News

MDaudit, an award-winning provider of technologies and analytics tools that enable premier healthcare organizations to retain revenue and reduce risk, sees the retirement of its long-time president and CEO, Peter J. Butler, effective March 31, 2023. Stepping into the CEO role will be the company’s current COO, Ritesh Ramesh.

Butler will continue serving on MDaudit’s Board of Directors and as an investor, advising on future investments and growth opportunities for the company. He has been with MDaudit for 30 years, including the past 16 as president and CEO.

The Office of Inspector General (OIG) makes no secret about the investigative target it has placed on Medicare Advantage plans and the use of unsupported hierarchical condition category (HCC) assignments. Over the past 18 months, its investigations have netted clawbacks as high as $54.3 million from SCAN Health Plan.

Nor are health plans the only ones at risk when it comes to high-risk codes. While payers may be the ones writing the checks for improper reimbursements, the providers who submitted the claims are being targeted with audits that will inevitably result in repayments to the health plan.

Healthcare organizations undoubtedly felt a sense of relief as 2022 faded in the distance, taking with it a devastating financial performance that resulted in negative profit margins for more than half of U.S. hospitals – the worst year hospitals have faced since the start of the pandemic, according to Kaufman Hall. Not only were operating margins down for most of 2022, but hospitals also struggled with higher labor costs in a more competitive market plagued by chronic clinical and administrative skill shortages.

Physician practices fared no better, with 90% saying that soaring expenses outpaced revenues last year, according to a survey by the Medical Group Management Association. Staffing and labor costs were cited most often as the source of rising costs. Other common culprits were lower reimbursement rates, significant increases in lab supply and drug costs, higher utility costs, lower patient volumes, and rising malpractice premiums.

On March 13, the HIMSS EHR Association submitted its comments to the Centers for Medicare and Medicaid Services on its Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule.

Over the years, computer-assisted coding (CAC) has proven its ability to boost revenue team productivity and accelerate critical decision-making while reducing denials, missed charges, and low-risk scores. CAC also increases coder productivity and code capture, and enables flexible and scalable coding to increase accuracy, efficiency, productivity, and flexibility.

Indeed, these benefits are why we are seeing a rapid uptick in adoption of CAC on the professional side of the healthcare house. Once reserved primarily for facility-based coding, today’s CAC solutions are stepping up to fill the void created by the chronic coder shortage that is impacting both facility and professional fee coding while helping to maximize the performance of any healthcare organization’s coding operations with improved throughput and quality – increasing coder productivity by 25%-45% and decreasing Discharged Not Finally Coded (DNFC) by between one and three days.

WASHINGTON, D.C. – March 7, 2023 – Revenue cycle management solutions leader AGS Health is pleased to announce the launch of operations in Manilla, Philippines. Serving as a strategic growth partner to more than 100 major healthcare providers across the U.S., the expansion will offer AGS Health and its customers increased access to global talent.

Identified as one of the most popular outsourcing destinations in the world, the Philippines is known for the quality of skills offered in the business process outsourcing (BPO) sector. With strong medical backgrounds and voice-based skills, AGS Health aims to focus on supporting end-to-end accounts receivable services. “By augmenting our service line with patient calls, responding to patient queries, and timely patient follow-ups, the addition of our Philippines operations represents an exciting added value to our customers,” said Patrice Wolfe, CEO of AGS Health.

Revenue cycle management company AGS Health opened an office in Manila, Philippines.

AGS said in a March 7 news release the expansion will support end-to-end accounts receivable services.

The HIMSS EHR Association this week sent a letter asking the Centers for Medicare and Medicaid Services to extend the comment period on its Advancing Interoperability and Improving Prior Authorization Processes proposed rule by at least 45 days.

Health tech companies are in a tizzy: After years of letting companies roll out software tools to guide patient care with little oversight, the Food and Drug Administration is taking a tougher stance.

