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Jennifer Bishop

Vice President, Product Content

VICE PRESIDENT | VITALWARE, LLC | 09/15 TO CURRENT I am currently responsible for the accuracy and timeliness of all of the content available to healthcare providers on our website. This includes all of the regulatory information published by CMS, the AHA, the AMA, the ASA, the ADA and other industry leaders. I am also responsible for maintenance of all of VitalWare's proprietary crosswalk information, including a CPT to ICD-10-PCS crosswalk, a CPT/HCPCS to modifier crosswalk, a CPT/HCPCS to revenue code crosswalk and others. I oversee a team of 10 billing and coding professionals to produce medical necessity edits for our customers, generate charge assurance and revenue integrity rules which are used to identify claims with potential coding and/or compliance issues and answer specialized billing and coding questions posed by our clients. I am also responsible for providing a variety of revenue cycle webinars throughout the year for our clients.

REVENUE INTEGRITY PROGRAM MANAGER | STANFORD HOSPITAL | 06/11 TO 09/15 During this period, my responsibilities included reviewing inpatient and outpatient accounts flagged for possible billing and/or coding compliance issues through our contracted charge assurance software. I was responsible for reviewing the accounts as well as correcting any identified issues before resubmitting the claims for reimbursement from the appropriate payor. I was also responsible for performing root cause analysis of identified issues and providing appropriate feedback and education to our clinics and hospital departments to assist with resolution. I had primary responsibility for integrating the charge assurance software into the hospital's daily workflow, which resulted in the capture of over $16 million worth of lost charges over the first 12 months of implementation in addition to the identification of multiple potential compliance issues which were able to be corrected prior to claim submission.

SENIOR CONSULTANT | MEDASSETS | 08/04 TO 06/11 During my tenure with MedAssets, I performed coding, billing and CDM audits for various clients, completed RAC preparation reviews, DRG reviews, APC reviews and physician E/M audits. I also had responsibility for preparing and presenting educational seminars on a variety of coding, billing and general compliance topics for hospitals and physician offices. My responsibilities also included providing ongoing support to a number of hospital clients across the country which included performing quarterly CDM integrity checks and answering their coding and billing questions on a daily basis.

CLINICAL DATA ANALYST | CASE MIX ANALYSIS | 08/02 TO 08/04 My primary responsibilities at Case Mix Analysis involved reviewing inpatient and outpatient hospital records for compliance with existing coding and billing regulations and providing educational training sessions for physicians and coders based upon identified issues. I performed, DRG, APC and E/M reviews for clients nationwide in order to improve coding accuracy and ensure compliance with established billing guidelines. I also composed and presented executive summaries for hospital administrators based upon review findings and recommendations.

CONSULTANT | PYRAMID HIM AND CODING SERVICES | 04/01 TO 08/02 As a consultant for Pyramid, I reviewed inpatient and outpatient hospital records for compliance with CMS coding and billing practices. Additionally, I composed executive summaries for hospital administrators to include review findings and recommendations and frequently presented my findings to hospital administration and staff.

CODING SUPERVISOR | YAKIMA VALLEY MEMORIAL HOSPITAL | 09/94 TO 04/01 I started at YVMH coding emergency department and other outpatient claims based on provided documentation and was promoted after three years to outpatient coding supervisor which included overseeing a staff of eight coders to ensure accurate and timely code assignments for outpatient accounts. I was responsible for training all new employees in the coding division and maintaining department policies and procedures. I served on the interdisciplinary revenue cycle committee and was responsible for coordination of JCAHO audits.

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The Prior Authorization Process: Need-to-Know Changes for 2021

In 2021, the Centers for Medicare and Medicaid Services (CMS) is updating the Prior Authorization for Certain Hospital Outpatient Department Services, which took effect in July 2020. Key elements of CMS’s changes include new service groups and submission guidelines. Health systems can prepare for these updates and avoid processing delays by organizing around the changes, including identifying a point person to track involved patients and follow up on decision letters.

Notably, the prior authorization changes include the addition of two service groups:

1. Implanted spinal neurostimulators.
2. Cervical fusion with disc removal.