare -What is Revenue Integrity -What is Denials Management and strategies to prevent downstream revenue cycle problems -How does CDI link Quality Measures, Care Coordination, Revenue -Integrity and Denials Prevention through ongoing data driven CDI practices -Focus on meaningful metrics to better manage outcomes

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OrHIMA 2020 Virtual Annual Meeting – Revenue Enhancement Through Patient Care Improvement During and After the Public Health Emergency

Through the 1135 Waiver authority, CMS waived certain telehealth requirements that have long presented a barrier to utilization and expansion of telehealth technology in the delivery of healthcare. This waiver was issued in order to limit the community spread of COVID-19 and keep vulnerable patients in their homes while maintaining access to needed routine and screening care. Prior to the Public Health Emergency declaration, the provision of healthcare services through telehealth faced many barriers which included acceptance of the technology by both patients and providers. The regulatory and reimbursement requirements for these services did not encourage and likely is courage implementation of telehealth. Telehealth regulations at both the Federal and state levels have not kept pace with technology. Prior to the COVID-19 outbreak, the American Telehealth Association projected that by 2030 50% of medical consultation would be conducted by virtual means. Many industry experts saw this as an ambitious projection. The changes we are seeing in the midst of this world-wide pandemic will likely serve as a catalyst for spurring not only use of telehealth technology, but acceptance by providers, patients, payers and regulators. Given current economic unknowns, healthcare providers must ensure reimbursement for the services provided and identify those services that best meet the clinical needs of patients while protecting the financial health of their organizations. In this presentation, we discuss not only reimbursement requirements under Waiver services; but, how to use the processes setup during this public health emergency for the financial benefit of healthcare providers.

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