Client News Coverage

Providers See Fourfold Increase in External Payer Audits

Posted in Client News Coverage on Friday, December 08, 2023.

The finding from the latest “MDaudit Annual Benchmark Report” found that external payer audits rose significantly compared to last year as Recovery Audit Contracts (RACs) and Medicare Administrative Contractors (MACs) sought to reign in overpayments made over the last two to three years. Additional Documentation Request (ADR) letters also became longer, with some providers reporting ADR letters over 100 pages long.

The report said long ADR letters can make it challenging for providers to parse and file appeals in a timely manner, putting healthcare revenue at risk.

Revcycle Intelligence»

Annual Benchmark Report Highlights the Need for Cross-Functional Team Collaboration, Technology & AI Investments

Posted in Client News Coverage on Wednesday, December 06, 2023.

MDaudit recently released its 2023 Benchmark Report on the trends, challenges, and opportunities being encountered by healthcare organizations in the United States.

Crucial needs emphasize that healthcare systems must proactively navigate an evolving landscape with cross-functional collaboration, technological innovation, and increased artificial intelligence (AI) investments to safeguard revenues. Going into 2024, operational excellence is the table stakes for healthcare organizations to improve bottom lines – and where AI and automation can provide a boost in productivity and costs.

RAC Monitor»

MDaudit Releases Service Provider Workflow to Support Line Service Provider Audits, Enhanced Provider Education

Posted in Client News Coverage on Friday, November 17, 2023.

MDaudit announced today the release of Service Provider Workflow. This latest enhancement to its industry-leading billing compliance and revenue integrity platform supports billing when rendering providers differ from service providers, reducing audit risks related to the billing of split/shared services.

Under changes to its Evaluation and Management (E/M) guidelines, the Centers for Medicare and Medicaid Services (CMS) require split/shared services — which are performed jointly between a physician and a non-physician practitioner (NPP) in the same group and in a facility setting — to be reported by the clinician who performs the substantive portion of the patient visit.

Electronic Health Reporter»

MDaudit’s 2023 Annual Benchmark Report Finds a Fourfold Increase in External Payer Audits in 2023 while Patient Volumes Rise by Double

Posted in Client News Coverage on Friday, November 03, 2023.

Wellesley, MA — November 3, 2023 — External payer audits quadrupled in volume in 2023, making timely responses more challenging than ever for resource-strapped healthcare organizations. Though patient volumes and surgeries have begun to recover from COVID-19 declines – with a 23% and 27% increase over 2022 – inflation, staffing shortages, reimbursement, and regulatory issues continue to jeopardize the financial health of healthcare organizations nationwide. These were among the key findings of the 2023 MDaudit Annual Benchmark Reportreleased today by MDaudit, an award-winning provider of technologies and analytic tools that enable the nation’s premier healthcare organizations to minimize billing risk and maximize revenues.

Becoming an Industry 5.0 Organization

Posted in Client News Coverage on Thursday, November 02, 2023.

With artificial intelligence (AI) infiltrating nearly every aspect of modern life, the once-revolutionary Industry 4.0 concept centered on AI, automation, robotics, and other technological advances has given way to Industry 5.0 and its focus on resilience, sustainability, and societal versus economic value – including the human-centric nature of putting people at the center of the organization.

Instead of shareholder value, Industry 5.0 emphasizes internal and external stakeholder partnerships within an organization. Internally, this reflects workforce diversity and workflows wherein AI, automation, and other digital tools support rather than replace employees. Externally, it emphasizes the organization’s positive impact on society, its ability to serve rather than merely sell, and its capacity to enhance resilience while delivering sustainable outcomes.

Workflow»

How Do Healthcare Organizations Feel About Autonomous Coding?

Posted in Client News Coverage on Friday, October 27, 2023.

Autonomous coding can help streamline revenue cycle processes and reduce administrative burden, but over half of surveyed healthcare finance leaders are not familiar with it, while others do not fully trust the automated tool.

survey from the Healthcare Financial Management Association (HFMA), commissioned by AGS Health, asked more than 450 healthcare finance professionals about their knowledge of and expectations for autonomous coding.

Revcycle Intelligence»

Autonomous Coding Highly Trusted by Healthcare Finance Pros, But Not Well Understood

Posted in Client News Coverage on Thursday, October 26, 2023.

Among the key benefits of autonomous coding is its ability to eliminate the potential for human errors that result in missed reimbursement opportunities, backlogs, delays, and claims errors, and its ability to push accuracy levels to near-perfect percentages. All of which can be achieved in near real-time with the right integration pipelines. Autonomous coding is also faster than its human counterparts – it can complete charts in seconds – yet it also understands what it does not know, flagging it for human review.

HIT Consultant»

AGS Health-HFMA Survey Finds Healthcare Finance Professionals Have High Expectations for, Limited Understanding of Autonomous Coding

Posted in Client News Coverage on Thursday, October 26, 2023.

