Client News Coverage

The ability for healthcare providers to appropriately connect with and securely share electronic health information with network stakeholders that are managing patient care is critical to support care coordination, continuity, and improved clinical decision support.

It is also crucial for supporting the patient’s ability to fully access their health record and enabling authorized parties to access any relevant and appropriate information for other purposes such as healthcare operations, benefits determination, public health and other authorized purposes.

In the months that have passed since the Office of the National Coordinator for Health Information Technology (ONC) issued the final Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) rule, the health IT sector has been working diligently to meet the earliest compliance timelines even as it continues an in-depth analysis of the regulatory impact on both developers and the providers who use certified technology.

There happen to be numerous overlapping federal requirements, such as the need for annual projects in order to maintain information blocking compliance as well as aggressive time frame when it comes to decision support certification, go ahead and represent big challenges for the health IT developers, according to the leaders from the HIMSS Electronic Health Record Association.

With a spate of regulations that happen to be driving the health IT product development, being in compliance with the regs that do not always work well with each other happens to be a big ask, as per Leigh Burchell, who happens to be the vice chair of the EHRA’s information blocking compliance task force as well as a member of the organization’s executive committee.

Hospital & Healthcare Management»

Several overlapping federal requirements – including the need for annual projects to maintain information blocking compliance and an aggressive time frame for decision support certification – represent big challenges for health IT developers, say leaders from the HIMSS Electronic Health Record Association.

Taking the risk to start a company is a feat few are fully equipped for. Any business owner knows that the first few years in business are anything but glamorous. Building a successful business takes time, lessons learned, and most importantly, enormous growth as a business owner. What works and what doesn’t when one starts a new business? What are the valuable lessons learned from the “University of Adversity”? As part of this interview series, I had the pleasure of interviewing Bill Wolfe.

Bill Wolfe is a senior executive with experience in both large corporations such as Cisco, Verisign, and Openwave, and startups including Hawk Systems, ISOCOR (IPO), Clickatell, and now YourHealth. He has held positions including CTO, CSO, Senior Vice President with P&L responsibility, and a variety of VP/General Management positions, with versatile experience including sales, product management, engineering, and M&A. With a passion for motivating talent through clear objectives and accountability, he has consistently delivered growth-oriented profitable operations on a global scale

Medium»

Best Practices for Transitioning to a New HIM Vendor—Why, When, and How

The HIM outsourcing market continues to thrive, with ResearchandMarkets.com projecting a compound annual growth rate (CAGR) of more than 12% for medical billing outsourcing between 2023 and 2030, during which its value will expand from $12.2 billion to $30.2 billion. Data Bridge Market Research further projects that the health care revenue cycle management outsourcing market will reach $8.56 billion by 2030, a CAGR of 15.2%.

Behind the rapid growth trajectory is a confluence of trends. A survey by Black Book Research found that 98% of hospital leaders plan to bring in more third-party vendors for cost efficiencies and to allow internal resources to be focused on priorities, including improving patient access, acquiring replacements for aging equipment, bettering profit margins, and implementing digital technologies. Further, as provider organizations look for ways to find adequate staff and reduce costs, outsourcing has emerged as a valid strategy to achieve a financially healthier organization.

Ongoing education and the right tools and resources can help physicians as they face increased coding responsibilities.

Twenty-five years ago in outpatient settings, doctors dictated notes using narratives and appropriate medical jargon to describe a patient’s presenting diagnoses. Samuel L. Church, MD, MPH, CPC, CRC, CPC-I, Georgia-local medical director at Aledade, Inc, remembers that coding happened after the dictation, apart from the physician. “It kind of happened magically,” he says. “We never had to worry about [coding] then. We were concentrating on doing good medicine.”

Today, however, the landscape has shifted. Physicians are often tasked with at least some of the coding responsibilities as they input notes into EMRs. “We get to these electronic records where we are asked to provide a specific diagnosis code. Ultimately, the doctor or the provider is the one who is responsible for the code. We have to do it at the time of the note signing,” Church says.

January introduced new split/shared services documentation and billing challenges for Medicare providers in hospitals and skilled nursing facilities (SNFs). The new regulations, rolled out by the Centers for Medicare and Medicaid Services (CMS) as part of the 2024 Medicare Physician Fee Schedule (MPFS) final rule, took effect on January 1, 2024, and finalized CMS’s definition of the “substantive portion” of a split/shared visit (first introduced in 2022).