In September, the FDA announced its intentions to regulate many of these AI-powered clinical decision support (CDS) tools as devices — which regulators say has always been their plan and within their purview. But the industry says it was blindsided by the move. In a fierce rebuttal, the Clinical Decision Support Coalition filed a petition earlier this month asking the FDA to withdraw the final CDS guidance, arguing regulators are overstepping their bounds by trying to police medical practice. They also claim the FDA’s move violates the 21st Century Cures Act, a 2016 law that says tools that “provide limited clinical decision support” don’t count as medical devices.

FutureRx (FRx) announced today the launch of its first-of-a-kind healthcare platform for health plans and pharmacy benefits managers (PBMs) that combines modular technology solutions and, if needed, seamless access to pre-vetted fully integrated service providers on a single platform. FRx is a cloud-based, modular, user-configurable technology platform that was built from the ground up to meet complex and continuously evolving compliance requirements in today’s Medicare and Medicaid environment. As such, it is 100% compliant with government-sponsored regulations out of the box.

Once on the platform, health plan and PBM users can select from a full range of technology modules – including Rx Prior Authorization, Appeals/Grievances, Part D Stars, Drug Management Programs (DMP) and more – that are preconfigured out of the box with workflow and letters, and fully integrated with SureScripts and CoverMyMeds, as well as fax, phone, email, and mail capabilities that eliminate costly and time-consuming implementations.

WASHINGTON, D.C. – February 21, 2023 – AGS Health, a leading provider for tech-enabled revenue cycle management (RCM) solutions and strategic growth partner to healthcare providers across the U.S., announces the acquisition of the India-based patient access outsourcing business unit of the Florida-based healthcare technology company Availity.

With more than half of U.S. hospitals anticipating a year of negative margins, achieving full and accurate reimbursement for services has never been more critical. With this expansion, AGS Health is positioned to provide faster, more flexible financial clearance solutions at an even greater scale to help increase customers’ first-pass reimbursements rates.

TAMPA, Fla. – February 21, 2023 – FutureRx (FRx) announced today the launch of its first-of-a-kind healthcare platform for health plans and pharmacy benefits managers (PBMs) that combines modular technology solutions and, if needed, seamless access to pre-vetted fully integrated service providers on a single platform. FRx is a cloud-based, modular, user-configurable technology platform that was built from the ground up to meet complex and continuously evolving compliance requirements in today’s Medicare and Medicaid environment. As such, it is 100% compliant with government-sponsored regulations out of the box.

Once on the platform, health plan and PBM users can select from a full range of technology modules – including Rx Prior Authorization, Appeals/Grievances, Part D Stars, Drug Management Programs (DMP) and more – that are preconfigured out of the box with workflow and letters, and fully integrated with SureScripts and CoverMyMeds, as well as fax, phone, email, and mail capabilities that eliminate costly and time-consuming implementations.

Efforts to identify the right path forward for healthcare’s patient matching problem are gaining a foothold as stakeholders from across the spectrum come together to remove obstacles and implement effective solutions. Most notably, in 2022, efforts by industry organizations like Patient ID Now led to the temporary removal of Section 510 from the U.S. House and Senate Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) appropriations bills. While it was ultimately reinserted in the final version, its initial removal by the Senate was the first time that chamber had done so in 20 years – a significant achievement in the fight to eliminate the outdated rider barring funding of research into a national patient identifier.

Meanwhile, the Office for the National Coordinator (ONC) through its Project US@ collaboration with standards development organizations and other stakeholders issued the

A healthy, stable revenue cycle is crucial to every healthcare organization’s success. However, managing the revenue cycle takes experienced coders, complete documentation, and timely resolution of denials.

Administrative processes account for about 30% of U.S. healthcare costs, which means that all areas of a patient encounter, from check-in to billing and claims, are potential targets to obtain greater efficiency.

In its comments to the ONC on the draft QHIN, Participant and Subparticipant Additional Requirements SOP, the EHR Association recommends workforce authentication requirements be applied only to the Qualified Health Information Network workforce, with specific consideration given to participants and sub-participants who are not HIPAA-covered entities.

WHY IT MATTERS

The Office of the National Coordinator for Health Information Technology (ONC) is accepting comments on proposed requirements for QHINs, participants and sub-participants under its Trusted Exchange Framework and Common Agreement developed by the enlisted Sequoia project.