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ANI: The Healthcare Finance Conference 2010

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HIPAA 278 Strategies for Administrative Simplification

Track : Managed Care/Payment/Reimbursement

Program Code: F10

Date: Wednesday , June 23, 2010

Time: 1:45 PM to 3:00 PM EST

Location: Venetian E

CO-PRESENTER (S):

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Richard (Chip) Davis, Vice President for Innovation and Patient Safety, Johns Hopkins Medicine

Richard Davis, Ph.D., Johns Hopkins Medicines Vice President for Innovation and Patient Safety, directs the institutions system-wide effort to improve the quality, efficiency, and safety of patient care. Dr. Davis and his team continuously collect data, analyze Johns Hopkins health care processes, and redesign systems so that they are more streamlined, effective and error-free. Dr. Davis also serves as Executive Director for the Johns Hopkins Medicine Center of Innovation in Quality Patient Care and Johns Hopkins Hospital Systems East Baltimore Ambulatory Operations. A faculty member of the Johns Hopkins Bloomberg School of Public Healths division of Health Policy and Management and the Johns Hopkins Carey Business Schools Business of Medicine program, Dr. Davis has taught graduate-level courses on leadership, organizational behavior, and quality in medical settings for more than a decade. He also regularly consults on leadership, quality, efficiency, cost control, patient safety, and other related issues for public and private health systems nationally and internationally. As Executive Director of the Center of Innovation in Quality Patient Care, which was created in 2002, Dr. Davis oversees a multidisciplinary staff to lead initiatives that facilitate innovative, patient-centered approaches to make Johns Hopkins the safest place to receive patient care. The Center corrects system flaws and directs organizational change by providing faculty, staff and students with training in Lean Sigma and Teamwork and Communication and by weaving healthcare quality and safety in the medical curriculum. Supporting a grass roots model of improvement, the Center helps coordinate the efforts of interdisciplinary teams of physicians, nurses, and managers throughout the Johns Hopkins Medical Institutions to ensure that evidence-based best practices are deployed throughout the system. The Centers approach is to systematically foster a culture rooted in safety by creating an expectation that safety is a priority In addition to supporting Johns Hopkins patient safety efforts, the Center has worked with numerous hospitals and healthcare delivery systems both in the United States and internationally to advance institutional and governmental leadership on how best to create adaptive and innovative delivery systems that address patient and provider needs.

Jeffrey Troutman, Executive Director & Senior Vice President, PNC Healthcare, PNC Bank N.A.

David Harris, Partner, PricewaterhouseCoopers LLP

David Harris is a Partner with the Healthcare Industries Advisory practice in PricewaterhouseCoopers' New York office. He has over twenty years industry experience in the health care and information systems field. David is the lead Partner for PwCs medical banking practice and specializes in payer, hospital and physician revenue cycle operations improvement, operation turnarounds/workouts, process redesign and business office integration, as well as denial management. He is involved with thought leadership, products and services for PwCs consumer directed healthcare (CDH) offering with in-depth knowledge of patient access, clinical documentation, health information management, inpatient and ambulatory coding, billing, claim adjudication, collections, A/R management and information systems. Most recently, David has consulted with several national banks on their healthcare strategies - focusing on bringing Health Savings Accounts (HSAs) to market and/or expanding beyond HSAs into the revenue cycle. He also leads Medical Banking Project's (MBProject.org) HSA Work Group as part of CDH. David Harris is a Partner with the Healthcare Industries Advisory practice in PricewaterhouseCoopers' New York office. He has over twenty years industry experience in the health care and information systems field. David is the lead Partner for PwCs medical banking practice and specializes in payer, hospital and physician revenue cycle operations improvement, operation turnarounds/workouts, process redesign and business office integration, as well as denial management. He is involved with thought leadership, products and services for PwCs consumer directed healthcare (CDH) offering with in-depth knowledge of patient access, clinical documentation, health information management, inpatient and ambulatory coding, billing, claim adjudication, collections, A/R management and information systems. Most recently, David has consulted several national banks on their healthcare strategiesfocusing on bringing Health Savings Accounts (HSAs) to market and/or expanding beyond HSAs into the revenue cycle. He also leads Medical Banking Projects (MBProject.org) HSA Work Group as part of CDH. Prior to becoming a consultant, David worked for IBM and Electronic Data Systems (EDS) where he assisted in the design, testing and implementation the first national claims processing system dubbed GMCS, which later became the NASCO system.

SPEAKER (S):

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Jeffrey Troutman, Executive Director & Senior Vice President, PNC Healthcare, PNC Bank N.A.

David Harris, Partner, PricewaterhouseCoopers LLP

SUBMITTER :

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Jeffrey Troutman, Executive Director & Senior Vice President, PNC Healthcare, PNC Bank N.A.

Description

Unlike its HIPAA transaction set partners, the 278 precertification transaction is not yet widely used between payers and providers. Johns Hopkins Medicine, PNC Healthcare and PriceWaterhouseCoopers worked together on a pilot project to implement automated preauthorizations for Hopkins outpatient services. Since the HealthCare Service Review Information (278) transaction was not currently used at Johns Hopkins, the project examined automating manual processes that were transacted between Johns Hopkins Hospital (provider) and Johns Hopkins HealthCare (payer). Improved accuracy and automation in the up-front authorization process could reduce the amount of remittance no authorization denials that are identified in the back office receivables process, as well as deliver other identified benefits to both the payer and provider. The project was designed to create a solution in a pilot situation which would then be scalable and usable for additional services as well as other payers. The speakers will cover the following content: Outline the scope of the pilot and the decision criteria for areas and services that would be included in the pilot; Identify the areas of the provider and payer impacted by the pilot; Review mapping processes for each impacted area reflecting activities before and after implementation; Outline other project steps including technical requirements determination, system impacts, and development of scenarios for testing; Identify and track the metrics needed to measure benefits projected and realized; Recap project challenges met; Share the future vision and next steps to continue the path to administrative simplification

Learning Objectives:

Categorize the provider and payer steps to automate work flow as part of a HIPAA 278 project
Determine whether similar projects could benefit your organization
Identify areas of potential cost reductions and other improvements by implementing the HIPAA 278 authorization request transaction, based on a Johns Hopkins Medicine pilot project
Measure effect of enhanced administrative simplication

Audio Synchronized to PowerPoint

(Code: F10M/F10)

Member:$29 USD

Non-Member $39 USD - Your Price

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(Code: F10)

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