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Reprinted with permission from Training Resource: Recognize Fraud and Abuse, in The Receivables Report, Vol.14, No. 10, p.7, Copyright 1999, Aspen Publishers, Inc.

TRAINING RESOURCE: RECOGNIZE FRAUD AND ABUSE

Patient accounting managers looking for resources on compliance planning may wish to check out a new product designed to help them understand as well as educate staff about fraud and abuse issues. A three-part, five-hour videotape series entitled Compliance and Awareness: Safeguarding Healthcare’s Cash Flow Cycle from Fraud and Abuse is produced by DeKaye Consulting in Oceanside, New York.

Allan P. DeKaye, MBA, FHFMA, a longtime health care consultant, and Gregory J. Naclerio, health law partner in the firm Ruskin, Moscou, Evans & Faltischek, P.C. offer information on topics such as understanding EMTALA, the importance of documentation, and the most common errors and types of fraud, among others. The series is videotaped at a New Jersey hospital during a seminar given by DeKaye and Naclerio.

The national perspective

The first tape covers the overall reasons why It has become necessary for health care providers to have compliance programs. Naclerio explains what constitutes fraud as well as why it is crucial for employees to understand why compliance is so important.

Targeting fraud and abuse

In section two of the program, DeKaye discusses such topics as preparing for audits and how hospitals can use their own data to build a defense against fraud. The hospital bill is a logical first place for business office employees to learn to identify problems. "We have to be alert in the midst of our regular routine, everything else we do, "he says. "If you see something wrong with a bill or you think you spot a pattern of problems, tell your supervisor." The compliance program sets up a chain of command for such reporting.

Identification and prevention

Videotape number three features DeKaye focusing on "cash flow cycle" issues. "Cash flow cycle department supervisors and staff must address the following potential problems, including duplicate billing, late charges/lost charges, edit reports/denials/audits, patient classification (inpatient vs. outpatient), and billing for discharged vs. transferred patients.

In the past, Medicare was the primary payer for most seniors. However, the Medicare Secondary Payer (MSP) regulations reverse this order, he notes. It recognizes that 1) as senior citizens work longer, they may still be covered by other insurance; 2) costs are shifted to other payers, which saves the federal government money; 3) providers need to identify these MSP conditions to avoid improper billing.

Ordering information

If you are looking for a way to educate staff regarding these issues without spending thousands of dollars to hire consultants and/or send dozens of people to training sessions, these videotapes should serve your purposes. The series costs $425.00 plus $20.00 shipping and handling per set. The price includes the three tapes and an accompanying workbook that contains the program slides referred to in the videotapes. Additional workbooks are available at $25.00 per book plus shipping.

For more information, contact DeKaye Consulting, Inc. at 231 Oakview Avenue, Oceanside, NY 11572; 516/678-2754.

E-mail: adkcmpa@aol.com. See DeKaye’s website: http://www.dekaye.com  

Browse Aspen’s Internet site for more information resources, directories, articles and a searchable version of Aspen’s full catalog, including the most recent publications: http://www.Aspenpublishers.com.

Video Tape Review

Reprinted with permission from Receivables Report, Gene Lass (Editor),12:6, pp.8-9, 1997, Aspen Publishers, Inc.

Staff Training at Your Convenience

From basics to fine tuning, video series covers the bases

"Emphasis on Education" - is a series of three instructional videotapes from DeKaye Consulting that essentially lets you hold an in-house staff training session whenever you like. Each videotape is accompanied by a workbook listing the points and tips covered in the video. Each video is actually a recorded training session held by Allan DeKaye for a hospital staff. The staff asks questions which are answered by DeKaye, and he also asks for their input on different issues. This makes the viewer actually feel part of the session at times, and the camera angle often makes you feel as if you're sitting in a chair at the other end of the table.

The first video, called Course 101: Patient Financial Services 2000, covers the more basic elements of collection and billing, such as collecting at time of service and electronic billing and collection. This course and the corresponding workbook would be good for training new biller and collectors, and it would provide an excellent refresher for more experienced employees. The general areas this tape covers include:

A. Strategies to improve admitting, billing and collection

B. How to get collect patient data

C. How to make an area conducive to payment at time of service

  1. Produce a bill or a billing estimate at time of service
  2. Educate patients and staff about the facility's financial policy

D. Improving patient satisfaction

  1. Phrases to use and avoid in patient relations

E. Competition within the business office

F. Adjusting your financial policy to meet managed care contract terms

G. Helping patients understand the terms of their managed care contracts

H. The benefits of patient loyalty

  1. 1. Satisfied patients usually pay their bills
  2. 2. Poor customer service is the primary cause of losing patient to rival facilities

I. Overcoming objections to payment

J. Offering alternative methods of payment.

K. The benefits of electronic data transaction

 

Learning About Managed Care

The second video takes a similar approach to a different subject. Course 102: Understanding the Managed Care Environment, analyzes managed care from the basics of what it is to how it affects your facility and what you can do to make managed care work for you. This course would benefit a facility that's about to become part of a managed care market as well as a facility that wants to operate better under managed care guidelines. Covered topics include:

A. How managed care has spread across the country

B. The impact of managed care on the health care industry

C. The impact of managed care on patients, and their reaction to it

D. National and regional reactions to managed care

E. Why hospitals and physician practices are merging and consolidating

F. How managed care affects admitting and other business office functions

G. How pre-certification and prior approval influences registration procedures

H. How to collect increasing deductibles and co-payments

I. Maintaining customer satisfaction in a managed care environment

J. How managed care affects financial policy and cash flow

K. Improving the exchange of data between physicians and hospitals.

 

The accompanying workbook also includes a glossary of terms which would be useful for those just learning about managed care.

 

The Final Course

The third tape in the series, entitled Course 103: Performing Our Roles as Professionals has the most information for experienced staff members, when compared to the other two tapes. The format of this tape differs slightly, as DeKaye begins by addressing tips and issues with the assembled hospital staff, then leads in to role playing exercises where staff take on the roles of patient and provider to determine how to best handle a situation. The tips in this course are good, but the most value can be gleaned from the role playing sessions, which employees at nearly any facility should be able to identify with.

Points covered include:

A. Improving self-confidence in patient situations

B. Understanding policy and procedure

C. Learning how to ask for payment from patients more effectively

D. Preparing yourself for the patient interview

  1. Reviewing paperwork
  2. Determine if patient has any open account balances or if there are any insurance inquiries or rejections on file

E. Learning to use your computer system and patient financial history effectively

F. Why account notes are important

G. Sources of verification for patient demographic and financial data

H. Demonstrating good interviewer attitude

  1. Be courteous, attentive, cooperative, attentive and concerned

I. Re-working policy and procedures around how managed care affects your operations

 

Summary

The price of the tape series ($119.00 for one tape, two tapes for $225.00 and all three for $325.00) is reasonable, given the amount of information in each course. It would cost more to bring in an in-house training consultant for a day once than it costs to buy a tape which can be shown to any number of employees again and again. The series isn't Hollywood quality. There are no effects by Industrial Light and Magic, and sometimes it's hard to hear the questions asked by the on-screen staff, though DeKaye always comes in clearly. But the series doesn't need Dolby stereo sound. It needs information you and your staff can use, which it has.

For more information concerning Receivables Report, contact Gene Lass at gene.lass@aspenpubl.com

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231 Oakview Avenue, Oceanside, NY 11572  Phone: (516) 678-2754   Fax: (516) 825-4458
URL: http://www.dekaye.com E-Mail: Adkcmpa@aol.com or DKConsult1@aol.com