Interview with: Lloyd R. Vaughan,
Founder, VHC, Inc.
“Most hospitals have fairly good billing
practices and feel all their...
The marcus evans - Finance
Summits group delivers peer-to-
peer information on strategic
matters, professional trends and
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How Hospitals Can Identify Billing Gaps & Recover Lost Revenue - Lloyd R. Vaughan, VHC, Inc.

Lloyd R. Vaughan of VHC, Inc., a revenue cycle solution provider company attending the marcus evans National Healthcare CFO Summit Spring 2015, on improving billing processes. Interview with: Lloyd R. Vaughan, Founder, VHC, Inc.
Published on: Mar 3, 2016
Published in: Business      
Source: www.slideshare.net


Transcripts - How Hospitals Can Identify Billing Gaps & Recover Lost Revenue - Lloyd R. Vaughan, VHC, Inc.

  • 1. Interview with: Lloyd R. Vaughan, Founder, VHC, Inc. “Most hospitals have fairly good billing practices and feel all their bases are covered, but in reality there are gaps that cannot be readily discovered by hospital staff,” according to Lloyd R. Vaughan, Founder, VHC, Inc. “There is pressure to get bills out the door, but if hospitals identified and rectified billing errors, they could recover one to three percent additional revenue,” he adds. VHC, Inc. is a revenue cycle solution provider at the marcus evans National Healthcare CFO Summit Spring 2015, in Palm Beach, Florida, May 17-19. What revenue do hospitals lose due to errors? How could they be avoided? Most mistakes are due to billing errors. To maximize reimbursement, they need to look at the billing process and uncover the source of the errors. Some level of retrospective review is required to recapture lost revenue. How can hospitals better identify what has been lost due to billing or payment errors? They need to review payments received in comparison to what they should have received. They must look at the medical records, charge items, payment terms in contracts, and identify how much was actually lost due to billing or payment error. In some cases, it is a matter of codes getting lost in the edit process or errors in the hospital charge master. For example, pharmacy items that are set up with a multiplier of one, when the correct multiplier is ten. The next step is to submit an amended bill to get the claim processed again. Depending on the payer, this can be a simple process or may require extensive dialogue to explain the reasons for the mistake and negotiate a settlement. It requires specific skills to understand how to get a payer to follow through. What measures would actually help hospitals avoid future payment errors? There are a number of things they could do. One, a charge master review, making sure the codes are set up correctly, the correct multipliers are in place and all the other things that need to be there to generate a correct bill. Another is to review the claims edit process to make sure the correct edits are in place, they are up to date and that the procedures for dealing with them are sound. In our experience, much of the lost revenue is due to edits not being handled correctly when a bill is reviewed before it is sent to the payer. This often generates exceptions and requires manual intervention. If it is not done correctly, codes can be lost and therefore a payment understated. Can this issue be fixed in-house by hospital staff? In theory, there is no reason why it cannot be done. The problem is, hospital resources are typically limited. The number one priority is to get bills out the door, which does not leave much time to identify and fix errors. Hospital folks do not have the expertise or resources to complete the process. Any final words of advice? Every hospital organization should be open to the idea of an independent retrospective review of their billing, and allow someone from outside to look at processes and end results. If they are open to getting an objective review, gaps will be discovered and they will be able to improve their processes. Much of the lost revenue is due to edits not being handled correctly How Hospitals Can Identify Billing Gaps & Recover Lost Revenue
  • 2. The marcus evans - Finance Summits group delivers peer-to- peer information on strategic matters, professional trends and breakthrough innovations. Please note that the Summit is a closed business event and the number of participants strictly limited. About the National Healthcare CFO Summit Spring 2015 The 21st National Healthcare CFO Summit is the premium forum bringing senior level finance executives and solution providers together. The Summit offers an intimate environment for a focused discussion of key new drivers shaping the healthcare industry. Taking place at the Eau Palm Beach Resort & Spa, Palm Beach, Florida, May 17-19, 2015, the Summit includes presentations on navigating new regulation, supporting growth through collaboration, managing population health and achieving operational excellence. www.nhcfosummit.com About VHC, Inc. VHC, Inc. specializes in recovering lost revenue for hospitals. Since 1996 the company has done specialty audits of Medicare, Medicaid and contracted payers. VHC also provides revenue cycle consulting services, including coding audits, chargemaster reviews and Business Office cleanup projects. The company has approximately 250 hospital clients. www.vhci.net About marcus evans Summits marcus evans Summits are high level business forums for the world’s leading decision-makers to meet, learn and discuss strategies and solutions. Held at exclusive locations around the world, these events provide attendees with a unique opportunity to individually tailor their schedules of keynote presentations, case studies, roundtables and one-on-one business meetings. For more information, please visit: www.marcusevans.com Upcoming Events CFO Summit - www.cfosummits.com Long-Term Care & Senior Living CXO Summit - www.longtermcaresummit.com National Healthcare CXO Summit - www.nhcxosummit.com Tax Officers Summit - www.taxofficerssummit.com To view the web version of this interview, please click here: www.nhcfosummit.com/LloydRVaughan3 Contact Sarin Kouyoumdjian-Gurunlian, Press Manager, marcus evans, Summits Division Tel: + 357 22 849 313 Email: press@marcusevanscy.com For more information please send an email to press@marcusevanscy.com All rights reserved. The above content may be republished or reproduced. Kindly inform us by sending an email to press@marcusevanscy.com

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