Five Ways to Improve Your RCM Process in the First Few Months of ICD-10

ICD-10 is here in full force, and many providers are already feeling the effects. Slowdowns and the anticipation of the first round of claims denials have many providers biting their nails hoping that they can somehow come back up to speed.
While a rocky ICD-10 implementation transition should be expected as your organization irons out the kinks, there are still many strategies you can employ to eliminate pain points, avoid claims denials and speed up your RCM processes in general. Here are a few suggestions that can revamp your RCM efforts and improve reimbursements overall:

1. Invest in Training
The coding procedures of ICD-10 are much more complex and intensive than the legacy ICD-9 system before it. While there were around 13,000 codes in ICD-9, ICD-10 has 68,000. Merely trying to translate ICD-9 to ICD-10 simply will not work because of the incredible new levels of nuance and complexity afforded by the ICD-10 coding system.

Train everyone in RCM on the ICD-10 procedures for claims, appeals and obtaining guidance from the CMS. Every employee should have at least cursory knowledge of the general theory and practice behind ICD-10 coding, and senior staff must have a definitive working knowledge of the coding procedures. With these knowledge leaders in place, your RCM staff can have someone to consult when they get confused about what they need to do next rather than throwing up their arms in frustration.

 

2. Appoint New Positions
One of the best ways to streamline RCM may seem like it adds more blockage to the workflow, but in the end it will help reduce setbacks that keep claims in billing for too many days or have reimbursement requests denied repeatedly.

Namely: hiring or appointing new staff positions. Having someone audit all claims before they are submitted helps ensure a lower incidence of denial. Having another person or group of people handle every denied claim and enact a dedicated appeals procedure helps prevent taking work power away from filing incoming claims from billing. The team that handles denied claims can also inform training processes down the road so that common mistakes are addressed.

 

3. Optimize Your Front Office with Automation
Many front offices are structured with redundancies or out-of-date practices that hinder efficiency. For example, many offices have manual processes that bog down claims submissions while causing newly-admitted patient accounts to become piled up behind them.

Developing some sort of automation for multiple stages of the billing cycle has been a popular solution to this problem. In the words of the Becker’s ASC Review: “Automating eligibility verification and patient cost estimation processes are two front-end improvements that can increase and accelerate revenue in two ways. First, it will decrease claims errors, thus ensuring you’ll have fewer denials and rejections. Second, it will enable staff to generate fast, accurate estimates, which will not only improve productivity, but will also increase patient collections by facilitating payment at point of care.”

 

4. Restructure Your Workflow
Like a tiny, one-story home that has achieved monstrous size with pieced-together additions and outbuildings, adding on new procedures to your existing RCM practices can make them unwieldy and not fit-for-purpose.

Evaluate your current front office and RCM procedure to map out how typical workflow occurs for Medicare patients, private insurance patients and self-pay patients alike. See if you can redraw that structure to be a more streamlined workflow that facilitates modern billing and claims request procedures rather than working at cross-odds with them.

 

5. Test Continually
You will need to periodically evaluate your RCM systems and procedures to ensure that everything is occurring optimally. The CMS and many payer systems recommended testing before ICD-10, but there is no reason to stop now.

Give your system a periodic “health checkup” that can highlight problem areas that are not so evident during day-to-day operations. Submit sample claims, audit them for correct coding and submission requirements and make recommendations based on problematic trends you identify.

 

Following these tips may require some up-front investment, but they will help providers avoid crippling claims denials or workflow interruptions in the long run. All a healthcare organization can really do in this situation is put more measures in place that prevent mistakes from happening while learning from the mistakes that still do happen. In the end, we will all get through ICD-10 one day at a time.

There are many strategies you can employ to eliminate pain points, avoid claims denials and speed up your RCM processes during the ICD-10 transition.

Author Bio:
Alex Tate is a digital marketing specialist, content strategist, and a health IT Consultant at CureMD who provides perceptive, engaging and informative content on industry wide topics including EHR, EMR, practice management and compliance.  http://www.curemd.com/revenue-cycle-management

 

Population Bodies and Chronic Diseases

How Terminal Illnesses Are Affecting Developing and Developed Nations

According to cdc.gov, in the year 2013, over 2.5 million Americans died at a death rate of 821.5 deaths per 100,000 population. Among the other interesting statistics that litter the webpage, one of the more interesting is the number of deaths per leading causes of death. The number one, two, and three spots are claimed by, respectively, heart disease, cancer, and chronic lower respiratory diseases. All three of these chronic illnesses combined claimed a total of 1.35 million lives.

