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Revenue cycle management optimization companies have been talking about automation for years.
Automation is not a secret, yet many organizations are not investing in automation in the right way.
A strategic approach to investing can work wonders for your organization. Instead of shoehorning robotic process automation (RPA) into fields where it doesn’t fit, you can target the best opportunities for automation, artificial intelligence, machine learning, and RPA.
How should your organization intelligently invest in automation for revenue cycle management? Here are some of the strategies organizations are using to maximize their success.
It’s a basic rule of business to identify the highest-value opportunities, then exploit those opportunities. Automation can benefit from a similar approach.
Identify the areas of your business with the biggest opportunities for automation. To find those areas, ask yourself the following questions:
If you understand your healthcare organization, then you should be able to quickly identify the best areas for automation.
The next step is to identify specific processes within these opportunities that can be automated.
Automation can’t solve every problem. Robots can’t fully replace human-style problem-solving (at least not yet).
However, automation is ideal for repetitive, rules-based tasks – especially tasks that your organization is performing manually.
If you can consistently identify tasks that can be done by a robot or program, then you can optimize your healthcare organization at many levels.
Look for tasks that are:
High-Volume: The best tasks to automate are tasks that are performed multiple times per day. These are the highest-value tasks to automate, as they decrease your organization’s efficiency every day.
Rule-Based: The best tasks to automate are also rule-based. Robots can easily understand a task when it’s associated with rules. If there are no rules, or if the task requires human-style thinking, then a robot may struggle to automate this task. Look for tasks with clearly defined rules, like where “If X occurs, then execute Y.” If you can repeatedly find rule-based tasks like that, you can find the best opportunities for automation.
Repetitive: To get the most value from your automation processes, you need to find tasks that are repetitive. You don’t want to invest in an automation system only to use it once or twice. You need to use it regularly to extract maximum value.
Performed Manually or Slowly: Identify tasks in your organization that are performed manually or slowly. Humans may be doing a task that could be done by robots. These tasks are ripe for disruption, and they free up time for human employees in other areas of the organization.
If you can find tasks in your organization that meet the above requirements, then you can find the highest-value opportunities for automation.
As Ontario Systems explains, automation shouldn’t be seen as a way to eliminate employees; instead, you should find ways to reskill employees.
Your employees are your most important assets. Automation technology frees employees from routine tasks, but it shouldn’t always reduce your headcount. Instead, direct employees to other high-yield, productive work.
You’ve already invested in training and onboarding an employee. Analyze the employee’s skills and apply those skills to a similar area. Automation can’t solve everything, and good employees can continue to deliver enormous value to an organization.
There’s plenty of competition in the automation software space. Healthcare organizations can choose from a range of providers.
All healthcare automation companies claim to offer similar benefits. They all claim to speed up revenue cycle management, optimize manual processes, and provide other crucial benefits.
However, not all healthcare optimization service providers are equally as effective. Some are implementing the latest neural network, machine learning, and data analytics technologies. Others are using decades-old platforms.
Spend time researching the right automation service to implement in your organization. Don’t be dazzled by the first healthcare automation service that comes across your desk. There are good and bad options in the automation space, and choosing the right option is crucial for maximizing the value of automation.
Data is a valuable asset, yet many organizations don’t use their data. You have data about patients’ behaviors, including the methods patients use to contact you. You have data about how patients access your services, how insurers interact with your organization, and more.
Even if you’re not using patient health data, you have plenty of data to use when automating your organization. By applying automation processes, machine learning, and artificial intelligence to this data, you can get surprising insights into how your organization can improve.
Leverage big data to optimize your organization, improve patient care, and maximize efficiency at every level of your organization. You already have this data. Use AI and automation to maximize the value of this data.
Automation is complicated. We understand. With so many technologies available in the automation space, it can be difficult to know the best option for your organization.
HMI, LLC can help. Request a consultation today. Let us identify the highest-value opportunities for automation in your organization.
Healthcare organizations are facing more competition than ever. If your organization does not have patient-friendly billing, then you could be pushing patients to competitors.
Adopting patient-friendly billing may be easier than you think. By implementing patient-friendly billing standards today, you can create better patient outcomes, customer service, and revenue cycle optimization.
Keep reading to discover some of the best and most proven strategies for creating patient-friendly billing standards.
Your patient billing system may already be good – but there is always room for improvement.
Analyze patient billing data to identify problem areas. Check metrics to make sure you understand how patients are managing your billing system and what steps you can take to improve.
Revcycle recommends checking three crucial metrics to identify problem areas within your patient billing system:
The Healthcare Financial Management Association (HFMA) has collected a list of the best patient-friendly billing strategies. By implementing these changes today, your organization can make it easier for patients to understand, accept, and pay each bill.
The HFMA emphasizes four foundational principles of a patient-friendly billing system, including:
Clear: Bills should be written in plain language. They should be easy for anyone to understand. Patients should be able to quickly determine what they need to do with that information.
Concise: Bills should contain the right amount of detail to communicate the message, but not too much detail to confuse customers.
Correct: Bills should not include estimates, incomplete information, or errors. All information on the bill should be accurate and correct.
Patient Friendly: The design of the bill statement should be based around the needs of the patient and the patient’s family – not the needs of the healthcare organization.
According to the HFMA, these are some of the best patient-friendly changes to make to your billing system today:
Organizations should continue to improve the billing process by incorporating better practices, implementing feedback from patients, and analyzing billing data.
We’ve explained simple changes to make to your patient billing system. Now, it’s time to test those changes in the real world.
To do that, test your patient billing system using the following techniques:
Set Benchmarks: You’ve invested in a new patient billing system. Set benchmarks. Say you want to reduce the statement date and payment date by 5 days, on average, for example. Use the metrics mentioned above to set practical goals.
Evaluate Costs: A new patient billing system could be cheaper or more expensive. Evaluate the costs of the billing system. Consider mailing costs, software costs, technology costs, and other expenses.
Isolate Changes and Split Test: Maybe you made a dozen changes to your billing system in the last week. You improved your billing processes, but you don’t know which process led to which improvement. Isolate changes and split test to see which changes work best.
By monitoring the three metrics above, you can calculate return on investment. Continue to track these measurements over time to ensure you maintain the most efficient possible patient billing system.
Patient-friendly billing is crucial for revenue cycle optimization. As revenue cycle management specialists, we can implement actionable changes to your billing system to improve your billing processes.
Schedule a consultation with HMI, LLC today to discover the best patient-friendly billing strategies.
Digital healthcare and telehealth are at the top pf the list of healthcare trends in 2021.
Leading healthcare organizations have invested significantly in digital healthcare, expanding services and optimizing patient outcomes.
Other healthcare organizations are already falling behind. Since digital healthcare isn’t going away any time soon, that’s a problem.
Today, we’re highlighting some of the best digital healthcare strategies you can use to optimize revenue.
Cloud infrastructure is an investment that has quickly paid dividends for healthcare organizations across the country.
In the last year, cloud infrastructure has allowed providers to rapidly deploy field hospitals, providing services wherever those services can safely be administered.
Good cloud infrastructure optimizes every level of your healthcare organization. It allows for more streamlined movement of clinical records between different medical systems. It optimizes patient care and improves continuity in uncertain times.
In a West Monroe Partners survey, 35% of healthcare partners reported holding more than half of their data or infrastructure in the cloud.
Why is the cloud so valuable? It reduces IT costs and improves access to data. Healthcare organizations can focus on what they do best – patient care – while leaving IT to the professionals. Cloud infrastructure is updated continuously for speed and security. And hybrid cloud deployments allow organizations to enjoy all of the benefits of the cloud – with fewer downsides than a cloud only deployment.
Moving forward, more healthcare organizations are set to embrace cloud infrastructure.
As pointed out by Forbes, firms like Amazon are taking note. Amazon Web Services just announced the launch of HealthLake, a cloud storage and analysis platform. HealthLake uses artificial intelligence and machine learning to analyze data in the cloud, making it easier for healthcare organizations to access and use their data.
The COVID-19 pandemic accelerated the inevitable: firms were already implementing more telehealth services every year, and COVID-19 forced more firms to adopt telehealth.
According to a McKinsey report, just 11% of Americans reported using telehealth services in 2019. In 2020, that number rose to 46%.
Virtual patient care, when implemented correctly, reduces costs for healthcare providers. It enables doctors to see more patients. It reduces overhead expenses. Studies show it can also improve patient outcomes.
With Medicare, Medicaid, and major insurance companies covering virtual care, telehealth isn’t going away any time soon. Expect telehealth to rapidly expand in the coming years. Smart healthcare organizations are already investing significantly into telehealth to prepare for the inevitable.
Healthcare providers took a huge hit last year during the COVID-19 pandemic. Providers were forced to halt services because of the pandemic. It led to plummeting revenue, especially for organizations that relied heavily on fee-for-service reimbursement.
That’s why smart healthcare providers are moving into value-based payment arrangements. They’re avoiding the increased risk of fee-for-service arrangements and seeking better insurer partnerships.
A fully integrated healthcare system provides organizations with a diversified revenue stream they can use to weather the pandemic – or any other unexpected events that could occur in the future. To build that integrated healthcare system, providers are searching for health insurer deals and partnerships.
This will ultimately lead to a shift in patient care. Insurers will emphasize preventative healthcare and maintenance. Instead of just treating sick patients, healthcare providers will be motivated to prevent patients from becoming sick in the first place.
We haven’t felt the full effects of the COVID-19 pandemic. Organizations still have hurdles to face. Some of the things to monitor as we get closer to the end of the pandemic include:
Higher Costs of Claims for Insurers: Patients have put off care for months. As restrictions drop, patients will return for care. Many of these patients are sicker because they deferred care. That could mean more spending on care for insurers – and higher patient loads for providers.
Increased Numbers of Medicaid and Self-pay Patients: Millions of Americans have lost healthcare after losing their jobs during the pandemic. Hospitals are reporting increased numbers of patients using Medicaid or self-pay systems to cover their costs. Some healthcare organizations are unprepared for this shift, while others have well-established procedures in place.
Smarter Business Continuity Plans: We don’t know what happens next, and we don’t know when restrictions will be lifted. But one thing is certain: businesses with strong continuity plans are better prepared than those with poor continuity plans. Some providers were able to adapt to changing regulatory frameworks rapidly, while others quickly fell behind.
HMI, LLC has decades of proven experience optimizing revenue cycle management, medical coding, compliance, chargemaster services, and more.
Contact HMI, LLC for a consultation – and identify areas of revenue growth for your organization in 2021.
Lean Six Sigma is a business optimization method that focuses on eliminating defects.
In healthcare, defects can be the difference between life and death. That’s why many healthcare organizations have implemented Lean Six Sigma principles.
When properly implemented, Lean Six Sigma optimizes every stage of patient care – from revenue cycles to patient outcomes.
Today, we’re explaining how Lean Six Sigma works in healthcare – and how it can help your organization eliminate defects.
Lean Six Sigma is a method that emphasizes a collaborative team effort for improving performance and reducing inefficiencies.
The method is based on lean manufacturing techniques. If you’re familiar with lean healthcare practices, then Lean Six Sigma may sound familiar.
In addition to targeting defects and waste, Lean Six Sigma targets overall cultural change. The system emphasizes growth and optimization.
You’ll encounter Lean Six Sigma at a range of corporations. It rose to popularity with electronics companies and car companies.
Since the mid-2000s, however, we’ve seen Lean Six Sigma in healthcare, finance, supply chain, and other sectors.
When implemented successfully, Lean Six Sigma maximizes efficiency while increasing profitability – in any field.
Many healthcare organizations use lean healthcare practices – or specific Lean Six Sigma strategies – to maximize efficiency and increase profitability.
Healthcare consultants spot inefficiencies within an organization. Good organizations can quickly fix these inefficiencies and move forward. Some organizations, however, need sweeping cultural changes and foundational shifts.
The purpose of Lean Six Sigma is to identify defects. In healthcare, a single defect can be the difference between life and death.
Medical errors in the United States contribute to the deaths of more than 210,000 people per year. They also cost healthcare organizations over $17.1 billion per year.
By implementing Lean Six Sigma strategies, healthcare organizations can improve patient safety by eliminating life-threatening errors. It’s not just about optimizing revenue: it’s about improving patient safety.
Lean Six Sigma and similar strategies can improve patient outcomes, maximize efficiency, and boost revenue at any healthcare organization.
When properly implemented, Lean Six Sigma could improve the follow areas of your healthcare organization:
Healthcare organizations may partner with healthcare consultants to implement Lean Six Sigma methods. Many healthcare consultants are certified in Lean Six Sigma (LSS) methodology.
Certified LSS experts often recommend the DMAIC method, where you Define, Measure, Analyze, Improve, and Control defects within a healthcare organization:
Define: The consultant defines the problems with the process and sets goals. The consultant might observe high rates of medication errors, for example, and sets a goal of reducing those errors. The analyst then creates a process map that details each step of the process, from the initial prescription to the final dispensing.
Measure: The consultant measures how the current process performs, gathering data for each step. The consultant looks for bottlenecks or areas with a high rate of errors. Where is the process inefficient?
Analyze: The consultant analyzes data from each step, identifying areas that could be optimized. The goal is not just to identify bottlenecks, but to identify the root cause of those bottlenecks.
Improve: The consultant develops and tests solutions. The consultant might recommend an extra safety check before the final dispensing of the prescription, for example, among other solutions.
Control: The consultant ensures the new prescription procedure stays on course. The consultant monitors the new system, analyzes the improvement at each step of the way, and verifies the improved outcomes.
The consultant repeats this process at every step of the organization.
Some of these consultants work within organizations. They have titles like Chief Patient Experience Officer or Director of Quality Management.
Other organizations hire outside consultants.
Some healthcare consultants specifically advertise their Lean Six Sigma certification. Or, a healthcare organization may require Lean Six Sigma certification for some leadership positions – including a Green Belt or Black Belt certificate.
