The IR-DRG course is a guide to understand the classification and dimensions of diagnostic homogenous groups, principles, components, assignment logic, calculation of the DRG’s
It also shows how the DRG’s impacts the patient Quality of care in standardizing medical data and accurately capturing the patient severity of illness, risk of mortality, resource weight, average length of stays, optimal maximal reimbursements for the hospitals and severity drivers along with case studies
The course will also make you understand how Clinical documentation improvement impacts the DRG’s and the case mix index (CMI) for the individual hospital
Course Objectives
Learn how to determine DRG weight
Eliminate reimbursement loopholes by accurate application of DRG
Get familiar with the various components of DRG and apply them in calculation
Understand the implication of CDI in determining right DRGs
Learning Outcomes
By the end of this course, you should be able to:
Know what are the Diagnostic Related Group, and understand the dimensions of IR- DRG classifications
Explain the definition of principal and secondary diagnosis in the context of coding guidelines
Recognize the Case Mix Index (CMI) and how it is impacted by the Clinical Documentation Improvement (CDI)
Manage the patient severity levels for the level of care provided in the context of clinical documentation and successfully know and apply the procedure hierarchy (CDI)
Learn from the examples of IR-DRG and CDI impact on severity of illness, risk of mortality, length of stay, resource weight and reimbursements
For the detailed Course Agenda, Download the brochure.
Knwbility’ s Denial Management for Specialties course offers a complete understanding of the rejection analysis, claims status checks, resolution of the denied claims, resubmission process. The core objective is to help collect all payments that are due for the medical billing services that have been delivered.
Terms such as claim denial and claim rejections are often used interchangeably by the healthcare billing personnel as both may be considered part of the denial management processes. Rejected claims will not be processed as they have not been received/accepted by the payor, therefore, these claims do not make it into the adjudication system. This simply means that a rejected claim must be submitted when the errors have been corrected. Occasionally; this leads to the reduction in cash-flows.
This course helps the learner identify and understand the difference between denials and rejections.
This course will benefit
Billing associates
RCM administrators, Managers
Medical Auditors, CDI Specialists
Physicians and other allied health personnel
Coders
Learning Objectives
Module 1 Denial Management - Introductory Module
By the end of this module; you will be able to:
Identify when to raise a physician query before encountering a denial
Recognize methods of compliance to support the denial management process
Become aware of the insurance/ payer guidelines to avoid denials
Reduce the claims rejection encounters by the facilities
Discover ways to improve the coding and billing process leading to improved Revenue Cycle Management (RCM)
Module 2 Denial Management - Specialty
By the end of this module; you will be able to:
Interpret clinical scenarios to accurately assign codes to specialty cases
Recognize the opportunities to identify and correct the issues that cause the claims to be denied by the insurance company
Classify denials by reason, source, cause and other distinguishing factors
Develop and assess effective denial management strategies
Accurately apply ICD-10-CM / CPT guidelines and other applicable diagnosis/procedures codes to outpatient case scenarios
Validate the accuracy of the physician-assigned codes and check if all the guidelines were applied in the code selection process to avoid the denials
Knwbility’s CPT Updates 2018 & It’s Impact On Billing is a listing of descriptive terms and identifying changes in the CPT codes for the medical and diagnostic services performed by physicians. The purpose of the code set is to provide a uniform language. This will help to accurately describe the medical, surgical, and diagnostic services and will thereby provide effective methods for reliable nationwide communication amongst the physicians, patients, and the third parties.
This course will take you through the basic understanding of CPT changes in each section of the CPT. It also highlights the difference in the number of codes from 2012 to 2018 (section wise).
For example, Integumentary and Musculoskeletal has total codes of 2,058 in 2012 and 2,048 in 2018. Total CPT changes from 2012 to 2018 is 132 including the new, revised, or the deleted codes.
This course will benefit
Medical coders
RCM managers and administrators
Medical auditors
Physicians and other allied health personnel
Billing managers
Learning Objectives
By the end of this course; you will be able to:
Be aware of the CPT changes that have occurred from 2012-2018
Apply the code changes related to a particular section or sub-section of CPT with confidence
Make more informed coding decisions in the new UAE healthcare environment
