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WASHINGTON, D.C. – February 21, 2024 – AGS Health, a leading provider of tech-enabled revenue cycle management (RCM) solutions and a strategic growth partner to healthcare providers across the U.S., announced today the appointment of Conrad Coopersmith to General Manager-Coding Automation. In this role, Coopersmith will focus on the creation and delivery of highly strategic automation solutions and services to meet AGS Health customers’ evolving coding needs.

“Conrad’s proven ability to optimize team performance and achieve organizational goals and objectives make him a valuable addition to the AGS Health leadership team,” said Patrice Wolfe, CEO of AGS Health. “Coding automation is a priority for healthcare organizations that are fighting to regain their post-COVID financial footing amid chronic staffing shortages, heighted scrutiny, and evolving coding and billing regulations. We look forward to the impact Conrad will have on AGS Health’s ability to meet our customers’ technology needs while exceeding their service expectations.”

The healthcare industry relies on trained individuals who are familiar with the coding systems used for insurance reimbursement. Additionally, the use of electronic health records (EHRs) is now becoming the norm. And these new standards require coding professionals who can maintain the medical data within those records.

If you’re interested in pursuing a career in medical billing and coding, you’ll need some training. One of the best ways to obtain it is with an online program. Online medical coding and billing programs present an excellent opportunity to build a lucrative and rewarding career. They are highly flexible, allowing you to go at your own pace. They allow you to schedule your studies around your busy schedule. And if you need to work while you attend medical billing and coding school, many colleges offer part-time options.

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»

What would happen if you had a medical emergency? Would the emergency room doctors know what medications you are taking? Would they know about your allergies? Would they know about your pre-existing conditions that might skew your blood work? Would they know who your emergency contact is? And would that emergency contact know all your important medical information to give to the emergency department staff?

Those questions kept Austinite Jennifer Devening looking for easy answers.

Austin American-Statesman»

Safeguarding revenues in the coming year requires healthcare systems to proactively navigate an evolving landscape with cross-functional collaboration, technological innovation, and increased AI investments. Additionally, 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.

Those are the high-level findings of MDaudit’s 2023 Benchmark Report on the trends, challenges, and opportunities encountered by U.S. healthcare organizations, which analyzes auditing, charge analysis, and denial assessment data from MDaudit’s network of more than 650,000 providers and 2,200 facilities. Insights are also from auditing professional and hospital claims totaling more than $5 billion and denials from commercial and government payors exceeding $150 billion.

Autonomous coding is an AI-driven leap forward from traditional Computer-Assisted Coding (CAC) systems, promising transformation for labor-intensive and error-prone coding processes in healthcare, with substantial benefits in terms of cost savings, efficiency, and reduced denials. However, to optimize its value and protect investments in coding solutions, healthcare organizations must understand the realities and limitations of this evolving technology.

Last week, the Medical Group Management Association (MGMA) suggested that federal regulators use corrective action plans and education to remedy information-blocking allegations instead of significant financial penalties. Now other stakeholders, including the EHR Association and Civitas Networks for Health, have weighed in with their concerns and suggestions for improving the final rule. 

Information blocking is when a provider knowingly and unreasonably interferes with the access, exchange, or use of electronic health information except as required by law or covered by a regulatory exception.

More organizations are releasing their comments to the Office of the National Coordinator for Health Information Technology, Centers for Medicare & Medicaid Services and Office of the Inspector General on the proposed federal rule to establish disincentives for information blocking by providers under the 21st Century Cures Act.

Most of the disincentives are aimed at providers participating in CMS programs, which some organizations like the American College of Radiology say is the appropriate mechanism for provider disincentives.

Finance leaders are battling the rising denial headwinds that threaten to derail the progress healthcare organizations have made toward stabilizing revenues after years of operating in the red. For many, the solution is an optimization of financial clearance and other patient access processes. Doing so, however, is often hampered by staffing and outdated technology limitations that impede efficiencies and increase front-end authorization errors – errors responsible for more than half of all claim denials.

However, as artificial intelligence (AI) and automation embed more deeply into healthcare revenue cycle management (RCM), a new subset of tools has emerged that can accelerate and streamline prior authorization, eligibility and benefits determination, and other back-end financial clearance workflows. Early adopters are reporting numerous benefits, most notably:

AI has become a fixture in healthcare revenue cycle management (RCM) as finance leaders seek to provide a measure of relief for overburdened, understaffed departments facing unprecedented volumes of third-party audit demands and rising denial rates.

According to the newly released 2023 Benchmark Report, growing investments in data, AI, and technology platforms have enabled compliance and revenue integrity departments to reduce their team size by 33% while performing 10% more in audit activities compared to 2022. At a time when RCM staffing shortages are high, AI provides a critical productivity boost.

Unite.AI»

Identity queue management is an important aspect of an effective value-based care strategy. It lays the foundation for establishing an effective person index, minimizing overlays, and facilitating streamlined care coordination. Left unresolved, backlogged work queues can have costly implications for patient care and safety, as well as revenue integrity.

However, many provider organizations are struggling to stay ahead of burgeoning identity error queues, with health system clients reporting that weekly error tasks have more than doubled. At one health system, the volume of potential overlays queue swelled from 2,000 per week to more than 5,000 per week over the course of just a few months, while another organization found itself dealing with a backlog of 100,000 identity interface errors. The health information management (HIM) director at a third health system shared that his team evaluated up to 400,000 potential overlay tasks in the last year to identify just 60 true overlays.

Optimizing financial clearance and other patient access operations is an important aspect of any strategy to offset revenue cycle issues that are behind more than half of all claim denials. Healthcare organizations struggle to do so, however, thanks to staffing and technology limitations that impede efficient operational processes and increase front-end authorization errors.

Those barriers are starting to crumble as artificial intelligence (AI) and automation become more deeply embedded in healthcare revenue cycle management (RCM). Of particular note is the emerging subset of tools designed to streamline and expedite aspects of financial clearance operations, including eligibility and benefits determination and prior authorization processes. Early adopters of these intelligent authorization tools are reporting rapid return on investment (ROI), including 70% to 85% faster eligibility and benefit determination and 85%-90% improvement in authorization determination time.