How much missed revenue due to denied claims?


An article in Healthcare IT News stated that 10% to 20% of claims that are denied can contribute to approximately 90% of missed revenue opportunities. However, a company experienced with RCM is able to maintain quality procedures and measures that keep pace with today’s ever-changing business needs and reimbursement models.

 

According to the Northern California Spring Conference, California health insurers rejected approximately 1 in every 5 medical claims, approximating $45.7 million in missed revenue between 2002 and 2009 alone (and that doesn’t include claims denied by Blue Shield of California).

 

Even more alarming are their statistics that a managed care hospital with a net revenue of $50 million may have – at any given time – $5 to $10 million in an open state of denial. Read more

4 Things every urgent care should know about health IT security


There’s no denying that the digital revolution has spawned an age of convenience, but with that convenience comes a growing concern for the security of consumer information.

This rings especially true for healthcare organizations that are responsible for mountains of patient information.

A stolen credit card can be canceled, but a medical record contains significantly more rich data and information about a person. These records contain family information, financial information, and of course, a medical history. “A person’s health information is worth 15 to 20 times more than financial information,” said Robert Wah, MD, President-elect of the American Medical Association and Chief Medical Officer for CSC, a health IT Company in Falls Church, VA.

Lisa Gallagher, Head of Privacy and Security at HIMSS agrees. “It’s easier for identity theft to take place from a medical record that’s not secure than it is from a financial record because they tend to be locked down a little better. Hackers and other perpetrators have moved to trying to get it from the medical record.”

All healthcare organizations, including urgent care centers, must educate themselves about health IT security so they can better protect their patients.

With this in mind, here are 4 things you should know about health IT security. Read more

 

Common Revenue Cycle Management Pitfalls to Avoid


When asked what the key to success is, most business owners will tell you the ability to stay competitive in the marketplace. Staying competitive is particularly important in the health care field where the financial success of a physician practice is fundamentally based on provider productivity and revenue cycle management. A practice that’s unable to reduce revenue leaks and increase their bottom line will have a hard time staying afloat.

When it comes to minimizing costs and managing revenue, medical practices of all sizes make the same mistakes. Here are 7 common RCM pitfalls to avoid at all costs.

Not Collecting at Point of Service

Not everyone is comfortable collecting from patients at point of service (POS), but avoiding this sometimes-difficult task can put your practice’s revenue at risk. You know firsthand that copays and reimbursements are a major part of how you and your staff get paid.

Should a payment not occur at POS, a lot of time and money is spent following up and chasing after patients. There are the endless phone calls and emails and paper invoices, and all of those “minor” expenses add up, not to mention the expense of having to hire a collections agency. Multiply these expenses by “X” number of patients and your revenue soon develops a slow and steady leak.

The moral of this RCM scenario is, it’s much harder to get patients to pay once they’ve been treated and are out the door, so make sure your staff has been trained on these procedures and can clearly communicate your collection policies. Read more 

MIPS Delay on the Cards


MIPS Delay on the Cards

MIPS (Merit-Based Incentive Payment System) delay & shorter reporting periods are the options CMS is willing to explore.

  • On July 13, at the congressional hearing on the Medicare Access and Chip authorization act, CMS Acting Administrator Andy Slavitt did not rule out the possibility of a MIPS delay.
  • Originally, MIPS is scheduled to start from January 2017 with payment adjustments beginning in 2019.
  • Since the release of the proposed rule, various physician groups have called for greater flexibilities, many of Which center around pushing the start date forward by at least six months.
  • With the final rule scheduled to release on November 1, leaving physicians with only two months to prepare CMS is Open to give physicians more time, said Slavitt. Read more

5 EHR Infographics that every provider must read


EHRs are an important element of the healthcare market. It is vital to realize the importance of EHRs and the direction the entire industry is headed in. With the help of info-graphics it is easier to show marketing trends, the following article will show you some of the best info-graphics relating to healthcare, ranging from subjects like; when to get a new EHR? What share do different vendors in the market hold? Does technology really improve the way a practice is run? Find out with below amongst many other important subjects.

