Client News Coverage

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.

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.

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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.

A 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.

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.

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.

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.

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.

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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.

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.

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.

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.

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.

FLORIDA STARTUP MOBILEOPTIX launched what it calls its “fully equipped vision care practice on wheels” last year to provide long-term care patients with the kind of access to eyecare and eyewear they often go without due to lack of mobility. The company’s fleet of self-contained clinics caters to nursing homes — where MobileOptiX’s ECPs examine and treat both patients and care providers — and events across central Florida. INVISION spoke to MobileOptiX CEO Rob Cash about how the idea to explore this underserved niche developed, and it’s a conversation we think has implications for any eyecare practice looking to step out from behind the bricks and mortar and meet less-mobile patients where they live.

The transactional nature of revenue cycle management (RCM) makes it a prime target for automation technologies, particularly when those tools are focused on automating the manual and redundant tasks within patient access, coding, billing, and collections. In fact, automation is addressing some of RCM’s biggest pain points, increasing revenue capture and helping early adopters achieve revenue integrity.

As automation grows in popularity – nearly all healthcare organizations have an automation strategy in place today compared to less than half just four years ago – a growing number of early adopters are discovering that bespoke technologies like robotic process automation (RPA) can deliver a far more rapid return-on-investment (ROI).

When the Hospital Inpatient Prospective Payment System (IPPS) Final Rule for the 2024 fiscal year (FY) takes effect on Oct. 1, 2023, it will usher in a number of important updates and changes to reimbursement factors and programs, such as the Hospital Value-Based Purchasing (VBP) Program, Hospital Readmissions Reduction Program (HRRP), and Hospital-Acquired Condition (HAC) Reduction Program. The rule, issued in August by the Centers for Medicare & Medicaid Services (CMS), also includes updates for long-term care hospitals (LTCHs) and their payment system, as well as modifications to the LTCH Quality Reporting Program.

Notable changes for FY 2024 include the creation of 15 new Medicare Severity Diagnosis Related Groups (MS-DRGs) and deletion of 16 existing ones, as well as updates to the complications and comorbidities (CCs) and major complications and comorbidities (MCCs) lists. There are also changes to the code edits and the inclusion of new ICD-10 codes, as well as the New Technology Add-on Payment (NTAP) program.