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Driving Audit Productivity and Efficiency: 5 Key Steps

Posted on November 30, 2016 at 9:00 AM, Susanna Partrick

By Susanna Partrick, Senior Privacy and Compliance Administrator, Weill Cornell Medicine

Nearly eight out of ten healthcare internal auditors in a recent survey by PwC believe risks are increasing. As a result, almost nine out of ten say they have gone through or will soon be involved in significant business transformation. The conclusion is that these increased risks and transformative changes in the healthcare industry will require internal auditing to change as well.[1]

Unfortunately, few healthcare organizations are able to add resources during a time of shrinking revenue and tightening margins. To meet this increased demand, therefore, those of us responsible for the internal compliance program functions must find ways to be more efficient with the resources we do have.  Doing more with less has become an inevitable mantra for compliance auditing groups in healthcare organizations striving to minimize overall risk.

The concepts of productivity and efficiency are often viewed negatively – as simply buzzwords to wring more output from overworked staff. That doesn’t have to be the case. A huge part of our responsibility as leaders is to work cooperatively with our teams to improve the amount of work being performed by optimizing their skills, our processes, and the technology under our control.

Here are five key steps you can take to improve the productivity and efficiency of your compliance audit team.

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Topics: healthcare compliance, Audits, Hayes Thought Leadership Blog Series

Happy Thanksgiving from Hayes

Posted on November 23, 2016 at 9:00 AM, Admin

In this season of appreciation, Hayes would like to give thanks to all of our friends, clients, and followers for your support and collaboration. We wish you a wonderful holiday surrounded by family, friends and loved ones.

Check back with us next week for our regularly scheduled weekly blog. Happy Thanksgiving!

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Topics: holiday, thanksgiving

Defining Your Terms: Do You Have the “Analytics” Solution You Really Need?

Posted on November 16, 2016 at 9:00 AM, Robert Freedman

Big Data. Bandwidth. Paradigm. Analytics?

It’s almost universally accepted that the first three have crossed over into buzzword territory and are in danger of losing any real meaning (if they haven’t already done so.) But is the term “analytics” heading down the same road?

We’re not saying analytics aren’t important. In fact, they are critical for healthcare organizations facing the onslaught of changes resulting from MACRA, increased oversight and the rush to value-based care.

But it’s important for us to define our terms. “Analytics” does not mean the same thing in all situations. In order to get maximum value, you need to make sure the analytics solution you’re using is appropriate for the task you are trying to accomplish. If it isn’t, you’re not likely to achieve your desired goals.

We spoke with one prospect recently who said, “Analytics is off the table. We already have so many analytics products. We don’t need any more.”

His situation may not be very different from your organization where you have no doubt deployed a number “analytics solutions.” You may have a large, expensive enterprise system in place. But if you’re like many organizations, those analytics programs are often focused on “bigger picture” issues like population health. While that is an extremely important initiative, as a compliance organization, you still need to leverage data for other operational goals like improving revenue flow and minimizing risk.

You may also have a number of system-specific analytics programs and visualization solutions that can provide valuable insight. Unfortunately, although these applications fall under the broad heading of “analytics,” they don’t provide answers that relate directly to your set of issues.

The end result is that even though your organization may possess powerful “analytics” solutions, you can often be left hungering for “analytics” that help you focus on your key risk areas. You may have trouble getting directly to the raw data you need but instead have to rely on filtered data provided by someone in an IT group. Such data sets compiled outside the compliance group can reflect a different purpose from the one you need. 

Actionable analytics requires iterative refinement of available data with subject matter experts who can pull out the “learnings” that are real and worthwhile. To accomplish that you certainly need “analytics,” but analytics that use raw billing and coding data to uncover risk areas before they can cause reputational and financial damage. These types of “analytics” solutions are much more specific. They are built on an analytics platform, but they are actually applications.

When looking for an analytics application best suited for risk and compliance management, here are five things you need.

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Topics: Healthcare Analytics, Risk-based audits

On the Road with John Halamka, Healthcare IT Observations

Posted on November 9, 2016 at 9:00 AM, John Halamka

By John Halamka, MD, CIO, Beth Israel Deaconess Medical Center and co-chair of the national Healthcare IT Standards Committee.

Over the past few months, I’ve been in England, China, Denmark, New Zealand, and Canada.

Each of them is rethinking their healthcare IT strategy and is not entirely satisfied with past progress.  

I’m often asked by senior government officials to help harmonize IT strategy at the country level. That I can do. I’m also asked to discuss the US Presidential campaign, but that defies rational explanation.