WASHINGTON, D.C. – October 26, 2023 – Autonomous coding enjoys a high level of trust among healthcare finance professionals who use or plan to use the technology, with 45 percent indicating it often works well and 16 percent placing complete trust in it. Yet despite its emergence as a powerful tool for streamlining and improving error-prone manual coding processes, autonomous coding suffers from an awareness problem, with 52 percent saying they do not know what it is.

Those are the findings of a new survey from the Healthcare Financial Management Association (HFMA) on behalf of AGS Health, a leading provider of tech-enabled revenue cycle management (RCM) solutions and strategic growth partner to healthcare providers across the U.S. More than 450 healthcare finance professionals were surveyed during the 2023 HFMA Annual Conference on their knowledge of and value expectations for autonomous coding, including 60 percent that use or plan to use autonomous coding.

AI Elevates the Audit Process and Improves Revenue Outcomes

Posted in Client News Coverage on Wednesday, October 18, 2023.

Healthcare organizations are in a precarious financial position. With operating margins still hovering near zero, revenues are at heightened risk because of a surge in third-party audits following the expiration of the public health emergency as well as increased scrutiny by federal and commercial payers alike to identify – and recover – billions in improper payments and penalties.

This sharp uptick in audit activity has many healthcare organizations – even those that have already adopted revenue cycle management (RCM) technologies to streamline workflows – struggling to comply with both the volume of incoming documentation requests (ADRs) and the timeframes within which they must reply.

Electronic Health Reporter»

FY 2024 ICD-10-CM Code Updates: Key Changes and Highlights

Posted in Client News Coverage on Monday, October 16, 2023.

The Centers for Disease Control and Prevention (CDC) has released the ICD-10-CM code updates for the 2024 fiscal year (FY), which became effective on Oct. 1, 2023. The update includes over 433 diagnosis code changes, including 395 code additions, 25 code deletions, and 13 code revisions. This brings us to a total of 78,044 codes in the ICD-10-CM code set for FY 2024.

It is essential for coding professionals and all applicable team members to keep up-to-date with these annual code changes, understand how to apply them and recognize any new documentation requirements.

ICD 10 Monitor»

Stop Patient Identity-Related Revenue Leakage

Posted in Client News Coverage on Friday, October 06, 2023.

Recent upturns in operating revenues haven’t shifted hospital finance executives’ laser-focus on revenue growth and retention, part of which is putting a stop to revenue leakage. That includes rooting out what are often unexpected sources as part of a holistic revenue cycle management (RCM) strategy – like inaccurate patient identification and information.

Patient misidentification issues cost the average healthcare facility $17.4 million per year in denied claims and lost revenue and cost the U.S. healthcare system over $6 billion annually. According to the Ponemon Institute, about 35% of denied claims incurred by hospitals each year can be attributed to inaccurate patient identification or inaccurate/incomplete patient information, adversely affecting both cash flow and AR days.

Healthcare Business Today»

Bridging the divide: Why payers and providers are collaborating to improve care

Posted in Client News Coverage on Friday, September 22, 2023.

The relationship between payers and providers has been typically viewed as adversarial, with the prices paid to physicians and hospitals being blamed for skyrocketing healthcare costs borne by the insured, while delays and denials by insurers are blamed for falling hospital revenues.

And while the arguments on both sides appear valid, the reality is that these supposed antagonists are closer than they would initially appear when it comes to revenue and payment integrity.

Health Data Management»

Halting Revenue Leakage with Integrated Financial Clearance

Posted in Client News Coverage on Tuesday, September 05, 2023.

Financial clearance activities are critical to constructing a strong foundation for a high-performing revenue cycle. However, a provider organization’s ability to financially secure appointments in advance of a patient’s visit is often limited by a lack of staffing, technology, and operational processes.

These limitations result in initial denials – the average rate of which increased to almost 12% in the first half of 2022 compared to just 10% in 2020 and 9% in 2016 – as well as net revenue leakage via avoidable write-offs and impacts to patient experience scores.

HealthIT Answers»

EHRA: Vendors and their healthcare clients ready for 'info sharing'

Posted in Client News Coverage on Tuesday, September 05, 2023.

Healthcare IT vendors have been getting ready for two years to make patient electronic health information available for access, exchange or use on September 1, according to leaders from the Electronic Health Record Association.

They can use patient portals, other web interfaces, APIs, and an abundance of technologies and platforms to make it happen. However, while OIG published its final rule on June 27, the Office of the National Coordinator for Health IT is still working out certification rules proposed earlier this year, they told Healthcare IT News this week.

Healthcare IT News»

HIMSS EHR Association: New payment models need IT timeline consideration

Posted in Client News Coverage on Wednesday, August 30, 2023.

The HIMSS Electronic Health Record Association has asked the Centers for Medicare and Medicaid Services to consider time lines for IT development in its release of new payment models.

In July, the Centers for Medicare and Medicaid Services solicited a request for information for a proposed episode-based payment model. Comments were due by Thursday, August 17.

Healthcare Finance»