Lean Six Sigma, also known as LSS, is a proven methodology that could improve patient outcomes – and boost revenue.
Many healthcare organizations have implemented Lean Six Sigma strategies with powerful results. Some healthcare organizations achieve similar results just by implementing basic lean healthcare practices.
HMI, LLC specializes in spotting inefficiencies within healthcare organizations.
Contact HMI, LLC for a consultation – and discover how your organization can improve patient outcomes and revenue.
Telehealth isn’t going away any time soon.
Telehealth was surging before the pandemic – and the pandemic pushed telehealth to new levels.
As telehealth rises in popularity, organizations are implementing telehealth in different ways. Some are investing billions into telehealth. Others are getting left behind.
Today, we’re highlighting the most important telehealth trends for 2021, including some of the rising and falling movements we’ve seen from telehealth in recent months.
The COVID-19 pandemic demonstrated the importance of family health. Moving forward, we’re seeing families put a renewed emphasis on protecting themselves and their loved ones.
As the dust settles on the COVID-19 pandemic, families want to prepare for the next threat. They’re more interested in preventative medicine. They might be more careful about scheduling checkups or managing conditions. Some have lost loved ones – and they recognize the importance of preventative care more than ever.
Telehealth services that were once considered “premium” are rapidly becoming standard. Remote patient monitoring and asynchronous communication, for example, are becoming more popular with providers.
Early in telemedicine, remote patient monitoring and asynchronous communication were premium services implemented by few providers. Today, they’re part of the standard operating procedure at many hospitals.
Patient-controlled health is the future. For decades, healthcare organizations have controlled patient data and dictated patient’s decisions. Moving forward, things are starting to change.
With patient-controlled health, the patient makes decisions in consultation with a healthcare provider. Instead of directly following the provider’s guidance, the patient makes a collaborative decision.
Patient-controlled health is fuelled by growing access to health technology and data. Patients have more insights into their health. They have more information than ever. With this information accessible at their fingertips, patients may take a more active role in managing their own health.
Healthcare organizations face regulatory hurdles as they implement telehealth systems.
We saw authorities relax some regulations at the beginning of the pandemic, and it’s possible we’ll see new regulatory frameworks emerge in the coming months.
Relaxed HIPAA Regulations early in the pandemic, for example, made it easier for providers to treat patients remotely.
As telemedicine becomes more common, providers will push for more regulatory clarity – or relaxed regulations. Regulatory clarity makes it easier for organizations of all sizes to implement telehealth systems and stay competitive.
Eventually, we’ll reach a point where telemedicine visits become more important than in-person visits.
Telemedicine is convenient. It works around the schedules of patients. It does not require in-person appointments or a day off work.
More serious problems may require in-person visits, but many aspects of patient care can move to telehealth – or have already moved to telehealth.
Medicare, Medicaid, and many major insurers now cover telehealth visits. It’s a big shift for the industry – and it sets the stage for rapid future growth of telemedicine.
Expect insurers to provide further clarity on how they cover telemedicine – and what they cover. Telemedicine is going mainstream, and insurers need to keep up.
Today’s telemedicine is the tip of the iceberg. We’re just beginning to see the potential of telehealth.
Moving forward, telemedicine will grow into spaces like mental health, providing remote psychology and psychiatry services to patients. We’ll see telemedicine deal with prescriptions (some call it “ePrescribing”).
Providers are still figuring out how to implement advanced healthcare with telemedicine. Expect more developments in the near future.
Telemedicine is changing the way healthcare organizations – and all organizations – think about location. Location is becoming less relevant.
Let’s say a patient returns home after surgery. Traditionally, doctors may ask the patient to return to the hospital for a checkup. With telemedicine, patients can receive instant care at home whenever they need it, making location less relevant.
Similarly, some healthcare providers will invest heavily into telemedicine, providing healthcare services to patients across the country from remote locations. Some providers may even maintain remote offices, distributing employees around the world.
Patient data management has become increasingly important in recent years. With telehealth, patient data is increasingly being transferred and tracked online – and that means organizations need to invest in secure patient data management systems.
Even the best healthcare organizations are one data leak away from losing their reputation.
Expect tech companies to lead the charge. Countless tech startups are already maneuvering to become patient health data management leaders. Tech giants like Apple, Google, and Amazon may also get involved.
Telehealth has always been the future.
In recent years, healthcare providers have tried to figure out remote healthcare. The COVID-19 pandemic was like getting thrown into the deep end.
Will your organization sink or swim as telemedicine expands?
Contact HMI, LLC today to speak with experienced healthcare consultants with proven experiencing solving complex problems.
It’s been challenging for some healthcare organizations to keep up. However, by implementing certain strategies today, your healthcare organization strategies can maximize revenue in 2021 and beyond.
How are today’s top organizations optimizing revenue? Today, we’re highlighting some of the strategies firms are using to get ahead.
The COVID-19 pandemic showed how fragile international supply lines can be. As the COVID-19 pandemic surged, countries with domestic medical manufacturing facilities reigned supreme.
Countries that had traditionally relied on China for PPE, for example, were suddenly unable to procure necessary amounts of equipment. Others struggled with drug supply lines. Some continue to struggle with vaccines.
None of this has been secret: it’s been painfully obvious.
Expect a significant “made in America” push in the coming years. Expect more domestic firms to rise to manufacture supplies, drugs, and equipment for healthcare organizations.
There have been increasing calls for domestic manufacturing of crucial medical supply lines. It’s not just a convenience or cost issue: it’s a national security issue. Watch for significant growth in this space throughout 2021 and beyond. Healthcare providers will switch to domestic suppliers if they offer better, cheaper solutions.
Telehealth isn’t going away anytime soon. It was surging in popularity before the pandemic, and the pandemic illustrated the importance of telehealth even further.
Virtual patient care is more common today than ever – and it’s going to become increasingly common in the coming years.
Smart healthcare providers invested in telehealth yesterday. They stay on top of remote health regulatory requirements. They invest in the latest telemedicine technology to optimize patient care.
Healthcare organizations that are not investing significantly in telehealth risk falling behind.
With Medicare, Medicaid, and major healthcare organizations now covering telehealth, you can’t ignore telehealth any longer. It’s here, and it may be more popular than in-person patient care in the near future.
One study showed 53% of all employers plan to offer more virtual care options in their benefits packages, making it the biggest change of the year.
Meanwhile, CMS data showed that telehealth adoption increased 50% for primary care visits with Medicare beneficiaries.
Telehealth has improved significantly in recent years. As telehealth grows to cover psychiatry and other areas of medicine, it will only become more popular.
We know more about our genetic code today than at any previous point in history. Our genetic health and wellness is becoming increasingly important. We won’t be changing our genetic code by the end of 2021, but it’s a space to watch moving forward.
As The Motley Fool reports, there are only 6,000 genetic experts in the United States, which isn’t enough to serve 330 million people (especially for in-person visits). Expect more virtual healthcare platforms in the genetic space – and more genetic health specialists – as we move forward in one of the most exciting areas of patient care.
Providers took a huge hit in 2020 when they were forced to halt services for COVID-19.
However, there was a silver lining to this shift: it forced providers into value-based payment arrangements.
Some analysts believe this will have the long-term effect of curbing healthcare spending in the United States. Payers will reimburse for improved outcomes instead of volume, which means lower overall spending.
In other words, people are realizing the risk of antiquated, fee-for-service models – so they’re embracing new alternatives.
Instead of focusing on caring for sick patients, for example, healthcare organizations may focus on keeping patients healthy. They’ll move further upstream, which ultimately reduces costs and improves patient outcomes.
This shift is particularly important for providers that are heavily reliant on fee-for-service reimbursements. These providers took a huge hit last year – and smart providers are taking steps to end 2021 with a better financial picture.
Many healthcare providers have also sought better insurer partnerships as a result of the pandemic. The pandemic has illustrated the importance of good health insurer deals and partnerships.
It’s no secret the pandemic will lead to more payer-provider partnerships. Multiple analysts have made similar predictions in recent years. As healthcare organizations see the benefits of a fully integrated health system, it’s illustrating the importance of maintaining good partnerships.
Millions have lost healthcare because of the pandemic. Healthcare organizations are seeing record levels of patients using Medicaid or self-pay to cover their healthcare costs.
Organization that are prepared for this surge are doing great. Organizations that are not prepared are falling behind.
Organizations with improper medical coding, limited Medicaid or self-pay optimization, and other issues are losing revenue.
As furloughs end for employees, and as jobless numbers continue to remain high, expect more Medicaid and self-pay patients throughout 2021.
HMI, LLC stays on top of healthcare trends so you don’t have to.
Schedule a consultation with HMI, LLC today. We have decades of proven experience optimizing healthcare organizations – from revenue cycle management to medical coding.
Many healthcare organizations struggle to retain talent. Unfortunately, this leads to big losses.
A median turnover in the emergency medical services (EMS) space costs an agency $72,000, according to Prehospital Emergency Care.
Meanwhile, the average cost of a turnover for a bedside RN is $52,100, causing the average hospital to lose $4.4 million to $6.9 million. Some healthcare organizations spend 5% of their annual operating budget on employee turnover and related expenses.
By emphasizing employee retention and minimizing patient turnover, healthcare organizations can save millions of dollars per year.
Today, we’re explaining why employees leave – and how today’s top healthcare organizations are attracting and retaining top talent.
Healthcare employees leave organizations for any number of different reasons. However, one study found that professional development, poor work-life balance, and bad managers were responsible for most departures.
According to a study featured in Employee Benefits News, 75% of the reasons employees leave could be prevented. Here are the top 3 reasons employees leave, according to that study:
Career Development: When healthcare organizations fail to give professional development opportunities to employees, they’re more likely to leave. Thanks to several recessions, employees understand the importance of having specialized skills. If organizations fail to invest in employee training initiatives, or if organizations fail to give employees professional opportunities, employees are likely to leave for greener pastures.
Work-Life Balance: Many employees leave organizations because of poor work-life balance. Work-life balance is important among all age groups, but it’s particularly important among millennials and parents (a class that is increasingly becoming blurred). Even older adults seek good work-life balance as they seek to care for increasingly aging parents.
Management Behavior: Good employee-manager relationships are crucial to retaining talent. Training your managers to treat employees well has always been important, but it’s more important today than it has been with past generations. Employees, particularly younger employees, are more likely to stick with an organization when that organization treats them well.
75% of employee turnover is preventable. By targeting and reducing preventable employee turnover, healthcare organizations can have a meaningful impact on their bottom line.
Foster a Positive Work Environment
Millennials increasingly value a positive work environment over salary and other benefits. Millennials are willing to take a pay cut if it means working in a less stressful position with better work-life balance.
According to the Harvard Business Review, healthcare organizations can have a negative work environment because of the following issues:
The Stress of Hierarchy Positions: High-stress jobs have 50% higher healthcare expenses than low-stress jobs. A company’s work environment could literally increase healthcare costs and have a significant impact on employee health.
Employee Disengagement: Disengaged workers are 37% more likely to skip work, according to a study by the Queens School of Business. Disengaged workers are also more likely to cause accidents, make errors, or produce work with defects.
Low Loyalty: Workplace stress decreases employee loyalty, making it 50% more likely for employees to leave.
Even employees at the best-run organizations have issues. When employees have issues, it’s crucial they have a way to communicate and provide feedback related to those issues.
Take the time to build a relationship with employees. Foster communication with employees. Let employees know they can approach you with various challenges and issues.
Organizations with poor manager-employee relationships can stifle this communication, leading to low employee retention, bad patient care, and overall organizational issues. When employees feel they cannot communicate with managers, it’s bad for any healthcare organization.
When organizations invest in an individual’s career development, it reduces the chances of that individual leaving. Individuals like to feel valued. They want to know an employer is investing in their future and their skills.
Invest in an employee’s career development. Invest in employee certifications and educational initiatives.
By investing in career development, you not only get a better employee – you get a more loyal employee. By combining career development with other strategies listed here, healthcare organizations can maximize employee retention.
Healthcare organizations that fail to invest in employee safety are unlikely to retain top talent.
This lesson is particularly true during the COVID-19 pandemic. Healthcare organizations that did not invest in employee safety early observed a mass exodus of employees.
Employees want to feel valued. They want to feel like more than just a number. They want to feel like human beings with real goals, needs, and safety concerns. When a healthcare organization ignores all of that, it leads to poor employee retention.
Not all employees learn the same way. Some employees will appreciate your learning initiatives – while others will feel left behind because it’s not catered to their learning system.
Millennial employees tend to learn differently than older employees, for example. As millennials continue to dominate the workforce, healthcare organizations need to adjust their training systems to avoid having employees feel left behind.
Invest in customized coaching instead of pre-packaged modules. Host real classes and educational initiatives. Emphasize employee training to maximize retention.
From employee retention to medical coding and revenue cycle management, HMI, LLC has 30+ years of experience helping healthcare organizations tackle the toughest challenges.
Request a free consultation with HMI, LLC today to discover how today’s best practices can help your organization attract and retain top talent.
Rural hospitals are closing across the country. Naysayers may say it’s the end of rural healthcare as we know it. However, many hospitals are flipping this trend on its head.
America’s best rural hospitals are thriving in uncertain times by expanding care, taking advantage of telemedicine, and specializing in in-demand areas.
By taking this approach, rural hospitals have grown revenue even when dealing with aging populations, higher-than-average Medicare patient totals, and other challenges that have sunk competing providers.
Today, we’re exploring four more rural hospital success stories from small towns across the United States.
Gold Beach, Oregon is a small, relatively isolated community along a picturesque section of Oregon’s southern coast.
For decades, the community was served by a small, outdated facility built in the 1950s. The facility exclusively provided acute care, meaning patients had to travel long distances to access specialized medical treatment.
Things became progressively worse for Gold Beach’s Curry General Hospital over the years. The facility could no longer meet local needs, and the building itself was not compliant with building doctors. The facility struggled to attract and retain doctors.