I frequently say that healthcare IT issues are the same all over the world.  Here’s a few common observations:

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Topics: healthcare IT, Hayes Thought Leadership Blog Series

The 3 C’s of Clinical Care – Clarity, Collaboration and Communication

Posted on November 2, 2016 at 9:00 AM, Susam Vang

While patients today have more complications and multiple health problems, clinical care has become even more complex and specialized.  These days, an entire team of healthcare workers including physicians, mid-level providers, nurses, and health professionals work together to coordinate a patient’s well-being while reducing the number of medical errors, increasing patient safety, and improving patient satisfaction. This collective effort also inevitably leads to improved patient outcomes.

Health information technology has also become even more important than ever as healthcare professionals manage patients suffering from multiple health problems and need to quickly learn new methods. Multidisciplinary health teams need to be assembled and work well together in order to solve complex health issues and attempt to understand the patient’s health problem(s). By asking probing questions, making an initial assessment and, after discussing among the team members, the healthcare team needs to provide a recommendation to the patient.

For this reason, healthcare is a multifaceted environment in which health professionals from different specialized knowledge, training, and responsibility for different tasks must work together, communicate often, and share resources. Teamwork is essential for delivering quality care to patients and in order to keep up with the ever growing healthcare challenges, you need to assemble the best team you can.

Teamwork in healthcare means collaboration and enhanced communication among team members in order to expand the roles of clinicians and health professionals. Additionally, teams function better when they are able to make decisions together, and when they have shared goals and a clear purpose in order to implement protocols and procedures.

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Topics: clinical optimization

5 Benefits of Increased Patient Engagement You May Not Know

Posted on October 26, 2016 at 9:00 AM, Susan Cruz

In today’s disruptive healthcare environment, we’re hearing of all sorts of new initiatives that aim to provide the best and most
affordable healthcare to patients.  Everything from MACRA, to Meaningful Use, to interoperability.  A common theme among these is the active foundation of improving health and realizing increased patient engagement.  With the shift from fee-for-service to fee-for-value, patients and consumers are becoming less passive and more proactive and engaged.  With this idea on the tip of everyone’s tongue, one might ask questions like, how do I create the best environment for my providers and their patients? What is the best way to educate patients on what exactly is going into their healthcare? How do I increase my patient engagement?

Not unlike using the age-old sentiment that history repeats itself, you can begin to answer these questions by going back to examples of how people have been engaged in their education in the past.  When you talk about education, you intuitively think of school. Active learning is a methodology utilized in the classroom to move the students from the role of passive receivers of information to that of active participants responsible for their own learning.  Techniques used in active learning include discussion, self-assessment, projects, group learning, self-defined goals, and more.  These techniques have proven to be far more effective than the traditional learning environment in which students sit passively and listen to lectures from a seemingly autocratic authority.

Similarly, the provider-patient role in many healthcare institutions has evolved throughout history into an authority and passive recipient relationship.  But as we noted earlier, this is clearly starting to shift within the healthcare industry today.  With the implementations of value-based care, we are seeing the provider-patient relationship shifting to organically place more ownership of the patients’ own health onto their plates to become more like the traditional consumer of any good or service, and less like a passive student within a lecture-style environment. 

While the healthcare industry is abuzz with all sorts of opinions about these initiatives and the shift value-based care, one perspective you can take is to see the win-win benefits of such an evolution of healthcare, especially for providers.

Here are five benefits that you may not have realized since the industry has started to steer patients into becoming active learning healthcare consumers.

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Topics: Fee-for-service, value-based care, provider education, patient engagement

Payment Posting: A Crucial Link to Efficient Revenue Cycle Management

Posted on October 19, 2016 at 9:00 AM, Sou Chon Young

“For the want of a nail the shoe was lost,
For the want of a shoe the horse was lost,
For the want of a horse the rider was lost,
For the want of a rider the battle was lost,
For the want of a battle the kingdom was lost,
And all for the want of a horseshoe-nail.”

- Benjamin Franklin

What’s a horseshoe-nail story got to do with healthcare revenue cycle management? It illustrates that the smallest detail can ultimately make the difference between success and failure. In revenue cycle management, that detail is payment posting. Posting errors can lead to all the major revenue cycle issues: understated accounts receivable, mounting denials, false credits and inaccurate patient statements.

Payment posting has never been a glamourous position – considered a simple “heads-down” data entry job with little impact on the revenue cycle. If that was ever true, it certainly isn’t today.

The massive changes in the healthcare landscape have dramatically affected the professionals responsible for posting payments. Sophisticated new technologies, multiple new payment models and organizations transitioning from one billing system to another means today’s payment posters must handle a much wider range of scenarios.

