A one-stop guide to fully compliant revenue cycle management
Managing an emergency department's revenue cycle is exceedingly complex - and filled with compliance perils. Moreover, because the ED is a primary patient admission gateway, the decisions you make affect revenues and compliance in other areas of the hospital. You have to get it right, but where do you find time to stay on top of the latest best practices and regulatory requirements? MedLearn's Emergency Department Reimbursement Manager book was created just for you. This one-of-a-kind, timesaving resource walks you through all the critical aspects of ED revenue cycle management, enabling you to fulfill your responsibilities with total confidence. Highlights:
- Reimbursement essentials, explaining which services are billable, how they're paid under the various models and third-party payer requirements
- How to develop a charge structure and chargemaster, reflecting current resource use and billable services
- Keys to managing the flow of data - demographic, clinical and financial information - to satisfy payer requirements
- Nursing documentation essentials - must-know requirements for supporting ED services provided, medical necessity and patient admissions
- Developing and managing a compliant hospital-specific evaluation and management (E&M) facility fee criteria
- NEW FOR 2011:
- Expanded guidance with documentation, focusing on facility E&M charges, infusion services, billing of ancillary services and the 72-hour rule, applicable to certain outpatient service
Findings from MedLearn consulting experts
MedLearn publications address your real-world challenges and concerns, including the following examples shared by our consulting experts.
No audit process in place - "Most hospitals start out with a solid charging framework for their emergency services. However, we've found that, over time, many of them don't keep it up to date. Consequently, hospitals may be missing the opportunity to bill for services that were not billable when they established their framework. Or they may be inappropriately billing for services that are part of their evaluation and management criteria. We recommend performing a charging strategy audit at least once a year; our book can be a valuable resource for this process."
Lack of time documentation - "We've identified a number of issues related to coding for infusion services. One of the biggest areas of concern is lack of proper documentation for time-based codes. For example, nurses often enter a start time for hydration or drug administration, but they do not enter a stop time. Without the stop time, hospitals cannot charge for the service. Given the large number of patients who require infusion services, the revenue implications can be substantial. Our book can assist managers with training their staff in documentation best practices."
Caution: RAC may be watching! - "Coordination between the ED and other departments continues to challenge many hospitals - and it may be attracting the attention of Medicare's Recovery Audit Contractors (RACs). Here's a common scenario: Patients are started on hydration in the ED and then admitted to observation. Nurses in observation need to know that an infusion was started in the ED so they can continue with additional time charges. Otherwise, they may charge for the initial hour again, resulting in a non-compliant claim."
About eBooks
For 2011, all of our publications are now available in either print or eBook formats. The eBook format is an exact copy of the print format in a protected PDF document downloadable to your computer. Everything that is provided in the print format is accessible in the searchable eBook format, where you may search by specific words or phrases, or codes located throughout your eBook.
To download a sample eBook, CLICK HERE
- The eBook format has exactly the same content as our print format.
- The eBook format is available for download prior to the release of the print versions.
- You may access your eBook(s) on your Windows or Mac computer at all times which allows for full text search capabilities and accessibility of the content on your computer without having to drag around a hard copy book.
- The eBook price is the same price as the print format (retail rate for each, with volume discounts) – but you pay no shipping costs!
- eBooks are non-printable.
- All eBook and print format content is copyrighted and may not be reproduced or transmitted in any form, by any means (electronic, photocopying, or otherwise) without with prior written permission of the publisher. To inquire about multiple user pricing, call Customer Care at 800-252-1578 ext 2.
- All resources are updated on an annual basis. Any pertinent updates to resources made throughout the year are found on our Product Updates webpage at http://www.medlearn.com/updates/.
- All eBooks are made to prevent the copy of any content contained therein. You cannot copy and paste or manipulate the eBook content into another program.
- The eBook format may contain blank pages. These blank pages are added pages, not the deletion of information and will not affect the quality of the eBook or your understanding of the material.
* To view our eBooks, you will need Adobe Acrobat Reader, a free download. You can download this program HERE.
Return Policy for eBooks
All eBook sales are final. Please fully read the eBook product description and view the Table of Contents to gain a full understanding of the book prior to your purchase. Should you have any questions prior to your purchase, please call Customer Care at 800-252-1578 ext. 2 to receive answers to your eBook questions. We will work with you to help resolve any technical difficulties you may experience regarding your eBook order.
eBook Delivery
After purchase* you will receive an auto-generated email from Promail5 at impactfulfillment dot com which will contain a link to download your eBook(s). If you do not receive the email, please contact your Network Operations or IT group for assistance. To help ensure that these emails are always delivered to your Inbox, please add the impactfulfillment.com domain to your "Safe Senders" list.
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Technical Assistance
For any technical assistance, please call Customer Care at 800-252-1578 ext 2.
