Avoiding Healthcare Service Reimbursement Gaps ...
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Avoiding Healthcare Service Reimbursement Gaps - Lloyd R. Vaughan, Vaughan Holland Consulting, Inc.

Lloyd R. Vaughan of Vaughan Holland Consulting, Inc., a solution provider company attending the marcus evans National Healthcare CFO Summit Fall 2012, on maximizing reimbursement in healthcare. Interview with: Lloyd R. Vaughan, Founder, Vaughan Holland Consulting, Inc.
Published on: Mar 3, 2016
Published in: Business      

Transcripts - Avoiding Healthcare Service Reimbursement Gaps - Lloyd R. Vaughan, Vaughan Holland Consulting, Inc.

  • 1. Avoiding Healthcare Service Reimbursement Gaps Medicare intermediaries that process much Medicare and other payers bills are also becoming more difficult to actually pay for them. In some cases, work with. We help hospitals submit reimbursement may be too little corrected bills and are constantly facing compared to the time and effort that road blocks, of intermediaries making us would need to go into it. Hospitals may submit paper documents that pretty need to re-evaluate some of their much disappeared 15 or 20 years ago. services. Outsourcing certain services or collaborating with other organizations How could hospitals avoid might be better. reimbursement errors from the start? It is hard for any hospital, no matter how big or sophisticated, to provide Healthcare CFOs need to be more every service in a way that is costInterview with: Lloyd R. Vaughan, vigilant with what types of patients are effective, so CFOs have to be more openFounder, Vaughan Holland admitted as inpatients. RACs are minded about the alternatives.Consulting, Inc. challenging many inpatient claims, saying that they could have been done Any final thoughts? on an outpatient basis. There areHealthcare Chief Financial Officers specific guidelines to determine who CFOs cannot do much about the rates(CFOs) cannot do much about the should be admitted as an inpatient, with that Medicare has set, but they canreimbursement rates that Medicare has some level of judgment involved, but it make sure their organization is paid forset, but they can make sure their takes experienced case managers to all services provided. That requiresorganization is paid for all services guide patients to the right setting. If someone to come in and take a look atprovided, says Lloyd R. Vaughan, this is done right on the front end, it the claims, and make sure they are paidFounder, Vaughan Holland would help hospitals avoid disputes with for everything.Consulting, Inc. Medicare.From a solution provider company at Secondly, when RACs take money back,the upcoming marcus evans National hospitals are allowed to appeal. SomeHealthcare CFO Summit Fall 2012, hospitals are challenging every singlein Dallas, Texas, October 21-23, case, while others are not. I think they Healthcare CFOsVaughan discusses how to maximize should challenge all of themreimbursement for healthcare aggressively and put RACs on notice, so need to beservices through better billing practices. if they do submit adjustments, they make sure to be right about them. more vigilantHow has the reimbursementenvironment changed in recent Should certain services or types of with whatmonths? patients be prioritized to maximize reimbursement? How can they types of patientsRecovery Audit Contractors (RACs) are avoid services falling through theplacing a lot more emphasis on finding reimbursement gap? are admittedoverbilling and taking money back fromhospitals, causing a lot of consternation First, they need to know what their as inpatientsand demanding a lot of time from services cost and have a good costhospital folks to come up with the accounting system. In order to knowrequested records and to challenge take what to charge and how muchbacks. This is definitely a strong trend reimbursement to pursue, they mustthat has picked up in the last year. know what the services cost and how
  • 2. About the National Healthcare CFO Summit Fall 2012 The marcus evans Summits This unique forum will take place at The Westin Stonebriar, Dallas, Texas, October groups deliver peer-to-peer 21-23, 2012. Offering much more than any conference, exhibition or trade show, information on strategic matters, this exclusive meeting will bring together esteemed industry thought leaders and professional trends and solution providers to a highly focused and interactive networking event. The breakthrough innovations. Summit includes presentations on increasing efficiency in an era of accountable care, growth strategies for today’s market, healthcare reforms and reinvigorating revenue cycle performance. www.healthcare-summit.com Please note that the Summit is a closed business event and the Contact number of participants strictly limited. 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 info@marcusevanscy.com All rights reserved. The above content may be republished or reproduced. Kindly inform us by sending an email to press@marcusevanscy.comAbout Vaughan Holland Consulting, Inc.Vaughan Holland Consulting, Inc. specializes in recovering lost revenue for hospitals. Since 1996 the company has done specialtyaudits of Medicare, Medicaid and contracted payers. The company has approximately 200 hospital clients.www.vhci.netAbout marcus evans Summitsmarcus evans Summits are high level business forums for the world’s leading decision-makers to meet, learn and discussstrategies and solutions. Held at exclusive locations around the world, these events provide attendees with a unique opportunity toindividually tailor their schedules of keynote presentations, think tanks, seminars and one-on-one business meetings.For more information, please visit: www.marcusevans.comUpcoming EventsLong-Term Care CXO Summit - www.longtermcaresummit.comNational Healthcare CNO Summit - www.healthcare-summit.comNational Healthcare CXO Summit - www.healthcare-summit.comTo view the web version, please click here: www.healthcare-summit.com/LloydRVaughan2

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