Revenue Integrity panelist Mai Goss, Director of Charge Capture, Revenue Integrity at Texas Health Resources shares insights into her career path, the current priorities for her team, and what she’s looking forward to discussing on the charge capture accuracy panel taking place this March.
Tell us about your professional background; what motivated you to start working in the healthcare industry, and what are some of the roles you’ve enjoyed in your career thus far?
I pursued an undergraduate degree in Finance, as I’ve always enjoyed numbers. At the time, my parents had their heart set on medical school for me, and though I served as a volunteer EMT for university sporting events, the journey to get there helped me realize I didn’t have an affinity for the clinical care setting.
This led me to pursue a Masters in Healthcare Administration degree. After graduating, I completed a one-year hospital administrative fellowship, which provided new graduates the opportunity to rotate through all facets of operations to help pinpoint a career path.
I was extremely lucky to work with an exceptional leader in Revenue Cycle during that time, Becky Korenek, who was at the time the Vice President of Contracting Strategies. She gave me my first opportunity in a revenue integrity adjacent role, which blossomed to what it is today. That role, as a payer contract analyst, is one that I’ve enjoyed most. None of the material had been taught in graduate school, so there were plenty of late nights consulting Google, and I was lucky my boss at the time was patient enough to teach me the material, as well.
I was very much in my happy place analyzing numbers. Of course, I enjoy my current role as well. We’re a relatively young department compared to others at Texas Health Resources, which means we have the opportunity to really develop a program from the ground up.
In your current position as the Director of Charge Capture and Revenue Integrity, what are your main goals or priorities for your team, as you look towards the year ahead?
Our main goal is to always ensure our hospital departments are set-up for success when it comes to capturing charges for the services they provide. We need to continually identify efficient charge capture workflows. What can lead to fewer clicks? What can we automate? The hope is that by helping them in this regard, we are also helping the Revenue Cycle as a whole maintain and / or improve clean claims, timely filing, and more.
We are looking forward to having you join us during our Revenue Integrity meeting on a panel that will address Improving Charge Capture Accuracy. Can you share one issue that you’re looking forward to discussing with the panelists and audience during the session?
Charging and billing ar treated synonymously at times, but in fact, they should be separate. I’m curious to know how other organizations handle scenarios where charging may conflict with payer billing guidelines. For instance, we performed these five services, but due to NCCI edits, MUE edits, etc., the payer only allows three of those to be on the claim (absent of modifiers or other exceptions). Should we charge? Should we not charge? Should the system handle the ‘extra’? So many questions! I am also curious to learn more about how other organizations maintain accountability for charge reconciliation, which seems to be an industry-wide challenge.
To join Mai and other revenue integrity leaders in an interactive and engaging discussion, join us on March 26th during the healthXchange Revenue Integrity: Optimizing Compliant Reimbursement meeting.