News

Healthcare organizations are in a precarious financial position. With operating margins still hovering near zero, revenues are at heightened risk because of a surge in third-party audits following the expiration of the public health emergency as well as increased scrutiny by federal and commercial payers alike to identify – and recover – billions in improper payments and penalties.

This sharp uptick in audit activity has many healthcare organizations – even those that have already adopted revenue cycle management (RCM) technologies to streamline workflows – struggling to comply with both the volume of incoming documentation requests (ADRs) and the timeframes within which they must reply.

The Centers for Disease Control and Prevention (CDC) has released the ICD-10-CM code updates for the 2024 fiscal year (FY), which became effective on Oct. 1, 2023. The update includes over 433 diagnosis code changes, including 395 code additions, 25 code deletions, and 13 code revisions. This brings us to a total of 78,044 codes in the ICD-10-CM code set for FY 2024.

It is essential for coding professionals and all applicable team members to keep up-to-date with these annual code changes, understand how to apply them and recognize any new documentation requirements.

ICD 10 Monitor»

TAMPA, Fla. – October 17, 2023 – FutureRx® (FRx) announced today that its innovative FRx cloud-based healthcare platform for health plans and pharmacy benefits managers (PBMs) will be implemented by Imperial Health Plan of California, Inc. to enhance medication adherence among its Medicare Advantage population. The health plan will leverage the platform’s Part D Stars module to automate business processes, enhance medication adherence, and improve Part D Star ratings.

Niagara Falls, N.Y. – October 6, 2023 – Harris Data Integrity Solutions, the leading provider of best-in-class patient data integrity services and software, announced today that its vice president of professional services, Rachel Podczervinski, MS, RHIA, will participate in a panel discussion on AHIMA’s newly updated naming policy framework during AHIMA23. The discussion takes place on Oct. 10, 2023, beginning at 2 p.m. ET during the conference, which takes place Oct. 8-10 in Baltimore.

Podczervinski was involved in creating the AHIMA Naming Policy Framework 2023: Enhancing Person Matching with Essential Demographic Data Elements which provides everything health information management (HIM) professionals and healthcare organizations need to know about person matching in health IT. She joins a panel of experts representing provider and vendor organizations to discuss the critical need for standardized naming policies and how the framework addresses the issue.

Niagara Falls, N.Y. – October 5, 2023 – Harris Data Integrity Solutions, the leading provider of best-in-class patient data integrity services and software, announced today that its Director of Professional Services, Megan Pruente, MPH, RHIA, was honored by the American Health Information Management Association (AHIMA) with its Community Service: Mentor Award. Part of AHIMA’s prestigious Triumph Awards, the Mentor Award honors those who have transformed the lives of new and emerging health information professionals and launched them toward new horizons.

“We are so proud of Megan, whose dedication to the HIM profession inspires all of us who are fortunate enough to work with and know her,” said Lora Hefton, Executive Vice President of Harris Data Integrity Solutions. “This recognition by AHIMA is well deserved and is testament to her tireless efforts to advance the next generation of HIM professionals and ensure the future of this profession.”

Recent upturns in operating revenues haven’t shifted hospital finance executives’ laser-focus on revenue growth and retention, part of which is putting a stop to revenue leakage. That includes rooting out what are often unexpected sources as part of a holistic revenue cycle management (RCM) strategy – like inaccurate patient identification and information.

Patient misidentification issues cost the average healthcare facility $17.4 million per year in denied claims and lost revenue and cost the U.S. healthcare system over $6 billion annually. According to the Ponemon Institute, about 35% of denied claims incurred by hospitals each year can be attributed to inaccurate patient identification or inaccurate/incomplete patient information, adversely affecting both cash flow and AR days.

The relationship between payers and providers has been typically viewed as adversarial, with the prices paid to physicians and hospitals being blamed for skyrocketing healthcare costs borne by the insured, while delays and denials by insurers are blamed for falling hospital revenues.

And while the arguments on both sides appear valid, the reality is that these supposed antagonists are closer than they would initially appear when it comes to revenue and payment integrity.

Sydney and Niagara Falls, N.Y. – 9-7-2023 – Hospital Products Australia (HPA), a prominent leader in delivering cutting-edge medical equipment and healthcare solutions, and Harris Data Integrity Solutions, the leading provider of best-in-class patient data integrity services and software, are excited to unveil a groundbreaking collaboration that marks a monumental leap in the realms of healthcare and technology.  Under the partnership, HPA assumes a pivotal role alongside Harris Data Integrity Solutions to tackle the challenge of duplicated patient records within Australia's evolving Electronic Health Records (EHRs) landscape.

Renowned for its unwavering dedication to excellence in providing top-notch medical products and services, HPA stands as a trusted ally for healthcare institutions across the region. This strategic partnership with Harris Data Integrity Solutions not only bolsters HPA’s commitment to excellence but also underscores its active role in incorporating advanced data management strategies that elevate patient care, streamline operations, and empower healthcare professionals with precise and timely information.

Financial clearance activities are critical to constructing a strong foundation for a high-performing revenue cycle. However, a provider organization’s ability to financially secure appointments in advance of a patient’s visit is often limited by a lack of staffing, technology, and operational processes.

These limitations result in initial denials – the average rate of which increased to almost 12% in the first half of 2022 compared to just 10% in 2020 and 9% in 2016 – as well as net revenue leakage via avoidable write-offs and impacts to patient experience scores.

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).