Things changed when the hospital received new funding. Residents of the Curry Health District approved a $10 million fund to fund construction on the facility. The hospital received an additional $20.9 million through the USDA Rural Development’s Community Facilities Program. By taking advantage of favorable interest rates and 40-year terms, the rural district was able to afford considerable healthcare spending it would normally be unable to afford.
Some rural hospitals have turned a disadvantage into an opportunity. Rural hospitals can be isolated – but that doesn’t mean they can’t attract talent.
Kalispell, Montana is a relatively isolated city in a picturesque corner of the state. Although isolated, the city is surrounded by world-class ski hills, Glacier National Park, multiple lakes, and considerable outdoor adventure opportunities.
By emphasizing these opportunities, Kalispell has attracted high-quality medical care to the region regardless of the remoteness.
On July 1, 2020, Kalispell Regional Healthcare opened the first floor of Montana Children’s. The $60 million facility was funded by debt, operating reserves, and philanthropy.
The opening is a big deal for the city of Kalispell. Previously, Kalispell residents needed to visit Spokane, Washington – four hours away across multiple wintry mountain passes – to get similar patient care for children. Parents of children with chronic diseases were forced to move to Spokane, Denver, and other larger cities – or face multiple harrowing drives each winter.
Now, thanks to the new opening, Kalispell residents can access quality patient care even in a relatively remote area.
In neighboring North Dakota, hospitals have faced a surge in revenue thanks to the booming oil and gas industry.
North Dakota’s McKenzie County saw its population double between 2010 and 2020, due mostly to oil and gas operations in the region. As the population grew from 6,000 to over 12,000, local legislators recognized the urgent need to expand healthcare.
Using federal and state loans, funding from the oil industry and private citizens, and a sales tax increase, the region opened the new McKenzie County Hospital in Watford City in June 2018.
Before the opening the hospital, residents had to drive 50 minutes to access surgeries and preventative healthcare services. Today, residents of the 12,000-person county enjoy high-quality healthcare even in a relatively remote, rural setting.
And, like Kalispell, McKenzie County has attracted talent by emphasizing the rural setting:
“Not everybody wants to live in a city, and not everybody should, and there are great places in America that should not have to suffer with second-class health care,” explains Patsy Levang, board chair of McKenzie County Healthcare Systems, in a statement to US News.
Mississippi’s Field Memorial Community Hospital (FMCH) is located in a town of 1,600 residents. While other hospitals serving similarly-sized towns close down, FMCH is taking the opposite approach.
Thanks to a federal grant, FMCH is building a new $21 million facility that will introduce big changes to local residents.
Centreville is located about 130 miles northwest of New Orleans, and approximately one-third of residents live below the poverty line.
The goal is to use FMCH as an economic driver for the region.
“A lot of times in the rural communities your health care systems are your economic drivers, and that’s true here,” explains Chad Netterville, chief executive of the Field Memorial Community Hospital, in a statement to NY Times, which covered the expansion in April 2015.
Today, Centreville has a 16-bed hospital thanks to the federal economic development program designed specifically to increase investment in low income communities. By targeting rural hospitals and expanding patient care, federal grants can revitalize local economies while contributing to higher-quality patient care.
Since 2010, more than 100 rural hospitals across the country have closed down, according to a study from the University of North Carolina – Chapel Hill.
While times are tough for some rural hospitals, others have succeeded despite these challenges. They’ve turned challenges into opportunities, taking risks where other hospitals are not willing.
Contact HMI, LLC today for expert revenue cycle management consulting, chargemaster service consulting, coding services, and more. Founded in 1989, HMI, LLC has revitalized small and large healthcare organizations across the county.
Healthcare organizations have many opportunities to train employees and enhance organizational revenue.
By taking advantage of these opportunities, healthcare organizations can significantly improve their bottom line.
From lean healthcare workshops to continuing education programs to other professional training systems, employee training opportunities can enhance organizational revenue in various ways.
Today, we’re exploring some of the best employee training opportunities for small and large healthcare organizations.
Lean healthcare workshops can singlehandedly change an organization’s bottom line. The idea of running a lean organization is nothing new in and out of healthcare – but healthcare organizations across the country are increasingly taking advantage of lean healthcare workshops to implement new techniques, philosophies, and management systems.
Some of the topics covered in a lean healthcare workshop include:
• An overview of lean healthcare practices, philosophies, and systems and how they work
• How all elements of a healthcare organization work together to create a lean organization
• Specific examples of healthcare organizations successfully implementing lean practices to rejuvenate operations
• How to identify core problems at a healthcare organization, including specific trouble spots that can benefit from a lean healthcare philosophy
By scheduling a lean healthcare workshop, organizations can discover the best practices modern organizations are using to maximize revenue while minimizing losses.
Many healthcare organizations recognize the importance of employee revenue training and employee certifications.
However, many organizations overlook another crucial aspect of patient care: a quality work environment, good employee relationships, and a good work-life balance.
Employee turnover is a significant expense for healthcare organizations. According to Employee Benefits News, employee turnover costs a company approximately $15,000 per employee who makes an average salary of $45,000. For employees who make a higher salary, the cost of employee turnover is much higher.
The top reasons employees leave a healthcare organization are:
• Career development, and an inability to grow or expand their skills at their current employee
• Work-life balance, particularly among younger adults or parents
• Management behavior, including the way managers treat employees and the things employees expect from managers
By addressing these areas, healthcare organizations are better able to attract and retain talent.
One of the best ways to address these areas is with employee training and workshops. Available training programs include:
Stress Management Workshops: Some employers invest in stress management workshops. These workshops explain how to reduce emotional exhaustion, manage stress, manage anger, and encourage positive thinking. By clarifying goals and team roles, these workshops can prevent employees from suffering negative consequences related to their work.
Employee Training Investments: Employees like to feel valued. They like to feel an employer has invested into their careers and development. It makes an employee less likely to leave. A growing number of healthcare organizations fund employee training, specialization, and certification programs. By investing in a healthcare employee, you get a better employee who is less likely to leave.
Work-Life Balance Initiatives: Work-life balance initiatives promote employee loyalty, making it less likely for skilled talent to leave for competing organizations.
Healthcare is more computerized than it’s ever been before – yet many hospitals continue to use aging infrastructure.
Hospitals with aging infrastructure risk being left behind. As competitors invest in employee training initiatives and big technology, some organizations risk dropping behind their competitors.
Offer computer-based training modules to employees. Make sure employees understand how to use – and maximize the benefits of – healthcare technology. Take advantage of big data. Give tablets to patients.
There’s more healthcare technology available today than ever before, and it’s impossible for an organization to utilize all of it – but the sooner your organization invests in healthcare technology training initiatives, the more successful the organization will be in the long run.
The health system offers thousands of training courses each year. Some of these courses are mandatory to maintain certification. Others are optional.
By emphasizing the right healthcare training programs, organizations can succeed, grow revenue, and retain talent.
Rural hospitals face considerable challenges throughout the country. While some rural hospitals thrive in challenging situations, others falter.
Today, we’re highlighting some of the best success stories of rural hospitals across America, including situations where ingenuity, creativity, and flexibility saved small hospitals in rural settings.
Rural areas of America tend to have older populations than urban areas. This increases challenges for rural hospitals.
It’s hard enough running a small, rural hospital. These challenges increase with older populations who have larger, more complicated healthcare needs – and who also tend to be Medicare patients.
Despite these challenges, a small hospital in Beatrice, Nebraska is thriving by implementing a seemingly obvious solution: they’ve invested in aging healthcare, allowing them to specialize in the specific areas where older adults need them most.
The average age in Beatrice, Nebraska is 6 years older than the average age in Nebraska. It’s an older, rural town with a population of 12,200 people.
To address these challenges, the Beatrice Community Hospital and Health Center (BCHHC) has implemented a range of solutions. BCHHC has continued to grow, opening a new building while doubling patient numbers since 2009.
What did BCCHC do differently? The hospital made significant investments in treating and serving the area’s aging residents. As the town’s population gets increasingly older, several nursing homes have opened in town, with BCCHC being the primary medical hub for these residents.
Today, BCHHC is the second largest employer in Beatrice. It has a 25-bed hospital employing 512 people with a payroll of $28 million. The hospital earned $100 million in revenue last year – even as other businesses are leaving Beatrice en masse.
Because of their foresight, the Beatrice Community Hospital and Health Center continues to thrive amid uncertain times for small, rural hospitals.
Similar to the BCHHC success story, Margaret Mary Community Hospital has succeeded in Batesville, Indiana by specializing in caring for older adults.
Batesville, Indiana is home to 6,500 people. To address their needs, Margaret Mary Community Hospital has built a rheumatology program specifically catered to the town’s aging population.
Like Beatrice, Batesville has an older than average population. By focusing on what they do well, and addressing the town’s healthcare needs, Margaret Mary Community Hospital has achieved success.
All of this healthcare investment attracts older retirees to the area. Residents can buy a three-bedroom home in Beatrice for around $70,000. With good healthcare and a low cost of living, Batesville’s future – and the future of Margaret Mary Community Hospital – looks bright.
Texas has been hit particularly hard by the rural health crisis in the United States. Small hospitals across the state have closed over the past two decades.
Despite these challenges, the hospital in Childress, Texas remains a success story. The 39-bed non-profit Childress Regional Medical Center is one of he few Texas hospitals operating profitably in these times.
What has Childress Regional Medical Center done differently? Some of the strategies implemented by the hospital include:
• The hospital offers expanded services, which means local residents no longer have to drive two hours to reach the nearest hospital; this approach led to nearly 1,000 new patient visits in the most recent fiscal year
• ¬Childress Regional Medical Center has invested in telemedicine units while also increasing the number of doctors and hours at its primary care clinic – all while competing hospitals have taken an opposite approach by cutting hours and service
By expanding staff and hours, Childress Regional Medical Center has become the go-to hospital for patients throughout the region.
Locals no longer have to travel hours to visit neighboring medical centers, for example, because the hospital hired an orthopedic surgeon in 2013. The hospital also hired an oncologist who visits the hospital once per month, with specialists in urology and cardiology visiting Childress Regional Medical Center on a similar schedule.
The hospital has also received a boost with telemedicine. Telemedicine allows physicians at Childress Regional Medical Center to consult with specialists at Children’s Medical Center in Dallas, making it easier to handle complex cases.
For all of these reasons, Childress Regional Medical Center continues to be a notable success story in a state where rural hospitals face increasing challenges.
Rural hospitals exist because of their communities. Sometimes, the community needs to save the hospital – not the other away around.
Such was the case in Haleyville, Alabama. In 2017, Lakeland Community Hospital in Haleyville, a town of around 4,000 people, announced it was closing down due to declining profits. After the closure, the closest emergency room would have been a 45-minute drive away.
The community banded together in response. Haleyville’s mayor, Ken Sunseri, began making calls to other hospitals in the region to explore how other legislators handled similar situations.
Mayor Sunseri repeatedly received similar advice: take ownership of the hospital and fight to keep it open – so that’s exactly what Haleyville did. Hospital employees worked extra shifts as the city worked to acquire the hospital from Tennessee-based Curae Health, which had recently filed for bankruptcy. Local authorities approved a 1% sales tax and an increase in county property tax to help fund the hospital.
Like rural Texas, rural Alabama has faced significant issues with hospital closures. The success story of Haleyville’s Lakeland Community Hospital shows it can take a community effort to save a rural hospital – but the effort is often worth it.
The success stories above show that rural hospitals can thrive even in uncertain times. While rural hospitals face challenges across the country, many hospitals continue to thrive, grow, and expand.
Request a free consultation with HMI, LLC today and get leading healthcare consultation from an organization with 30+ years of experience in revenue cycle management, medical coding services, physician services, chargemaster services, compliance, and more for all sizes of healthcare organizations.
A good case management service providers in Healthcare, optimizes multiple aspects of your operation. Today, we’re highlighting some of the most important advantages of hiring a case management service provider in Healthcare.
The first and most important benefit of a case management service is that it improves processes at every stage of your operations.
A well-designed case management system implemented by a knowledgeable team is a guaranteed way to improve internal processes.
Customizable dashboards, for example, allow an organization to create a system that works for its unique needs. Instead of shoe-horning an outdated solution into your organization, a well-designed case management dashboard can improve organizational efficiency significantly.
Many organizations use customizable dashboard to highlight items that need immediate attention, for example, and keep patients flowing at an optimal rate.
Good case management services present all relevant information in a coherent way. Patient information from multiple specialists, healthcare systems, and organizations can be presented within one convenient dashboard.
When employees have all of the information available within a single case file, it allows them to work efficiently on every patient while equipped with the knowledge they need.
You wouldn’t want a carpenter to build a house using a half-empty toolbox. So why would a healthcare provider work on a patient without having all available information?
Instead of having to search through a database or find a paper document, employees can view information at-a-glance from an efficient, all-in-one dashboard. Better information management leads to smarter, more confident, and more accurate decision making.
The hospital chargemaster is the heart of an organization’s revenue cycle. A good chargemaster service keeps that heart pumping smoothly.
Improved chargemaster services and case management services make every aspect of an organization more efficient.
A good chargemaster service contains a complete list of prices for every procedure along with the service, supply, prescription drugs, diagnostic tests, fees, room charges, and more. This list must be up-to-date with the organization’s in-house standards, but it must also be compliant with the latest medical billing and coding lists – including coding lists from the American Medical Association (AMA) and other organizations.
Failure to maintain an accurate, up-to-date list of codes and prices for services rendered means organizations are letting revenue escape.
With improved case management comes improved chargemaster services, and that means a more effective revenue stream for your organization.
Manual processes increase the risk of compliance errors. Running a medical organization is already complex. Manual processes exacerbate this complexity.
Good case management services take significant manual labor out of the hands of employees, reducing the risk of compliance lapses. Thanks to effective case management, organizations are giving themselves the best possible opportunity to remain compliant.
