Client News Coverage

The Centers for Medicare and Medicaid Services (CMS) has made no secret of its intentions to crack down on fraud, abuse, and waste, throwing more budget dollars into audits, heightening program integrity oversight of Marketplace plans, and exploring new methods of using advanced technology to conduct more rapid and thorough documentation reviews.

Historically, as CMS goes, so do commercial payers, putting healthcare organizations in the crosshairs of an unprecedented level of third-party external audits. To emerge relatively unscathed, organizations need to put in place proven processes that guide immediate and effective actions in the wake of adverse findings.

With potential outcomes such as patient identification errors, repeated care, redundant medical tests, and denied claims, patient record duplication costs healthcare systems billions of dollars each year. This critical hindrance stems from inconsistent naming conventions for patients across disparate health systems and hospitals and poor-quality data sets that lack critical identifying information on a patient. At the same time, the rise of self-registration/scheduling patient portals is hindering tech-driven patient matching algorithms from generating desired results; for instance, untrained users often incorrectly fill required fields, resulting in the aforementioned discrepancies. As a result, most hospitals today face errors in their Master Patient Index (MPI), leading to increased costs and dire complications.

Maintaining patient data integrity is more complicated than ever; cybersecurity threats loom, patients are taking more ownership of their care (self-registration, for example) and health system merger activity is on the rise. It can make the quest for the ever-elusive 1% maximum duplicate rate seem, at times, unattainable.

But a secure, accurate, and duplicate-free MPI/EMPI can be achieved. It just requires a multi-pronged approach to protect data throughout its journey into a health system and at every touch along the way.

David Bucciferro, vice chair of the HIMSS Electronic Health Record Association and co-chair of its Opioid Crisis Task Force, demonstrates how electronic records can help providers keep their patients safe.

Exacerbated by pandemic-induced burnout, resignations, and even terminations¹, chronic coding and revenue cycle management (RCM) staffing shortages have healthcare organizations struggling to find ways to keep revenue flowing despite a lack of qualified professionals to handle critical processes. It is a situation that has been brewing for years, as too few qualified professionals are entering professions that are expanding more rapidly than ever before.

The American Health Information Management Association (AHIMA), the American Medical Informatics Association (AMIA), and the Electronic Health Record Association (EHRA) announced today the release of a final report that examines key issues related to operationalizing the definitions of “electronic health information” (EHI) and “designated record set” (DRS). The report is intended to serve as a resource to assist providers, health IT systems, health information exchanges, and health information networks in complying with the information blocking provisions of the Cures Act Final Rule.

Engage Venture Partners, a Minneapolis-based venture capital firm, recently launched with a focus on early stage medical tech companies. The firm was established to decrease friction between early stage medical tech companies and their investors by bringing its investments to market via special purpose vehicles (SPVs).

Health care organizations are increasingly turning to corrective action plans (CAPs) to address suboptimal audit findings and correct any internal processes and/or billing practices that contributed to identified issues quickly and efficiently.

More than simply road maps to mitigate or remediate the circumstances or conditions that contributed to problematic audit findings, CAPs also help health care organizations reduce future billing compliance risks—and significantly enhance their ability to achieve revenue integrity.

Even as the COVID-19 pandemic grabbed much of the healthcare system’s capacity and the nation’s attention over the past two years, organizations have continued to deal with a rising undercurrent of opioid abuse.

While opioids haven’t received the press during the pandemic, the toll remains high — and grew higher, during the pandemic.

Faulty and errant documentation and coding are driving outpatient reimbursement inefficiencies, costing U.S. healthcare about $54 billion annually. Unaddressed, these costs are increasing alongside outpatient revenue, growing at a year-over-year rate of 9%.

For providers, the primary catalysts for change are an evolving regulatory environment that includes the ongoing transition to value-based care and restrictions, such as Medicare’s Two-Midnight rule. For patients, escalating healthcare costs and the convenience of outpatient care are pushing people away from hospitals.

Having identified the existing prior authorization process as a burden with wide-ranging impacts across multiple healthcare domains – contributing to provider burnout and care delays that put patients at risk – the Office of the National Coordinator for Health IT (ONC) is seeking solutions that leverage its Health IT Certification Program to advance electronic prior authorization (ePA).

An analysis by RTI International on behalf of America’s Health Insurance Plans (AHIP) agrees that the ONC’s objective is worthwhile. Published in Evaluation of the Fast Prior Authorization Technology Highway Demonstration, the analysis examined prior authorization transactions before and after implementation of ePA and found the time between request and decision was 69% faster with ePA. Time spent on phone calls and faxes also decreased significantly, and transparency of prior authorization requirements was improved.

As third-party and internal payment integrity and compliance audits ramp up, healthcare organizations need to put in place proven processes that guide immediate and effective actions in the wake of problematic findings. With the clock ticking to correct any internal processes and/or billing practices that contributed to those findings, many organizations are turning to the corrective action plan (CAP) to ensure below par outcomes are swiftly addressed and mitigated.

Healthcare organizations that work from CAPs also find the chances of future billing compliance risks drastically reduced, and the ability to achieve revenue integrity significantly enhanced.

As the nation’s death toll from COVID-19 inches towards one million, the Biden administration is intensifying efforts to inform clinicians and ordinary Americans about treatments for the disease, and to make testing and treatment more widely available.

The real-world testing of certified health information technology products is finally underway. And while health IT developers have the obligation to assess how their products perform in the real world, the testing will have both direct and indirect effects on providers, patients and others.

Real-world testing (RWT) is one of the Conditions of Health IT Certificationestablished by the 21st Century Cures Act Final Rule issued in 2020 to test health IT products’ interoperability and functionality.

We live in an age where incredible amounts of data are available to us all the time. But in healthcare, the challenge can be finding the right data, at the right moment, to achieve the best outcomes for patients. EHR technology has been game changing, but it’s also led to practitioner frustration: While EHRs can present all the data available about a given patient, they’re not always good about surfacing precisely what a physician needs.

As the industry moves toward value-based care models, clinicians have an even greater need to optimize their patient care through access to high-value information. According to physicians like Bill Hayes, MD, CMO at CPSIand a member of the HIMSS Electronic Health Record Association (EHRA) Executive Council, now is the time for stakeholders to improve EHR system functionality, and for EHR designers to enable input from clinicians and thereby ensure the most clinically relevant information is available at the point of care.