6 Steps to Improve Revenue Cycle Management

Revenue Cycle Management is of the utmost importance when it comes to enhancing profitability and ensuring success at care practices. Many providers wonder why their earnings are not protected the way they should be. What they don’t realize is how easily that can be done with a few simple steps.

What is the actual process?

The process of Revenue Cycle Management actually starts when you sign a contract with a payer. It is best to get started with general questions you might have such as contract terms and offered rates of reimbursement.

After the required numbers are obtained, confirm the reimbursement by looking at your payments. This data is available from your clearinghouse.

The next step is to extract data which shows the administrative burden posed by your insurance provider or payer. There are revealing indicators for this such as the percentage of services the insurance company requires to be authorized on a prior basis.

Essential Steps

Get the percentages received from each payer balanced against a scenario where you are out of network [not contracted with any payer]. It is essential to meet the payer representatives and prepare a presentation showing or elaborating the quality of care you provide so that the payer is aware of your worthiness.

Collect more at lower cost through our best practices. Getting the highest revenue at your practice is best accomplished by following important proven operational principles. It is because of this reason, we have created a new white paper ‘’6 Steps to Improving Revenue Cycle Management’’.

Learn how to speed up the revenue cycle process, avoid missed collections and receive payments at the right time by reading our latest white paper.

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The Transitioning Industry

The healthcare industry is moving at a staggering pace with numerous changes taking place simultaneously. The road ahead lies with a lot of barriers for policy makers, implementers and healthcare service providers.

With the ominous deadline for ICD-10 implementation and Meaningful Use Stage 2, life is not going to be easy for concerned stakeholders.The final date for Meaningful Use Stage 2 and ICD-10 implementation has been extended to October 2014 – giving providers a fresh breath of air before they can plunge into the changes which come along. This extension actually shows the awareness of policy makers regarding the transitioning industry and what problems lie ahead for providers, EMR vendors, insurance companies and patients.

Sue Bowman, director of Coding Policy and Compliance at the American Health Information Management Association agreed with the deadline extension and advocated for the implementation of ICD-10 together with other initiatives such as Electronic Medical Records and Accountable Care Organizations because “they all relate together.” She adds. “To separate them out and say ‘this piece doesn’t need to be done now’ is somewhat shortsighted, they all link together and are interrelated in a way to promote value for healthcare both to improve the quality and costs. I don’t think we are going to see the anticipated benefits of all of the other initiatives unless we move to a better coding system.”

Mr. Ed Hock, a Senior Director at the Advisory Board Committee sheds some light on the importance of clinical documentations required by physicians and how specific they have to be in their diagnoses andsays, “The reality is ICD-10 will require physicians to document things they’ve never had to document before, if they don’t start documenting these new concepts, three things will happen: A claim will be coded lower than it should have and will be reimbursed less than it should have; the claim can be submitted and billed but eventually will be denied; or you don’t end up billing it and query the physicians, which is fine, but it slows down the process significantly.”

It does not end here though; the Healthcare community has to work diligently to put into practice stage 2 of the Meaningful Use program. Providers who want to be eligible for financial incentives under the Meaningful Use program have to apply specific measures and meet objectives to qualify. These objectives range from incorporating clinical lab-test results into Certified EHR Technology as structured data, generate lists of patients by specific conditions to use for quality improvement and reduction of disparities, research, or outreach. Eligible professionals have a different set of objectives than the eligible Hospitals and Critical Access Hospitals.

It is evident that as soon as the stakeholders in the healthcare industry realize the importance of the looming transitions and start working on implementing the changes, the better it will be. Those who neglect the changes will have to live in an era where every stakeholder will be operating a standardized system such as an EMR, where every process will be done electronically by every entity involved – and the ones who still operate on the previous system will eventually be alienated by their own industry.

Farzad Mostashari, the National Coordinator for Health Information Technology voiced similar concerns by saying that pushing the implementation of Meaningful Use would actually segregate the stakeholders in the industry and “both the vendor and provider communities must be given enough time to implement it successfully”.


Best EMR checklist

Finding the right EMR for your practice is as important as making the right diagnosis for your patient. If you are feeling a little lost and confused by the options available in the market & the influx of information on vendor websites don’t worry: picking a good solution for your practice is time consuming but not as hard as it seems. This checklist will guide you in making the most suitable EMR choice for your practice. However, please note that this is not a substitute to the initial homework you must do to understand the goals of your practice and how an EMR can help you achieve them.

