revenue cycle consortium news - Windham Brannon

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This change applies to all facilities, including free-standing emergency departments. Palmetto Sleep Lab requirement —
REVENUE CYCLE CONSORTIUM NEWS April 2018

Tenet Healthcare — Strategic Alternative or Sale?

In This Issue: •

Tenet Healthcare



UHC ER Reimbursement



Palmetto Sleep Lab Requirements



A.I. in Healthcare

Last year, Tenet Healthcare, one of the largest for-profit hospital systems, announced it is exploring strategic alternatives, or an outright sale (according to InsideARM). According to Tenet’s website, the system operates 470 outpatient centers, including 79 hospitals. Tenet is the third largest forprofit hospital system, behind CHS and HCA. Conifer, Tenet Healthcare’s outsource service group currently serves more than 700 clients. Will this affect your organization?

UHC Emergency Room Reimbursement As of March 1, United Health announced there will be a review of “When someone is going facility claims for the most severe and most costly ED visits for through a storm, your silent patients enrolled in the company’s commercial and Medicare presence is more powerful Advantage Plans (Modern Healthcare, 03/2018). Facilities that than a million empty words. “ submit Emergency Department visits, levels 4 & 5 Evaluation and Management codes (specifically those used for patients with - Unknown complex, resource-intensive conditions) could observe an uptick of claims adjusted downward or denied. All adjustments are based on the facility’s contract with United Health, if the insurer reviews the claim, then determining whether or not the claim did justified the high 4– or 5– level codes. This change applies to all facilities, including free-standing emergency departments.

Palmetto Sleep Lab Requirement Sleep lab providers who previously submitted claims to CAHABA, are now required, under the new Palmetto MAC agreement, to ensure all providers are accredited and have listed Accreditation Commission for Healthcare (ACHC) as an accepted accreditor (Palmetto GBA 2018)

Artificial Intelligence in Healthcare - Is Your Organization’s Revenue Cycle Team Ready for A.I.? According to Digitize.AI, “Studies show that 84% of physicians surveyed said the burdens associated with prior authorization were high or extremely high, and 86% percent said the burdens associated with prior authorization have increased significantly (51%) or increased somewhat (35%) during the past five years." How could A.I. benefit your organization?

Contact the Revenue Cycle Consortium leaders below for more information (Exclusive to Consortium members ONLY).

For more GHA/WB Revenue Cycle Consortium information, please contact: Valerie Barckhoff—Direct: 404-918-1673—[email protected] Danielle Epps—Direct: 470.269.5658—[email protected]