“Finally Friday!” 2MN Rule Update & Auditing to Stop Chasing Your Tail

FRIDAY August 14, 2015:

“Auditing to Stop Chasing Your Tail

Onward thru the fog…

(no reference to Oat Willie, and the origin of the phrase)

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The "fog" is still with us. BUT... now we can actually SEE at least some of the trees, so you can avoid bashing your face into them, as you move forward...

The “fog” is still with us. BUT… now we can actually SEE at least some of the trees, so you can avoid bashing your face into them, as you move forward…

In years past, it was common practice to chase denials via appeals departments, with little information passing up the chain of the revenue cycle. Part of the reason was because it was difficult to know what the payors were thinking and nigh onto impossible to argue with them and win. Over the past couple of years, however, it has become increasingly possible to win appeals, with substantial success at the 3rd level of Medicare. The proliferation of review contractors has at least one advantage for providers: you can see what the auditors are thinking and doing to post denials. And appeals in particular show what is valid and what is not, one way or the other. Now I’m not suggesting that all these audits and denials are a GOOD thing. I’m just saying that at least we know more than we did before, and THAT can be used to preempt denials, at least more than ever before.

In the Terminator series, Sarah Connor refused to accept the lousy, predictable future. So she did a Root-Cause analysis! And then she went after that Root Cause. So what are you doing?

In the Terminator series of movies, Sarah Connor refused to accept the lousy, predictable future. So she did a Root-Cause analysis! And then she went after that Root Cause. So what are you doing?

The danger is in accepting the status quo, or doing only what you’ve done before – conforming to “that’s how we’ve always done it.” The fog of war is certainly upon us, and although it shows no signs of dissipating anytime soon, we can be better prepared to enter it and suffer fewer casualties. But you MUST take some actions – ones that are effective.

In that light, there is no shortage of topics to discuss, but this week we choose to talk about some immediate things you can do to prepare, to start getting out in front of coming malestrom, ready to go… onward through the fog!

The will to fight is key. No need for panic. No need for drastic measures. There are plenty of tools available, today.

The will to fight is key. No need for panic. No need for drastic measures. There are plenty of tools available, today. We’ll talk about a few on this week’s show.

We start by using a part of our friend Mike Magliaro’s newsletter on getting ready for ICD-10, and then get into some real world examples of what Bill Malm and others have been doing to get ready for the onslaught.

We will review and discuss with things you can do RIGHT NOW to move out ahead of all the mess coming at you:

  • Preparing CDI for ICD-10 Codes & Claims
  • Using ICD-10 prep to deep dive into denials
  • Using data analytics and pattern recognition to combat payors’ predatory practices
  • Using DMAIC and the 5 Whys to determine root cause
  • Importance of random audits moving forward to sustain remediations
  • Think people, process and technology

So listen in, share your own insights and bring your questions for us!

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Moderators for the Show:

Ernie de los Santos, MBA, SSA, SAC — Faculty Chair at Appeal Academy

Sharon Easterling, MHA, RHIA, CCS, CDIP, CPHM – Revenue Cycle & Appeals Expert and Auditor

William Malm, ND, RN, CMAS, CRCR – Practicing Clinician and Certified Medical Auditor

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