Articles

As experts and thought leaders in the healthcare arena, Coker Group associates frequently write articles to help our readers better understand and navigate through the industry’s foremost issues. Below are a few of our recent articles, several of which appeared in the industry’s top publications.

Rolling the dice: Gambling with improper documentation and billing practices
By Deborah Hill, MBA, CMPE, CPC, CHC, Compliance Today

The July 2017 issue of HCCA’s Compliance Today published an article written by Coker Senior Manager, Deborah Hill. The article addresses the following key takeaways.

  • Some internal processes may enhance revenue but increase risk.
  • Various documentation elements can expose your practice to compliance risk.
  • The documentation process imposes imposes limits on use of support staff.
  • Coding outliers in your organization can be identified.
  • Baseline and regular random reviews are critical to maintaining compliance.

Read the full article here.

Surviving Value-Based Healthcare with Revenue Integrity
By Annette Sullivan, RHIA, Compliance Today

The June 2017 issue of HCCA’s Compliance Today published an article written by Coker Senior Manager, Annette Sullivan. The article addresses the following key takeaways.

  • The impact of revenue integrity on value-based healthcare is often overlooked.
  • Revenue integrity must be a formal, centralized process that is constant and inclusive of all departments and individuals that affect the revenue cycle.
  • The integrity of your data in 2017 will determine the payments you receive and the penalties you incur in 2019.
  • Track and trend issues, determine the root causes, and implement solutions to improve efficiencies.
  • Develop an audit plan to reduce day in AR and mitigate risks of claims denials.

Read the full article here.

Data-Driven Solutions, Set in Motion
Outpatient Outcomes – 2017 Issue 6, Interviewed Phil Meyer, Consultant with Coker Group

Outpatient Outcomes 2017 issue 6 was published in May 2017. This issue included an article on Data-Driven Solutions in which Coker Consultant, Phil Meyer, was interviewed regarding initiatives at South Shore Ambulatory Surgery Center where he is functioning as the chief operating officer.

Read the full article here. Used with permission by Medline and Phil Meyer.

Transaction Strategies and Long-Term Value Creation: Do Deals Automatically Result in Success for Health Care Organizations?
By Mark Reiboldt, Senior Vice President, published in AHLA’s 2017 Health Care Transactions Resource Guide

AHLA published their 2017 Health Care Transactions Resource Guide in April 2017 for distribution at the Health Care Transactions Conference. This resource guide included an article written by Mark Reiboldt, Senior Vice President of Coker Group. This article discuss the importance of long-term value creation in today’s health care environment. It goes on to review transaction strategies and evaluate trends from deals that have taken place in the current market landscape.

Read the full article here.

Clinical Integration: What Hospital Board Members Need to Know
By Ellis “Mac” Knight, MD, MBA, Governance Institute E-Briefing

The Governance Institute’s March 2017 E-Briefing – Volume 14, No. 2 published an article written by Coker’s Senior Vice President/CMO, Dr. Ellis “Mac” Knight. Clinical integration is a key ingredient as providers attempt to re-tool care processes and procedures to operate successfully in a reimbursement environment moving towards value-based payments. This article looks at organizing providers around value-based care delivery and the key components of a clinically integrated network.

Read the full article here.

The uncertainty of the implied certification theory
By Daniel Kiehl, JD, LLM, Compliance Today

The March 2017 issue of HCCA’s Compliance Today published an article written by Coker Associate Consultant, Daniel Kiehl. The article addresses the following:

  • The False Claims Act prohibits submitting false or fraudulent claims to the government.
  • The Supreme Court in Escobar did not define what it determines to be a material misrepresentation.
  • The appellate court circuits were split in regards to the scope of the implied certification theory.
  • Escobar does not consider whether the misrepresentation involves a condition of payment.
  • The False Claims Act provides for triple damages for violations.

Read the full article here.

Aligning Physician Compensation in a Value-based World
By Keith L. Martin, Physician Practice

On October 28, 2016, Physician Practice spoke with Justin Chamblee, CPA, Senior Vice President and Jon Morris, JD, MBA, Manager at Coker Group about compensation changes and how practices can move forward “with minimal impact to physicians and daily operations.” Below is the beginning of this discussion. For the full article click here.

Employed Physician Network Turnaround
By Jeff Gorke, MBA

Coker Group’s article, Employed Physician Network Turnaround: A Roadmap to Financial Success, was recently featured in AHLA’s 2015 Healthcare Transactions Resource Guide and appeared as the resource guide’s headlined article in AHLA’s newsletter. Take a look at the article for valuable, tested advice on how to successfully integrate an EPN into a health system’s organizational structure.

Repositioning from IPA to CIN
By Max Reiboldt, CPA and Ellis “Mac” Knight, MD, MBA
(Featured in May 2015 by Becker’s Hospital Review)

As the healthcare industry moves slowly but inexorably toward a more value-based reimbursement environment, many independent physician associations (IPAs) are looking at becoming clinically integrated networks (CINs). The difference between these two entities is not a matter of mere semantics. Instead, the distinction gets to the core of which model better allows physicians and other healthcare providers to enter into value-based contracts with confidence and perhaps become full-fledged population health managers.

The transition, however, is not easy nor is it without risks. This article will hopefully clarify much of the confusing nomenclature used in this area and provide the reader with a valuable roadmap to guide them through this often very complicated transformation process.

Physician Compensation in an age of Decreasing Reimbursement: A New Perspective on the Median
By Justin Chamblee, MAcc, CPA
(Featured in a 2014 issue of HFMA’s hfm publication)

The current trends of hospitals heavy (and oftentimes sole) use of benchmark data in establishing physician compensation is inadvertently increasing physician compensation, presenting a situation that is likely to undergo mounting scrutiny in an environment under pressure to lower costs. The merits and consequences of using benchmark data, focusing on median compensation per wRVU ratio, to build a compensation model and its long-term feasibility are examined in this paper. Also presented are modifications that can be made when developing wRVU-based compensation models that will address the issues of using benchmark data to derive compensation that aligns with productivity levels and general market trends.

Hot, Emerging HCIT Tool and Trends
The Pace Quickens
By Jeffery Daigrepont, EFPN
(Featured in the January, 2014 Edition of AMGA Group Practice Journal)

Health systems and clinics of every size are preparing for an accelerated pace for healthcare information technology (HCIT) adoption and implementation, which will increase influence in every part of the clinical, financial, and operational workflow. This article addresses the five emerging tools/trends where acceleration will be most profound and necessary for future viability and participation in quality care initiatives.

Three Rights Equal Value
A Success Formula
By Ellis “Mac” Knight, MD, MBA, Jeffery Daigrepont, EFPM, and Nilam Patel, MPH

Three critical requirements in developing an IG framework include establishing a team, defining key performance indicators (KPIs) by roles, and implementing a protocol. This article details how to go about putting in place these key components and outlines a roadmap for achieving a sustainable IG initiative.

ACO/MSSP CMS to Increase Participation in the Shared Savings Program
By Ellis “Mac” Knight, MD, MBA, max Reiboldt, CPA, and Nilam Patel, MPH

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on December 1, 2014, to improve the Medicare Shared Savings Program (MSSP). The changes will take effect in 2016 and aim to improve the rules and regulations of the overall program. The proposed rule will affect all accountable care organizations (ACOs) considering MSSP and those already participating in the program.