Established Vendor

EMRs are without doubt a long term investment in your practice. Therefore, the vendor is as important as the product they are selling. Always remember to research the vendor to gauge their stability and longevity in the market – to avoid a situation where you must switch EMRs because your vendor ran out of business. A good starting point for this is independent healthcare review organizations such as KLAS research – providing updated comparative analysis and reports on different vendors.

Similarly, before finalizing an EMR always ask for references specific to your specialty. This way you will have an unbiased view about the system and any customization or usability problems associated with it. It is always wise to know what to expect before you reach the implementation stage and to prepare yourself accordingly.

Multiple Back ups

Computers crash. Papers don’t. One of the chief complaints against EMRs: a system crash completely paralysis the practice workflow causing discomfort to staff and patients alike. To safeguard against this many practices opt for relatively expensive server based systems requiring in house IT staff support rather than the more economical web based option for small practices.  Web based software are not necessarily less reliable than server based systems, provided that you have chosen a quality vendor. In fact, as other studies have indicated web-based systems essentially  mean lower up-front costs, minimal hardware procurement, free upgrades, efficient maintenance and free server repairs. It is also a more cost effective option for small scale practices.  Thus, while looking for an EMR always opt for a product that has multiple backups so that you never lose access to your data no matter what the circumstances.

Remember to ask your EMR consultant about the historic downtime of their product and their disaster preparedness plans.

Customer Support

Usability is an important feature to look for in EMRs. It refers both to the ease of using the software and the quality of support services provided. With the myriad of stakeholders involved in care delivery process, we need to make sure that communication between these stakeholders is smooth. The future of Health IT depends upon the overall integration of healthcare system. We need to think about usability as a perfect connection between technology, use, training and design which enhances our own prospects and potential. We also need to look at technology such as Electronic Medical Records as a usable tool through which we can magnify our potential.

On an average most vendors provide 20 hrs of training on site or off site before a practice goes live. However, care providers or their staff may require additional help after they start using the system. Thus, quality support is a value added service that you should not compromise on while choosing your system.  Cutting cost through outsourcing customer support is a common strategy used by many vendors as it makes perfect business sense for them. However, variation in dialects may serve as a communication hurdle for you. Thus, consider choosing a vendor located in your areas or someone nearby to immediately respond to all your support needs in a timely and effective manner.

Intelligent Billing

Some clients prefer to opt for separate EMR and practice management system. This might seem like a minor thing, but keeping billing integrated with patient information is the best possible way to ensure that you handle billing as efficiently as possible. Thus, an integrated solution that covers clinical, administrative and financial side of the practice is usually the most efficient choice.

These solutions have eligibility verification feature that allows you to verify healthcare coverage, limits and insurance caps of your patient anytime. Most vendors also have the feature to automatically verify eligibility every time an appointment is scheduled reducing the chances of non-payment.

Similarly, the system automatically generates procedure and diagnoses code for billing. In cases where you disagree with the system E&M code calculations, you may use separate values and the system will guide you in supporting documentation so that you do not become a victim of down coding. Thus, reimbursement denials and questions are virtually eliminated streamlining your billing process. You also receive the status of each claim in real time helping you keep track of your payment and to follow up as and when required.

In short, an integrated solution consisting of EMR, practice management and a patient portal beats non integrated (separate) systems hands down.

Data visualization

For a doctor, provider notes may be the make or break feature upon which their buying decision is based. A system with the ability to adapt to your workflow best practices is the best thing that can happen to your practice. A good vendor will try to make the implementation process as painless as possible- which means customizing your existing templates, be intuitive enough to store templates for patients with similar complaints and to allow you to use drop downs, tick boxes or descriptive data entry options depending on your ease.

Some features to look out for that will add value to your practice include:

  • A system that organizes and presents data in the right way can tell important stories about your practice. A personalized dashboard feature for example, gives you a snapshot of information of interest to you. This saves you time.
  • An EMR that shows you a timeline of the patient tagged with their symptoms, medications, lab results, vital signs, and any other pertinent data makes your life easier and ensures that you deliver quality care with minimum medication or diagnosis errors.
  • The report feature integrated with EMRs helps in business analysis and planning. The end result of incorporating such a feature in electronic medical records is to help in examining and reviewing the different aspects of your practice that involve healthcare information documentation for exercising superior healthcare decisions.

On an ending note, we know it’s tempting to spend years choosing just the right vendor. However, do remember that many of your competitors have already joined the EMR bandwagon and are enjoying the benefits of EMR adoption, which include enhanced patient safety, enterprise productivity, provider efficiency and countless government incentives. Be wise, make an informed decision but do not delay!

