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Tale of Two Systems: Making the Right IT Choice Following a Merger or Acquisition

Posted on April 27, 2016 at 9:00 AM, Pete Rivera

A recent survey reported that healthcare promises to be one of the most active sectors when it comes to mergers and acquisitions (M&A) in 2016. Almost half of the M&A professionals surveyed felt healthcare would be the third most active sector behind only the technology and biotech/pharmaceutical industries. KPMG, who conducted the survey, reported that healthcare M&A’s are being driven by geographical expansion, new service lines development, and adjustments to new reimbursement models.[1]

Many strategic challenges come with a merger or acquisition – financial, legal, cultural - but one of the most significant involves technology. Selecting between the IT systems of two combining entities can be a difficult process and to make the right decision, the organization must evaluate both systems before deciding on the best option going forward.

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Topics: healthcare mergers and acquisitions, IT strategy, systems analysis

Caring for the Clinician: The Key to Improving Patient Experience, Enhancing Health Outcomes, and Reducing Cost

Posted on April 20, 2016 at 9:00 AM, Jerry Ford, CEO, Marathon Health

According to the CMS National Healthcare Expenditure Projections report, the U. S. healthcare system is the most expensive in the world, making up 17% of the country’s gross domestic product. Projections have that number reaching to nearly 20% by 2020.[1] Aging populations combined with chronic health problems have put an enormous strain on medical and social services.

The reality is our healthcare system is broken. The way it’s constructed makes it difficult to navigate – for patients, providers, and employers. The good news is that visionary leaders and organizations are embracing change in an attempt to make a meaningful difference. That’s important because we should not be handing over the healthcare delivery system we’ve created to future generations. But instead of pointing fingers or assessing blame, we should be working together to make needed changes.

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Topics: patient satisfaction, Fee-for-service, value-based care, Hayes Thought Leadership Blog Series, healthcare improvement

Risk-Based Auditing: Why It May Be The Right Choice for Your Organization

Posted on April 13, 2016 at 9:00 AM, MDaudit Team

Authors: Carrie Walters-Derksen and Susan Horahan

In a recent survey of Chief Audit Executives, an increased focus on risk management was named the top initiative by 60% of respondents.[1] The continuing growth of regulatory compliance demands in the healthcare industry – and the heightened risk that comes with it - is placing an enormous strain on auditing resources in most organizations. Deploying those resources in the most effective way means narrowing audit focus to those areas that pose the greatest risks.

The growing adoption of this type of approach explains why risk-based auditing is such a hot topic in healthcare circles today. With only so much time available for auditing, it’s critical for organizations to target specific areas of interest and not devote time to areas with little or no significant impact. Moving from an annual risk assessment program to a risk-based audit plan can be one of the most important moves a healthcare organization can make.

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Topics: OIG Workplan, risk management, Risk-based audits

Transitioning to a New EMR – 3 Tips to Smooth the Way

Posted on April 6, 2016 at 9:00 AM, Clinical Transformation Team

Authors: Rosie Montemayor and Kelsey Kazmierczak 

 Electronic Medical Records (EMR) have become a crucial part of everyday healthcare operations.  Chances are your organization is currently working with an EMR system. Many organizations have not only adopted one, but have transitioned to another, newer model in hopes of returning the significant investment if the first implementation did not go as well as planned.  By the second go-live, organizations have a list of what to do and what not to do based on lessons learned from the first time around.  So how do you know if adopting a new EMR is the best choice?  What are some of those tips and tricks that you could learn from your peers? 

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Topics: ehr implementation planning, clinical optimization, EMR implementation

HCC model: Down to the Basics from Coding to Documentation

Posted on March 30, 2016 at 9:00 AM, Johanna Legaspi

The Basics

Hierarchical Condition Categories (HCC) were mandated in 1997 by the Centers for Medicare and Medicaid Services (CMS) and have been the basis for reimbursement for Medicare Advantage plans (MA) since 2004. HCCs use data to prospectively estimate predicted costs for enrolled members during the next year of coverage. These estimates are based on demographic information such as age and major medical conditions documented in the previous 12-month period. They are used to adjust Medicare capitation payments to Medicare Advantage health plans based on the anticipated risk of enrollees calculated from relevant ICD-10-CM codes.