Despite the United States’ low mortality rates and above-average life expectancy of about eighty years, in comparison to other nations around the world, the nation is still a generally good example of what chronic disease can do to a developed country that is having increasing difficulty in solving its own financial crises. On the opposite end of the spectrum, over with developing and underdeveloped countries, the statistics are not as mild. In another statistic that the World Health Organization published, eighty per cent of deaths caused by chronic diseases occur in low and middle income nations, half of which are in women. In a similar statistic, in the year 2005, chronic diseases alone claimed a peaking number of thirty-five million global lives.

As is probably evident, it would not be difficult to talk about and discuss the ambiguities and general stats that are available about chronic diseases and how they’re cluttering vulnerable, global populations. But the foundation of a more interesting and revealing discussion would not lie in what everybody already knows and widely accepts; it would lie in what everyone does not know, or is least aware of, and an example of such a foundation would be the reasons and primary causes for these chronic and noncommunicable diseases that sprout not during old or even middle age years, but during youth.

The World Health Organization has done a lot in the past to try and communicate this idea, and has stated that the four, primary risk factors for these terminal illnesses are tobacco, alcohol, lack of exercise, and poor nutrition. Excessive involvement in the two substances or association with the two malnourishments at early ages set the stage for chronic illness later in life. This is a scene most commonly found in undeveloped, underdeveloped, or still developing countries with middle to low income and poor qualities of life. When an ever-growing number of these nations’ youths has to resort to other, less favorable means of care and income, such as drugs and other methods of trafficking and substance abuse, it foreshadows the inevitable increase on more World Health Organization documents of chronic disease statistics and deaths in the years to come.

There are, however, equally important statistics other than death rates that must be understood in order to fully comprehend the issue of disease in middle and low income countries. According to an article published on prb.org, one such statistic that is quite salient is the age at which noncommunicable diseases strike. Poorer countries, such as some found in Sub-Saharan Africa, experience more frequent strikes of noncommunicable diseases at younger ages, whereas richer countries inhabit the opposite. A supporting factor of the former is the tobacco industry’s targeting of its campaigns to new smokers in developing regions, most certainly aiding in their economic growth while depressingly and simultaneously increasing the percentage of young smokers and tobacco users, all contributing to the larger, looming picture that is chronic disease.

With all of this circulation and attention that our world’s epidemics and Medicare problems are receiving, the time has well passed now where people had to start looking for viable solutions. Among the other options available, one such option is improving how we do population health management. By aggregating patient data across a multitude of health information technology resources in order to better understand how groups and populations of people are developing sickness patterns and other common causes that contribute to high mortality rates, it’s far easier to achieve successful insights and results. “Technological Innovations in health IT and the fast approaching implementation of ICD-10 will permit sharing of data at the international level which would not only allow better patient diagnosis but also help in identifying various epidemics at an early stage”. – Bilal Hasmat, CEO CureMD

Improved population health management can also be beneficial in producing more cost-effective and dollar-saving ways of treatment, especially in countries that have healthcare systems designed for treating the short-term instead of the long-term, such as that found in the United States.

For example, forahealthieramerica.com says that, in the U.S., heart diseases and strokes, two leading causes of death, drive healthcare costs at a damaging rate of $432 billion per year. Chronic disease treatment is at a minimal and plays a very large part in the healthcare crisis the nation still faces today, alongside obesity and diabetes. Healthcare improvements have to be made before any progress can, and this is addressing one of the most developed nations in the world. Imagine the conflicts that developing and underdeveloped nations are being forced to struggle with.

Another overriding difficulty that Americans specifically face are, as touched on above, rising healthcare costs. Twenty-five per cent of Americans with chronic diseases face some sort of activity limitation, as mentioned on the same website, which may include being restricted from or needing help with personal tasks, like bathing and getting dressed, and may even prevent them from attending school and or work altogether. A disabled American who cannot provide for him or herself financially or physically could not have it worse. This specific scenario supports the growing need for population health management and overall healthcare improvements in just the United States alone.

The many attributes and factors that make up the worldwide issue of controlling chronic disease, such as the financial cost, the work needed, and the human cost itself, cannot be passed or shoved along to someone else to fix. It’s an issue that everyone is facing, in one way or another, and an issue that everyone has to take some part in solving. No matter how it’s done or the motivations behind it, it’s time to stop focusing on what we want to be done, and time to start focusing on the more prevalent issues that must be taken care of.

