News

Tracking the Pandemic: Healthcare Billing Compliance and Revenue Integrity Insights and Implications

Posted in Client News Coverage on Thursday, January 06, 2022.

As the Omicron variant spreads across the US and the delta variant continues to push COVID-19 cases higher, it’s a grim reminder that the COVID-19 pandemic is far from over. Although 60% of the country is vaccinated with multiple doses and many lessons were learned by the 2020 pandemic cycle, hospitals and health systems are preparing for a rough road ahead. They are bracing for higher utilization, staffing shortfalls, and an increase in demand for COVID-related services leading to an increase in the clinical and financial pressure in days and months ahead.

Since the advent of the pandemic in 2020, healthcare organizations are trying to mitigate compliance and revenue risks. We will continue to provide data-driven insights to healthcare organizations during and after the pandemic.

Healthcare Business Today»

Profile of a Founder - Brad Bostic of hc1

Posted in Client News Coverage on Monday, December 06, 2021.

An exclusive Tech Tribune Q&A with Brad Bostic (co-founder, chairman, and CEO) of hc1, which was honored in our:

  2022 Best Tech Startups in Indianapolis

  2021 Best Tech Startups in Indiana

  2021 Best Tech Startups in Indianapolis

  2020 Best Tech Startups in Indiana

  2020 Best Tech Startups in Indianapolis

The Tech Tribune»

Challenges Facing Senior Care in 2022

Posted in Client News Coverage on Sunday, November 28, 2021.

The senior care industry has had to navigate tremendous challenges over the past year. From staffing shortages to the demands of the COVID-19 pandemic, 2021 hasn’t been easy. While advancements like the COVID-19 vaccines have brought some relief to those challenges, the senior care industry will face many more challenges as we move into 2022.

We reached out to experts in the senior care field to learn their predictions about the coming year.

iAdvantage Senior Care»

The Forces Shaping The Health IT Landscape of Tomorrow

Posted in Client News Coverage on Wednesday, November 24, 2021.

Accelerated adoption of digital health and health information technology (health IT) is well into the process of transforming access to and delivery of healthcare in the U.S. and across the globe – and their power has been on full display throughout the unprecedented global COVID-19 pandemic. From telehealth and information exchange to artificial intelligence and machine learning, optimizing the reach and utilization of health IT has brought safe, quality care to previously underserved areas while creating new opportunities that promise to make a lasting impact on patients and providers alike.

While advancements have been made, interoperability and comprehensive standards to support health information exchange are works in progress, and uncertainty over compliance with new and evolving regulatory mandates – such as those governing handling of patient data in the 21st Century Cures Act – persists. The good news is that collaborations between health IT developers, provider and payer organizations, industry associations and state and federal agencies continue to evolve and improve.

Business View Magazine»

40% of Charges for COVID-19 Services Initially Ended in Claim Denials

Posted in Client News Coverage on Tuesday, November 23, 2021.

November 03, 2021 - Providers are having a difficult time billing for services related to COVID-19, with 40 precent of charges for coronavirus-related care initially winding up as claim denials in the first 10 months of 2021, according to a recent analysis of more than $100 billion worth of denials and $2.5 billion in audited claims.

The analysis performed by healthcare technology company Hayes also found that 40 percent of professional outpatient audits for COVID-19 and 20 percent of hospital inpatient audits for COVID-19 failed.

Revcycle Intellegance»

A national unique patient identifier faces an uncertain, bumpy road

Posted in Client News Coverage on Wednesday, November 10, 2021.

The Senate’s recent decision to repeal the ban on funding for the development of a unique patient identifier (UPI) marks a potential watershed moment in the development of what previously has been a hot third rail for privacy concerns.

This controversial possibility of developing a UPI provides a new opportunity to link a patient’s health records throughout the health ecosystem, but also highlights the inherent challenges of such a project.

Health Data Management»

A national unique patient identifier faces an uncertain, bumpy road

Posted in Client News Coverage on Wednesday, November 10, 2021.

The Senate’s recent decision to repeal the ban on funding for the development of a unique patient identifier (UPI) marks a potential watershed moment in the development of what previously has been a hot third rail for privacy concerns.

This controversial possibility of developing a UPI provides a new opportunity to link a patient’s health records throughout the health ecosystem, but also highlights the inherent challenges of such a project.

Health Dara Management»

The Forces Shaping the Health IT Landscape of Tomorrow

Posted in Client News Coverage on Thursday, November 04, 2021.

Accelerated adoption of digital health and health information technology (health IT) is well into the process of transforming access to and delivery of healthcare in the U.S. and across the globe – and their power has been on full display throughout the unprecedented global COVID-19 pandemic. From telehealth and information exchange to artificial intelligence and machine learning, optimizing the reach and utilization of health IT has brought safe, quality care to previously underserved areas while creating new opportunities that promise to make a lasting impact on patients and providers alike.

While advancements have been made, interoperability and comprehensive standards to support health information exchange are works in progress, and uncertainty over compliance with new and evolving regulatory mandates – such as those governing handling of patient data in the 21st Century Cures Act – persists. The good news is that collaborations between health IT developers, provider and payer organizations, industry associations and state and federal agencies continue to evolve and improve.

Business View Magazine»

Hayes’ Healthcare Audit and Revenue Integrity Analysis finds COVID-19 Claims and Bundling Errors Driving Denials

Posted in Press Releases on Thursday, October 28, 2021.