The bottom line: take your payment posting operation for granted at your own peril. Here are some of the major new competencies you should be looking for in your payment-posting professionals.

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Topics: revenue cycle management, Payment Posters

DSRIP: A Major Step Toward Reinventing Medicaid

Posted on October 12, 2016 at 9:04 AM, Kelly Barland, CIO

By Kelly Barland, Chief Information Officer, St. John’s Episcopal Hospital, New York City

The pros and cons of the Affordable Care Act (ACA) continue to be debated, but one point appears to be beyond dispute: the ACA has significantly contributed to the explosive growth of the Medicaid program. In FY 2015 – the first full year of ACA coverage expansion – enrollment and spending in Medicaid across the 50 states and DC increased by an average of nearly 14%.[1] Combined federal and state spending for Medicaid was more than $500 billion in 2015 and is projected to reach $750 billion by 2020.[2]

Many initiatives are being implemented to help stem the rising costs and improve patient outcomes including increasing the value and quality in managed care contracts, instituting home health for individuals with chronic conditions, and testing innovative delivery and payment models.

One of the more promising efforts has been the Delivery System Reform Incentive Payment program (DSRIP). Rolled out in 2010-11 in California, Texas, and Massachusetts followed by New Jersey and Kansas, in 2012, DSRIP originally focused on funding for safety net hospitals and resulted from negotiations between HHS and the states on how to pay for hospital care. The program has evolved into a way to initiate payment and delivery system reforms and provide the states with funding to support hospitals and other providers in changing methods of providing care to Medicaid beneficiaries.

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Topics: Medicaid, Hayes Thought Leadership Blog Series, DSRIP, ACA

Amidst the Angst, Value-Based Care Is Working

Posted on October 5, 2016 at 9:00 AM, Don Michaels, Ph.D.

“It’s not the strongest of the healthcare organizations that survive, nor the most intelligent, but the ones most responsive to change.”

–With apologies to Charles Darwin

People – and organizations – tend to fear and therefore avoid change. That often applies to healthcare organizations facing the new reality of value-based care reimbursement models. As a result, many are holding back trying to maintain the status quo against the rising tide of inevitable change.

On the other hand, some organizations have embraced and committed fully to the change. They have implemented various versions of value-based care programs, been patient and as a result, are starting to reap rewards. They are proving the truth of Darwin’s “repurposed” statement above, and have the best chance to survive – and thrive – because they have been the most responsive to change.

The changes these organizations are going through are not only succeeding in strictly financial terms. They are also increasingly meeting the other major goal of value-based care – better patient outcomes.

Here are three examples of the kinds of positive change possible in the new value-based care environment.

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Topics: value-based care

False Claims Act Penalties Doubling: Time to Beef Up Your Compliance Program

Posted on September 28, 2016 at 9:00 AM, Robert Freedman

If you mistakenly submit a single claim that results in a $100 government over reimbursement, you could now be subject to a penalty of over $20,000, according to the lawyers at Mintz Levin, specialists in healthcare law.[1] And that’s for every single claim.

To quote Alec Baldwin’s character in the famous Glengarry Glenn Ross monologue, “Have I got your attention now?”

The Department of Justice recently passed an interim final rule that has nearly doubled the civil penalties under the False Claims Act (FCA) from an already oppressive $5500 minimum to $11,000 maximum per claim to a minimum of $10,781 and maximum of $21,562. The increases – which went into effect August 1 - are the result of a “catch-up” clause in the 2015 Adjustment Act that amended the Federal Civil Penalties Inflation Adjustment Act of 1990.

The act mandates agency heads to adjust civil monetary penalties based on the difference between the Consumer Price Index in October of the year they were established and October 2015. After this initial catch-up, agencies must make additional annual adjustments, so the costs are only going to increase from these new dizzying heights.

The impact for the healthcare industry is seismic. The cost of any slip up in Medicare and Medicaid claims can be financially disastrous and the doubling of penalties means a doubling of “whistleblower” rewards, so organizations can expect increased scrutiny from employees, former employees and competitors looking to cash in.

To make matters worse, because of the sharing of Medicaid costs, the act incentivizes individual states to pass FCA laws in addition to Federal statutes. The pressure on healthcare organizations to “get it right” when it comes to claims submittal has never been greater. With the financial stakes ratcheted even higher, it may be time to refocus your efforts on compliance.

Here are five ideas to help strengthen your compliance program.

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Topics: billing compliance software, mdaudit, compliance programs

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