Revenue Spotlights and Tips

Revenue Spotlights

IRM’s Revenue Spotlights examine current changes as well as long-term challenges that face hospital revenue managers. These Spotlights offer step-by-step instructions for examining these issues in your facility and include suggested reports, action steps, and recommendations for quantification. They are designed to stimulate process improvement initiatives and identification of systemic fractures.

PDF, 0.04Mb		New Pacemaker C Codes July-06 Over the past few years CMS has implemented several strategies to capture the cost of expensive devices that are used in conjunction with certain outpatient procedures. The latest version of this process is captured in the Medicare Claims Processing Manual 100-04, Chapter 4, section 61, and in MedLearn Matters article MM4017. Read July's IRM Spotlight to learn more!

PDF, 0.04Mb		Cardiac Rehabilitation - UPDATES June-06 June 2006 UPDATE: The Office of the Inspector General (OIG) continues to watch cardiac rehabilitation services closely. Review this IRM Spotlight to learn more about Outpatient Cardiac Rehab and the tools and best practices for reimbursement and complia

PDF, 0.02Mb		Implantation of Automatic Implantable Cardic Defibrilators (AICDs) March-06 CMS recently added two additional diagnoses that meet criteria for the implantation of AICDS and they are 996.04 and V53.32. CMS has backdated the use of those codes and will allow denied claims with those diagnosis codes to be re-billed. Read this mont

PDF, 0.04Mb		Cardiac Rehabilitation February-06 The Office of the Inspector General (OIG) continues to watch cardiac rehabilitation services closely. Review this IRM Spotlight to learn more about Outpatient Cardiac Rehab and the tools and best practices for reimbursement and compliance. Read this mon

PDF, 0.03Mb		Procedure Codes and Medicare Devices January-06 According to the most recent five years of Medicare Provider Analysis and review data, between 45 percent of all Inpatient hospital admissions are being processed without a primary ICD-9 procedure code. Read this month's RMD Spotlight for more informatio

PDF, 0.10Mb		Home Health October-05 The potential for increased reimbursement by auditing Home Health Medicare PPS (Prospective Payment System) episodes with a negative response to the MO825 Oasis (Outcome & Assessment Information Set) question. Read this month's RMD Spotlight for more in

PDF, 0.10Mb		DRG's September-05 The potential impact of 2006 DRG changes on coding as well as managed care contracts and payments. Read this month's RMD Spotlight for more information!

PDF, 0.08Mb		Recalled Devices June-05 Billing CMS for replacement of cardiac pacemakers and defibrillators that have been recalled by the manufacturer. Read this month's RMD Spotlight for more information!

Revenue Tips

Revenue tips are short stories of successes that have been achieved by IRM's partner facilities. These tips summarize the area of focus, the correction that occurred and the financial impact. Also included are how these tips may apply in your own facility.

PDF, 0.03Mb		Discharge Disposition and Transfer DRGs October-06 October's Revenue Tip highlights discharge dispositions and transfer DRGs and how they can cost hospitals money. Included is a case study from St. Joseph Regional Health Center (SJRHC) in Bryan, Texas, discussing their success at ensuring the accuracy of discharge dispositions in their facility. Click to read more!

PDF, 0.03Mb		Process Improvement - PFS Business Process Redesign September-06 Read September's Revenue Tip that discusses the forward-thinking initiatives regarding PFS claim edits as offered by the University Health Care System's Revenue Management Department. Click to learn more!

PDF, 0.03Mb		Bill Presentation - Hyperbaric Treatment August-06 Read August's Revenue Tip to discover a great example of how clinical departments can do all the right things and yet reimbursement is reduced because of a broken business process. Click here for more information!

PDF, 0.02Mb		Inpatient Admission Followed by Death Prior to Room Assignment July-06 With a written physician order for admission, if a patient is discharged or dies prior to a room assignment/occupation an appropriate room and board charge may be entered on the claim. Read July's Revenue Tip for more information!

PDF, 0.03Mb		Registered Accounts with No Charges Applied June-06 June's Revenue Tip discusses identifying and capturing missed charges on registered accounts with no charges having been applied to the account. Read here to learn more!

PDF, 0.02Mb		Epogen Injections May-06 An IRM client recently identified over $510,000 in additional net revenue related to Epogen injections that were provided, but did not meet medical necessity per Medicare Part A. Read May's Revenue Tip for the full story!

PDF, 0.02Mb		High Cost Supplies April-06 High cost supplies may be missed without vigorous audit reconciliation controls. Read April's Revenue Tip for more information!

PDF, 0.02Mb		G0168 Rejection by Claim Scrubber March-06 Your facility's Dermabond (G0168) costs can be recovered by appropriately packaging the APC. Read March's Revenue Tip to learn more!