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Published byRandell McBride Modified over 8 years ago
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P R E S E N T E D B Y: Corporate Reimbursement Strategies January 26, 2009 Eric Lucas Senior Director, Government Programs Mike Smith Director, Reimbursement
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2 Cost Report audit findings inconsistent throughout system Regulatory knowledge not utilized effectively Reimbursement opportunities ignored Vendor arrangements inconsistent between hospitals Compliance concerns Corporate Reimbursement: Early Observations
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3 1.Ensure Appropriate Reimbursement 2.Standardization & Best Practices 3.Maintain Program Compliance 4.Communicate Timely Program Information 5.Advocacy Objectives
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4 Reimbursement Managers covering multiple sites Out of the hospital and into the central business office More duties become managed under corporate initiatives/directive Communication and project management skills Reimbursement Personnel Trends
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5 Standardization & Best Practices Extract system benefits from local successes Identify unique skill sets in local markets for system-wide opportunities Adopt best practices into standardized procedures –Government reporting –Accounting
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6 Cost Reporting Accounting Reserves Compliance Disclosures Vendor arrangements Education & Training Policies and Procedures
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7 Maintain Program Compliance Work closely with Compliance Department P&P’s are reviewed periodically to address new or changing compliance issues Standardization Review
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8 Communicate Timely Program Information Stay current on government payment matters Identify appropriate recipients for regulatory information Consistent communication is key Strategic understanding of changes Resources
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9 Education : HFMA American Health Lawyers Association State Associations Publications & References CCH / Medi-Regs Dennis Barry’s Reimbursement Advisor Various Association Newsletters American Hospital Directory website Equally important to the Corporate team has been the external advisors in our networks. Resources
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10 Advocacy Commitment to this area has increased Recognize trends and policy proposals early Strategy and analysis Communication
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11 Ensure Appropriate Reimbursement Recognizing reimbursement changes; Collaborating with other departments; Developing procedures to identify appropriate reimbursement; Ensure all appropriate reimbursement is claimed “Make sure all the fruit is harvested”
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12 CHALLENGES Focus Getting it all done Staying current Remaining flexible
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13 CHARACTERISTICS Integrity Perseverance Optimism Experience
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14 AREAS OF CONCERN Group Appeals Individual Appeals Wage Index Bad Debts IME/GME Reopenings DSH
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15 CONCLUSION Keep focused Remain optimistic Never give up Questions?
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