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How to Effectively Manage Your Optimization Process after Go-Live: MOP IT UP!

Posted on August 24, 2016 at 9:00 AM, Tamarah Alexander

A new system implementation can really stir up a lot of dust within your organization!  Between trying to mitigate risks,
 complete required tasks, consolidate and contain the limits of the scope, reduce redundancy, design new workflows, and reconciliation, it really can feel like the needs of your end users are being sucked into a vacuum. An implementation is not “one size fits all” but it can feel like it in the beginning when you are introduced to the new technology and learn how others are using it in the industry.

Once you have completed the “hammering of the nails” behind the build, it is important to evaluate what has been done and what is not truly completed yet.  Once the dust of the go-live has fallen and settled on the floor, it’s time to “M.O.P. I.T.” up and begin the optimization process.

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Topics: EHR go-live support tips, Change management, System optimization

The 21st Century Revenue Cycle Leader: 3 Key Factors for Success in the Evolving Healthcare Environment

Posted on August 17, 2016 at 9:00 AM, Steven M. Wagner, PH.D., M.P.A,

By Steven M. Wagner, PH.D., M.P.A, Executive Director Medical Practice Income Plan; Clinical Instructor in Health Policy, Finance and Administration, Department of Medical Education, Texas Tech Health Sciences Center El Paso at the Paul L. Foster School of Medicine, faculty instructor for Independence University, and Research Fellow at the Centers for Healthcare Research in the School of Advance Studies for the University of Phoenix.

Healthcare leaders need to look at the bigger picture of healthcare reform rather than narrowly focusing on its separate components. Fragmented legislation and grants led us to where the healthcare industry stands today, and only integrating networks of components in healthcare can lead us to successful reform. Success means that healthcare becomes accessible and affordable with or without insurance to all payors, quality outcomes take into account the functional and holistic health of the patient, and patients are satisfied and feeling well.

The hard reality is that in the end, everyone in the industry will be dealing with less revenue because the over-arching goal for the US government is cost containment. Only when leaders take all the changes into account will we, as an industry, be able to facilitate truly beneficial change. To make that happen, revenue cycle leaders need to be able to integrate cost, quality, and access into our routine processes of patient care, frequently analyze outcomes including the patients’ self-perceived health statuses, and develop actionable solutions.

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Topics: revenue cycle management, value-based care, Hayes Thought Leadership Blog Series

The Two Sides of MACRA: Examining the Pros and Cons

Posted on August 10, 2016 at 9:00 AM, Don Michaels, Ph.D.

The shock and awe of the April release of the 962-page Notice of Proposed Rulemaking (NPRM) for the Medicare Access and CHIP Reauthorization Act (MACRA) has started to wear off as the healthcare industry continues to dig into the details. Slogging through the NPRM is an intimidating but necessary chore as healthcare organizations try to determine how it affects them.

MACRA represents change – significant change – in the way Medicare providers conduct business so it’s not surprising that much of the feedback has been negative. People dislike and fear change regardless of the reasons for it or the potential positive outcomes. Adding to the resistance is the fact that in recent years, changes in the healthcare industry have been aimed at providers like water from a fire hose and “change fatigue” is starting to set in. Lastly, providers know that most governmental changes to reimbursement have meant fewer collections for their practice. At best, they have been trained to hope that these types of changes are revenue neutral.

Despite the negative reviews, MACRA and the NPRM that puts it into action is not all bad. In fact there are several positives to be taken from the new law. Here is a look at the major pros and cons of MACRA.

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Topics: cms, Fee-for-service, value-based care, MACRA

7 Ways to Plug High Deductible Health Plan Revenue Leaks

Posted on August 3, 2016 at 9:00 AM, Paul Fox

According to a recent report, three out of four employers now offer high deductible health insurance plans, up from just over two out
 of four five years ago.  At 22 percent of employers, it’s now the only option and nearly half of employers plan to make high deductible plans the only choice by 2018.[1]

high-deductible health plan (HDHP) is a health insurance plan with lower premiums and higher patient deductibles than a traditional plan. Choosing an HDHP is required if an individual wants to take advantage of the tax benefits of a health savings account (HSA/FSA). HDHP’s make employees personally responsible for a higher portion of their family’s healthcare costs, with the goal of motivating them to comparison-shop for medical services.