Case management service providers can conduct code reviews to ensure your organization stays secure, compliant, and competitive.
Code reviews are critical for healthcare organizations seeking maximum efficiency. When an organization fails to maintain an accurate code list, it can cause the organization to quickly lose its competitive edge.
A third party code review from a case management service can ensure your organization is performing at its best while staying competitive with other regional providers.
A good case management services provider can analyze your organization’s revenue cycle services to ensure efficiency at every stage of the cycle.
Integrated revenue cycle management systems, for example, can integrate directly with your case management system, allowing seamless end-to-end billing and improved patient accounting management.
Ultimately, a good case management system leads to better decision-making at both the individual and group level.
When staff have the information they need in front of them at the right time, it allows them to make the best possible decisions.
Better decision making leads to better end results and better health outcomes. It’s that simple.
In recent years, the healthcare industry has used case management to create a more optimized healthcare experience from start to finish.
With a good case management system, your organization can make the best possible decisions while ensuring every employee is equipped with the best possible information.
Does your case management system need to be reworked? Contact HMI Corp. We have 30 years of experience implementing modern case management solutions into organizations across the United States.
Smart medical organizations do everything in their power to maximize revenue – from implementing new technologies to minimizing unnecessary costs.
Today, we’re highlighting some of the unique strategies America’s top healthcare organizations are using to maximize revenue by Revenue Cycle Management Consulting Services
The evaluation and management (E/M) patient visit is a crucial part of any healthcare organization.
Good healthcare organizations can maximize revenue by understanding how to properly document and code E/M patient visits.
Proper documentation and coding does more than just boost revenue; it also reduces the stress of audits and boosts the efficiency of staff.
A July 2019 article published in Medical Economics highlighted four ways healthcare organizations can boost revenue by getting E/M coding right, including:
Ensure the E/M code supports the specific patient encounter. Not every patient with asthma, for example, will justify reporting CPT code 99213.
Refer to E/M guidelines when assigning codes. Assigning E/M codes is not a subjective process. Many physicians under-document E/M level 4 and 5 visits for new patients, for example. Follow E/M guidelines for coding and billing.
Use copy and paste functionality carefully. Some healthcare organizations get into trouble by over-utilizing the copy and paste functions. A physician who automatically copies and pastes historical information from a previous encounter into a current note, for example, may accidently inflate the E/M level.
Be cautious with pre-populated EHR templates. Pre-populated templates can lead to upcoding – say, when certain body systems are always indicated as having been reviewed even when they’re not relevant to the current encounter. These templates can also lead to contradictions that lead to red flags with payers – say, if a physician diagnoses a patient with strep throat and uses a default ear, nose, and throat exam template, opening the door for a post-payment audit.
Implement better E/M coding practices into your healthcare organization to boost revenue.
A recent study showed most healthcare executives believe charge capture is essential, yet 40% discuss it just once a month or less and only 8% discuss it daily.
Charge capture is obviously critical for revenue generation within healthcare organizations.
That’s why some leading healthcare organizations have started using unique strategies to optimize charge capture services: they’ve started to implement artificial intelligence.
AI-powered charge capture services are helping to boost staff efficiency for providers while also encouraging greater self-sufficiency for consumers.
It’s part of a widespread trend of healthcare organizations using AI to enhance revenue. Today, AI is helping companies revamp everything from registration to scheduling to billing.
Artificial intelligence automates significant parts of the charge capture service cycle, freeing staff from tasks that are important – but also time-consuming and redundant. Thanks to the latest AI technology, organizations have reduced labor costs and recovered leaked revenue while focusing on both high-dollar and low-dollar accounts.
The hospital chargemaster is the heart of a hospital’s revenue generation. That’s why it’s so surprising to see some healthcare organizations fail to adequately maintain their chargemaster.
Inadequate or poorly-maintained chargemasters can lead to overpayments and underpayments, claims rejections, and compliance violations, among other issues.
Chargemaster maintenance is a continuous process that ensures all services are accurately charged. Good maintenance involves reviewing and updating the chargemaster to ensure the hospital is compliant with government pricing regulations, for example, and ensuring the organization receives accurate reimbursement.
As public and private payers continuously update or change coding and reimbursement rules, chargemaster maintenance can become particularly challenging. Smart healthcare organizations, however, solve these challenges to optimize revenue.
Poor compliance can quickly lead to poor revenue. Smart organizations confirm compliance regularly to ensure revenue flow remains strong.
One of the best ways to confirm compliance is to conduct a code review.
HMI Corp specializes in code reviews for inpatients, outpatients, and E/M coding to ensure compliance. We can comprehensively review your organization for compliance issues, then explain exactly what needs to be changed to optimize revenue.
One of the best ways to maximize revenue, of course, is to minimize costs. Medical organizations can minimize costs in all different ways.
Discover how your healthcare organization can minimize costs and maximize revenue. Schedule a consultation with HMI Corp today. We have proven expertise offering healthcare revenue cycle management consulting services and chargemaster reviews among other revenue-boosting services.
Medical coding is an in-demand profession at healthcare organizations across the country. Despite the surging demand for medical coders, however, many people do not understand how medical coding works.
Today, we’re explaining what is medical coding is, how it works, and how a medical coder adds value to an organization.
Medical coding traces its origins all the way back 17th century recordkeeping in England. During this time, clinics kept crude records for each patient, using specific numbers and ‘codes’ to track the treatment received by each patient.
Today, the American Academy of Professional Coders (AAPC) defines medical coding as, “the transformation of healthcare diagnosis, procedures, medical services and equipment into universal medical alphanumeric codes.”
In other words, medical coders translate important medical information into simple codes to document medical records and inform accurate medical billing.
Thanks to a standard coding system, medical records can be seamlessly transferred from one organization to another.
A medical coder is the individual responsible for translating a physician’s report into useful medical codes.
The coder will look at the physician’s report and determine the treatment that was provided to the patient. Then, the coder will translate all pertinent information into code. This code is used when referencing the treatment in the future and for billing purposes.
A medical coder’s job varies depending on the setting.
A medical coder working at a hospital will document and assign codes for each medical procedure received by a patient, for example.
A medical coder working for an insurance company, meanwhile, will verify the accuracy of incoming claims, checking to make sure the patient received treatment according to his or her insurance plan.
Some medical coders work remotely from home. Many medical coding jobs can easily be performed entirely over a computer and an internet connection, making the need for an on-site office irrelevant.
Without medical coding, doctors would use common language to describe each patient’s treatment plan. That may sound good in theory. However, common language is too inexact to give an insurance company the accurate details it needs.
That’s why a specific set of codes has been developed to define medical procedures. The medical coder’s job is to translate common language into code so information can be efficiently transferred around a hospital and between organizations.
Medical coders can work in all types of healthcare organizations, but they can also work in a number of other settings, including all of the following:
• Hospitals and doctors’ offices
• Healthcare consulting services
• Educational institutions
• Home offices
• Insurance agencies
• Law firms
• Government agencies
Obviously, people expect to see medical coders in hospitals, clinics, and urgent care facilities. But many people are surprised to see medical coders in other settings as well – from home offices to law firms to insurance agencies.
Some medical coders have bachelor’s degrees or master’s degrees. However, no formal education is required to be a medical coder.
Some technical colleges have introduced medical coding programs that teach coders the intricacies of the profession. These programs take one to two years.
Prospective coders will also seek specialized certifications – which are similar to the ‘graduate degrees’ of the coding world. Specialized certifications make a medical coding applicant stand out.
Popular specialty certifications include Certified Professional Coder (CPC0, Certified Outpatient Coder (COC), Certified Risk Adjustment Coder (CRC), and Certified Inpatient Coder (CIC).
As the healthcare industry continues to grow, demand is increasing for medical coders. The Bureau of Labor Statistics expects medical coding jobs to grow at a faster-than-average rate of 13% through 2026.
HMI Corp specializes in contract coding, including inpatient, outpatient, same-day surgeries, ancillary departments, and physician E/M.
All medical coding services are provided by credentialed coding staff based right here in the United States.
Today’s leading healthcare organizations rely on healthcare revenue cycle consulting services to be successful.
How can a consulting service like HMI Corp boost your organization’s bottom line? Today, we’re highlighting some of the ways healthcare consulting services can enhance your organization’s revenue.
The security of a healthcare organization is paramount. Security audits can identify weaknesses within all aspects of an organization’s operations.
A security audit can identify problems with premises security, for example, and the ways in which malicious individuals might attempt to access facilities.
Or, the audit could identify digital security issues, including how the employees respond to phishing attempts.
Without regular security audits, a healthcare organization can trick itself into thinking it’s secure. When a healthcare revenue cycle consulting service performs a security audit, however, it can indicate what works – and what needs to be improved – for maximizing revenue.
Smart healthcare organizations anticipate risks before they impact the organization. In a recent report from consulting firm Crowe, healthcare researchers defined a risk as, “anything that might impede the organization’s ability to achieve its goals in critical areas such as patient care, regulatory compliance, operations, strategic growth, and financial performance.”
One of the major benefits of hiring a healthcare revenue cycle consulting service is that you can identify risks and take action early.
A consulting service might identify compliance issues, for example, that could enhance the risk of audits and challenges from insurance companies. Chargemaster issues, on the other hand, could raise the risk of disruptions to the care and billing process.
Healthcare organizations that ignore cybersecurity expose themselves to significant risk. The healthcare industry is increasingly under attack by all types of bad actors. Hackers might try to access patients’ medical records, for example, creating a compliance nightmare for an organization.
A cybersecurity analysis can identify your organization’s strengths and weaknesses. It can spot security holes before bad actors find them.
Some cybersecurity analyses can even involve penetration tests – or pen tests. These tests show how your organization responds to a real threat. This pen test could involve a bad actor physically entering the hospital to access data on an unsecured, for example, or a hacker testing your organization’s digital defenses.
For all of these reasons and more, healthcare organizations conduct regular cybersecurity analyses to identify and resolve security weaknesses as quickly as possible.
Efficient medical coding is the difference between good and bad healthcare organizations. Picture medical coding like the railroads and highways of a healthcare organization: when the infrastructure is smooth, efficient, and fast, it improves the entire organization.
Consulting services offer contract coding and coder quality reviews to improve the efficiency of an organization.
HMI Corp can make sure your organization has accurate coding for inpatient, outpatient, same-day surgeries, ancillary departments, and physician E/M, among other medical services. Medical coding and code reviews are performed by U.S.-based credentialed coding staff.
The chargemaster is the heart of a healthcare organization. Unfortunately, many healthcare organizations spend too little time maintaining their chargemaster.
Many organizations think they have compliant and accurate chargemaster services until it’s too late.
Over time, a lack of chargemaster maintenance leads to compliance issues, billing disruptions, and poorer patient care. Ultimately, it impacts the organization’s revenue.
Understandably, healthcare revenue cycle consulting services focus considerable attention on optimizing an organization’s chargemaster services. By fixing chargemaster issues today, the consulting service can implement real solutions that improve revenue generation.
Major healthcare revenue cycle risks in 2019 include charge capture, coding, and denial management, among other issues.
By hiring a good healthcare revenue cycle consulting service today, you can identify these risks within your organization, then take action to limit their impact on revenue.
With today’s complex regulatory requirements, compliance is more important than ever for healthcare organizations.
That’s why leading healthcare organizations hire healthcare revenue cycle consulting services to help maintain compliance.
Today, we’re explaining how healthcare revenue cycle consulting services like HMI Corp. help organizations maintain compliance at every level of a healthcare organization.
Compliance means meeting or exceeding the standards set for legal, ethical, and professional operation of healthcare organizations.
Any organization handling electronic protected health information (ePHI) is required to maintain compliance by implementing appropriate processes, policies, and procedures.
The Department of Health and Human Services (HHS) and the Office of the Inspector General (OIG) have identified seven areas where healthcare organizations should focus for compliance. By focusing on these areas today, organizations can avoid healthcare issues in the future.
An effective healthcare compliance program must, at the very least, address the following seven areas:
• Development, distribution, and implementation of written standards of conduct and written policies and procedures that explain the organization’s commitment to meeting and exceeding legal and ethical standards of compliance
• Designation of a chief compliance officer and other appropriate committees and individuals dedicated to maintaining compliance at every level
• Development and delivery of effective employee education programs
• Development and maintenance of effective lines of communication for reporting of compliance concerns
• Development and implementation of an effective response system or discipline system when compliance issues are identified with specific employees
• Development of internal auditing and monitoring system to observe and maintain compliance
• Creation of appropriate response system to quickly fix detected compliance issues
Consulting companies – including HMI Corp. – can help organizations develop or improve all seven of these areas.
A consulting company can perform a compliance assessment on your organization. An assessment determines where your strengths and weaknesses lie. Then, experts work to correct those weaknesses and improve those strengths.
During an assessment, experts will answer all of the following questions:
• How does the healthcare organization collect, receive, store, and transfer data?
• What does the current security system cover?
• What does the current security system not cover?
• What potential threats or vulnerabilities could disrupt the organization?
• What are the chances of a threat being carried out against the organization?
• How much would an attack cost if an attack were to occur?
Compliance assessments are not optional for healthcare organizations. The HIPAA Privacy Rule requires healthcare organizations to undergo assessments like the one above annually.
Healthcare organizations must collect this information, then compile a report on their findings.
Healthcare organizations have different compliance needs. Some of the most common areas of improvement required for healthcare organizations, however, include:
Standardizing Policies and Procedures: Healthcare organizations may have a mess of policies and procedures for different departments. This makes things difficult for staff. It’s more than just a compliance issue – it can also be an efficiency issue. Standardizing password management, PHI storage and usage, encryption, privacy, and other elements can vastly improve compliance.
Reviewing Access Control Clearance: Compliant healthcare organizations carefully limit access to sensitive files and patient data on the network. An assessment might recommend limiting access to data only to those who require data to do their jobs, for example.