 

Author Bio

Daniel Schwartz is a content strategist who sheds light on various engaging and informative topics related to the health IT industry. His belief in technology, compliance and cost reduction have opened new horizons for people in the health care industry. He is passionate about topics such as Affordable Care Act, EHR, revenue cycle management, and privacy and security of patient health data. He can be contacted at daniel.schwartz@curemd.com

Top Population Health Management Software

Top Population Health Management Software

Population health management is an essential aspect of today’s healthcare provider environment. Solutions for population health management have become increasingly essential for medical practitioners in all aspects of their business. Why?

Use of population health management software:

  •  encourages interaction between patient and provider
  • manages high risk patients
  • analyzes and utilizes the most efficient and effective evidence-based protocols to treat and diagnose patients in the most cost-effective manner

The emphasis in healthcare today, mainly due to the Affordable Care Act, is in shifting from quantity to quality, or from volume to value, in regard to patient care. Physicians and healthcare providers focusing on high-quality patient-centered care is the goal. However this is not as easy as it sounds.

When it comes to looking for PHM solutions, what should you look for?

What to look for in PHM solutions

High-quality population health management software enables healthcare providers to automate communication, reporting, data integration, and analysis in all aspects of patient care and delivery. An effective system identifies gaps in care, oversees managed care, and provides greater analysis of measurement outcomes. Major benefits of optimal population health management systems:

  • Coordinate care among multidisciplinary teams and settingsCreate an organized system of care
  • Improve and enhance access to primary care scenarios
  • Centralize resource planning
  • Provide greater utilization and access to data and reporting for improved communication between patients and providers as well as between healthcare providers

 

Such a system makes management easier through:

  • Data collection, management, and storage
  • Optimizing health in any given population
  • Monitoring
  • Patient-focused care and interaction
  • Optimal outcome measurements
  • A focus on team-based strategies and interventions

Population health management software should cover a variety of products, services and accessibility when it comes to quality, risk management, operations, document training and control, and health and safety based on environment and operations. Document control and planning cannot be underestimated in today’s reimbursement atmosphere to ensure compliance, increase efficiency, and reduce review and approval time.

Look for software systems that can be utilized across a wide platform of specialties and that are HIPAA compliant. A number of popular systems today include:

  • CureMD ICE
  • eClinicalWorks
  • NueMD
  • Practice Fusion
  • ADP AdvancedMD

Software Insider[1] provides detailed information regarding over a dozen popular EHR and PHM systems today. Comparisons should be made regarding desired platforms, features, accessibility, clinical practice and specialty, and intended use, such as private practice or hospital use.

 

How do a few of the most popular PHM systems compare?

Several of the most popular and highly rated software systems in this aspect of health care include offer a variety of solutions and main features

 

Solutions:

EMR Medical Billing Practice Management Patient Scheduling
CureMD yes yes yes yes
eClinicalWorks yes no no no
Practice Fusion yes yes yes yes

 

Main Features:

CureMD eClinicalWorks Practice Fusion
  • Credit card processingü  API options
  •  Document management
  • Patient Portal
  • Reporting dashboard
  • E-Prescribing
  • Electronic remittance advice
  •  Credit card processing
  • Claim scrubber
  • E-Prescribing
  • Electronic remittance advice
  • Patient portal
  • Document management
  • E-Prescribing
  • Lab orders and results
  • Online booking
  • Patient portal

 

Specs:

CureMD eClinicalWorks Practice Fusion
Platform
  • Online
  • Online
  • Mobile
  • Online
  • Mobile
  • On premise
Mobile platforms
  • iOS
  • Mobile website
  • Android
  • iOS

Data: Office of National Coordinator for Health IT and Software Vendor Sites

 

Importance of population health management important in today’s healthcare economy

The Patient Protection and Affordable Care Act of 2010 encourages responsibility of healthcare providers in regard to not only quality of care, but the cost of that care. An increased demand in measuring value of care and payment is required.

A good system helps medical providers provide optimal care in a variety of environments. Companies providing such platforms and solutions are invaluable in maintaining accuracy and optimal reimbursement in a timely manner. Due diligence is key in researching and selecting the PHM software system that works best for sole practitioners to hospital environments.

 

Author bio: Nina Keller Health IT expert for HCIT Consulting. Writes frequently about ICD10 , EHR ,HIPAA Medical Billing and health care reforms.