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4 Opportunities Analytics Can Provide

Posted on March 29, 2017 at 9:00 AM, Robert Freedman

The risks of non-compliance in the healthcare industry have never been greater. In fy2016, the HHS Fraud and Abuse Control Program returned $3.3 billion to the Federal government and private parties. The Department of Justice (DOJ) opened 975 new criminal health care fraud investigations.[1]

In fy2015, Medicare Recovery Audit Contractors (RAC’s) identified and corrected 619,000 claims resulting in $441 million in improper payments - $360 million in recovered overpayments and $81 million in underpayments repaid to providers.[2]

With both top and bottom lines continuing to shrink, you can’t afford to be hit with a massive overpayment penalty or to undercharge for patient activity by hundreds of thousands of dollars.

The key to managing both risk and opportunity is getting into your billing and collections data, and for that you need a robust analytics solution. Here are four opportunities you can take advantage of with a comprehensive analytics program.

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Topics: mdaudit, Healthcare Analytics, Risk-based audits

7 Tips to Cultivate Your Trainer, Part 2 of 2

Posted on March 22, 2017 at 9:00 AM, Angela Hunsberger

This is the second installment of a two-part blog mini-series where I share the tricks of the trade with detailed tips surrounding 7 essential “train the trainer” categories.  Missed the first half? No worries, you can check it out here: 7 Tips to Cultivate Your Trainer, Part 1 of 2.

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Topics: training, clinical optimization

7 Tips to Cultivate Your Trainer, Part 1 of 2

Posted on March 15, 2017 at 9:00 AM, Angela Hunsberger

Preparing your trainer to deliver an impactful learning experience is essential for getting the most return on your training program. Aside from the curriculum, learn how to inspire, groom, and mentor your trainer to enhance your program and promote skill set growth. A good teacher mixed with a thoughtful technique can make the difference in what learners retain.

This is the first of a two-part blog mini-series where I share the tricks of the trade with detailed tips surrounding 7 essential “train the trainer” categories.

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Topics: training, clinical optimization

Managing Denials in a Valued-Based Reimbursement World

Posted on March 8, 2017 at 9:00 AM, Revenue Cycle Transformation Team

Claims denials continue to be a thorn in the side of most healthcare organizations. The transition from manual to electronic documentation and billing has helped but denial rates still consume an average of nearly three percent of an organization’s net revenue annually. In recent years, denials have grown to encompass 15-20 percent of the billing value of total claims. That can mean a $6 million hit for a 200-bed hospital to over $260 million for an 1100 bed facility.[1]

And things don’t figure to get any easier. The switch from fee-for-service to value-based care will complicate billing even further despite new technology solutions. Value-based payments are complex and will undoubtedly lead to more denial issues.

Reducing revenue leakage due to denials is usually at the top of every organization’s focus list. Here are three things you can do to better manage your claims process and minimize denials.

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Topics: denial management, revenue cycle management

The ACA Replacement: How the Views of Trump, Ryan, and Price Tell Us What to Expect

Posted on March 1, 2017 at 9:00 AM, Don Michaels, Ph.D.

“They’re like the dog that caught the bus.” 

That was the comment from Senate Minority Leader Chuck Schumer in a January episode of This Week with George Stephanopoulos referring to the GOP and their pledge to repeal and replace the Affordable Care Act aka Obamacare.

In the more than six years after the passage of ACA, the House of Representatives voted to repeal it 60 times.[1] In December 2015, the Senate used a special budgetary procedure to approve one of the bills with simple majority vote instead of the 60-vote threshold normally needed for major legislation. As expected, President Obama promptly vetoed the bill. But the GOP had finally made a statement.

With the election of President Trump and a majority in both houses of Congress, Republicans can now make policy and do what they have been promising to do since the controversial law was passed in 2009. The GOP has finally caught the bus.

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Topics: value-based care, Healthcare insurance, ACA

Optimizing Your EMR Project: Utilize Your Lessons Learned

Posted on February 22, 2017 at 9:00 AM, Lisa Laravie

“If I knew then what I know now…”

How many times have we all uttered that phrase? It’s easy to see mistakes or opportunities for improvement once a project or event is complete. The trick is taking that knowledge and utilizing it for current or future projects to avoid unnecessary headaches.

Nowhere is that truer than when you’re implementing an EMR. Learning from your experience during implementation helps you fill in functionality gaps and optimize your EMR as you go. If you’re like most organizations, your EMR projects represent a huge undertaking.  With the resource management, legacy systems to adjust, and new processes to be put into place, you will find it hard to keep track of all the details.  You can often be left wondering how you’ll maintain the project on time and on budget, let alone how to optimize the change. 

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Topics: project management, clinical optimization, EMR implementation

Driving Cultural Transformation: Bringing an Innovative Mindset to Healthcare

Posted on February 15, 2017 at 9:00 AM, Mark Long

By Mark Long, Group Vice President, Digital Innovation, Providence St Joseph’s Health

During my time at NASA, Zynx Health, several startups and Amazon I learned a thing or two about innovation. The key lesson is best summed as “Success is not delivering a project or product; success is learning how to make your customers great at what your customers care about.”  This has been written about by many other thought leaders including Steve Blank (Customer Development) [1], Kathy Sierra (Making Users Awesome) [2], and Eric Ries (The Lean Startup) [3].  It’s grounded in a learning culture.