Contract Coding and Medical Coding Issues: Liability issues related to coding can be significant. Coding and reimbursement are so complex and vital that healthcare organizations devote significant resources to doing it correctly. Unfortunately, many healthcare organizations still expose themselves to liability with various medical coding issues.
Claims Reviews: Many compliance issues involve problematic claims. This type of misconduct can be prosecuted civilly under the False Claims Act or under a range of criminal statutes – including healthcare fraud. Claims fraud cases are common targets for regulators and prosecutors, which is why it’s particularly important to review claims issues for compliance.
Compliance is crucial in any industry, but it’s particularly important in the healthcare space.
Every organization thinks they have good compliance standards until it’s too late.
Order a compliance assessment from HMI Corp today and determine exactly how and where your organization can improve all aspects of compliance.
Millions of Americans depend on small, rural hospitals for healthcare. Unfortunately, due to several challenges, many of these small hospitals are struggling to survive.
Between 2010 and 2014, 47 rural hospitals across America stopped providing inpatient services, according to a report by the Rural Health Research Gateway. An additional 673 rural hospitals are at-risk for closure.
Today’s climate may seem daunting for small, rural hospitals – but it doesn’t have to be. Today, we’re highlighting some of the best strategies today’s small, rural hospitals are using to survive.
Good hospital management starts with good data. One of the smartest things a small hospital can do is to conduct a 360-degree financial analysis using at least five years’ worth of data.
An objective third party – like HMI LLC or other medical consulting organizations – can pore over the data to issue concrete recommendations. You can see how your hospital compares to other organizations with a similar size and market.
Financial audits can reveal surprising problems with smaller, rural hospitals, including:
• Revenue cycle issues
• Denials management issues
• Longer lengths of stays compared to other hospitals
• Outdated systems still in use
• Medical coding and compliance issues
• Billing and purchasing problems
A top-to-bottom financial analysis can show a small, rural hospital what they’re billing and buying and how the hospital is doing it. It can identify key problems at every stage of the organization, including areas of missed revenue expectations, the best areas of potential improvement, and actionable changes the organization can implement today.
Many of America’s small, rural hospitals are at risk because of outstanding debts. If the hospital can learn to effectively manage this debt, it can be the difference between surviving and shutting down.
Debt management strategies vary between organizations but can include all of the following:
Judicial Reorganization: Judicial reorganization is a bankruptcy handled through the court. There are pros and cons to this type of debt management. Reorganizations can trigger default on bonds, making them due immediately, for example. Bankruptcy can also lead to the loss of revenue streams from CMS and other payors. However, for some small hospitals in certain situations, it’s the best path forward.
Debt Structure Refinancing: Refinancing hospital debt may be a smart option when interest rates are low or a hospital’s credit rating improves. However, it’s not the right choice for all hospitals in all situations.
Non-Judicial Reorganization: With non-judicial reorganization, hospitals restructure their debt and payment plans with debtors outside of the court. Good reorganization can create additional time for the small hospital without resorting to bankruptcy.
Selling: Putting a hospital on the market is one option for smaller hospitals overwhelmed by debt. This option can be particularly challenging, as larger systems will naturally absorb the patient flow after a hospital closes even if they don’t buy the facility.
Generating new revenue is a great way to revitalize any business. With smaller hospitals, it’s easier said than done. However, small hospitals that want to become financially sustainable will need to develop new revenue sources – especially the hospitals that cannot cut or refinance their way to a solution.
One of the most common ways for small, rural hospitals to create new revenue is by teaming up with outpatient healthcare providers. A smaller hospital can make its facility available to the group and setup a revenue sharing program.
Many hospitals have successfully setup behavior health programs, for example, because Medicare and Medicaid now cover behavioral health services. It’s a new revenue stream that also provides a valuable service to the community.
There are approximately 80 primary care physicians (PCPs) per 100,000 people in the United States, although there are only 68 PCPs per 100,000 people in rural areas.
With that in mind, many smaller hospitals have achieved success by increasing residency programs and partnerships. It’s not just about training new doctors: it’s about keeping them long-term.
Here’s how one report explained the benefits of better rural residency programs:
“Medical residents who train in rural settings are two to three times more likely to practice in a rural area; especially those who participate in rural training tracks.”
Smaller, rural hospitals may not have specialists on-site for every patient’s needs. That’s why a growing number of smaller hospitals are using telehealth to fill the gaps.
Telehealth can fill the gaps in subspecialist care, eliminating the need for patients to travel long distances to see a qualified healthcare provider.
Telepharmacy is one growing area of telehealth. Telepharmacy gives patients the convenience of remote drug therapy monitoring and authorization for prescriptions. Patients can also remotely access pharmacy counseling to maintain compliance with prescriptions.
There’s also telepsychiatry, which provides behavioral health services to patients who would otherwise have to drive hours to see a mental health provider.
Most people prefer to shop local. Just like a small business, a small hospital must build brand loyalty with the community.
By strengthening ties with consumers, physicians, and the local community, hospitals can keep their brand in the front of patient’s minds. Create a hospital-branded mobile app, for example, or sponsor local events.
Smaller, rural hospitals don’t have the resources of larger providers, so they need to compete in other ways.
An in-depth consultation or assessment can reveal surprising insight into missed revenue opportunities and inefficiencies within a hospital.
Some smaller hospitals have long wait times, which means patients are turned away and forced to visit other providers, leading to lost revenue every year.
Other hospitals have inefficient or outdated systems, increasing the number of steps taken before every treatment.
By eliminating steps in payroll processing, contract management, and other organizational systems, hospitals can save time and money, leading to lower costs and better patient care.
Hundreds of small, rural hospitals across America are at risk of shutting down. However, even hospitals teetering on the edge of bankruptcy or closure can change their course by implementing smart solutions today.
Contact HMI LLC to discover the best options available to your small, rural hospital. Our team has combined decades of experience solving complex problems for medical providers across America.
A good revenue cycle assessment will help your organization become more profitable.
But what’s involved in a revenue cycle assessment? How can revenue cycle experts maximize medical profits? What actionable steps will revenue cycle assessment experts help you implement? Today, we’re explaining everything you need to know about what’s involved in a revenue cycle assessment.
Some organizations perform a revenue cycle assessment on their overall organization, hiring a consulting company to conduct a bottom-to-top assessment.
Other organizations request specialized revenue cycle assessments in one or more areas of the organization.
Typically, revenue cycle assessments focus on the organization’s core areas, including:
• Pre and post-system implementation
• Organizational structure
• Process flow and design
• Vendor performance
• Staff and team performance
• Denials prevention and management
• Functional office metrics
• Key performance indicators
During a revenue cycle assessment, our experts analyze key areas of a medical organization to determine areas of improvement. Our experts use their combined decades of industry experience to solve your organization’s revenue issues.
Here’s a more detailed breakdown of how each step of our revenue cycle assessment will work:
Coding and Documentation Reviews: Good revenue management starts with good coding and documentation. Our experts will analyze your organization’s documentation and coding to ensure billed services are supported while adhering to payer mandates and guidelines.
Self-Pay Strategy: Our experts will analyze your organization’s performance for self-pay and self-pay after insurance collections. We’ll assess reporting, point of service collections, liability estimators, patient contact strategies, and third party vendor management, among other areas.
Denials Management: By analyzing your organization’s denials management, we can reduce write-offs and revenue leakage. Our team will help identify clinical and operational denials, outline identify process and workflow improvement opportunities.
Case Management & Utilization: By assessing your case management and utilization, our experts can identify process gaps that could lead to fatal level-of-care denials.
Charge Capture: Many organizations are surprised by the problems that charge capture analysis can reveal. Good revenue starts with a good chargemaster.
Patient Access: How does your organization perform for insurance eligibility, registration accuracy, centralized scheduling, prior authorization, and point of service collections? Our team will assess your patient access to identify areas of improvement.
Coding & Hierarchical Condition Categories: HMI LLC employs experienced coding consultants who assess your organization’s reimbursement risk related to coding. Every day, medical organizations across the country lose reimbursement because of coding and HCC issues.
Accounts Receivable: We can analyze your accounts receivable, then provide support and training to maximize revenue.
Job Shadowing: Revenue cycle assessment can involve employee shadowing and management training, ensuring your organization is capturing revenue from the lowest levels of the organization to the top.
Negotiations with Payers: We can negotiate with payers for increased reimbursement carve outs, enhancing organization revenue.
Dedicated, Long-Term Revenue Cycle Team: After the revenue cycle assessment is complete, we can form a revenue cycle team dedicated to tracking the revenue of your organization long-term.
The goal of a revenue cycle assessment is to give the client actionable advice they can implement today to boost revenue. Some of the concrete deliverables created by a revenue cycle assessment include:
• A strategic roadmap for improving the client’s overall operational performance
• Identification and breakdown of current revenue cycle issues
• Identification and quantification of opportunities for improvement
• Detailed recommendations for improving key revenue cycle function areas
• Comparison of an organization’s metrics in relation to overall industry benchmarks
HMI LLC specializes in performing revenue cycle consulting for medical organizations across the United States.
Our team has a unique blend of industry, consulting, and system experience, allowing us to analyze your operations and identify ways to improve your performance.
A healthy revenue cycle is critical for organizational success. Schedule a revenue cycle assessment with HMI LLC today.
The remote revenue cycle management industry has been booming in recent years. A growing number of healthcare organizations are making the switch.
Should your organization make the switch to a remote revenue cycle management (RCM) program? These third party service providers make big promises – but do they actually live up to these promises?
Today, we’re exploring the benefits of remote revenue cycle management programs.
Insurance claims may be denied because of inaccurate coding or other chargemaster issues. Good remote revenue cycle management services can reduce denied insurance claims. 90% of claim denials are preventable, and yet they still occur at every organization. Remote RCM services can mitigate the issues that lead to denied claims.
Billing and coding errors increase the number of claim denials. Remote revenue cycle management services solve these bottlenecks, helping organizations capture revenue and avoid denied insurance claims.
Cleveland Clinic claims its remote revenue cycle management program has improved employee satisfaction by enabling employees to telecommute. Employees can perform pre-registration and financial counseling remotely, helping save money and improve employee satisfaction. One executive said the work-from-home program increased productivity 113%, for example, while also reducing employee turnover and absenteeism.
Patients and insurers have better access to information with remote revenue cycle management services. Instead of old, manual, paper billing processes, for example, new systems use modern electronic processes to boost performance.
Aging, legacy systems can make interoperability painful. Remote revenue cycle management services can lead to better interoperability between health systems, enabling the seamless transfer of data.
Remote RCM services offer streamlined denial management. Good RCM services make it easy to determine the cause of denials, mitigate the risk of future denials, and get paid faster. Common claims denial management obstacles include managing different payer rules, using manual processes, and making simple mistakes – and remote RCM systems can help avoid all of these issues.
Automation and AI continues to become closely integrated into the healthcare space. Remote revenue cycle management programs are increasingly using automation and AI to get ahead of the competition. The best remote revenue cycle management programs rely on AI to boost revenue and performance across organizations.
Increased government regulations in recent years have made compliance more difficult for healthcare organizations. It’s difficult for healthcare organizations to follow regulatory mandates for the adoption of electronic health and medical records, for example.Remote revenue cycle management programs improve regulatory compliance, making it easier for organizations to stay up-to-date with the latest regulations.
Remote revenue cycle management programs offer complete patient billing solutions. Failure to maintain necessary HIPAA and HL7 compliance and protect the patient’s data from a breach can lead to serious liability issues. Healthcare organizations are turning to remote revenue cycle management companies for better, safer patient data management.
Remote revenue cycle management companies are aware that healthcare organizations don’t want to lose control. That’s why many make control a key issue.By choosing the right remote revenue cycle management program, companies can avoid losing control over crucial aspects of their organization. Today’s leading RCM companies emphasize a ‘win-win’ solution – and they’re increasingly living up to that promise.
The market for remote revenue cycle management programs is expected to grow to $90 billion by 2022, up from $51 billion in 2017.
As more healthcare providers recognize the benefits of remote revenue cycle management programs, remote revenue cycle management isn’t expected to slow down anytime soon.
Revenue cycle management has experienced ups and downs in recent years. What lies ahead for revenue cycle management?
Last year, we saw the continued rise of automation and AI. We also saw battles over price transparency.
Continuing the trend from previous years, we also saw healthcare organizations contend with patient expectations, government regulations, and a growing number of technology options.
Let’s take a look at some of the revenue cycle management (RCM) trends we’re preparing for in 2020.
Healthcare pricing transparency battles occurred across the country in 2019. Expect battles to continue into 2020.
A Waystar survey released in August 2019 found that lack of price transparency was the biggest factor to a negative patient experience. Governments are pushing for increased healthcare transparency, and healthcare organizations are adapting.
Last year, we saw healthcare organizations implement strategies to better manage the patient financial journey. In 2020, we expect healthcare organizations to take the next step.
Some organizations have published the chargemaster online, giving patients full transparency over how much services cost. However, because chargemaster prices are not necessarily the prices charged to the patient, these resources can be difficult for patients to interpret.
In June 2019, the Trump administration signed an executive order mandating that health systems provide out of pocket cost estimations to patients upfront.
Look for increased transparency and better patient access to prices as we move through 2020.
Revenue cycle management outsourcing is becoming increasingly popular among healthcare organizations – and it’s been a trend for several years.
The trend towards revenue cycle management outsourcing is expected to continue into 2020.
Revenue cycle management companies advertise benefits like sharing the risk and reward, which creates a win-win solution for partner organizations. Healthcare organizations can create a sustainable, high-performing engine while still enjoying growing cash flow.
As revenue cycle management outsourcing companies become more competitive, outsourcing is an increasingly attractive option for healthcare organizations.
Cybersecurity has been a priority for healthcare organizations for over a decade, and this trend is expected to continue into 2020.
Cybersecurity attacks aren’t stopping anytime soon. Healthcare organizations need a coherent cybersecurity strategy to stay competitive.