1) Electronic Health Records Infographic

How do electronic health records (EHRs) connect you and your doctor? In the past, medical data was only stored on paper, making it difficult for your health care providers to share your information. Read more

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2) The 20 Most Popular EHR Software Solutions

As the deadline for implementation in the U.S. draws near, talk of electronic medical records (EMR) and electronic health records (EHR) software is a hot topic at the doctor’s office lately. These systems assist medical practitioners in the creation, storage, and organization of electronic medical records, including patient charts, electronic prescriptions, lab orders, and evaluations (just to name a few common features).  Read more

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3) Why are EHR users replacing EHR SOFTWARE?

 This infographic created for Honeywell depicts the top reasons why hospitals and medical practices are replacing their EHR software. See more

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4) 11 indicators that you need a new EHR

Often so deeply immersed in looking for ways to make their practice more efficient, physicians sometimes fail to see the most obvious hurdle preventing this very process from occurring; their EHR. If your Electronic Health Record (EHR) solution is not up to the mark, you might be losing out on precious profits, and incurring costs that you can easily overcome. Read more

11-indicators-that-you-need-a-new-ehr

5) The Convergence of Big Data and EHR Infographic

“In the next 10 years, data science and software will do more for medicine than all of the biological sciences together,” said venture capitalist Vinod Khosla. Data science holds great promise for patient health, but patient data is only actionable in so far as it is digital. Read more

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5 Hidden Costs to Account for When Budgeting Your EHR Implementation


One of the biggest problems practice owners and provider organizations are running into when implementing EHR systems is unanticipated costs. Learn how and why to budget for this problem by reading on.

First ICD-10, Now This? Getting Your Budget Ready for EHR Implementation

As if the ICD-10 transition was not enough, many practices and providers are being strongly encouraged to also transition to electronic health records (EHRs).

Like ICD-10, EHR implementation promises strong gains in an effort to modernize medicine. For one, the government will provide incentives in the form of increased reimbursements. For another, patient care promises to become more consistent and thorough, particularly when moving from provider to provider.

Regardless of the benefits, the here-and-now of EHR implementation promises to be a challenge. Looking exclusively at the problem of hidden expenses, providers are going to have to budget extra money and time in order to cope with unexpected costs.

Because of the likelihood of this problem, the HealthIT.gov website recommends adding to your budget with emergency provisions and anticipatory funds. How much? Several years ago in 2012, the Modern Medicine Network recommended squirreling away an additional 50 percent on top of your current expected EHR implementation budget.

That number may not be precise, but providers are going to have to set aside quite a large chunk of change in order to meet budget bloat head on. Here are just some of the things they will need to account for:

EHR Software

Hardware Costs

EHR software needs something to run on, and your organization’s current systems and hardware may not be up to snuff. At the very least, you are likely to invest in a few extra workstations and an increase to your networking capabilities, including an internet bandwidth upgrade.

For many providers, a full-scale replacement of computing systems may be in order. That means new, faster computers and a full suite of networking and application hosting servers, as well as all the wiring and installation costs that come with it.

All said and done, some providers are going to be saddled with a huge bill before they can even run their Best EHR Software. Plenty of others are lucky enough to get away with minimal hardware upgrades, but you have no way of knowing which category you fall into until your software is finally running as it should be.

Estimated added baseline cost: $5,900 on average

IT Staff and Outside Support

Most vendor service contracts include some amount of system support and troubleshooting, especially during the initial installation phase. Even with this help, your organization is likely to need some IT support of their own once the training wheels are removed.

Also consider that some support services are not provided by vendors, or that the support may not be available at all hours. These factors in addition to the inevitable IT staffing upgrade that will occur during full EHR implementation can increase providers’ tech payrolls into the foreseeable future.

Estimated added baseline cost: $3,094 on average

Training

Training the entire staff will be necessary, with separate training goals based on their role within the EHR system. Physicians alone needed two weeks of training before they were able to satisfy the Meaningful Use requirements, according to one study.

On top of that, front-house staff will need to know how to use EHR systems for things like billing and patient registration. You will also need an IT department with many staff members who know the EHR system backwards and forwards. All of these training hours add to lost productivity and overtime wages, the single-most anticipated expense when it comes to labor.

Decreased Patient Loads and Increased Staffing Needs

Every moment spent troubleshooting or learning the EHR system is a moment taken away from patient care. Once implementation is complete, these bumps are expected to smooth out, but full EHR implementation for some organizations could take one to two years.

To make up for the lost productivity, new staff may be needed just to handle the leftover administrative and patient-end responsibilities. The combination in decreased patient loads and increased labor costs is predicted to be the most variable and unpredictable for providers implementing EHR.

