Becker's Hospital Review

23 CFO / FINANCE The best way for hospitals to avoid revenue loss: 2 execs weigh in By Katie Adams U .S. hospital margins remained narrow in the first quarter of 2021, prompting healthcare revenue cycle leaders to ex- amine their processes and make sure no money is falling through the cracks. Donna Ellenburg, revenue cycle director at Bir- mingham, Ala.-based Grandview Medical Cen- ter, said hospitals can avoid losing revenue by verifying insurance benefits before a patient's visit, ensuring there is an authorization for the service if one is necessary, and collecting the patient's responsibility before their arrival or upon arrival. "Another way to avoid lost revenue is by having a good charge reconciliation process to ensure all charges are posted to a patient account both timely and accurately," Ms. Ellenburg said. Michele DeSmet, the director of revenue integ- rity and Grand Rapids, Mich.-based Spectrum Health, said one of the best defenses against lost revenue is collaboration between the clinical care and revenue cycle teams. "Revenue is typically generated by the clinical teams who care for patients," Ms. DeSmet said. "When clinicians understand how their doc- umentation of patient care triggers revenue, they're better able to identify gaps in revenue and use their expertise to help design process improvements to eliminate revenue variances." Ms. DeSmet said that educating nurses and other clinical care teams about how their actions affect the revenue cycle — and by extension, the hospi- tal's financial performance — helps them better understand how their documentation supports the hospital's mission and bottom line. n Hospitals charging hundreds more than average $159 for COVID-19 tests By Morgan Haefner M edicare claims data show some hospitals are charging up to $650 for COVID-19 tests that cost less than $50 to do, according to a Hospital Pricing Specialists analysis cited by Kaiser Health News. More than 421 million COVID-19 tests have been performed in the U.S., and the range that large health systems are charging per test is wide. The national average is $159 for a diagnostic test, but some are charging $20 for the tests, while others are charging $1,419 per test, according to a national survey from the Kaiser Family Foundation. A freestanding emergency department may charge more than $1,000 for a test. For the most part, those charges are to insurance companies and not to individuals, and many hospitals follow Medicare's $100 rate for high-vol- ume tests, according to the report. However, some experts are saying the practice of charging much more than the cost of the test is predatory. Ge Bai, PhD, an associate professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore, told Kaiser Health News that insurers "have no bargaining power in this game" because in some situations there are no price caps. n New Jersey hospital received $4.8M in overpayments, OIG says By Katie Adams C amden, N.J.-based Virtua Our Lady of Lourdes Hospital failed to com- ply with Medicare billing requirements for 40 of 100 inpatient and outpatient claims reviewed, according to a report from HHS' Office of Inspector General released May 4. The billing errors resulted in the hospital receiving $666,021 in overpay- ments during the audit period of Jan. 1, 2016, through Dec. 31, 2017, according to the OIG. Based on review of the 100-claim sample, the OIG estimates that Virtua Our Lady of Lourdes received overpayments of at least $4.8 million for the audit period. The OIG provided several recommendations to the hospital, including that it refund Medicare $4.8 million, identify and return any additional overpayments, and strengthen its policies and procedures to ensure compliance with Medicare billing requirements. In comments attached to the draft report, the hospital disagreed with the OIG's findings and recommendations. Despite the hospital's objections, the OIG maintained its findings and recommendations. n

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