In April 2019, the United States government reported 44 healthcare data breaches, which was the highest number of healthcare breaches reported in a single month since the government started tracking healthcare breaches in 2010. The previous record was set in April 2018, when there were 42 breaches.
Ransomware attacks are particularly common. Last year, Carbon Black released a study showing that 66% of healthcare organizations experienced a ransomware attack within the last 12 months.
Hospitals nationwide ended 2019 with an increase in hospital profitability. The increase was linked to surges in net patient revenue and service volumes. Hospitals were treating more patients – and making more money from those patients – than ever, according to a report by RevCycle Intelligence.
This profitability increased despite a slight increase in supply expenses, increases in bad debt, increases in charity care, and mixed performance on expenses.
Over 800 hospitals across the country saw particularly high volumes in adjusted discharges, emergency department (ER) visits, and operating room (OR) minutes.
It was a positive trend after a tough year. The December 2019 increase was the first year-over-year operating EBITDA margin increase in six months. Hospital operating margins also increased by 171.8 basis points compared to November 2019.
Overall, EBITDA margins rose 136.9 basis points year-over-year in December 2019. It’s possible this trend will continue into 2020.
The role of the healthcare CFO has been changing in recent years. 2020 might be the year it becomes even more evident.
CFOs are expected to continue taking a leading role at every level of the healthcare organization. Modern healthcare CFOs don’t just listen: they act.
Healthcare IT Leaders Revenue Cycle Lead, Larry Todd, recently recommended that CFOs go beyond listening and start implementing:
“…any implementation will affect the revenue of the organization so it’s very important for CFOs to be involved in the implementation project and to be informed of key parts of the project that could put the organization and its revenue at risk.”
In the same article, Linda Hoff of Legacy Health described how CFOs need to take a specific interest in not just financials, but also patient satisfaction and quality. All metrics are closely intertwined:
“You have a passion for what you’re doing within your facilities, how you’re interacting with patients. You have to be as interested in patient satisfaction and quality as you are in the financials. If you don’t have that passion for all those aspects, you’re really not going to land yourself in a CFO role especially today.”
Surprise billing took a beating at the end of 2019. In December, members of Congress announced the expansion of a bipartisan investigation into supress billing practice. Because of that expansion, the investigation will now look at physician staffing companies and health insurers.
That same month, a Health Affairs study found that annual healthcare spending for patients with employer-sponsored health insurance would drop by $40 billion if specialists were not able to bill out-of-network.
A Kaiser Family Foundation report released in June, meanwhile, found that one in six Americans received a surprise medical bill in 2017 despite being covered by health insurance.
As surprise billing continues to make media headlines nationwide, surprise billing practices will continue to be attacked.
Look for these trends and more to make headlines across the revenue cycle management field in 2020.
The hospital charge description master, or hospital chargemaster, communicates medical bills to payers and patients.
The hospital chargemaster plays a crucial role in revenue cycle management: it’s the heart of the healthcare revenue cycle. It’s the central point from which all billing gets sent to patients and insurers.
Organizations that fail to maintain the chargemaster face enormous problems. Poor chargemaster maintenance leads to revenue leakage. It can also lead to inaccuracies, non-competitive fees, and claim rejections.
The hospital chargemaster is a list of all the billable services and items to a patient or patient’s health insurance provider.
The chargemaster lists the costs of each product and service offered by the healthcare organization, including any procedures, services, supplies, prescription drugs, and diagnostic tests provided by the hospital. The chargemaster lists the cost of everything related to that service, including any equipment fees and room charges.
When a patient receives service from a hospital, the healthcare provider documents the encounter in the medical record. Then hospital staff – like professional coders – assign the service a code for reporting and claim submission.
The codes are sent to the chargemaster. Each code is matched with a specific product or service and a fixed rate. Then, the charges are billed to the patient, creating a claim for payers – like insurance companies – to pay.
Hospitals use chargemasters to keep track of the cost of all products and services offered by the organization.
Each product or service offered by the hospital – like a diagnostic test or specific surgery – gets its own entry in the chargemaster.
Each chargemaster entry includes the following:
Item Number: This number is assigned by the facility and is unique to that product or service.
CPT or HCPCS Codes: Current Procedural Terminology (CPT) codes or Healthcare Common Procedure Coding System (HCPCS) codes help keep track of each product or service in a standardized way.
Item Description: Each entry has a brief text description of the product or service.
Revenue Code: A unique code based on the revenue of that item.
Charge Amount: The fee assigned to the item.
Alternative CPT or HCPCS Codes: Sometimes, codes overlap. Or, some insurers may require additional codes.
Numeric Designation for Department: A unique code describing the department where the product or service took place.
Ledger Number: A general number for organization accounting purposes.
A hospital may offer thousands of products or services. There’s a chargemaster entry for each one.
Healthcare transparency battles raged throughout 2019. In response, some organizations are making chargemasters more transparent.
However, it’s easy for patients to get confused about chargemaster prices. The prices displayed on the chargemaster are rarely the prices paid by customers.
In fact, most patients do not see the chargemaster price from their hospital visit unless they are uninsured and must actually pay the chargemaster rate.
Why are chargemaster rates so different from real prices? It’s because of markups.
Chargemaster services are heavily marked up to make negotiations with insurance companies easier. One recent study found that the average hospital in the United States had a charge-to-cost ratio of 4.32, which means the hospital charged $432 when the service really only cost $100.
Maintaining marked up chargemaster prices also makes it difficult for patients to compare prices between organizations.
Hospitals defend this practice, claiming that markups help hospitals stay open and competitive. However, there’s been a push for transparency in recent years, and hospitals have started changing how they treat the chargemaster.
Inadequate chargemaster maintenance is a serious issue. Even the best healthcare organizations experience chargemaster-related issues, and these issues lead to lost revenue.
Accurate chargemaster maintenance is crucial for revenue integrity. A lack of maintenance leads to revenue leakage.
Poor chargemaster maintenance can lead to overpayments or underpayments. It can also lead to claim rejections from insurance companies, poor patient experience, or compliance violations.
Many organizations are surprised to discover they have been significantly undercharging or overcharging for specific treatments because of poor chargemaster maintenance. A chargemaster audit can reveal surprising results.
Hospital chargemaster maintenance is crucial to revenue cycle management. Here are some tips to help your organization manage.
First, the American Academy of Professional Coders (AAPC) recommends maintaining chargemaster lists by following the three C’s: correct, complete, and compliant codes.
Correct Codes: Chargemaster coordinators should check that the correct codes are billed. There may be differences between what is captured in the order entry system or EHR and what is reported on the chargemaster. Someone may assign an unlisted HCPCS code when a specific code is available, for example, or the entry may be missing HCPCS codes for separately paid drugs.
Complete: Chargemaster code sets need to be complete. Hospitals need to capture the charges for all the services and items provided to patients. Failure to maintain complete code sets can lead to missed payments and revenue leakage.
Compliant: Chargemasters must also be complaint with coding standards and federal, state, and commercial payer rules. Failing to adhere to regulations can lead to significant issues, including repayments to payers, healthcare fraud, and healthcare abuse.
Ultimately, all of these issues can be solved with frequent chargemaster code reviews. Check your chargemaster code to ensure it’s correct, complete, and compliant to ensure good revenue cycle management.
Healthcare organizations have turned to telehealth during the COVID-19 pandemic. However, some are not prepared to handle telehealth coding and billing.
Demand for contract medical coding experts is surging. Companies like HMI Corp can help your organization manage complicated COVID-19-related telehealth coding. Our coding experts have proven expertise across the United States.
Today, we’re highlighting some of the best telehealth coding and billing practices for the COVID-19 coronavirus pandemic, including changes to be aware of.
In response to the COVID-19 pandemic, HHS has relaxed certain telehealth coding rules. HHS allows providers to offer telehealth services while charging the same amount they would for in-person care.
Whether providing care virtually or on-site, providers can get paid the same amount for patient care because of these new HHS regulations.
Specific services covered under these regulations include:
• Telehealth visits
• Virtual check-ins
These rules are changing regularly.
CMS recently announced that doctors can directly care for patients at rural hospitals, across state lines if necessary, via phone, radio, or online communication, without having to be physically present. They announced similar options for nurse practitioners, occupational therapists, and hospice nurses. These changes affect critical access hospitals (CAHs), federally qualified health centers (FQHCs), rural health clinics (RHCs), skilled nursing facilities (SNFs), and home health agencies and hospices.
You can learn more about the CMS’s COVID-19 emergency declaration blanket waivers for healthcare providers and telehealth services at CMS.gov here.
CMS has released a list of HCPCS codes for telehealth services and other virtual patient treatment sessions.
These codes are covered under the Physician Fee Schedule, and they will continue to be covered throughout the COVID-19 pandemic.
You can view the full list here.
AMA has released information on telehealth billing and CPT codes, including telehealth visits, online digital visits, remote patient monitoring, and similar telehealth services.
AMA’s guideline was updated on May 22 and covers the implementation of telehealth in response to COVID-19, including how to code telehealth services.
The goal of the guideline is to help providers implement telemedicine and remote care services while ensuring uninterrupted care for 100 million Americans with chronic conditions.
Items covered by AMA guidelines include:
• Store and forward technologies that collect images and data for transmission and interpretation at a later date
• Real-time, audio-video communication tools that connect physicians and patients
• Remote patient monitoring tools like blood pressure monitors, wearables, Bluetooth devices, and other devices that collect biometric data for review (including mHealth apps).
• Verbal/audio-only and virtual check-ins via patient portals, messaging platforms, etc.
Hospitals are now using telehealth services to triage patients whenever possible, according to a recent report from the Office of the Inspector at HHS.
As demand for elective and non-urgent services declines, ambulatory organizations are following similar guidelines.
That means demand for telehealth services continues to grow – and the demand for effective telehealth coding guidelines is increasing with it.
COVID-19 has left organizations scrambling. Some are struggling to effectively code for telehealth services. Others are struggling with COVID-19 coding.
Whatever your coding issue may be, these tips can help:
Stay up-to-date. The AMA, CDC, and CMS are releasing new guidelines regularly, and the COVID-19 pandemic is changing weekly. Spend extra time checking information from all relevant providers to help your organization stay up-to-date.
Spend extra time verifying EHRs to ensure accuracy and compliance. This is always a good tip, but it’s particularly important during an uncertain situation when coding errors are rampant.
Consider hiring contract medical coding experts for assistance. Contract medical coding experts are a guaranteed way to solve inefficiencies and reduce errors. They’re experts at medical coding, and that expertise is invaluable during a time like this.
HMI Corp has contract medical coding experts standing by to solve medical coding issues for your healthcare organization.
Whether struggling with telehealth coding or COVID-19 coding, your organization cannot risk inaccurate or ineffective coding.
Our US-Based contract medical coding specialists are credentialed by AHIMA and/or AAPC. They have firsthand experience in Inpatient/MS-DRG, Outpatient Surgery, Physician E/M, Emergency Department E/M, Interventional Radiology, Ambulatory Surgery, GI/Endoscopy, and other fields of care. They can work with TruCode, Meditech, VISTA, 3M, McKesson, Cerner, Epic, and CHCS/CHCSII.
Contact HMI Corp for effective contract medical coding for your organization. Whether dealing with telehealth coding issues with COVID-19 or general medical codinginefficiencies, we can help.
Demand for medical coding companies has surged in recent months. COVID-19 has revealed medical coding inefficiencies, and firms are struggling to keep up.
Good medical coding companies work with healthcare organizations to solve inefficiencies and reduce errors. Effective medical coding tips helps a company avoid wastage, capture lost revenue, and reduce patient conflicts.
Your healthcare organization might have effective medical coding systems in place. Unfortunately, a pandemic like COVID-19 can reveal problems with any organization’s medical coding.
The CDC, CMS, and AMA have all released COVID-19 coding guidelines in recent weeks. We’ll summarize that information below to help your organization manage the COVID-19 pandemic.
COVID-19 has put strain on healthcare providers across the United States. Effective coding and billing helps organizations manage the infectious disease and avoid becoming overwhelmed.
The healthcare industry is adapting to COVID-19 and creating new codes for the novel coronavirus. The pandemic is bringing in new patients with unique needs, creating more coding and documentation challenges for organizations.
Below, we’ll summarize some of the guidance released by the CDC, CMS, and AMA in weeks for medical coding during COVID-19.
The Centers for Disease Control released new medical coding guidance in March for COVID-19. The CDC added the new International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) emergency code from the World Health Organization.
Based on that guidance, the code for the diagnosis of COVID-19 is U07.1, 2019-nCoV acute respiratory disease.
The CDC expected to implement that code in October 2020, but they moved the implementation date to April 1 after the rapid spread of the disease.
The CDC recommends only using U07.1 to document a confirmed COVID-19 case based on a confirmed test result or a presumptive positive test result. This code also applies to asymptomatic patients who test positive for coronavirus.
U07.1.1 is a principle or first-listed diagnosis code. That means providers should sequence the code first, then use appropriate codes for associated manifestations of the illness, unless dealing with obstetric patients.
The CDC does not recommend using the U07.1 code to diagnose suspected, possible, probable, or inconclusive cases of COVID-19. Providers should only use this code for confirmed (or presumptively confirmed) test results.
The CDC recommends using code Z03.818 for exposure to COVID-19. This code covers encounter for observation for suspected exposure to other biological agents ruled out and screening, according to CDC regulations.
CMS created Healthcare Common Procedure Coding System (HCPCS) codes to help providers get reimbursed for diagnosing patients and stopping the spread of COVID-19.
CMS recently announced two new codes, including U0001 and U0002, which cover COVID-19 tests:
• U0001: This code is used to document and bill for tests performed at CDC laboratories.
• U0002: This code is used to document and bill for tests performed at non-CDC laboratories, including clinical laboratories outside of the CDC.
