Client News Coverage

Health care is realizing the promise of artificial intelligence (AI) across a broad and seemingly endless range of use cases. The opportunities for using advanced technologies to accelerate labor-intensive processes touch everything from research and operations to supply chain and point-of-care decision making.

Data-hungry revenue integrity and billing compliance functions are no exception. AI tools such as machine learning, natural language search, and anomaly detection are fueling new and expanded insights into revenue integrity, billing compliance, and quality assurance to advance process improvement initiatives. And not surprisingly, the value proposition of these tools is growing rapidly amid COVID-19 as health care organizations try to maximize reimbursements against notable challenges such as revenue shortfalls and rapidly changing regulations.

ForTheRecord»

Finding new revenue opportunities and avoiding claims denials has taken on greater urgency as hospitals and other healthcare organizations face growing reimbursement shortfalls in the wake of the COVID-19 pandemic.

It is why Hayes, makers of the industry’s leading integrated compliance and revenue integrity platform for the nation’s premier healthcare organizations, has launched Revenue Optimizer to equip healthcare organizations with actionable insights that help eliminate barriers to revenue integrity and manage overall financial performance.

THE CORONAVIRUS pandemic has underscored that the field of epidemiology, which focuses on discovering the causes of disease outbreaks and tracing the spread of illness, is an academic discipline with real-world relevance. When policymakers propose solutions to the COVID-19 outbreak, they often base their recommendations on advice from epidemiologist.

Epidemiologists, sometimes referred to as "disease detectives," are trained to recognize, control and mitigate the proliferation of disease within a population and often work in academia, government or the nonprofit sector. They also sometimes work for corporations that require guidance on occupational and environmental health and safety measures. 

U.S. News and World Reports»

Little by little, we’re working towards a National Patient Identifier.  For those not familiar with the topic, the US government in a section of the federal budget has banned HHS from even working with the private sector to develop a national patient identifier.  However, the House of Representatives thanks to leadership from Representative Bill Foster (D-IL) and Representative Mike Kelly (R-PA) have passed a bill to remove this ban.

“On behalf of our patients and caregivers, Intermountain Healthcare applauds House passage of the Foster-Kelly Amendment and looks forward to a future in which patients can accurately, safely, and consistently be matched to their health data across the care continuum,” said Ryan Smith, Vice President and Chief Information Officer at Intermountain Healthcare.

Reimbursement is becoming increasingly complex for today’s providers. And while it is fair to say that a certain amount of missed revenue has always been part of the bottom-line equation, healthcare organizations simply cannot afford to leave money on the table in the current market climate.

Already operating within razor-thin margins, today’s hospitals and health systems must now address current and future reimbursement and revenue risks introduced by the COVID-19 pandemic. In a recent study, Strata Decision Technology estimated that 97% of health systems will lose an average of $1,200 per coronavirus case, or as high as $8,000 in some instances—even with the 2% Medicare payment increase.

Carrot believes in enabling a future where each of us has no barriers to leading our healthiest lives. Unfortunately, health in this country is distributed very inequitably. In the Twin Cities we have communities with a 30-year gap in mortality: Medina at ~90 years, Frogtown in St. Paul at ~60 years.

That distribution is often based on lines drawn by racism. Take food insecurity. Those who struggle to get enough to eat report the highest levels of poor health – exacerbating nearly every medical condition.

In Minnesota, the ‘average’ person has much better access to food than the national average – only 75% of the national risk. Until we look at the data by race – in North Minneapolis, a family has 1.6x the likelihood of food insecurity, compared to the nation as a whole.

Medical Alley»

Saying that telehealth has moved front and center amid the COVID-19 pandemic is an understatement. With the Centers for Medicare and Medicaid Services (CMS) now reimbursing for remote care models, adoption of telehealth is rapidly advancing as physicians strive to overcome barriers to continuity of care and maintain operations amid stay-at-home orders.

Notably, one analysis found that from March 14 to April 1, daily telehealth claims for upper respiratory infections using ICD-10 diagnosis codes from private insurance increased nearly 12 times from the daily average over the previous month. In this case, upper respiratory infections were chosen to reflect COVID-19-related illnesses prior to the introduction of a diagnosis code for COVID-19.

Physicians Practice»

While the introduction of new COVID-19 reimbursement rules and regulations have brought on their share of confusion, there is one certainty healthcare organizations can bank on: oversight of incentive dollars will be a regulatory priority. In fact, federal watchdogs are not wasting any time, as reports suggest monitoring of billing and claims data is already underway to ensure that hospitals are not upcoding to take advantage of higher COVID-19 reimbursement rates.

