WVHIMA | The Impact of Clinical Validation Denials and ICD-10 Coding Changes on Revenue Integrity

The health care industry is currently undergoing monumental changes in the U.S. Transition from utilization-based to outcomes-based payment structures has resulted in declining net revenue for many healthcare organizations.

Overview:

The health care industry is currently undergoing monumental changes in the U.S. Transition from utilization-based to outcomes-based payment structures has resulted in declining net revenue for many healthcare organizations. Aggressive predictive analytics and extrapolation techniques are aimed at recouping money. In addition to traditional Medicare’s RA coding audits, the RAs, Medicare Advantage, Medicaid and multiple third party payers are ramping up clinical validation audits. Coding and clinical documentation quality directly affects organizational financial performance.

Today, coders and clinical documentation specialists must understand multiple payment methodologies, including Hierarchical Condition Categories (HCCs), APR-DRGs and MS-DRGs. Each of these reimbursement models focus on disease burden. In order to reflect the level of care being provided, coders must to have a deep understanding of disease processes, surgical procedures and coding changes so that ICD-10-CM/PCS codes are applied accurately.

Coding compliance should be considered a top priority to protect net revenue on a continual basis. Benchmarking, monitoring, and continual coder education are crucial steps healthcare organizations can take to protect the bottom line. This presentation is designed to ensure that attendees are prepared to successfully mitigate predatory recoupment activities by all payers by identifying changes in coding and clinical documentation requirements.

Published:

July 2017

CEU:

CEU – 1.0 – Clinical Data Management

Speaker:

Lynette Thom, BS, RHIT, CCS, CDIP

Lynette Thom is a Senior Consultant with Blue & Co., LLC on the Indianapolis Revenue Cycle team. She joined the firm in June 2012.

Lynette brings more than 15 years of experience in the field of healthcare. Her experience includes a wide variety of services in the health information management (HIM)-related revenue cycle. Settings of experience includes hospitals, clinics and ambulatory surgery centers (ASCs) as well as academia. She is a subject matter expert in hospital coding for all patient types – inpatient, outpatient surgery, observation, emergency department, psychiatric and geri-psychiatric health as well as chemical dependency, dental and physical therapy. Lynette also has experience in non-coding HIM functions (i.e., management, release of information, etc.)

Her work has included performing Recovery Audit Contractors (RAC) review management, denials management, and developing coding policies and procedures. Ms. Thom works with coders and physicians in hospitals around the country to improve clinical documentation to increase revenue and decrease risk of recoupment. She has developed and presented CDI training programs for physicians and surgeons.

Lynette’s work in academia includes four years as an instructor at community colleges in Oregon and Washington in health information technology, medical assisting, transcription, radiology and other clinical programs. Her curriculum included ICD-9-CM and CPT coding, health information privacy and release of information (HIPAA compliance), medical legal theory, pathophysiology, medical terminology, transcription, front office reception and many others.

She holds a Bachelor of Science in Health Care Administration, and is a Registered Health Information Technician (RHIT). In addition, Lynette is a Certified Coding Specialist (CCS), a Clinical Documentation Improvement Practitioner (CDIP), as well as an AHIMA Approved ICD-10 Trainer, certified through AHIMA.

Lynette has also served in different capacities in state component associations of the American Health Information Management Association (AHIMA). Mrs. Thom is currently serving as president-elect of the IHIMA.

Pricing:

AHIMA/WVHIMA Member: $75
Non-Member:$75

Instructions:

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Course Includes

  • 1 Lesson
  • Course Certificate