Business Improvement

Below is a list of our continuing education services for business improvement.

Fees for continuing education will be based a number of factors. Most classes will have a set rate per student but will fluctuate depending on client need/depth of training. For example, if you request training to be performed on site, the fee for travel and incidentals would then be included. 

Please email info@gptchb.org or call 605.721.1922 for more details.

And here is the AAPC Billing and Coding Application.

Basic Billing 101

This class will be helpful from the new employee to the existing leadership. Learning basic billing will provide you with the basic understanding of the billing process and each step along the way. This class is not intended to overwhelm the learner with complex regulations but, rather, show how the process works. By doing this, the learner can start thinking of their place in the chain of events and find ways that they can make it more efficient/effective in their current role. 

Topics include:

  • Patient Registration/Front Desk
  • Understanding different types of insurance plans
  • The importance of accurate coding
  • Billing compliance issues
  • How to read a EOB (Explanation of Benefits), RA (Remittance Advice), etc
  • Denial review and resubmission
  • Overview of Revenue Cycle

Basic Coding (Certification)

Understanding coding fundamentals will help you understand the importance of thorough documentation and accurate application of codes. This course is geared towards billing staff supporting the certified coder or those actively working in accounts receivable/collections to give them an understanding of how codes affect revenue. Additionally, the knowledge of anatomy, physiology and medical terminology is necessary to correctly code provider/facility services and patient diagnoses, which is an essential part of accounts receivables and collections. This course will present the coding process in easily understandable terms and help decipher complicated codes into usable information. 

Topics include:

  • Basic Anatomy
  • Basic Physiology
  • Medical Terminology
  • Knowledge of HCPCS, Diagnosis and Procedural codes
  • LCD (Local Coverage Determination) and NCD (National Coverage Determination)
  • Basic coding concepts and guidelines
  • Introduction to ICD-10

ICD-10 Readiness

ICD-10 is the impending update to ICD-9 in which ALL providers will need to be in compliance by October 2015. We will help you understand what this means for your facility, practitioners and billing staff, and then help you put an implementation plan in place so that you are ready when the deadline comes. All those involved in the billing process should attend, including IT staff, administration and decision-makers. The implementation will require software and hardware upgrades in order to facilitate the changes in coding formats. 

Topics include:

  • Introduction to ICD-10
  • Outline the difference between ICD-9 and ICD-10
  • Cross-walk assistance
  • Readiness Assessment tools
  • Implementation map

CPC Credentialing

Each facility should have, at minimum, one Certified Professional Coder (CPC) on site. Certified coders are able to identify areas that can increase revenue, decrease chances of CMS audits and assist physicians with coding compliance. This is a 21 module course that we will help facilitate so that each student is ready to take the American Academy of Professional Coders (AAPC) 6 hour certification test. At the end of the class the student will have the necessary tools to successfully take the certification test. A practice test is given prior to final exam to assure that the student is ready and point out the areas that the student needs to work on. 

Includes:

  • 21 modules (Anatomy, ICD-9 applications and guidelines,CPT, HCPCS Level IIand modifiers, Review of all systems,Anesthesia, Radiology, Pathology and Lab, E & M Services)
  • Chapter reviews
  • Chapter tests, to monitor progress and recommend study areas
  • Study Sessions
  • One-on-one trainingand support
  • Practice Exam

HIPAA Privacy Training

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandates increased privacy and security for patients’ records and data, thus increasing the need for qualified staff. HIPAA rules are voluminous and have changed dramatically since its original inception, therefore, increasing the need to continue training. Anyone working in the healthcare field or involved in patient care should know the law, protecting your organization from potential liability and/or fines. We can assist you by teaching you specific areas of interest to the “HIPAA Police” and provide the information necessary to assure compliance within your office or area of practice. 

Study areas:

  • Business Associate
  • PHI
  • EHR
  • Identifying breach
  • Omnibus Final Rule
  • Identify Risks
  • Potential fines

Federal Medical Care Recovery Act (FMCRA)

IA FMCRA claim exists when a patient’s injury is due to another person deemed to be at fault such as: motor vehicle accidents, animal bites, electrical shocks and falls, for example. This course will familiarize the student with what the FMCRA requirements are and show them the importance of gathering accurate patient information. Latest numbers show that Great Plains Area IHS received approximately $206,000 from FMCRA efforts last year. Only nine facilities reported receiving FMCRA funds from third­ parties. Did your facility get FMCRA reimbursements? Could it have received more? Let us help you get the funds you deserve from third-party payers, thus removing the burden of these payments from Purchased/ Referred Care (formerly Contract Health Service or CHS). 