Medicare has accepted these codes since April 1, 2020, although any codes will be retroactive to February 4 to account for any tests performed since that date. Providers can expect to receive approximately $35 for U0001 coded claims and $51 for U0002 coded claims through Medicare.
On May 20, AMA released new coding and guidance for the Medical Coding Tips COVID-19 coronavirus.
AMA’s new Current Procedural Terminology (CPT) codes were created to streamline the novel coronavirus testing available across the United States.
Key points from the AMA’s CPT codes include:
• The AMA accepted the addition of code 87635 to report infectious agent detection by nucleic acid (DNA or RNA) for COVID-19 by amplified probe technique. The code is effective from March 13 onward.
• The AMA accepted the revision of code 86318 to report immunoassay for infectious agent antibodies and to be a parent to 86328.
• The AMA accepted the addition of code 86328 to report single step antibody testing for COVID-19. They also accepted the addition of child code 86769 to report multiple-step antibody testing for COVID-19. These new codes and revisions were effective from April 10 onward.
• The AMA accepted the addition of PLA code 020U to report the BioFire Respiratory Panel 2.1 (RP2.1) test, with the new code effective from May 20 onward.
You can view full details of the AMA’s expanded COVID-19 medical coding additions and revisions here.
More healthcare providers are using telehealth for patient care. Telehealth can introduce new coding challenges beyond COVID-19.
HHS has relaxed certain rules during the COVID-19 pandemic, allowing providers to use telehealth while getting paid the same amount for patient care – even though care is provided virtually instead of on-site.
CMS has released a list of HCPCS codes to document telehealth services and other virtual patient visits. These codes will be covered under the Physician Fee Schedule throughout the COVID-19 pandemic.
AMA has released its own guidance on telehealth billing with CPT codes. The AMA’s guidance covers telehealth visits, online digital visits, remote patient monitoring, and similar telehealth services.
COVID-19 medical coding can be complicated. By following these tips, you can minimize disruption and maximize patient care during the pandemic:
• Check the latest information from the CDC, CMS, AMA, and other official organizations frequently. The situation is changing constantly, and these organizations regularly release new coding guidelines.
• Assess documentation guidelines in EHRs to ensure providers are accurately documenting services.
• Take extra care to provide complete, precise, accurate documentation that reflects all related conditions during this pandemic. Researchers will use this data to assess this pandemic and the response, and high-quality data will be more valuable for preventing future pandemics.
Struggling to keep up with medical coding during COVID-19? Your organization is not alone.
HMI Corp is one of America’s leading contract medical coding companies. We have decades of proven expertise solving medical coding issues across the United States.
Our contract medical coding specialists are all US-Based and have experience with TruCode, Meditech, VISTA, 3M, McKesson, Cerner, Epic, and CHCS/CHCSII.
All coding services are performed by AHIMA and/or AAPC credentialed medical coding professionals. Our professionals have firsthand expertise in Inpatient/MS-DRG, Outpatient Surgery, Physician E/M, Emergency Department E/M, Interventional Radiology, Ambulatory Surgery, GI/Endoscopy, and many other fields.
For help from one of the leading contract medical coding companies in the United States, contact HMI Corp today.
97% of America’s healthcare organizations have experienced some disruption due to COVID-19.
As states re-open, healthcare organizations continue to navigate healthcare revenue cycle management. Some organizations are managing more effectively than others.
COVID-19 has introduced billing and coding challenges, patient financial responsibility issues, and other problems for healthcare organizations.
Today, we’re explaining strategies firms are using to manage revenue cycles during the COVID-19 pandemic – including how your organization can stay ahead.
Many organizations have faced billing and coding challenges during the COVID-19 pandemic.
To navigate the pandemic, your organization needs to know what is covered by health plans for both inpatient and outpatient care.
Rules are changing constantly. That means staff require frequent training and regular updates to avoid billing and coding problems.
Many outpatient facilities are scheduling telehealth appointments, for example. Some insurance companies treat telehealth appointments the same way as in-person appointments. Others treat them differently. Check if the insurance company pays the same full rate for telehealth appointments. Check if the insurer needs further documentation or approvals.
Many healthcare organizations have shifted their billing office to work remotely. With some preparation, organizations can handle billing responsibilities from home.
To setup remote billing, an organization may need to give employees remote access. Employees may need to access certain systems and equipment to remain productive.
Employees also need to adhere to regulations – including privacy and data security. Working from home introduces new challenges with HIPAA, and your organization needs to address these challenges before compliance issues occur.
COVID-19 has made some healthcare organizations starkly aware of business continuity issues. Some organizations have strong emergency preparedness plans. Others do not.
Every healthcare organization has some type of emergency plan – but few healthcare organizations were prepared for a multi-month pandemic-related shutdown.
You may think it’s too late to address emergency preparedness for the coronavirus pandemic. However, nobody knows what happens next: a second wave later this year could be worse than the first wave. There’s no such thing as too much preparation.
Several Medicare changes were introduced in recent weeks. Healthcare organizations need to review these changes and stay up-to-date on other upcoming changes.
Some of the biggest changes involve billable services, including services that can and cannot be billed under Medicare. Medicare allows billing for the treatment of uninsured patients with COVID-19, for example, or providing telehealth care.
Another big change is with Medicare cash flow: organizations can receive accelerated or advance payments from Medicare in certain situations, increasing cash flow at a time when needed most. By taking advantage of these cash flow changes, organizations can minimize COVID-19 disruptions.
Patients are facing higher financial responsibilities during the coronavirus pandemic. Some patients are facing financial difficulties because their health plan lacks coverage for coronavirus-related bills.
Today is a great time to evaluate your organization’s collection and credit system. Each organization should evaluate its credit and collection policies. Pay close attention to changes in:
Copays and Deductibles: Some of America’s largest insurers have changed copay and deductible policies, including out-of-pocket responsibilities for patients.
Standard Referral Requirements: Consider standard referral requirements, as this can move payment obligations from the patient to the insurer.
By keeping staff trained and up-to-date on patient financial responsibility changes, healthcare organizations can optimize revenue cycles during the pandemic.
Healthcare organizations are dealing with countless challenges during the coronavirus pandemic. Other things to consider with revenue cycle management include:
Capacity Assessment: Hospitals in many states are facing a surge in patients, including surges that overwhelm capacity. Your healthcare organization needs to develop proactive revenue cycle strategies to ensure you continue to meet patient needs when nearing capacity.
Staff Management: Your staff are on the front line of patient care. Has your organization created proactive plans for hours of operation, staffing and documentation requirements, telehealth accommodations, and other unique situations created by the coronavirus?
There’s never been a better time to hire a revenue cycle management consultant. A good revenue cycle management consultant spots inefficiencies that impact revenue.
By implementing a consultant’s recommendations, your organization can thrive during the pandemic, surpassing revenue management cycle obligations and goals.
Revenue cycle management consulting is an investment. A good consultant firm provides a return on that investment, providing actionable recommendations that impact your firm’s revenue immediately.
At HMI Corp, we have offered revenue cycle management services since 1989. As a diversified healthcare company, we provide a spectrum of revenue cycle management services, including charge capture, chargemaster reviews, medical bill audits, and claims reviews.
Our clients include physician groups, large teaching hospitals, and organizations of all sizes in between. Contact us today to discover how we can help optimize revenue cycles for your organization. Our goal is to help you meet revenue goals while maintaining quality and compliance standards.
The COVID-19 pandemic has introduced many challenges for healthcare organizations.
The situation is fluid, and it’s uncertain what happens next. However, organizations must continue to meet obligations and missions throughout the pandemic.
Using the strategies above, healthcare organizations can manage and thrive during the coronavirus pandemic, ensuring they meet revenue cycle goals.
The COVID-19 pandemic has wreaked havoc on healthcare organizations across the United States.
But as some organizations are failing, others are thriving. By capitalizing on changes, and by training staff, organizations can optimize healthcare revenue cycles throughout the coronavirus pandemic.
Today, we’re highlighting five ways COVID-19 has impacted healthcare revenue cycles for organizations across the United States – and how organizations are thriving in the face of change.
Obviously, telehealth has surged in recent months. Many outpatient facilities have switched to telehealth appointments, giving patients the same quality of care via a safer, remote environment.
Telehealth appointments are also introducing coding and billing challenges. Some healthcare plans have updated policies for telehealth, while others have not. Medicare has introduced telehealth-related changes, for example, while other insurers are struggling to manage.
Meanwhile, some staff have inadequate training for telehealth billing. They bill patients when they should be billing healthcare plans, for example, or they’re charging inaccurate out-of-pocket payments and co-pays to providers. Some organizations have improper coding in place, complicating things further.
It’s not just patients accessing care remotely: staff are working remotely. Many organizations have requested billing and other support staff to work remotely throughout the pandemic.
Hennepin Healthcare in Minneapolis, for example, recently shifted nearly all support staff to remote positions, including coders, coding educators, coding auditors, coding support specialists, coding coordinators, and transcriptionists, as explained in an interview with HealthLeaders.
Remote work has introduced new challenges. Remote employees need to access company infrastructure to work, for example. Remote employees also need to consider HIPAA, taking extra care when managing patient data in an unfamiliar setting.
With employees using their own equipment, it introduces new challenges. IT departments across the country are struggling to keep up.
There have been multiple billing and coding changes as a result of COVID-19. Good healthcare organizations are staying up-to-date on changes, while other healthcare organizations are lagging behind.
In April, the American Medical Association (AMA) announced it was fast-tracking the development of a unique Current Procedural Terminology (CPT) code for coronavirus testing.
CMS also released guidance on billing and reimbursement for treating COVID-19. CMS had previously released two Healthcare Common Procedure Coding System (HCPCS) codes, allowing labs to bill for certain COVID-19 diagnostic tests.
These changes can seem confusing, but good coding is the backbone of healthcare revenue cycle management.
As part of an $8.3 billion emergency funding measure passed earlier this year, Medicare now covers telehealth services. Healthcare organizations can receive payment from Medicare for telehealth appointments. Medicare covers video visits and similar telehealth appointments.
It’s possible this change is permanent: some experts suggest it will forever change the way we deliver healthcare.
When patients can access care without leaving their home, and when specialists can provide treatment from a remote setting, it changes the face of healthcare.
Many patients have postponed elective surgeries due to concerns about coronavirus transmission in hospitals. Revenue cycle experts have also encouraged patients who can’t afford out-of-pocket costs to postpone elective procedures until they have a payment plan in place.
In April, CMS recommended that “all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.”
Prior to that press release, organizations had already announced their own elective surgery policies.
Organizations across the country postponed elective surgeries to free up resources in preparation for a surge in cases.
All of these shifts have a significant impact on revenue cycles.
Good healthcare organizations were prepared for this pandemic. They had emergency preparedness plans in place. They had previously established business continuity plans. Other organizations were less prepared: they were prepared for smaller emergencies or short-term surges, but they were not prepared for a months-long pandemic.
Revenue cycle management consultants can establish emergency preparedness plans for organizations. They can create business continuity guidance, helping firms navigate a complex, uncertain future while maintaining quality patient care and compliance.
Revenue cycle management consultants are in high demand. Organizations across the United States are struggling to deal with the coronavirus pandemic – but some are thriving.
The difference between good and bad healthcare organizations is effective revenue cycle management. At HMI Corp, we specialize in revenue cycle management consulting. We highlight inefficiencies in your organization, then fix them.
Schedule a consultation with HMI Corp today. Discover effective revenue cycle management services that deliver a proven return on investment. We have 30+ years of experience helping small, medium, and large organizations optimize revenue cycles.
Artificial intelligence has solved countless human challenges – and medical coding might be next.
As organizations prepare for ICD-11, medical coding is about to become more complicated. Healthcare organizations in the United States already manage 140,000+ codes in ICD-10. With ICD-11, that number will rise.
Some propose artificial intelligence as a solution. AI could aid computer-based medical coding systems, identifying errors, enhancing patient care, and optimizing revenue cycles, among other benefits.
Today, we’re highlighting some of the ways in which artificial intelligence could change medical coding in the future.
It’s impossible for humans to memorize the 140,000+ codes in ICD-10. With ICD-11, we’ll see more codes, making things even more complicated.
The coding of medical diagnosis and treatment has never been easy. In fact, it’s one area where many organizations struggle. Poor coding can lead to missed revenue opportunities. It can impact patient safety, increase insurance denials, and harm reputation.
Could artificial intelligence solve these problems? According to a report from Forbes, medical coding with artificial intelligence is closer than you think – and AI is already solving medical coding challenges for organizations around the world.
First, it helps to understand what ICD-11 is and why it’s important.
International medical organizations currently use the ICD-10 medical coding standard. It’s the tenth version of the International Classification of Disease codes. ICD-10 was created by the World Health Organization (WHO) and has 10,000+ codes available for diagnosis and treatment.
The next version of ICD has already been approved for implementation. WHO member states voted to implement ICD-11 in May 2019, and implementation will begin in WHO member states – including the United States – in January 2022.
ICD-11 is a significant change from ICD-10. It contains four times more diagnostic codes: instead of the 10,000+ codes in ICD-10, healthcare organizations will have 55,000 diagnostic codes from which to choose.
In America, medical coding is even more complicated. There is an enhanced version of ICD-10 specific to the United States. This version has over 140,000 classification codes, including roughly 70,000 codes for diagnosis and 70,000 codes for treatment. It’s possible the American version of ICD-11 could have several times that number.
It’s already impossible for a human being to memorize the 140,000 codes in America’s ICD-10 medical coding system. In fact, it’s impossible for someone to memorize the 10,000 codes in the international version of ICD-10.
That’s why medical coders rely on code books. They thumb through a book or scan a database of codes to find the most appropriate code for the services performed.
Complicating things further is the fact that the same medical service can qualify for multiple codes. Depending on interpretation, there may be multiple ways to code a service.
Some suggest using artificial intelligence to help. As AI becomes smarter and more powerful, many healthcare organizations are turning to artificial intelligence.
