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The current process for reimbursing healthcare providers functions as a pay-and-chase model, meaning you get paid for services under the presumption that the provider represented the services they rendered accurately and in accordance with various regulatory requirements.
Organizations are reimbursed for services based on the assumption that their clinical documentation validates the services billed. However, this approach can lull healthcare providers into a false sense of security, leading them to believe that receiving payment indicates full compliance with all regulations. This assumption could not be further from the truth. Just because you got paid, doesn’t mean you billed services compliantly. This is why an effective revenue integrity process is crucial to ensuring you get paid for the work you provide compliantly. Revenue integrity focuses on proactively getting paid accurately for the services you provide – without fear of costly and intimidating payer audits and recoupments.
Accurate and compliant coding and billing promote revenue integrity. When you bill the right codes, you receive the right payment. No more, no less. Clinical documentation deficiencies, coding and billing errors, compliance risks, and overpayments are most often identified in post-payment audits that occur retrospectively (meaning after the services were already paid for by a third-party).
Payer Audits and Recoupments are insidious and can lead to catastrophic consequences for healthcare providers. Many healthcare organizations fail to maintain a strong revenue integrity program.
This webinar by industry expert Toni Elhoms, CCS, CRC, CPC, AHIMA-Approved ICD10-CM/PCS Trainer, will define revenue integrity in various contexts and examples, demonstrate how to build an effective revenue integrity program, showcase various revenue integrity initiatives, and spotlight examples of where revenue integrity made all the difference in healthcare fraud, waste, and abuse investigations, and so much more.
This webinar aims to provide participants with a comprehensive understanding of revenue integrity in healthcare billing. By exploring the complexities of the pay-and-chase model, Toni will highlight the importance of proactive compliance and accurate billing practices. Attendees will learn how to build and maintain an effective revenue integrity program to ensure compliance with regulatory requirements and minimize the risk of audits and recoupments.
