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Wellesley, MA — March 22, 2024 — MDaudit, an award-winning provider of technologies and analytic tools that enable the nation’s premier healthcare organizations to minimize billing risks and maximize revenues, has released a series of automation and reporting enhancements to its billing compliance and revenue integrity platform workflows. Made based on insights and feedback from MDaudit customers – including more than 70 of the nation’s top 100 health systems with $1 billion in net patient revenue – the enhancements are designed to eliminate noise and streamline results around system reports and workflows.

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

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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.

Niagara Falls, N.Y. – March 5, 2024 – Harris Data Integrity Solutions, the leading provider of best-in-class patient data integrity services and software, has responded to growing demand for faster and more affordable duplicate record cleanup with the launch of its latest innovation, Intelligent MPI Triage Solution. Leveraging the efficiency of AI-driven logic paired with 20 years of data integrity expertise, Intelligent MPI Triage delivers precise and swift duplicate resolution to lower duplicate rates by easing backlogs created by higher patient volumes and fewer health information management (HIM) resources.

“A perfect storm of razor-thin operating margins, double-digit labor cost increases, and widening staffing gaps have HIM leaders scrambling to find ways to maintain the integrity of their patient data. Our clients reached out for help, and we responded with Intelligent MPI Triage Solution,” says Lora Hefton, Executive Vice President of Harris Data Integrity Solutions. “With it, Harris Data Integrity Solutions can partner with HIM teams and leverage our unique AI-powered ‘assess, treat, and refer’ process to quickly reduce potential duplicate queues, protecting patient records for a fraction of the cost.”

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.

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.

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