The healthcare industry is going through a transformation driven by many forces including changes in regulations, risk and price structures, and consumer expectations set by other industries. Technology is playing an increasingly important role in healthcare, but the answer is not to focus on the development of more tools and apps for their own sake. Instead success will come from an iterative learning process that leverages technology to focus on new ways to improve the lives of our patients, members, and providers.  

When we committed to digital innovation at Providence St. Joseph Health, we vowed we were not going to be a passive player in the healthcare transition game. We were determined to lead this revolution and reinvent healthcare along the lines of our mission.  Many Pacific Northwest organizations have reinvented industries such as Boeing, Microsoft, Costco, Nordstrom, Starbucks, REI, and Amazon. Now it’s our turn. 

After several years on the front lines of the revolution, Providence has identified four key concepts that we feel are essential for traditional healthcare organizations to disrupt the way they deliver services and stay relevant.

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Topics: healthcare transformation, Hayes Thought Leadership Blog Series

Verifying Patient Eligibility: Leveraging Epic Benefit Collection Workflow for Improved Collections

Posted on February 8, 2017 at 9:00 AM, Karen Lilly Castle

The turmoil in the healthcare industry is no more apparent than the effect it is having on patient health insurance. Rising costs in premiums and deductibles, the establishment of healthcare exchanges under the Affordable Care Act (ACA) and a workforce that continually changes jobs is forcing mass confusion in the healthcare insurance market.

As people assume more responsibility for payments, they are shopping for less expensive insurance options. To accommodate this new consumer mentality, insurance companies are offering a wider variety of plans than ever before. These dynamics place even more stress on the already overburdened front office function of most providers.

With patients moving from plan to plan, verifying eligibility has become crucial for hospitals and physician practices. The complexity of plan options makes the process even more challenging for front office staff. Determining coverage, benefits, co-pays and deductibles for each patient can be an overwhelming task.

Despite widespread use of electronic business transactions, many providers are still handling eligibility verifications manually. A recent report from CAQH Explorations reveals that health plans fielded more than 72 million phone calls on eligibility in 2015. The same report says the cost of a manual verification process is $8.39 per transaction, more than 17 times greater than the $0.49 cost of an electronic verification. In all, CAQH estimates the healthcare industry can save over $5 billion by using an electronic eligibility verification process.[1]

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Topics: clinical optimization, epic, Real Time Eligibility

How Analytics Can Benefit 4 Key Members of the Compliance Team

Posted on February 1, 2017 at 9:00 AM, Robert Freedman

As healthcare organizations have reached near universal adoption of EHR and practice management systems, the amount of available billing and claims data has grown exponentially. This data has the potential to offer insight to issues that can adversely affect the organization both from a regulatory and financial standpoint. Compliance and revenue cycle leaders are both coming to realize the benefits of collecting and analyzing this valuable information.

However, as compliance teams move from static auditing schedules to proactive risk-based programs to help identify and manage risks, it has become clear that it’s not just managers and supervisors who can benefit from data analytics. A robust analytics program can provide valuable insight that can help every member of the compliance team perform his or her job better.

In particular, use of analytics can significantly improve communication between the compliance team and other departments in the organization. There can often be friction between an auditor and those being audited, but focusing on data and providing a bigger picture view for both parties helps foster better working relationships and more effective issue resolution.

Using actual data instead of hypothetical situations can diffuse disputes and make audit finding discussions positive and more productive. It can also provide a wider view of a potential issue that can aid in instituting effective corrective action, both huge benefits for the compliance team.

For example, an auditor may find an instance of an incorrect E&M billing. It can easily be written off by the physician as a one-time error. However, analytics can reveal a pattern and show it was not an isolated instance. The auditor and physician can then rationally discuss the issue backed by data. That can be a tremendous advantage for compliance teams and helps take the emotion out of findings discussions.

Here are four key members of the compliance team that can get significant value from an organization’s analytics program.

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Topics: Healthcare Analytics, compliance programs

Leveraging the EHR as a Building Block for 3 Key Healthcare Initiatives

Posted on January 25, 2017 at 9:00 AM, Brent Magers

By Brent D. Magers, FACHE, FHFMA, CMPE, Executive Associate Dean and CEO, Texas Tech Physicians

With the advent of Electronic Health Records (EHR) in the late 2000s came rampant resistance. Meaningful Use requirements forced healthcare organizations to begin implementing an EHR but many were unhappy about it. As we transition from fee-for-service to value-based care – from volume to value – and move from current state to MACRA, adoption of EHRs has become both necessary and nearly universal.

As of 2015, nine out of 10 office-based physicians had adopted an EHR.  As of March 2016, more than 90 percent of hospitals eligible for the Medicare and Medicaid EHR Incentive Program have achieved meaningful use of certified health IT.[1] Overall, 96 percent of hospitals have adopted CEHRT.[2]

However, near universal adoption doesn’t necessarily translate to 100 percent acceptance. When it comes to incorporating an EHR, many providers have undergone the five stages of grief - denial, anger, bargaining, depression and finally now, to grudging acceptance. Like death and taxes, EHRs are here to stay and will remain an integral component of the healthcare landscape of the future.

The reality is that EHRs are essential if we hope to meet the overriding goal of providing better healthcare outcomes at reduced costs. EHRs form the basic building block for much of what needs to be accomplished in healthcare. Here are three key initiatives that rely on EHRs for their ultimate success.

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Topics: EHR optimization, evidence based medicine, Hayes Thought Leadership Blog Series, population health, patient engagement

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