News

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.

The payer/provider relationship is often seen as adversarial, with delays and denials by insurerstaking the blame for falling hospital revenues. But these supposed antagonists are closer than they would initially appear.

For providers, the goal of revenue integrity is to take great care of patients, maximize the reimbursement to which they’re legitimately entitled, create operational efficiencies, and maintain regulatory compliance. Contrast that with payment integrity on the payer side, the goals of which include enabling a great beneficiary experience, member retention, payment accuracy, operational efficiencies, and maintaining compliance.

WASHINGTON, D.C. – June 27, 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., has been named a Leader in Revenue Cycle Management (RCM) Operations by Everest Group for the third consecutive year.

Everest Group Revenue Cycle Management (RCM) Operations PEAK Matrix^® Assessment evaluated 25 RCM providers’ market impact and ability to successfully deliver services based on subdimensions, including market adoption, portfolio mix, value delivered, and strategic vision and capability. Results were then used to determine each organization’s overall market leadership position – Aspirant, Major Contender, or Leader.

The payer/provider relationship is often seen as adversarial, with delays and denials by insurerstaking the blame for falling hospital revenues. But these supposed antagonists are closer than they would initially appear.

For providers, the goal of revenue integrity is to take great care of patients, maximize the reimbursement to which they’re legitimately entitled, create operational efficiencies, and maintain regulatory compliance. Contrast that with payment integrity on the payer side, the goals of which include enabling a great beneficiary experience, member retention, payment accuracy, operational efficiencies, and maintaining compliance.

TAMPA, Fla. – June 20, 2023 – FutureRx (FRx) announced today the appointment of Eric Grossman as its Chief Commercial Officer, tasked with all aspects of the commercial strategy related to its innovative FRx cloud-based healthcare platform and FRx Marketplace for health plans and pharmacy benefits managers (PBMs). Grossman will oversee FRx product and partner development, marketing, sales, and customer service strategies to build market share and maximize revenues.

“Eric brings to FutureRx a remarkable track record of developing highly effective commercial strategies for healthcare technology companies that deliver innovative SaaS solutions to the payer market,” said Anil Kottoor, CEO of FutureRx. “He will be an exceptional asset as FutureRx embarks on an aggressive growth strategy focused on providing health plans and PBMs with access to a highly unique suite of technology tools and services that lets them reclaim control over their pharmacy benefits programs.”

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.

During a virtual media briefing this week, the HIMSS Electronic Health Record Association outlined some of the comments it plans to send the Office of the National Coordinator for Health IT about its draft Health Data, Technology and Interoperability: Certification Program Updates, Algorithm Transparency and Information Sharing proposed rule, or HTI-1.

While some of the rule's details are still being parsed, EHRA said it has reservations about the ability of its member IT companies to balance new regulatory compliance with other HHS requirements – and has questions about a lack of provider incentives, information blocking rule challenges and more.

When the federal Public Health Emergency (PHE) ended on May 11, many of the waivers that kept external audits in check also vanished. As a result, healthcare organizations are bracing for an influx of demand letters, claim changes, and heightened regulatory and billing practice scrutiny by Recovery Audit Contractors (RACs), Medicare Administrative Contractors (MACs), Supplemental Medical Review Contractors (SMRCs), Unified Program Integrity Contractors (UPICs), Targeted Probe-and-Educate (TPEs), Comprehensive Error Rate Testing (CERT), and commercial payors.

The uptick in audit activity doesn’t have to leave provider organizations exposed, however. Proper planning and a well-designed external audit strategy can ensure a rapid, effective, and compliant response while mitigating future risk.

With revenue cycle (76%), clinical administration (55%), and finance (36%) among the top five areas benefiting most from automation and artificial intelligence (AI), it’s easy to see why 98% of health care leaders say their organizations have implemented or are planning to implement AI. That includes nearly 48% that have already taken the leap, according to Optum’s annual survey on AI in health care.

However, it makes no difference how large the investment or advanced the technology solution is if the patient data flowing through it lacks integrity. In other words, when it comes to AI and patient data, the adage “garbage in, garbage out” still applies. It’s also a very real problem, as evidenced by an average duplicate patient record rate that runs as high as 18% in the typical facility and patient misidentification issues that cost the health care industry more than $6 billion in denied claims.

NIAGARA FALLS, N.Y.  – May 10, 2023 – Harris Data Integrity Solutions, the leading provider of best-in-class patient data integrity services and software, has released a white paper that undertakes an in-depth examination of the healthcare industry’s chronic people matching problem. In addition to dissecting the challenges and impacts patient misidentification has on care safety, outcomes, and costs, People Matching in Healthcare: Challenges, Impact and Solutions explores efforts underway on multiple levels to identify a system-wide resolution to the problem.

Patrice Wolfe, MBA is CEO of AGS Health of Washington, DC.

TAMPA, Fla. and COLLINSVILLE, Conn. – April 26, 2023 – FutureRx (FRx) and Nuwae, a member of the Goodrootcommunity of companies, announced today the addition of Nuwae’s pharmacy and medical rebate services and software to the FutureRx Marketplace, providing FRx health plan and pharmacy benefits manager (PBM) customers with streamlined access to rebate optimization and management solutions. With Nuwae on the FRx Marketplace, FRx customers can easily integrate solutions designed to lower prescription drug costs for both patients and payers from a company focused on solving the issues that drive medication prices to astronomical levels – thereby lowering out-of-pocket costs and providing equitable access and outcomes for stakeholders.

When health systems are immersed in data related to billing, denials, internal audits, and external payer audits, it can be overwhelming to track, manage, and process what is an overwhelming amount of raw data. Creating a value-generating revenue integrity team and pairing it with technology is the answer to harnessing that data and using it to positively affect the tight margins experienced by many healthcare organizations.

While this might seem like a bold statement, the only way to productively use your data is to employ sophisticated analytics that will provide actionable insights on how to improve billing compliance and maximize revenues.

Nashville - AGS Health works with scores of hospitals providers on revenue cycle management and helping sure organizations get money more quickly, but the company is also working with organizations on health equity.

Cheryl Cruver, chief revenue officer of AGS Health, spoke about the growing interest in health equity in a conversation with Chief Healthcare Executive® at the ViVE Conference.