Revenue Recovery in Drug Administration: Strategic Insights for Billing & RCM Professionals

Revenue Recovery in Drug Administration: Strategic Insights for Billing & RCM Professionals

Presented by Ashley Carson, Ashley Hunter, & Mary Suhr

Thursday September 25th, 2025
9am PT / 10am MT / 11am CT / 12pm ET

This program is scheduled for 60 minutes and is valid for 1 CHBME credit.

Member Price: $49.00
Non Member Price: $99.00

Description:
Are you navigating the complex world of medical billing and need a solid foundation in key CMS (Centers for Medicare & Medicaid Services) concepts? Join us for a practical and insightful session designed specifically for HBMA members and revenue cycle professionals.

In this webinar, we will break down essential CMS resources and terminology that directly impact billing companies and their operations. Whether you're new to healthcare business management or looking for a refresher, this session will demystify common but often misunderstood CMS elements, including:

• HOPPS (Hospital Outpatient Prospective Payment System): Understand how outpatient services are reimbursed and the implications for billing accuracy.
• MPFS (Medicare Physician Fee Schedule): Learn how physician services are valued and how to navigate annual changes.
• NCCI (National Correct Coding Initiative): Discover how coding edits impact reimbursement and avoid costly denials.
• RVUs (Relative Value Units): Explore how RVUs drive payment rates and their role in resource-based compensation.
• MACs (Medicare Administrative Contractors): Identify the function of your regional MAC and how their policies shape local billing procedures.
• LCDs (Local Coverage Determinations): Learn how coverage decisions vary by jurisdiction and why understanding them is critical.
• CMS.gov Navigation Tips: Master locating the resources and updates you need most, efficiently and effectively.

Our expert presenter will provide real-world examples and answer your most pressing CMS-related questions. Attendees will leave equipped with the terminology, tools, and confidence needed to support billing operations, compliance, and communication with provider clients.

Learning Objectives:
Course participants will be able to:

• Identify and define key CMS billing and reimbursement terms, including HOPPS, MPFS, NCCI, RVUs, MACs, and LCDs, and explain their relevance to daily billing operations.
• Locate and interpret essential CMS resources on CMS.gov, including fee schedules, coding edits, and coverage policies, to support accurate and compliant billing practices.
• Apply foundational CMS concepts to real-world scenarios in order to improve claim accuracy, reduce denials, and enhance communication with providers and payers.

Speaker Bio:
Ashley Carson
Ashley Carson, the Director of Coding & Compliance at RCCS, has over 20 years of experience in coding, auditing, education, and workflow optimization. She leads a team of coding and compliance experts, ensuring adherence to industry regulations and best practices for healthcare organizations nationwide. Her expertise spans evaluation and management (E/M) coding, surgical coding, and compliance strategies that drive accuracy and revenue integrity.

Prior to her current role, Ashley worked as a professional coding educator, onboarding and training coders, auditing documentation, and developing provider education programs. She has extensive experience working with physician practices and hospital systems, implementing compliance frameworks that enhance coding accuracy and operational efficiency.

Ashley has played a key role in developing and implementing coding compliance programs that improve documentation accuracy and reimbursement outcomes. She has led initiatives to enhance provider education, ensuring compliance with evolving regulatory requirements and industry standards.

Ashley Hunter
Ashley Hunter is a skilled Senior Consultant specializing in revenue cycle management, financial analytics, and healthcare consulting. With extensive experience in financial reporting and business analysis, she helps healthcare organizations optimize revenue cycle processes and improve financial performance. Ashley provides strategic guidance on all aspects of the revenue cycle, from front-end operations like scheduling and authorizations to backend processes like denial management and, reimbursement trends, to support healthcare providers in maintaining sustainable revenue streams.

Prior to her current role, Ashley worked as a Senior Financial Analyst, where she played a key role in the creation and maintenance of financial reports and analysis that informed client decision-making. She also collaborated with leadership teams to develop customized financial strategies, ensuring alignment with organizational goals. Her expertise in data-driven insights and process optimization has allowed her to contribute significantly to healthcare financial strategies.

Ashley has led initiatives to streamline financial analytics and enhance revenue cycle efficiencies for healthcare organizations. She has implemented workflow enhancements that have resulted in measurable reductions in denials and improved cash flow for providers. Her expertise in data analysis has contributed to the development of performance dashboards and financial modeling tools, which she uses in tandem with process observations to improve revenue management. She continues to drive strategic improvements in financial performance and operational effectiveness for her clients.

Mary Suhr
Mary Suhr is the RCM Business Operations Director at RCCS, specializing in revenue cycle performance, coding accuracy, and financial optimization. With over 20 years of experience in healthcare, she has a demonstrated ability to identify revenue opportunities and drive process improvements for hospitals and physician practices. Mary oversees revenue integrity initiatives, ensuring compliance with regulatory standards and optimizing billing and reimbursement strategies.

Prior to her current role, Mary ran her own revenue cycle consulting company, providing services for physician billing, charge reconciliation, denial analysis, and provider education. She also served as the Coding and Revenue Optimization Specialist for a large hospital system, where she implemented efficient revenue cycle workflows and strategies, recovering over $30M in missing charges for her clients.

Mary has successfully developed revenue optimization programs that have led to significant financial improvements for healthcare organizations. Her expertise in reconciliation processes and charge capture initiatives has streamlined revenue cycle efficiency, reducing revenue loss and improving cash flow. She has also played a key role in the development of strategic billing and compliance frameworks to ensure accurate reimbursement and regulatory adherence.