Auditing PFS: Your Guide to Revenue Integrity
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\ From The CriticsReviewer: Lena L Watson, Dr. RN, MBA/HCM(University of Phoenix)\ Description: This comprehensive resource provides a clear explanation of basic patient financial service (PFS) department processes and reimbursement principles. Readers will not be disappointed.\ Purpose: "The purpose is to provide step-by-step guidance to running a financially successful patient financial services unit. The book also is an excellent resource for training and educating patient financial service staff. This is a much needed resource because it provides effective insights to both meeting the bottom line and complying with regulatory requirements. It offers practical approaches to a number of key areas such as billing accuracy, PFS managerial roles and responsibilities, regulatory and reimbursement pitfalls, and benchmark and performance standards. "\ Audience: "Although no specific audience was identified, this book is suitable for a broad audience including, but not limited to, healthcare administrators, healthcare regulators, claims examiners, PFS managers, and PFS trainers. The book reflects the author's 20-plus years of experience in the detailed tools and information on the operational and practical aspects of patient financial services. "\ Features: "The book makes no assumptions about readers' prior PFS knowledge. The first chapter covers the life of a claim in a PFS setting and claims process flows by payer type. Key areas covered include: effective strategies for internal controls such as verifying bill accuracy; an overview of a PFS managerial roles and responsibilities; ways to avoid common regulatory and reimbursement pitfalls; and ways to increase productivity and achieve benchmark and performance standards. Specific topics explained include: claims adjustments; charge cut-off and editing; audits; collections; accounts receivable (self -pay, charity, bad debt, and credit balances); and relative industry best practices in the field. This book is reader friendly with a format that has a logical flow. It has a number of unique features worth mentioning, including case studies that give readers an opportunity to apply theory and practical knowledge and numerous easy-to-navigate process flowcharts and checklists. An accompanying CD-ROM contains sample spreadsheets, policies and procedures, and other useful tools. Readers can access a web site to obtain more resources. The end of the book contains a question and answer transcript adapted from a 2005 audio conference titled: "Auditing PFS: Strategies to Improve Billing and Collections." "\ Assessment: This is a handy, easy to read reference. It is a practical, at-your-fingertips resource that concisely covers didactic and operational information for healthcare professionals responsible for virtually every aspect of claims management, payment, and oversight. The information is reliably accurate and objective. It's conceivable this publication will provide users credible insights to developing and sustaining a successful and effective patient financial services unit.\ \