RACmonitor»

The last 15 years have seen steady, continual growth in both Medicare Advantage (MA) enrollment and the number of payers offering MA health plans. Yet much of that growth has gone to handful of large, national vendors—UnitedHealthcare, Humana, the Blues, CVS-Aetna—that control nearly 70% of the market Carrot Health has been analyzing its robust database of consumer information to explore how behavior is changing in light of the pandemic and—dare we imagine—the post-pandemic world.

InsureTech360»

Listen to the entire podcast here»

When you’re an established, comprehensive company bringing products to market in a vertical industry such as healthcare, there’s a certain amount of expectation that runs alongside your everyday processes. That is, of course, until a pandemic comes knocking on your door.

So what happens when an industry hemmed in by HIPAA guidelines and government regulations is given the proverbial green-light to act quickly? They pivot — and they pivot with lightning speed.

In this episode, Sheila Loy discusses how HID Global took a proven, tested product and reworked parts of the platform to meet the need for infectious disease tracking that’s necessary not only in today’s COVID-19 economy, but for future disease-specific crises as well. Sheila gives us insights into:

• The importance of having a strong understanding of your market and how that can help uncover an unmet need

• Staying on track with expectations in a fast moving pivot when your company has historically long go-to-market procedures
• How to know when you have a product that is relevant in the current market — and when you need to add to, or scale back, that product to give clients the most useful end-product for their needs
• Timing and relevance and how they represent half the battle when bringing a product to market
• Why communication and internal education is key to a successful pivot — when everyone is on the same page, it’s easier to make the necessary adjustments and keep your company’s momentum moving forward

Guest Bio

Sheila Loy is the Director of Vertical Segmentation of Strategy at HID Global, a worldwide leader in providing trusted security solutions in the identity and access management space. Sheila manages the framework strategies and how HID goes to market as a comprehensive company in a vertical industry such as healthcare.

You can reach Sheila at  This e-mail address is being protected from spambots. You need JavaScript enabled to view it . You can also visit HID Global’s website to learn about their contact tracing and surge response solutions.

Patient identification and matching (PIM) errors carry consequences that range anywhere from frustration due to relatively minor mistakes to outcomes that can only be described as devastating.

At one end of the spectrum is a scenario in which two siblings were patients at the same physician practice. When a medical assistant didn’t check multiple identifiers for one of the siblings, they accidentally documented in the wrong file, leading the physician to write a note in the incorrect sibling’s chart. This mistake, fortunately, was caught early.

Journal of AHIMA»

On Mar. 9, 2020, the U.S. Department of Health and Human Services (HHS) finalized “two transformative rules that will give patients unprecedented safe, secure access to their health data.” Issued by the Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS), the Final Rules implement interoperability and patient access provisions of the 21^st Century Cures Act and support President Trump’s MyHealthEData initiative.

U.S. hospitals are straining under the weight of an influenza season that hit hard and fast, with the Centers for Disease and Prevention (CDC) estimatingat least 280,000 flu hospitalizations out of a minimum of 29 million flu illnesses between Oct. 11, 2019 and Feb. 15, 2020. Now, they’re bracing for a potential pandemic in the form of the novel coronavirus (COVID-19), which has made landfall in the U.S. with the number of confirmed cases climbing.

It’s a one-two punch that can quickly overwhelm emergency departments (ED) and inpatient resources of hospitals that lack optimized patient flow strategies.

HealthIT Answers»

The dynamic of moving from classroom to practice is transformational for any nurse. It’s a sizeable step—one that cannot be taken lightly.

Consider the following real-life experience of a brilliant new nurse who just entered the workforce. Highly recommended, this nurse looked great on paper in terms of grades, but he also possessed the tremendous recall ability of a photographic memory. Yet, his first experience with an emergent situation spoke volumes about preparedness for practice. When he encountered a patient who was not breathing, the newly-graduated nurse froze, unable to take the necessary steps to initiate an emergency “Code Blue.”

Humana recently released some noteworthy figures related to the company’s value-based care programs. An annual review of the health plan’s efforts reported 27% fewer hospital admissions and 14.6% fewer emergency rooms visits compared with traditional approaches.

That’s good news for the healthcare industry in terms of the sizable investment it has made into evolving pay-for-performance models over the past decade, especially in light of early studies that suggested lackluster returns. In fact, one 2016 study published in the British Medical Journal found minimal evidence to support the theory that value-based care models impacted mortality rates.

The question now becomes: What is driving Humana’s results?

HISTalk»