That definition – more than half of the total time spent by the physician or nonphysician practitioner performing the split or shared evaluation and management (E/M) services or a substantive part of the medical decision-making (MDM) – is crucial in 2024 for determining who will bill Medicare for such visits. It was developed in response to public comments asking CMS to allow either time or MDM to serve as the substantive portion of a split or shared visit.

For the first time in a decade, the Centers for Medicare and Medicaid Services (CMS) has overhauled its hierarchical condition categories (HCC), upgrading the underlying methodology to align with ICD-10-CM – which the rest of the healthcare system has been using since 2015. As a result, HCC version 28 requires greater specificity in documentation and code assignment to ensure accurate risk adjustment.

Matt Bridge continues his three-part series on how to achieve a high-performing revenue cycle for your facility. Bridge reports that you need an understanding as to where your organization falls on the RCM Maturity Framework. Here is Part Three in this exclusive series for ICD10monitor.

The journey toward fully mature revenue cycle management (RCM) is typically a five-step process that starts with evaluating the maturity of the current state of operations to determine where the organization falls on the RCM Maturity Framework, outlined in the first two articles of this three-part series. This is followed by the establishment of a realistic long-term maturity target, followed by the development of iterative annual goals to achieve it.

Matt Bridge continues his three-part series on how to achieve a high-performing revenue cycle for your facility. Bridge reports that you need an understanding as to where your organization falls on the RCM Maturity Framework. Here is Part Two in this exclusive series for ICD10monitor.

The RCM Maturity Framework, introduced in the first edition of this three-part series, is a powerful diagnostic tool in the quest to optimize and digitally transform revenue cycle performance. It serves as the basis for a practical approach to transforming revenue cycle management (RCM) to help future-proof operations through a hybrid model of in-house management, global services, advanced technologies, and actionable analytics.

Four stages make up the Maturity Framework: Emerging, Foundational, Advanced, and High-Performing. Where an organization falls within those stages is determined by its level of maturity across three pillars: service delivery, technology and interoperability, and analytics.

EDITOR’S NOTE: Medicare’s legacy quality reporting programs were consolidated and streamlined into the Merit-Based Incentive Payment System, known as “MIPS.”

The Merit-Based Incentive Payment System (MIPS) uses a composite performance score to determine if eligible physicians will receive a payment bonus, a payment penalty, or no payment adjustments.

If a physician bills more than $90,000 for Part B-covered professional services and they see more than 200 Part B patients, and has provided more than 200 covered professional services to those patients, the physician must participate in the MIPS program. It’s essential for all eligible clinicians to report in order to prevent a 9-percent downward adjustment for all Medicare Part B claims paid two years from the reporting year.

Matt Bridge begins a three-part series on how to achieve a high-performing revenue cycle for your facility. Bridge reports that you need an understanding as to where your organization falls on the RCM Maturity Framework. Here is Part One in this exclusive series for ICD10monitor.

Though healthcare organizations were expecting 2023 to end on a modestly high note, with many telling Kaufman Hallthat they expected to finally hit the 3 to 4-percent operating margins needed to help ensure long-term sustainability, the pressure is nonetheless on to hasten their rebound from 2022 margins that were 39 percent lower than 2021.

In response, finance leaders are seeking ways to accelerate cash flow, reduce expenses, and increase profitability, with many turning to global resources and technology to transform their revenue cycle management (RCM) operations.

February 07, 2024 - The 2024 Best in KLAS Software & Services report has recognized EHR vendor Epic as the top overall software suite, marking the fourteenth consecutive year that the company has earned the award.

The 2024 Best in KLAS report leverages information obtained from more than 26,000 evaluations representing the opinions of healthcare professionals from over 5,000 healthcare organizations.

Used by the Centers for Medicare and Medicaid Services (CMS) and commercial payors to forecast medical costs for patients with more complex healthcare needs, the HCC risk adjustment model measures relative risk due to health status to determine reimbursement levels. The more complex the patient's medical needs, the higher the provider's payment.

HCCs are now the preferred method of risk adjustment for the Medicare population which, according to figures from CMS, includes nearly 60 million people on both Part A and Part B, approximately 30.2 million of whom are enrolled in a Medicare Advantage (MA) plan. Thus, doing it correctly is crucial to Medicare providers and payors who wish to be appropriately reimbursed for the care provided to patients and beneficiaries.

BC Advantage»