Understand the rules and policy, while mitigating common misunderstandings surrounding the billing for incident-to and split-shared services.

Hospitals live and die on data. Everything has to be measured, and every measure has to be compared to a benchmark. But data and benchmarks that are flawed and inaccurate can create a world of trouble for hospitals. Inaccurate data can lead hospitals to inadvertently set unrealistic targets which, in turn, has the potential to pressure staff to go outside the boundaries of compliant practices, leading to increased risks of audits or action by government enforcement agencies. Flawed data can even lead to poor patient outcomes.

But producing accurate and meaningful data requires an understanding of relevant measures, how the data is calculated, and how data could be misinterpreted.

During this essential session, Dr. Ronald Hirsch will analyze the most common key performance indicators (KPIs) used in case management and utilization review in order to calculate observation rates, length of stay (LOS), and case mix index (CMI). Dr. Hirsch will also explain how data should be calculated and describe and how the miscalculation of data can lead to false assumptions and unintended consequences. From this discussion, you will receive guidance from Dr. Hirsch on the proper measurement and benchmarking to ensure that your hospital is not only efficient but also compliant.

Why This is Relevant:-

Hospital C-suite executives are fixated on measuring everything. But inaccurate and flawed measurements can lead hospitals to set unrealistic targets, which may result in pressuring staff to go outside the boundaries of compliant practices to order to attain those targets. Such action could lead to increased audit risks or potential action by government enforcement agencies.

Learning Objectives:-

• Understand the KPIs used in utilization review and case management
• Become familiar with current measurement techniques
• Describe faults in current methods
• Predict the downstream effects of improper measures
• Learn how to develop more accurate measurement methods

Who Should Attend:-

Those professionals that are responsible for professional billing, including medical auditors, coders, and billers, and compliance, audit and appeal managers, and those employed by hospitals who bill for physician services billed by hospitals.