An established and esteemed nurse, Barbara is well respected for her dedication to patient focused care. With 40 years of experience, she is also no stranger to crisis situations. From potential explosive hazards to COVID-19, her commitment to her patients and her team shines through. Join us as we follow her story on how to deliver effective patient care under the worst situations.
Emily has had a truly unique experience with COVID-19. Not only did she treat ailing patients in the fight against the disease as an ER Nurse, but she was also one of the first in Indiana to contract COVID-19. Spending weeks in recovery during a time when the disease was still new, she managed to kick coronavirus to the curb. Join us as we follow her story of recovery and passion for what she loves most, nursing.
HealthLeaders Revenue Cycle Editor Alexandra Pecci speaks with Privia Health's Jeannette Wood, vice president of revenue cycle management, and Amy Waller, vice president of HIM and coding integrity, about how their revenue cycle developed an online workbook that can be updated and shared in real time to manage coding and billing changes effectively across their multistate network.
HealthLeaders Revenue Cycle Editor Alexandra Pecci speaks with Patrick McDermott, interim VP of revenue cycle for ProMedica, about how his revenue cycle team quickly worked to enable employees to work safely at home in response to COVID-19 and how to manage the workforce in this new environment.
HealthLeaders Revenue Cycle Editor Alexandra Pecci speaks with Shawntea Moheiser, owner of ITS Healthcare, LLC in Omaha, and Kem Tolliver, president of Medical Revenue Cycle Specialists in Maryland, about the revenue cycle implications for the new COVID-19 CMS telehealth billing changes.
In this Vocera Sponsored podcast, HealthLeaders Nursing Editor Jennifer Thew, RN, speaks with Rhonda Collins, RN, CNO of Vocera, about the evolving role of nurses, the importance of communication, and how to use technology to improve care team collaboration.
HealthLeaders Finance Editor Jack O'Brien speaks with Jenny Barnett-Sarpalius , CFO of LCMC Health in New Orleans, about analyzing the financial damage done from the virus and looking to implement effective revenue growth strategies and expense control measures going forward.
HealthLeaders Finance Editor Jack O'Brien speaks with Meghann Hutchison , CFO of Lovelace Medical Center in Albuquerque, New Mexico, about how the organization responded to COVID-19, what the plans are to bring back elective procedures, and how to prepare for a potential second wave in the fall.
HealthLeaders Finance Editor Jack O'Brien speaks with Steve Lawler , president of the North Carolina Healthcare Association, about the ongoing coronavirus disease 2019 (COVID-19) outbreak, what business strategies provider executives should put into place to bolster the bottom line, and the future of telehealth solutions.
Using proactive external peer review to mitigate the risk of high-dollar lawsuits
Medical necessity investigations and lawsuits are a significant threat to healthcare providers, especially those that rely on internal medical staff peer review programs to identify adverse patterns in clinical behavior, according to the new brief Medical Necessity: Checks and Balances Most Hospitals Don't Have, but Should.
"All too often, the medical staff is not up to the task of policing for medical necessity and therefore does not produce adequate oversight," says Rick Sheff, MD, chief medical officer and national director of external peer review at The Greeley Company. As a result, healthcare executives may not know the extent to which their organizations are at risk for fraudulent billing.
This is a critical issue, given the OIG has recently settled numerous multimillion-dollar lawsuits with hospitals and physicians for performing medically unnecessary tests and procedures.
Whistleblower lawsuits in particular are damaging to a hospital’s reputation and bottom line. "There is no shortage of people willing to blow the whistle in medical necessity cases and retire comfortably for their trouble," says Thomas Anthony, an attorney with Frost Brown Todd LLC. Whistleblowers receive between 15% and 30% of the amount recovered by the government.
Hospitals face big risks when the medical staff peer review process does not lead to medical necessity decisions that match OIG guidelines.
The brief describes how to establish an effective medical necessity surveillance and accountability program. One key step includes creating an external peer review process, which is a best practice for hospitals looking to reduce risks related to medical necessity. Experienced external peer reviewers not only perform impartial assessments, but also raise the red flag when self-reporting might be warranted. Go here to learn how to structure and implement medical necessity checks and balances.