Client News Coverage

Congress was full of good intentions when it directed the Department of Health and Human Services to make sure patients get their test results as soon as they’re available.

But the implementation of that directive has set off a battle between doctors on one side and HHS and patient advocates on the other, and raised a fundamental question: How should patients get bad news? The debate underscores how medicine’s digital transformation is changing the doctor-patient relationship and upending ingrained practices.

As 2022 draws to a close, many healthcare organizations are dealing with a unique double whammy – both on supply and demand. That’s according to our 2022 MDaudit Annual Benchmark Report, which found that as consumers cut discretionary healthcare spending and postpone medical visits, patient volumes began falling dramatically in physician office visits and hospitals. The 3rd quarter of 2022 saw declines as steep as 33% relative to the first two quarters.

Healthcare organizations are also under tremendous pressure to reduce compliance risk and optimize revenue flow, a feat that will require flawless optimization for billing compliance, coding, revenue cycle, and revenue integrity capabilities. Amidst the challenges, however, our analysis also revealed many opportunities for health systems to accelerate digital initiatives and drive sustainable value with analytics, automation, collaboration, and upskilling people.

This month’s roundup of surveys and reports from around the industry includes the 2022 National Healthcare Quality and Disparities Report, the No Surprises Act prevents more than 9 million surprise bills since January 2022, caregivers in financial precarity, uncertainty of healthcare costs deters 35% of American from seeking care for themselves, and more!

Health IT Answers»

In today's digital age, technology leaders possess a unique opportunity to drive growth and innovation by adopting certain traits and transformation strategies – ways of working and leading that provide real value and make a direct impact on outcomes for the team and organization.

Most importantly, success at driving innovation (IT or otherwise) hinges on whether leaders possess several skills, some of which might be surprising to see. Based on my experience, two are most critical. The first skill of effective IT leaders is working toward becoming a bilingual strategist with well-rounded business and technology acumen.

Every organization, regardless of its level of success, must continuously evolve and transform. It is a necessity for any organization that seeks to grow, but when the focus is on transformation through IT innovation, the results are particularly powerful.

Leaders driving the digital agenda require a holistic mindset of understanding the market and industry needs and executing digital initiatives that are oriented towards both the growth and value agendas that drives business outcomes. No longer is it enough for the CIOs and CTOs to define technology stacks, manage costs and select software vendors and tools. They must now also possess a strategic mindset to collaborate with business leaders as they reimagine their business models and execute digital transformations.

Healthcare organizations are always looking for ways to save money — so what if they could retain 15%-25% of overall revenue? It’s possible, using workflows designed to resolve issues in billing and coding before claims are submitted.

According to MDaudit research, claim denials increased across the board in 2022, both in terms of number of denials and the average amount of each denial. More than half of denied claims are never reworked – translating into $3.5 billion left on providers’ tables – and the price tag is hefty for those that are. The average cost to rework a claim is $25-$31. Consider the number of denied claims in a month and multiply that number by $25 to get a rough estimate of the additional funds your organization is spending to rework claims.

ICD-10-CM coding guidelines state that all documented conditions coexisting at the time of an encounter that require or affect patient care treatment or management must be coded as a diagnosis. As such, physicians must clearly and precisely document each diagnosis based on clinical medical record documentation from a face-to-face encounter, which means that diagnoses cannot be completely determined from test results and a patient’s past medical history.

For example, well-documented progress notes include the history of present illness, review of systems, and physical exam. They also detail the medical decision-making process. Each diagnosis must be documented in an assessment and care plan. To ensure this is the case, many organizations use the “MEAT” criteria—monitoring, evaluation, assessment, treatment—for their documentation practices, along with hierarchical condition category (HCC) assignments and ICD-10-CM diagnosis coding.

One of the major challenges to maintaining data integrity is accurate patient matching—ensuring that an individual is connected to the correct medical record—which also can directly affect care. “This problem of patient matching has been around for decades,” says Joaquim Neto, chief product officer at Verato. “HIM professionals have been struggling with it for years. The ecosystem of data is so much more complex now. That has only made the record-matching problem worse, despite organizations having sought primary EHRs from a single vendor. Because there are so many innovative technologies that need to integrate with EHRs, the patient-matching problem is bigger than it’s ever been before.”

In part one of this two-part explainer on IT innovation, we focussed on the necessary traits to drive innovation and key strategies to build success. It’s always important to ask a few questions when planning on change and innovation. What are you attempting to create, what do you want to build in service to your organization or customers, and which direction or priority do you desire to take? In so doing, note your team’s achievements, then celebrate them. This time is a great time to determine what is working, what areas missed the mark, and how to take steps to improve.

The best time to rework a denied claim is before the claim is ever submitted.

According to MDaudit research, up to 80% of all denial dollars can be traced to just 20% of claims. Most of these denied claims stem from systemic issues that can be solved through retrospective diagnostics and predictive analytics.

Identifying and correcting issues that impact denials on the front end can help providers protect their revenue streams, which remain under threat from high costs, tight labor markets, and increased federal efforts to scrutinize spending more closely.

A strong business case exists for addressing the financial impacts of social determinants of health (SDoH) and new reimbursement models designed to emphasize health equity. Involving revenue cycle management (RCM) is necessary for any comprehensive SDoH/health equity strategy.

This is because health disparities contribute more than $93 billion in unnecessary medical care costs and more than $42 billion annually in lost productivity. Additional economic losses are a result of premature deaths. Further, according to the W.K. Kellogg Foundation, eliminating these inequities by 2050 may erase more than $150 billion in unnecessary medical care.

Welcome to the weekly edition of Healthcare IT Today Bonus Features. This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job.

With 82% of 2022 claims denials associated with Medicare, and third-party audit volume rapidly climbing, hospitals and health systems are under intense pressure to protect and grow revenues.

These were among the key findings of the 2022 MDaudit Annual Benchmark Report released today by MDaudit, the healthcare technology company that harnesses the power of analytics and its proven track record to allow the nation’s premier healthcare organizations to retain revenue and reduce risk.

With 82% of 2022 claims denials associated with Medicare, and third-party audit volume rapidly climbing, hospitals and health systems are under intense pressure to protect and grow revenues. These were among the key findings of the 2022 MDaudit Annual Benchmark Report released by MDaudit, the healthcare technology company that harnesses the power of analytics and its proven track record to allow the nation’s premier healthcare organizations to retain revenue and reduce risk.

“Our analysis suggests that the post-pandemic era has given rise to a new phenomenon for healthcare. Medical spending is more discretionary for consumers impacted by inflation, driving dramatic reductions in revenues generated by physician office and hospital visits for the third quarter of 2022,” said Peter Butler, President and CEO, MDaudit. “Exacerbating this situation is the need to successfully defend against more third-party audits amidst chronic personnel and resource shortages.”

The Centers for Medicare and Medicaid Services (CMS) has made no secret of its intentions to crack down on fraud, abuse, and waste, throwing more budget dollars into audits, heightening program integrity oversight of Marketplace plans, and exploring new methods of using advanced technology to conduct more rapid and thorough documentation reviews.

Historically, as CMS goes, so do commercial payers, putting healthcare organizations in the crosshairs of an unprecedented level of third-party external audits. To emerge relatively unscathed, organizations need to put in place proven processes that guide immediate and effective actions in the wake of adverse findings.