Topics include:

  • History of FMCRA
  • FMCRA and IHS
  • The importance of working with outside facilities
  • Identifying pertinent team members
  • How to file FMCRA claims

Purchased and Referred Care (PRC; formerly Contract Health Services or CHS)

Purchased/Referred Care, formerly known at Contract Health Services or CHS, is the process in which referrals for care need to be made to outside providers for services that are not performed or available at the local IHS facility. Those interested in learning more about this process will include any employee that has contact with patients and/or patient care and outside facilities that take care of our patients. By learning how the process works, the user will be better able to facilitate referrals and work with PRC staff. This is also an important area of study for Patient Benefit Coordinators or Eligibility Coordinators, as well as outside entities working directly with patients. 

Study areas:

  • C.F.R.(Code of Federal Regulations) affecting operations
  • PRC requirements for patients
  • Eligibility Requirements
  • Notification Requirements
  • Priorities of Care
  • Alternate Resources and requirements
  • Patient advocacy
  • PRC revenue problem areas
  • Patient’s Rights and Responsibilities
  • Medicare-Like Rates information

Cultural Relevancy

Led by our Mission: 

“The mission of GPTCHB is to provide quality public health support and healthcare advocacy to the tribal nations of the Great Plains by utilizing effective and culturally credible approaches.” 

As well as our Vision: 

“All tribal nations in the Great Plains will achieve optimum health and wellness through the embrace of culturally traditional values that are empowered by tribal sovereignty.” 

We believe it is important for outside entities that are unfamiliar with our culture and struggle with relationship building learn ways to communicate more effectively with an increased understanding of our way of life. This is of significant importance with delicate matters such as IHS, policy and patient care.

Auditing

The objective of auditing is to provide efficient and quality care and to improve the financial position of your facility. Audits are necessary to determine areas that require improvements and corrections. It entails conducting internal or external review of coding accuracy and policies and procedures to ensure you are running an efficient and hopefully liability-free operation. Auditing services are provided in your facility and require the cooperation of staff and administration. 

**Auditing fees will be assessed on a per hour basis and a fee proposal will be submitted prior to implementation of services.

Coding Auditing

Assuring coding compliance in this transitional period is especially important due to the complexity of the impending ICD-10 conversion. A chart audit will provide you with a risk assessment tool to measure accuracy and compliance as well as coding errors that can not only be costly to your bottom line, but can cause huge fines and penalties if not corrected. Bundling and unbundling of services will be identified.

Charting

Quality health care delivery is based on accurate, timely and complete clinical documentation in the medical record. With a chart audit, you can improve the clinical documentation by providing accurate and helpful feedback to avoid penalties and fines.

Current Revenue Cycle Assessment

The revenue cycle begins at the time the patient walks in the door. There is a need to acquire current patient data including address, insurance etc., in order for the whole process to work correctly. 

If you fear that your system may not be in compliance, we can help. Using auditing tools specific to gauge billing compliance, a report will be made to decision makers- which will allow them to better judge their current process’ and make needed adjustments. By building sustainability, your facility will see an increase in revenue that can be used to increase patient services and employee morale. These audits can also protect you from and detect fraudulent claims and billing activity.

Third-Party Billing

GPTCHB can assist you with third-party billing training, assessments or complete the process for you. Whether you are short staffed and need temporary assistance or need full services, we can help. Our goal is help your office efficiently generate the best profit possible.

Accounts Receivable (A/R)

Do you need help understanding those lengthy reports or identifying problem areas? We can not only help you understand these important documents, but also help you identify how the process can work more effectively. Our goal is assist you get your collections down and continue turning them around at the fastest rate possible. 

Our staff specializes in revenue recovery and can assist you in capturing lost revenue, including third party payer collections.

Custom Business Consulting

We are able to personalize a service specific to your needs. After working with you and listening to your areas of specific concern, we can assess the problem area and make recommendations based on findings. Our staff will travel onsite to make an assessment, create a report and generate efficient solutions to help you attain best practices. We can establish forms such as: registrations and encounter forms, referrals, or assist with patient educational material.

Last modified: Friday, 28 October 2016, 10:05 AM