Client News Coverage

A patient’s risk within social determinant of health (SDOH) domains is typically assessed by social care and healthcare professionals through either conversation, standard screening questionnaires, or validated testing instruments. The challenge is the lack of consensus on which specific domains should be assessed for patients – and how they should be assessed.

Artificial Intelligence and Machine Learning are two vast topics of discussion as we work on implementing these tools into a multitude of areas in the healthcare space. So lets narrow that down a bit and focus on Revenue Cycle Management. We reached out to our brilliant Healthcare IT Today Community and asked them – where is true AI and machine learning being used to improve revenue cycle management? The following are their answers.

Making well-informed decisions is very important in the healthcare space, especially for areas that are necessary for your organization to function, like revenue cycle management (RCM). The best way to make sure that we have all of the information we need to make the best possible decisions is through data analytics and business intelligence tools. To get more insights on how these tools impact RCM, we reached out to our talented Healthcare IT Today Community to ask them – how does the integration of data analytics and business intelligence tools contribute to proactive decision-making in revenue cycle management, and what key performance indicators are being monitored to assess financial health? The following is what they had to share.

One of the leading causes of burnout in the healthcare industry is the overwhelming amount of tasks that need to be completed without nearly enough time to do them. And unfortunately, this is a problem that only compounds on itself. The more that you have to do, the more overworked and overwhelmed you get, which means you start to make mistakes and therefore have more work that needs to be done as you now need to go back and re-do your previous work, and the cycle continues until something breaks. This is why implementing advanced technologies and automation into healthcare is crucial for your staff’s and your organization’s wellbeing. So what does that look like for revenue cycle management?

In the aftermath of the cyber-attack on Change Healthcare by the BlackCat ransomware group, a renewed interest has emerged in protecting operations and ensuring contingencies are in place.  For impacted providers, the financial fallout from the attack is estimated at $500 million to $1 billion per day and climbing, driving home the fact that business continuity is everything in the aftermath of a cyber-attack.

Presently, many healthcare organizations remain in limbo after the attack, which exposed 6 terabytes of sensitive patient data, without access to important services such as claim processing for prescriptions, and daily workflows around auditing and reporting. While Change is working to fully restore the more than 100 applications across pharmacy, medical record, clinical, dental, patient engagement, and payment services it was forced to disconnect, recovery will be a long, slow, painful process for all

Efficient patient access is paramount for physician practices in today’s evolving health care environment. When patient access and financial clearance processes are outdated, the resulting inefficiencies create delays in the patient’s journey from initial contact to care access – delays that contribute to revenue leakage and can impact patient satisfaction.

Yet many physician groups are struggling to streamline and improve patient access operations, thanks in part to chronic staffing shortages, rising patient volumes, and more complex prior authorization requirements. As a result, they are falling short of core financial clearance benchmarks.

The prior authorization process has evolved in complexity as the healthcare industry transitions from fee-for-service to value-based care. At the same time, payers are expanding the number of services subject to prior authorization to establish medical necessity and appropriateness. It’s a one-two punch that leaves providers and provider organizations struggling under the weight of a prior authorization burden that, left unaddressed, can have long-term revenue cycle impacts.

Today’s prior authorization process involves time-consuming steps, including gathering and submitting medical documents to insurance companies and waiting for approval. It also often involves dealing with denials and appeals – all while guidance around required documentation becomes stricter.

When you go to implement new technology into your organization, it’s important to look at all of the ways that it can go wrong so that way you can ensure you have safeguards and procedures in place. However, it is equally important to look at all of the ways that it can benefit your organization. After all, the ways that new technology improves the care of our patients and improves the work life of our staff is the sole reason we implement it. So while there are challenges and concerns with AI, let’s take a moment to look at its benefits and its potential.

We reached out to our talented Healthcare IT Today Community and asked them – what novel ways are you seeing AI being applied to healthcare? Where hasn’t it been applied yet that you think it should be? The following are their answers to these two questions.

The charge description master, or CDM, is vital to the revenue cycle, serving as the central comprehensive file of a hospital’s chargeable items. It includes such entries as diagnostic tests, procedures, supplies, prescription drugs, and fees for equipment and room use. According to the AACP,

“Every patient revenue dollar that flows through an organization is generated through this file. Hospitals that take great care to ensure their CDM is correct are able to optimize their revenue cycle for enhanced patient experience and improved financial sustainability.”1

The quest for a national patient identification system goes all the way back to the introduction of HIPAA in 1996. Yet decades later, the health care industry is still no closer to achieving the original goals laid out, as detailed by an op-ed that appeared in the HIPAA Journal last year.1

And while the public-private debate continues over where ownership of a patient identification standard should live, the industry at large recognizes there is much at stake when it comes to accurate patient matching and safety. The shortfalls of patient mismatching and inaccuracies are well established in the industry and can lead to information gaps in patient records, repeated testing, delayed care, and unnecessary costs. Notably, one recent study conducted by Patient ID Now revealed organizations are spending 110 hours per week resolving patient identity issues, and one-third are spending $1 million annually on patient matching.2

One in 4 adults in the U.S. has a temporary or permanent disability, including visual, auditory, cognitive and mobility impairments—a number that will climb as the population ages. Nearly half (46%) of Americans aged 75 and older report having a disabilitycompared to just 24% of those 65 to 74 and 12% of those 35 to 46.

The prevalence of disability is why the health IT developer community must prioritize electronic health record (EHR) designs that advance disability inclusion across healthcare, allowing patients, providers and other healthcare workers requiring accommodation to fully and effectively participate in both the provision and receipt of healthcare.

The HIMSS Electronic Health Records Association recently analyzed how healthcare organizations collect social determinants of health information.

While EHRA's Social Determinants of Health and Health Equity Task Force sees great value in using SDOH to help address healthcare disparities, it says a gradual transition toward more widespread adoption of standardized screeners – in sync with the health IT industry's evolution and readiness to adopt new tools – is the correct approach.

A task force of the EHR Association has made recommendations for how social determinants of health (SDOH) data should be captured in electronic health records.

The association’s Social Determinants of Health and Health Equity Task Force's recently published “Recommendations for Determinant Capture,” notes that there is currently a lack of consensus around which SDOH domains should be assessed by healthcare providers and a standardized approach to capturing the necessary information.

In fact, as inpatient organizations prepare to start reporting on patient screenings for social determinants in 2024, the EHR Association advises that CMS consider postponing this requirement. “This delay would allow for sufficient time to gather insights and learn from industry practices,” the task force said.

Time-consuming and cost-intensive processes within outdated patient access and financial clearance operations contribute to delays in the patient journey from the initial point of contact to the date of service – delays that introduce inefficiencies into the process and contribute to lost revenues. Streamlining these patient access processes is crucial to ensuring that patients are financially secure and have timely access to necessary medical services.

A synchronized financial clearance methodology centered around a well-designed and efficiently operated patient access team and modernized processes will accelerate revenue by decreasing payment delays caused by front-end errors, reducing rescheduled appointments, and improving patient satisfaction. Driving this patient access overhaul are new technologies and innovative solutions that streamline operations by engaging people, processes, and technology through collaboration and communication.

Medicare providers in hospitals and skilled nursing facilities (SNFs) are adjusting to new split/shared services documentation and billing regulations rolled out by the Centers for Medicare and Medicaid Services (CMS) as part of the 2024 Medicare Physician Fee Schedule (MPFS) final rule. The most notable change within the new regulations, which took effect on Jan. 1, 2024, is the finalization of CMS’s definition of the “substantive portion” of a split/shared evaluation and management (E/M) visit.