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Sequester Cuts and the Disgruntled Healthcare Community

With the budget plan approved by the Senate on March 23rd, President Barack Obama released the proposed fiscal budget for the year 2014, announcing major cuts to the healthcare industry.

A joint study by the American Medical Association and the American Hospital Association estimated that the reduced funding for healthcare would result in a loss of 766,000 jobs by the end of year 2021. These job cuts would penetrate through the economy and around 496,000 jobs would be lost in healthcare and related industries by the end of this year.

The proposed budget means to reduce $400 billion dollars from Medicare over the next ten years. Research shows that these cuts are highly unpopular with around 82% of the population against the cuts in Medicare.

Through the sequestration, $140 billion of funding to scientific research will be cut by 7% including a $1.6 billion cut to the National Institute of Health, which is the largest Biomedical Research Institute in the world. The CDC (Center for Disease Control and Prevention) also faces a cut in funding by $289 million.

The American Association of Cancer Research gathered 15,000 protestors in Washington D.C., comprised of healthcare professionals, patients and researchers alike to protest against the sequestration cuts. Eric Hoffman, director of the Center for Genetic Medicine Research at Children’s National Medical Center in Washington voiced his dismay and said, “They are doing cuts on top of cuts on top of cuts”.

Gene Ransom, executive director of the Maryland State Medical Society said, “Doctors are very nervous about this, it’s not like the cost of business has gone down”.

Rich Umbdenstock, CEO of the American Hospital Association said, “In addition, the budget would jeopardize the ability of hospitals to train the next generation of physicians by cutting funding for graduate medical education, and hinder care for people in rural communities by reducing funding for critical access hospitals.

Furthermore, industry experts say that the budget cuts would wreak havoc and result in around 3000 lesser inpatient admissions, 804,000 lesser outpatient visits and 424,000 lesser HIV tests granted by the CDC.

Despite the ongoing protest against the budget cuts and its potentially damaging effects on care delivery, a segment within the healthcare community believes that 2% reductions do not make that much of a difference and are largely unconcerned. Rob Schile, partner in charge of health systems and reimbursement at CliftonLarsonAllen said, “While these cuts are significant in terms of total dollars and undoubtedly will have some overall impact on the economy, the remaining $85 billion targeted for 2013 represents just over 2 percent of the total $3.8 trillion in federal spending for 2013” He added, “In reality, the proposed cuts should not equate to the level of devastation currently portrayed in the media”.


Declining PC Sales and what it means for the Healthcare Industry?

Witnessing the worst drop in sales in the last 19 years, PC sales have declined 14% in the first quarter of this year. Industry experts see the increased use of smart phones and tablets as the main reason, along with negative reviews of Windows 8 contributing to the decline in shipments.

The first quarter of 2013 saw a decrease in market share for all major vendors including HP, Lenovo, Dell, Acer Group and ASUS. Compared to the first quarter of 2012, the first quarter of this year has seen a staggering 14% decrease in overall market share. On the other hand, tablet and mobile phone sales continued to increase and are forecasted to grow consistently in the upcoming years.

What does this mean for Healthcare IT?

A reduction in PC sales means that consumers are now buying alternative devices such as smart phones, tablets and ultra-thin laptops. The increase in usage and availability of these alternate devices suggests that PCs are on the road to becoming obsolete. It means that the next generation of consumers will have portable computer systems instead of personal computers.

This rise in portability gives credence to the fact that we are in an age where information sharing is constant and holds no geographical boundaries. Consumers thoroughly review any product or service they are about to purchase on the internet using their portable computer systems. Consumers share their location with others while they are travelling. They also use these computers to search for and consult doctors; and find out possible treatment options.

Healthcare as an industry is trending towards increased patient engagement, which entails better accessibility of medical records, increase in accountability so that patients have more say in the use of their personal information, safety and sharing of information in an interoperable manner. This trend has lead to the emergence and usage of electronic devices as a means to gain access and share information by patients and doctors alike.

A decline in the sales of PCs will lead to patients using alternative devices to access their electronic medical records. Patients will use features of Patient Portals to have constant access to personal health information, be reminded about important dates through warnings and alerts; detailed medication instructions and access to lab results, radiology reports and procedural information.

Doctors will use their tablets to look at and update Electronic Health Records. They will use that information to send claims to insurance companies. Through Remote Patient Monitoring Technologies, doctors will effectively be able to care for patients without having to monitor them in the same room just like patients will be able to view their lab results at home.

Even though the news of declining PC sales does not bode well for computer technology vendors, it certainly shows us the way in which healthcare information technology is going forward. It is instrumental for the healthcare community to move side by side with trends in technology and avail its benefits which can lead to quality care provision and patient safety.