Network Security

With more sensitive patient data traveling through their networks, providers are going to have to invest in robust network security solutions and IT expertise so that all that data will be protected. Anyone who fails to do so and who could be found negligent could potentially face HIPAA violation fines.

Conclusion: Form a Contingency Plan, Allocate Extra Budgets, Prepare for the Worst

The purpose of outlining all of these potential costs is not to deepen your despair. Instead, you should take this information to heart and plan positively and proactively by preparing a contingency plan.

Set aside extra budgetary funds that provide for a significant cushion when unexpected costs arise. If you feel like you cannot come up with such a budget, request help from your local Regional Extension Center (REC), which is designed to provide advisory knowledge and support for EHR implementers.

Finally, develop a strategic plan that accounts for setbacks like lost productivity for two or more years into the future. Keep in mind that you may need to upgrade your systems by that point as well.

With all these elements in place, your provider organization should have a substantial safety net to prevent you from falling on your face should you stumble. Remember that everything should get smoother as adoption increases and systems are refined. Many providers and government organizations even expect for EHRs to provide some ROI in the not-too-distant-future. So spend now and be grateful later that you did.

Why and how must you immediately begin preparations for the ICD-9 to ICD-10 conversion?


Last year, the much debated ICD-9 to ICD-10 conversion deadline was delayed another year and set to October 1, 2015. However, numerous provider groups and stakeholders have been pushing for another delay, which would be the third in total, stating that the conversion will result in unmanageable financial pressure on the already challenged practices.

This article summarizes how ICD-10 differs from ICD-9, what the Congress had to say about the deadline, and in what way must you prepare for the conversion.

CureMD ICD-9 Into ICD-10

The new codes

The first question that most providers have is about the specific changes in the code sets. Here’s a summary:

* 68,000 diagnosis codes as opposed to just 13,000 in ICD-9

* A maximum 7 alphanumeric characters per code as opposed to 3-5 in ICD-9

* Very specific, more complex, and more flexible codes

* Lateral codes as well (different codes for right and left)

* 87,000 procedure codes as opposed to 3,000 in ICD-9

* 7 alphanumeric procedure code characters in contrast to 3-4 numbers in ICD-9

* With detailed methodology descriptions, procedure approach mechanisms, more detail, and flexibility

The Meeting

Last week, the Energy and Commerce Committee’s Subcommittee on Health held a public forum to discuss the ICD-10 deadline. The meeting panel comprised of experts and stakeholders from across the industry, and included doctors and EHR vendors.

The Response

Despite opposition from a few stakeholders who held the view that small practices wouldn’t be able to manage the new codes, the majority voted in support of the October 1 deadline.

The way forward

The response by the congress via the meeting is clearly tilted towards ensuring that the deadline holds. If you were anticipating a delay, and haven’t yet started working on the conversion; you can still manage. Here’s how:

  1. Contact your EMR and Practice Management vendor and enquire your system’s readiness for the conversion. Ensure that their software possesses the necessary updates and ICD-9 to ICD-10 conversion mapping tools to make certain that your system is ready for, and will facilitate the conversion.
  2. In the case that your vendor is not ready, immediately begin looking for a new system. This is because from October 1, your claims will not be processed on ICD-9 codes.
  3. Delegate an ICD-10 expert (from you staff, or hire a professional) to train your staff, and to devise and execute plan for the conversion in line with your practice workflows.
  4. Consider Outsourcing Medical Billing if your ICD-10 expert (and yourself) feel that your current staff will not be able to manage claims processing on the new code set.
  5. Get in touch with payers and clearinghouses to determine their readiness.

The target for completing these steps (apart from staff training which could be ongoing) should ideally be March 15.

  1. Next, you must begin internal testing of the new codes between March and April, to check how well your staff will manage the new codes. Ideally you should be done by this till the end of June at maximum; and make the necessary workflow adjustments to fix errors in which the process proceeds.
  2. After internal testing in June, you need to begin external testing with clearinghouses and payers to determine how well your test claims (with ICD-10 codes) will do once out of your practice.

It is imperative to identify and correct any slow or disruptive processes in every stage of your conversion process. Doing so will enhance the efficiency of your practice, and help make certain that you are ready and equipped for the ICD-9 to ICD-10 conversion by October 1.