Revenue Cycle: Tracking Reimbursement for DRGs, APCs and MPFS

Event Information
Product Format
Prerecorded Event
90 Minutes
Product Description

Recognize How Reimbursement Tracking Can Enhance Overall Reimbursement

Why is reimbursement tracking an important element within the revenue cycle?
How does reimbursement tracking help improve revenue and compliance at the same time? What elements you need to understand while tracking reimbursement? Why are DRGs, APCs and MPFS so complicated? Is it difficult to determine just how much we should be reimbursed? What unique issues are embedded within the Medicare Physician Fee Schedule?

Find the answers by joining expert Duane C. Abbey, Ph.D. in this riveting session, where he will shed light on why financial personnel are so intent on tracking the DRG case-mix. Is there a case-mix index for APCs? Find out whether other private payers use system like DRGs, APCs and MPFS. Learn what particular consideration you need to make for provider-based clinics; and whether or not reimbursement tracking should be used to assess cost-outliers as a potential compliance issue—in this 90-minute audio session.

Training Objectives:

  • Review reimbursement tracking as part of the revenue cycle
  • Understand the basics of DRGs, APCs and MPFS
  • Know how payment is calculated for DRGs, APCs and MPFS
  • Find out how extra payments can be made through DRGs, APCs and MPFS
  • Recognize how reimbursement tracking can identify improper reimbursement
  • Learn how compliance issues can be raised relative to overpayments
  • Review how reimbursement tracking can provide feedback into the billing and claims filing processes
  • Comprehend how provider-based clinics require exclusive reimbursement tracking
  • Know quantification techniques in tracking overall reimbursement

Topics covered in the session

  • Introduction
    • What is the revenue cycle?
    • What is the reimbursement cycle?
    • What are the sub-processes with the revenue cycle?
    • Why is tracking reimbursement important?
    • Why healthcare providers really track reimbursement?
    • Compliance and reimbursement tracking
  • Establishing Tracking Mechanisms
    • Understanding the Given Payment System
    • Ability to Calculate the Proper Payment
    • Extra and Outlier Payments
    • Groupers and Claims Adjudication Software/Logic
    • Medicare vs. Non-Medicare Payers
  • DRGs – Overview
    • DRG Background and Associated Payment Characteristics
    • DRG Grouper
    • DRG Cost Outliers
    • Tracking Reimbursement
    • Case-Mix Indexes and Quantification
  • APCs – Ambulatory Payment Classifications
    • APC Background and Associated Payment Characteristics
    • APC Grouper
    • APC Cost Outliers
    • Tracking Reimbursement
    • Case-Mix Indexes and Quantification
  • MPFS – Medicare Physician Fee Schedule
    • MPFS and RBRVS Background
    • Adjudication Logic
    • Payment Calculation
    • Extra Payment
    • Quantification Techniques
  • Provider-Based Clinic Tracking
    • Provider-Based Clinic Review
    • Unique Issues for Reimbursement Tracking
  • Compliance Issues and Reimbursement Tracking
  • Sources for Further Information

Prerequisites for Participating:  General knowledge of hospital and physician billing operations and healthcare payment systems.

Who should attend: Financial Analysts, Revenue Cycle Personnel, Chargemaster Coordinators, Coding Personnel, Coding, Billing and Claims Transaction Personnel, Internal Auditing Personnel, Financial and Compliance Personnel, Information Technologists, Physicians and Other Interested Personnel

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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
More Events By The Speaker

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