Wellesley, MA — October 28, 2021 –– Bundling errors continue to wreak havoc on hospital bottom lines in 2021, causing 34% of inpatient charge denials with an average value of $5,300 each. That’s according to an auditing and revenue integrity report analyzing more than $100 billion worth of denials and $2.5 billion in audited claims released today by Hayes, makers of MDaudit, the industry’s leading integrated auditing, billing compliance and revenue integrity platform for the nation’s premier healthcare organizations.

Healthcare Auditing and Revenue Integrity: 2021 Benchmarking and Trends Report shares the findings of Hayes’ review of professional and hospital claims audited in MDaudit Enterprise during the first 10 months of 2021. Internal auditors identified a significant number of concerns in the claims they reviewed, with approximately 33% of the audits resulting in “disagree” findings. The concerns centered primarily around disagreements between procedure codes and diagnoses.

Compliance Reimagined: Transforming the Value Proposition of a Traditional Cost Center

Posted in Client News Coverage on Wednesday, October 27, 2021.

Compliance has gotten a bad rap in healthcare. Traditionally viewed as a necessary cost center, this department is too often viewed as the police force of a health system.

A lot is missing from this simplistic view of the processes that ensure hospitals and health systems aren’t hit with avoidable penalties when the auditors come knocking. Within a rapidly evolving regulatory framework that includes more than a year of fluctuating COVID and telehealth guidance (among other changes), compliance in essence becomes the safeguard to a healthy, sustainable bottom line.

HISTalk»

Collaborating for Compliance: Helping Actors Comply with Cures Act Final Rule

Posted in Client News Coverage on Thursday, October 21, 2021.

As actors work to comply with the Cures Act Final Rule, it’s become clear that greater consensus is needed regarding the interpretation of the definition of electronic health information (EHI) and the designated record set (DRS). As many readers know, the Cures Act Final Rule includes interoperability requirements related to information blocking and health IT certification. Both rely on the definition of EHI, which is grounded in the definition of the DRS, as defined by HIPAA.

I’m proud my organization AHIMA has been able to collaborate with the American Medical Informatics Association (AMIA) and the Electronic Health Record Association (EHRA) on a taskforce to examine the relationship between specific aspects of the Cures Act Final Rule and the definitions of DRS and EHI.

Healthcare IT Today»

Collaborating for Compliance: Helping Actors Comply with Cures Act Final Rule

Posted in Client News Coverage on Thursday, October 21, 2021.

As actors work to comply with the Cures Act Final Rule, it’s become clear that greater consensus is needed regarding the interpretation of the definition of electronic health information (EHI) and the designated record set (DRS). As many readers know, the Cures Act Final Rule includes interoperability requirements related to information blocking and health IT certification. Both rely on the definition of EHI, which is grounded in the definition of the DRS, as defined by HIPAA.

I’m proud my organization AHIMA has been able to collaborate with the American Medical Informatics Association (AMIA) and the Electronic Health Record Association (EHRA) on a taskforce to examine the relationship between specific aspects of the Cures Act Final Rule and the definitions of DRS and EHI.

Healthcare IT Today»

Brad Bostic of hc1: In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System

Posted in Client News Coverage on Friday, October 15, 2021.

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.

As a part of this series, I had the pleasure to interview Brad Bostic, CEO of hc1.

Brad founded hc1 to bring the benefits of precision health to all patients after witnessing his mother lose her battle with cancer while being treated like a number. He created hc1 with a bold vision to bring the power of precise diagnostic and treatment insights into the care delivery process, believing that transforming lab data into personalized healthcare insights would empower healthcare organizations to ensure patients get optimal diagnostic lab tests and personalized prescriptions for the best possible outcomes. Today, hc1 is the bioinformatics leader in precision testing and prescribing and its hc1 Precision Health Cloud™ is live across more than 20,000 lab and health system locations.

Authority Magazine»

EPtalk by Dr. Jayne

Posted in Client News Coverage on Thursday, September 30, 2021.

Due to critical shortages of healthcare personnel and ICU beds, several states have declared “crisis standards of care,” including Alaska. As if they don’t need one more thing to worry about, a new virus has been detected in the state. Dubbed “Alaskapox” by the media, the virus was found in two additional patients who sought treatment at a Fairbanks urgent care clinic. The symptoms include skin sores, fever, joint pains, and swollen lymph nodes. Both patients recovered within a few weeks, but it’s worrisome as these cases are similar to an initial case in 2015 and another one five years later. The virus has been identified as one from the same family as smallpox and cowpox. Epidemiologic investigation linked the virus to outdoor cats who may have picked it up from cows or other mammals, including voles. Just goes to show that public health was important before COVID-19 and will continue to be important in the future. Let’s hope governmental entities show up with their pocketbooks to fund the kinds of investigations needed to tackle emerging illnesses.

A new report from AHIMA, AMIA, and EHRA asks for consensus on the definitions of “electronic health information” and “designated record set” to better help organizations operationalize the requirements found in the 21st Century Cures Act. The organizations had formed a task force last year in preparation for key compliance deadlines. The task force will be asking stakeholders for feedback on the report and will continue to refine their work as the 2022 deadlines for compliance to the information blocking portions of the Act approach. The health information export portion of the Act kicks in at the end of 2023.

HIStalk»

Cures Act EHI Definition Needs Clarification, Health IT Orgs Say

Posted in Client News Coverage on Wednesday, September 29, 2021.

ONC must standardize the definition of electronic health information (EHI) for the successful operationalization of the 21st Century Cures Act final rule’s interoperability goals, according to a report from three major health IT organizations.

The American Health Information Management Association (AHIMA), the American Medical Informatics Association (AMIA), and the HIMSS Electronic Health Record Association (EHRA) formed a task force to create the Defining EHI and the Designated Record Set in an Electronic World report.

EHR Intelligence»