News

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.

NIAGARA FALLS, N.Y.  – Aug. 23, 2023 – Harris Data Integrity Solutions, the leading provider of best-in-class patient data integrity services and software, announced today the appointment of Eric Helbig as vice president of sales. He brings more than two decades of executive leadership to his role overseeing sales operations and designing and implementing sales strategies to expand the firm’s footprint among the nation’s leading hospitals and health systems.

“Eric’s expertise in change management, strategic marketing and sales planning, and performance optimization make him a great addition to the Harris Data Integrity Solutions leadership team,” said Lora Hefton, executive vice president of Harris Data Integrity Solutions. “His impressive track record of designing highly effective sales strategies and optimizing team performance are an asset as we continue to focus on expanding the reach of our innovative data integrity services and solutions.”

WASHINGTON, D.C. – August 22, 2023 – AGS Health, a leading provider of tech-enabled revenue cycle management (RCM) solutions and strategic growth partner to healthcare providers across the U.S., announced today the release of Intelligent Authorization, a single-source solution that automates and optimizes the financial clearance process and avoids prior authorization-related denials. Part of AGS Health’s AI Platform, Intelligent Authorization streamlines and expedites processes by up to 90% through a variety of configurable automation solutions that improve operational efficiency, reduce costs, and enhance the patient experience.

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.

Harris Data Integrity Solutions, the leading provider of best-in-class patient data integrity services and software, has been engaged by University Hospitals (UH) to undertake a comprehensive cleanup of UH Lake Health’s Master Patient Index (MPI) in preparation for the facility’s migration to Epic. In addition to eliminating duplicate and crossover patient records, Harris Data Integrity Solutions will support UH in clearing the hospital’s Roster Management Engine (RME) error queue.

Lake Health, which joined the Cleveland-based University Hospitals health system in April 2021, consists of UH Lake West Medical Center, UH Beachwood Medical Center, and UH TriPoint Medical Center. It is currently migrating to UH’s Epic electronic health record (EHR) system. However, prior to its patient information being integrated into the EHR, Lake Health’s MPI must be analyzed for and subsequently cleaned of any duplicate and potential crossover patient records that may exist across the UH system.

Cleveland-based University Hospitals tapped Harris Data Integrity Solutions to clean up Concord Township, Ohio-based Lake Health's patient index before transitioning to Epic.

The health system is working to eliminate crossover patient records and eliminate errors before it transitions to Epic. Lake Health joined University Hospitals in April 2021, according to an Aug. 8 Harris Data Integrity Solutions news release.

NIAGARA FALLS, N.Y.  – Aug. 8, 2023 – Harris Data Integrity Solutions, the leading provider of best-in-class patient data integrity services and software, has been engaged by University Hospitals (UH) to undertake a comprehensive cleanup of UH Lake Health’s Master Patient Index (MPI) in preparation for the facility’s migration to Epic. In addition to eliminating duplicate and crossover patient records, Harris Data Integrity Solutions will support UH in clearing the hospital’s Roster Management Engine (RME) error queue.

Lake Health, which joined the Cleveland-based University Hospitals health system in April 2021, consists of UH Lake West Medical Center, UH Beachwood Medical Center, and UH TriPoint Medical Center. It is currently migrating to UH’s Epic electronic health record (EHR) system. However, prior to its patient information being integrated into the EHR, Lake Health’s MPI must be analyzed for and subsequently cleaned of any duplicate and potential crossover patient records that may exist across the UH system.

The ongoing – and worsening – labor shortage plaguing all corners of the healthcare ecosystem is hitting revenue cycle management (RCM) particularly hard, with RCM and billing departments reporting vacancy rates as high as 75%. Exacerbating an already significant challenge is the threat it poses to revenues at a time when hospital operating margins continue hovering near zero.

To keep their limited RCM teams from drowning and avoid the inevitable impact on the revenue cycle, healthcare finance executives are increasingly turning to technology to automate manual billing compliance processes and deploy advanced analytics as they recruit skilled professionals to close staffing gaps.

Wellesley, MA — July 24, 2023 — MDaudit, an award-winning provider of technologies and analytics tools that enable premier healthcare organizations to minimize billing risk and maximize revenues, announced today it has elevated the artificial intelligence (AI) and automation capabilities of its industry leading billing compliance and revenue integrity platform with the addition of Insights.ai and SmartScan.ai. A Generative AI tool, Insights.ai democratizes faster insights in response to natural language questions while SmartScan.ai leverages AI to automate key aspects of the external audit workflow process to efficiently manage payer audits. The MDaudit platform is used for compliance and revenue integrity outcomes by more than 70 of the nation’s top 100 health systems with $1 billion in net patient revenue.

Overcoding is in the crosshairs as the Centers for Medicare and Medicaid Services (CMS) continues its quest to ferret out fraud and abuse and recoup improper reimbursements-a focus that returns $8 for every $1 spent on audits. There are no signs that they are letting up any time in the future, as the federal government has increased funding for audits and fraud investigations.

Overcoding-intentional or accidental-can bring significant fines in addition to repayment of the original claim. And the reputational damage of a fraud finding is hard to overcome. As such, provider organizations need to be vigilant with their compliance and education programs to avoid finding themselves on the losing end of a CMS or other third-party audit. Overpayments also have a negative impact on patient acquisition and experience, thereby deflating growth. The whole idea of declaring financial results to the public domain and restating the results repeatedly due to uncertain compliance risks is a nightmare for most of the financial leaders within health systems.

BC Advantage»

The MDaudit platform is used by more than 70 of the nation’s top 100 health systems for compliance and revenue integrity outcomes.

Wellesley, MA — July 11, 2023 — MDaudit, an award-winning provider of technologies and analytics tools that enable premier healthcare organizations to minimize billing risk and maximize revenues, announced today that it has received two 2023 Golden Bridge Awards for its industry leading billing compliance and revenue integrity platform. The platform was also shortlisted in the 2023 SaaS Awards program in the Best SaaS Product For Healthcare category.

Revenue cycle management (RCM) has never been more important to the success of healthcare providers across the care spectrum, but the industry faces myriad challenges. A continuing labor shortage and lack of skilled workers threaten revenues at a time when hospital operating margins hover near zero.

While highly skilled professionals are still needed, RCM teams can work smarter and not harder by using technology to automate manual processes and deploy advanced analytics to identify the cause of denials. Further, as private insurers follow Medicare’s lead by increasing third-party audits, providers need to understand their claims and auditing process at a foundational level to support their billing practices and maximize legitimate revenue.