With an HDHP, consumers pay for all their medical services — at the insurer’s negotiated rate — until they meet their deductible. After that, consumers typically are responsible for a co-pay, normally 10 to 35 percent of the service — until they reach their out-of-pocket maximum. If payment isn’t collected at the time of service, the provider is left having to bill the patient for the remaining self-pay balances after a normal 20-40-day adjudication period. Most studies suggest the longer the self-pay account goes unpaid, the less likely it becomes that the provider will ever collect.

Can your organization survive under those financial terms? Most would answer an emphatic “no!”

There’s no question that HDHP’s are adding financial stress to healthcare organizations. Here are seven strategies you can use to help prevent revenue loss as a result of the growing use of HDHP’s.

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Topics: high deductible health plans, revenue cycle management, Healthcare insurance

Things to Consider When Selecting a Healthcare IT Vendor

Posted on July 27, 2016 at 9:00 AM, Jim Rielly

Many healthcare organizations are finding that the clinical or revenue cycle systems they installed 20, 10 or even five years ago no longer meet the needs of their complex and growing organizations. You may be filling functional gaps with manual work arounds or a myriad of bolt-on solutions. HIPAA, Meaningful Use, ICD-10, population health and many other industry initiatives have invoked the need for additional system requirements. While many vendors have kept up, some have struggled. Additionally, the need to improve operational efficiency and implement best practice workflows often stresses the limits of existing systems.

If you are taking the journey in selecting a new healthcare IT vendor or install a new system, there is a lot to consider beyond the analysis of the features and functions of the proposed system. Consider the areas below to make sure you are selecting a strong and dependable partner with a superior product.

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Topics: EHR go-live support tips, strategic planning, Healthcare IT Vendor Selection

Looking to Embrace Population Health? Focus On Your People, Process, and Technology

Posted on July 20, 2016 at 9:00 AM, Don Livsey

By Don Livsey, former Vice President and CIO, UCSF Benioff Children’s Oakland, Founder DZL Solutions

Big data, informatics, business intelligence, and data mining have all been floated as “silver bullets” to solve the riddle of healthcare reform. One that will likely have the biggest impact, however, is population health. HealthcareIT News recently reported that population health and data analytics are the top two topics of interest for 2016. Everyone wants it, but few can clearly define what it is, and we don’t know what it will cost.

David Kindig of the Department of Population Health Sciences at the University of Wisconsin and Greg Stoddart from the Department of Clinical Epidemiology and Biostatistics at McMaster University in Ontario, are credited with this first attempt at a definition of population health in 2003:

“The health outcomes of a group of individuals, including the distribution of such outcomes within the group. These groups are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons, prisoners, or any other defined group.”[1]

A 2015 survey of 100 healthcare leaders conducted by Milken Institute School of Public Health noted that the definition was accurate but focused strictly on measurement and didn’t explain or acknowledge the “role that healthcare providers must take to impact those outcomes.”[2]

What isn’t in dispute is the fact that population health will be a significant focus of the healthcare industry going forward. A recent industry 2015 report identified three key trends involving population health:

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Topics: value-based care, Hayes Thought Leadership Blog Series, population health

7 Things to Know for Successful Provider Education

Posted on July 13, 2016 at 9:00 AM, Beth Enders

The first six years of my career, I worked for two providers in a small privately-owned family practice in the southwest.  My responsibilities included rooming patients, checking vital signs, updating medical information in patient charts, and poking countless patients with needles. Early on I learned how to build a rapport and more importantly, build trust with people of all ages and personalities including the two temperamental doctors who yelled and threw charts.  Little did I know the skills I was developing over those six years would teach me how to handle many difficult situations and people throughout my career.