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Topics: compliance, HCC, Coding and Documentation

3 Evolving Revenue Cycle Trends: Leveraging Them to Improve Financial Viability

Posted on March 23, 2016 at 9:00 AM, Celeste Daye

Celeste Daye, Senior Director Patient Financial Services, Dana Farber Cancer Institute

Healthcare finance executives from leading healthcare organizations like the Mayo Clinic, Kaiser Permanente, and the Cleveland Clinic have dubbed 2016 the “year of integration” for revenue cycle. They see consolidating complex revenue systems as the best way to reduce waste, increase efficiency, and improve the patient experience. One of the key aspects of such integration is involving the patient more in the financial aspects of their care.[1]

At Dana Farber Cancer Institute, the shift to value-based care, the evolving consumer mentality in healthcare, and a greater focus on clinical care plans are key changes impacting our revenue cycle. We not only recognize these fundamental changes, but are working to leverage them to benefit the organization.

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

The Sound of Project Success: Orchestrating the Noise into a Symphony

Posted on March 16, 2016 at 10:00 AM, Susan Eilman

If you’re like most organizations, you’re probably neck deep in this year’s projects already and are so busy that’s it tough to achieve your goals in a day, a week, or even in a month. On one hand, time is of the essence, deadlines must be met, and you want to do an outstanding job, but you just can’t do everything yourself and may need help in driving your goals to a successful outcome. While there is stress, there are some days when everything is going smoothly, you are on top of your game, and knocking things off your to-do list. On the other hand, it’s inevitable to have days that seem like nothing gets done and the number of tasks continues to grow. So how do you convert the noise into success?

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Topics: project management, revenue cycle

Fee-For-Service to Value-Based Care: The Future is Now

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

The U.S. Department of Health and Human Services (HHS) has a stated goal of shifting 85% of Medicare fee-for-service reimbursement into value-based models by 2016. Private payers will no doubt follow close behind. Meeting this aggressive goal is causing angst among healthcare providers with much conjecture about what it means for their organizations going forward.

The future, however, isn’t as bleak as it may seem. Several forward-looking organizations have leapt into the breach and embraced the change. Although there have been bumps along the way, a few have successfully made the transition and offer both a preview into life in the new reimbursement model world and examples of what you need to do as a provider organization to be successful.

Here are three examples.

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Topics: ACOs, Fee-for-service, value-based care

Insurance carrier setup neglect: a costly oversight - Part 2 of 2

Posted on March 2, 2016 at 9:00 AM, Angela Hunsberger

In last week’s blog Angela Hunsberger outlined the importance of cleaning up the insurance carrier list to ensure efficiency to maximize payor reimbursement.  More than consolidating an old list, she explained the nuances of paper vs. electronic claim submission and suggested partnering with the billing team to tackle the list.

Continued in Part 2 of a two piece post, Angela provides an instructional roadmap detailing six steps of insurance carrier cleanup.   This article will provide the knowledge and tools needed to revamp carrier settings and revel in the financial payoff of a job well done.

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Topics: revenue cycle management, electronic healthcare information, Healthcare insurance

Insurance carrier setup neglect: a costly oversight - Part 1 of 2

Posted on February 24, 2016 at 9:00 AM, Angela Hunsberger

Insurance submission and processing has evolved over the past decade transitioning from printing paper claim forms to an electronic workflow. Adaptations include the NPI implementation, using a new standard paper claim form, sending more electronic claims as payors offer connections (or even refuse paper claims), moving to the ANSI 5010 electronic claim submission format, and most recently transitioning to ICD10. Considering those changes, along with the flurry of your other projects, have you audited your insurance carrier setup lately to ensure it is configured to maximize revenue cycle efficiency? By efficiency, I am referring to leveraging technology you are already paying for to get the most bang for your buck and maximize payor reimbursement.

Some people may think cleaning up the carrier list is a grueling meaningless chore and a waste of valuable time. On the contrary, the payoff is quick and it’s in real dollars and cents so you will want to reap the benefits by tackling the list at full speed. The outcome is not simply to consolidate an old insurance carrier list; it is much more dynamic than that. This blog, the first part of a two piece post, will explain what to look for and why. Read on my friend.

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Topics: revenue cycle management, electronic healthcare information, Healthcare insurance

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