WK04: Advanced Billing Workshop

This session builds upon the foundational content presented last year, offering a more comprehensive examination of critical challenges within the intake, billing, collections, compliance, and audit processes. Attendees will gain insights into common operational pain points and receive actionable guidance for effectively addressing these issues. The presentation will feature interactive discussions and real-world case studies to enhance engagement and practical understanding.

Key Topics of Discussion

1. Intake Process

The session will underscore the importance of thorough insurance verification, including an in-depth discussion on CMS’s consolidation of billing across Skilled Nursing Facilities (SNF), Hospice, and Home Health (HH).
Strategies will be presented for obtaining essential documentation when initial records lack sufficient detail to support medical necessity.
Guidance will be provided on assembling a complete, billing-ready file, including accurate identification of the appropriate payment category for each product and a clear understanding of the corresponding billing requirements.

2. Billing and Collections

Emphasis will be placed on the creation of clean claims that align with payer-specific billing guidelines, including the correct use of modifiers, narratives, span dates, and other critical elements. The variability among payers will be addressed.
The session will explore best practices for achieving and maintaining a healthy accounts receivable, including key performance metrics and strategies for monitoring and responding to denial trends.

3. Compliance and Audit

A review of CMS Quality and Supplier Standards will be conducted, highlighting the most frequent violations and offering practical approaches to mitigate risk.
Attendees will gain an understanding of the various auditing entities and learn effective strategies for successfully navigating audit processes.
 

Subject matter experts will present essential performance metrics across each operational area, equipping suppliers with the tools to monitor organizational health and drive continuous improvement. Participants will leave the session informed, confident, and empowered to implement best practices within their respective organizations.