Medical Necessity Best Practices to Reduce Outpatient Denials and Compliance Risks
Patient Access and Scheduling Director
Beth Israel Deaconess Hospital-Plymouth
Vice President of Product Management
Commercial payer and state Medicaid programs are moving to a combination of medical necessity and prior authorization requirements. How will reduced cash flow, compliance risks, and increased exposure for denied claims affect your provider organization?
During this webinar, revenue cycle experts discuss the importance of communication and physician education in the development of medical necessity and prior authorization protocols. Also, this webinar discusses the evolving importance of optimizing these complex processes and the role of the patient access department.
Beth Israel Deaconess-Plymouth—an affiliate of Beth Israel Deaconess Medical Center in Boston—shares how it designed and implemented a medical necessity solution to reduce exposure to denied claims, and provides lessons learned to help you avoid pitfalls and accelerate your organization's readiness and sustainable success.
After This Webinar You Will Be Able To:
- Understand the differences between medical necessity and prior authorization and their effects on ICD-10 and how each plays a part in reducing denials.
- Develop a better overview of the Advance Beneficiary Notice requirements and workflow.
- Apply the pros and cons of an integrated vs. non-integrated, single-payer vs. multi-payer, and centralized vs. decentralized options to determine the best solution for your organization.
- Define vendor selection criteria to streamline the request-for-proposal process and be confident in your choice.
- State the benefits of a medical necessity solution that will motivate the patient access department to adopt the solution.
- Use metrics for monitoring denials and providing feedback to keep other team members excited and engaged.
Tools & Takeaways
Assessment tool to help determine your facility's compliance risk and a medical necessity vendor selection criteria list
Directors and other professionals in the areas of patient access, patient registration and scheduling, revenue cycle, compliance, and patient accounts
Field of Study: Specialized Knowledge and Applications
Delivery Method: Group Internet
Level: Basic understanding of patient access and medical necessity process is recommended
Non Members: $99
Note: This on-demand webinar is available until June 3, 2015.