Parker Indian Health Services
Situation
Parker Indian Health Services hospital was not certain they were adhering to regulatory compliance in their clinical and billing processes in accordance with Medicare. The impact on a critical access hospital of practices related to these areas is tremendous. If coding is not performed correctly, overall revenue will be affected, regulatory compliance risk increases, management information may be inaccurate, and poor business decisions may result. Wipfli assists health care organizations to ensure that their billing and coding are accurate and that revenue and compliance processes are efficient and effective.
Strategy
With Wipfli’s ability to provide critical access hospital swing-bed unit clinical, operational, and financial training services, we promptly assessed the situation and recommended two on-site days of clinical and coding compliance education:
- Review of regulatory compliance processes and comprehensive clinical training
- Proper completion of the UB-04 for swing-bed services, including in-depth information on coding and completion of key UB-04 fields
- Frequency of billing
- Consolidated billing/billing exclusions
- Notices of noncoverage
- Part A demand bills
- Medical review by the fiscal intermediary
- Coding for continuing-stay residents
- Submitting no-pay bills
Benefits
Hands-on education and consulting resulted in enhanced reimbursement, ensuring regulatory compliance, improved clinical processes, and increased cost efficiency. With the appropriate clinical and billing tools, procedural knowledge, and timely and accurate financial information, Parker Indian Health Services was given the ability to operate their swing-bed status more efficiently and more profitably.