Twenty-six years later I am still in the medical field and have learned just how vital it is to the success of an organization to have a positive working relationship with the providers, even the difficult ones.  I feel the first step to do this is training the physicians and mid-level providers on proper medical record documentation.  The goal is not to turn the providers into coders, but rather to give them the information and tools they need to be able to document their services accurately and thoroughly.

Across all specialties, we frequently identify common documentation deficiencies.  Physicians and other providers are often unaware of which data elements must be separately documented and are critical for proper code assignment.  Add to this the inherent complexity of E&M coding guidelines that make it difficult for a busy physician or mid-level provider to select the correct code from an often densely populated charge ticket or EHR.  Thus, it has become necessary for people like me, a coder and clinical documentation specialist, to work with these providers to help them understand the do’s and don'ts in the world of clinical documentation and coding.

Over the past several years I have been training and conducting provider education on best practices for clinical documentation and coding and have come up with seven tips for communicating with physicians and mid-level providers.

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Topics: physician education, codes, healthcare compliance, provider education

4 Steps to creating super users for your system implementation

Posted on July 6, 2016 at 9:00 AM, Susan Eilman

In the world of healthcare technology, there are numerous system implementations occurring each year.  In order to make an implementation successful, it is crucial to develop your users into “super users” during the implementation process.  It is common for implementations to include and involve roles such as Project Managers, Practice (Operations) Managers, IT System analysts, and trainers, among others.  Each of these roles  have well defined parameters and expectations.  Often implementations involve super users, but this role is not always well defined and expectations are not always clear. 

A super user is your department’s champion for system knowledge and workflows. This person becomes your expert for the system implementation and teaches other employees how to use the new system features. Once you've identified your super users, you need to have clear expectations for this critical role. 

Questions should be asked early when selecting the super user.  Questions to consider include: Which user should you pick? What qualities should a super user have? How do you train them? Sometimes, you may pick someone that you feel is right for the job but turns out to be someone that is not quite fit for the role. 

Consider the following tips when choosing your super users for your next implementation:

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Topics: training, EHR, EMR training, revenue cycle management

MACRA 101: 9 Things You Need To Know

Posted on June 29, 2016 at 9:00 AM, Don Michaels, Ph.D.

Congressional passage of the Medicare Access and CHIP Reauthorization Act (MACRA) last year was only the beginning of a major upheaval in Medicare reimbursements. This past April the other shoe fell – all 962 pages of it. The Centers for Medicare & Medicaid Services (CMS) released the Notice of Proposed Rulemaking (NPRM) providing the details on the plan to transition healthcare providers from a payment system based on volume to one that rewards value. MACRA is the next step in driving healthcare organizations from a fee-for-service to a value-based care reimbursement model.

The massive NPRM document will be dissected and discussed (and maybe even read) for many months to come, but the implications for clinicians providing care under Medicare Part B are real and far-reaching. The major consequence for those of you who are Medicare providers is that you will soon have to choose to operate under a merit-based incentive program or transition to an Alternative Payment Model. Other than leaving the practice of medicine, there is no third choice.

Here are nine things you need to know to help you begin digesting this next significant change in the healthcare industry.

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Topics: cms, meaningful use, value-based care, MACRA

8 Things About Healthcare Analytics That May Surprise You, Part 2 of 2

Posted on June 22, 2016 at 9:00 AM, Lisa English

In last week’s post, Lisa English described the growing importance of healthcare analytics in dealing with large-scale initiatives like population health. She also outlined the important role analytics can play in solving the day-to-day problems of monitoring risk areas, supporting continuous risk assessment, and complementing limited compliance resources that organizations face every day.

In spite of the increased reliance on analytics, Lisa stressed that there is still much we need to learn. She outlined four things about analytics that might surprise you. Here are four more considerations surrounding analytics that you may not have realized.

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Topics: mdaudit, Healthcare Analytics, risk management

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