Over the past 20 years, healthcare organizations have increasingly adopted computer-assisted coding systems. These systems recommend codes and identify coding errors.
By enhancing these systems with artificial intelligence, organizations can optimize revenue cycle management, avoid coding errors, and enhance patient care.
Artificial intelligence could:
• Identify inconsistent code usage within an organization
• Spot coding errors
• Identify the use of a rare or unique code
• Automatically recommend codes based on the services performed
• Provide actionable data on code usage, patient activity, and medical services performed
• Track codes within a patient’s history to avoid manual code entry with every visit
Overall, artificial intelligence could perform a role similar to contract medical coding specialists, helping healthcare organizations identify missed opportunities.
Artificial intelligence will aid medical coding in the future. Today, however, healthcare organizations rely on medical coding specialists to help.
Contract medical coding specialists can implement better systems for inpatient, outpatient, same-day surgeries, ancillary departments, and physician E/M.
Unfortunately, not all medical coding services are alike. Some medical coding specialists have just a few months of training. Others have years or decades of experience.
By hiring the right medical coding specialist, healthcare organizations can optimize revenue cycle management, avoid coding issues, and enhance patient care.
Like it or not, medical coding is becoming increasingly complex. With the launch of ICD-11, things could become more complex in the near future.
To help your organization prepare for future medical coding challenges, contact our medical coding specialists at HMI, LLC today. With decades of experience optimizing medical coding, HMI, LLC helps healthcare organizations capture missed revenue opportunities and avoid coding errors.
When some think of revenue cycle management, they think of larger healthcare organizations with complex needs. But healthcare organizations of any size can benefit from revenue cycle assessments.
Yes, smaller hospitals can benefit from revenue cycle assessments and healthcare consulting. In fact, these assessments could have a greater proportional impact on smaller, rural hospitals.
Rural hospitals need help. In 2016, 41% of rural hospitals in the United States operated with negative margins. As populations age, this problem is getting worse – not better.
Today, we’re highlighting some of the ways that small, rural hospitals can benefit from a revenue cycle assessment.
The first and most important step is to understand the unique challenges smaller hospitals face. Smaller, rural hospitals face challenges that don’t exist with larger hospitals in big cities:
• 20% of the US population lives in rural regions, yet only 10% of physicians practice in rural regions, leading to a consistent physician shortage of smaller, rural hospitals
• Nearly half of all rural hospitals in the United States operate with negative margins
• Rural hospitals deal with different, more challenging patient demographics than larger hospitals in metro areas; rural areas tend to have older populations and higher rates of unemployment, creating problems for smaller hospitals seeking to optimize revenue cycles
• Hospitals in rural areas deal with more challenging patients than hospitals in urban areas; there are more patients over 65, higher rates of childhood poverty and premature death, and increased childhood mortality rates, among many other issues
Smaller, rural hospitals cannot change these factors: they’re inescapable parts of rural life in many parts of the United States. Instead of complaining about these challenges, good rural hospitals have learned to surmount these challenges by optimizing revenue cycles.
Smaller, rural hospitals may already be operating with negative margins, making it harder for them to attract physicians. Typically, organizations that struggle to attract physicians can increase pay or other benefits. With smaller, rural hospitals, that may not be an option.
Instead, organizations seek other solutions.
Many rural hospitals implement team-based care models that depend on advanced practice clinicians, for example.
One 2016 study by the American Academy of Physicians Assistants found hospitals that used a higher physician assistant-to-physician ratio, reduced care costs more than other teams in the same hospital using a traditional staffing model. These care teams had 3.5% lower costs, for example.
A separate study found that team-based care improved overall organization productivity. A recent MGMA survey, for example, found that implementing physician assistants into patient care led to a 34% boost in productivity compared to similar organizations.
While physicians may be the cornerstone of patient care, many rural hospitals are achieving success by switching to a team-based care model.
Rural hospitals also face challenges on the IT side. While larger hospitals have the resources for full-featured IT departments, smaller hospitals do not. This can create technology headaches for patients and staff. It could impact patient data and organizational security.
A 2016 MGMA report found that a typical health IT implementation costs up to $32,500 per physician. That’s a 40% increase in costs over the last five years. That’s a challenging cost for rural hospitals to cover.
Some rural hospitals take a different approach, using paper-based systems even in 2020 and beyond. These clunky systems reduce productivity and reduce patient security, among countless other downsides.
Thanks to technology, there’s a viable alternative: cloud-based systems. Cloud-based health IT systems allow rural hospitals to access the power of a full IT department without hiring a full IT department. They can use cloud-based health IT systems to boost productivity and enhance patient care – all at a comparable cost to what their larger, more metropolitan competitors are paying.
A good healthcare consultant can analyze organizational needs, then recommend and implement the best health IT system.
Rural areas tend to have higher poverty rates than suburban areas. They also tend to have more adults 65 and older. That means more Medicaid and Medicare claims for rural healthcare providers.
Uncompensated care continues to be an issue for rural healthcare providers. One study found that 6% of rural hospital budgets go towards uncompensated ‘charity’ care, while urban hospitals pay just 5.1% towards uncompensated care. It’s a disproportionate burden for rural hospitals to bear.
Patients are expected to cover the cost of care out of pocket. However, patients in rural areas tend to have higher rates of poverty and unemployment. Even when patients owe money to the healthcare provider, the provider may never get it. Hospitals may setup extended payment plans, only to leave themselves with bad debt.
Healthcare consultants can implement payment systems that enhance a patient’s likelihood to pay, making it easier for rural hospitals to capture lost revenue. Many rural hospitals have achieved success with value-based reimbursement, for example.
Rural hospitals seeking to compete with larger competitors should implement the following strategies, according to the National Rural Health Resource Center:
• Expand primary care services and hours
• Build a larger primary care network by aligning primary care physicians with other providers, fostering relationships between departments and staff, and creating affiliations with neighboring healthcare organizations, among other partnership opportunities
• Boost market care quality and patient satisfaction scores to get a competitive edge
• Invest in facilities and health IT
• Maximize fee-for-service revenue by building on existing services and customer loyalty (like marketing services to local providers for referrals).
Rural hospitals face many unique revenue cycle management challenges. Unfortunately, much of the revenue cycle optimization guidance published today is catered towards larger organizations – not smaller providers.
Fortunately, a health care consultant can help. A good healthcare consulting team can analyze an organization’s needs, then recommend actionable solutions.
Even small changes are magnified at rural hospitals. That means minor improvements can lead to proportionally significant results. Optimizing a single medical coding system can have noticeable impacts on the bottom line.
For all of these reasons and more, consider hiring a revenue cycle management consultant for your smaller, rural hospital. Contact HMI, LLC today to get started.
Healthcare organizations in the United States and around the world use the ICD-10 medical coding standard. Starting in 2022, however, organizations will switch to the ICD-11 standard.
ICD-11 has four times as many codes as ICD-10. That means new challenges for healthcare providers – and new problems with missed revenue, coding errors, and denied claims.
Keep reading to discover some of the significant changes in ICD-11 medical coding, including how your organization can prepare for the release of ICD-11.
The World Health Organization has created the ICD-10 medical coding standard, which is currently in use in the United States and around the world. It’s the tenth version of the International Classification of Disease (ICD) codes.
In May 2019, WHO member states voted to implement the 11th version of that system: ICD-11. As healthcare changes and new diagnoses and treatments emerge, WHO regularly needs to update its coding system.
ICD-11 is scheduled to be implemented in all WHO member states, including the United States, in January 2022.
ICD-11 marks a significant increase in medical coding challenges. While ICD-10 had just 10,000 codes, ICD-11 has over 40,000.
Complicating matters further is that healthcare organizations in the United States use a modified version of ICD-10 that has 140,000+ codes, including 70,000 codes for diagnoses and 70,000+ codes for treatments.
In other words, ICD-11 is expected to introduce significant coding challenges for healthcare organizations in the United States.
Healthcare organizations in the United States already struggle with ICD-10 coding challenges. Organizations lose revenue, sacrifice patient care, and face insurance denials, among other issues. Across the country, organizations lose billions to coding challenges every year.
With the launch of ICD-11, organizations will face new coding challenges. Smart healthcare organizations are already preparing. Here are some steps to help your organization get started.
ICD-11 has thousands of new codes and chapters. Many of these codes and chapters have not been seen in previous versions, and they’re totally unfamiliar even to experienced medical coders.
There’s a new code for work burnout, for example. Burnout appears in the ICD-11 section on problems related to employment or unemployment. The goal of adding this code is to make physician burnout a thing of the past.
ICD-11 defines physician burnout as:
• Feelings of energy depletion or exhaustion
• Increased mental distance or feelings of negativism or cynicism related to one’s job
• Reduced professional efficacy
Issues like time constraints, technology, and regulations increase the rate of physician burnout.
This code may seem straightforward to implement, but it’s more complicated than organizations realize. As AMA explains, organizations need to differentiate professional burnout from adjustment disorder, anxiety disorders, and mood disorders. Organizations also need to use this classification exclusively for professional burnout – not burnout in other areas of one’s life.
This is just one example of how ICD-11 will change the way organizations handle various challenges. Smart organizations are familiarizing themselves with these new codes and chapters today to avoid surprises in the future.
To prepare for ICD-11, organizations need to ensure they have the latest versions of EHR and revenue cycle management software.
Inevitably, during the switch to ICD-11, some organizations will get stuck using older versions of software. This will introduce significant coding challenges and missed revenue opportunities, among many other issues.
Ensure your EHR and revenue cycle management software is updated and optimized to the new changes to ensure a smooth transition process.
Some organizations are hiring leaders to oversee the implementation of ICD-11. These leaders self-assess the organization for coding discipline. They oversee training efforts in the leadup to January 2022. They lead educational initiatives for the new codes and challenges of ICD-11.
Ultimately, organizations that start preparing for ICD-11 today will be better equipped to handle these challenges than their competitors – and that means better organizational efficiency moving forward.
ICD-11 can be overwhelming – especially for organizations that lack medical coding leaders.
Many organizations have begun to hire medical coding specialists to prepare for the implementation of ICD-11.
A good medical coding specialist can optimize revenue cycle management, reduce coding errors, and enhance patient care, among other benefits. Even months before ICD-11 is implemented, medical coding specialists can recommend actionable changes that improve the efficiency of your organization.
Medical coding specialists are experts at ICD-10 and ICD-11. It’s their job to understand the unique challenges of ICD-11. They know the medical coding challenges faced by organizations, and they know the changes organizations need to make to optimize efficiency during the shift.
Contact HMI, LLC to hire a contract medical coding specialist today.
HMI, LLC has a proven reputation for solving complex organizational challenges. We’ve helped organizations deal with ICD-10 coding challenges – and challenges related to the upcoming launch of ICD-11, among many other coding challenges.
Optimize your revenue cycle today by solving your organization’s coding challenges. Hire HMI, LLC and discover how your organization can improve and prepare for ICD-11 medical coding.
Most people assume healthcare consulting benefits the organization – not necessarily the physicians within that organization. However, that’s not true. Physicians can and do benefit from healthcare consulting.
Physicians experience actionable improvements from healthcare consulting. These improvements can benefit the organization’s bottom line, improve patient care, and make it easier for physicians to do their job.
Today, we’re explaining some of the ways physicians can benefit from healthcare consulting whether running a small practice or working for a larger organization.
Healthcare consultants conduct charge capture reviews. You may not know how much you’re losing in possible reimbursement until you order a charge capture review.
Without accurate charge capture processes in place, potential reimbursement slips through the cracks. It can increase claim denial rates and waste money at multiple levels of an organization.
Many organizations struggle to identify charge capture errors – especially if they’re unfamiliar with the complex nature of charge cycles. As any healthcare consultant will tell you, charge capture is among the most destructive problems in healthcare reimbursement.
As a doctor at a hospital, charge capture review has less of a direct impact on you. As a physician at a private practice, however, charge capture reviews can add significant revenue to your business – you’re already performing this work, and you need to get paid for it. The success of your private practice depends on it.
A good healthcare consultant will conduct:
• Charge capture reviews
• Physician/provider claims reviews
• Review of office and inpatient E/M visits coded and billed
By targeting these areas of the organization, healthcare consultants can identify missed revenue opportunities – enhancing profitability for doctors, their practices, and their organizations.
Support staff keep an organization running smoothly. When support staff are in a stressful or unhealthy environment, it impacts every level of an organization. Whether running a private practice or working for a hospital, keeping support staff productive is crucial.
Healthcare consultants optimize the administration of an organization. They assign support staff to their best possible roles. They analyze each person’s strengths and weaknesses, placing individuals in the best positions.
Many are surprised to discover how smoothly things operate with a few simple changes to administrative structure and support staff. Healthcare consultants know what works at other organizations, and they can recommend actionable changes for your organization to achieve real results.
Hiring a healthcare consultant can provide a significant return on investment. You pay money today to discover how your organization can make more money for years into the future. If you’re running a small medical practice, this advice is priceless and provides a substantial return on investment.
Good healthcare consulting is worth every penny. You’re hiring someone to improve the profitability of your business. Yes, you pay the consultant today. But if you hire the right consultant, you get actionable advice that can add significant amounts to your bottom line year after year.
Many doctors are leaving their private practices to work at hospitals. They like caring for patients – but they don’t like the behind-the-scenes paperwork and added stress.
A healthcare consultant can fix these issues. A good consultant manages these areas of your business, allowing you to enjoy less stress and better work flow.
With a good healthcare consultant, you can focus on what you do best, leaving all other work to the professionals.
As a physician at a hospital, these issues matter to you too. Many physicians at hospitals get caught up in paperwork and billing issues. They do work that has little to do with practicing medicine. It’s more administrative work and less medical work. That’s inefficient for the organization and frustrating for doctors.
Medical consultants improve the patient experience at any practice or hospital. They handle the behind-the-scenes aspects of running a business, allowing you to maximize time spent with patients.
At a medical practice, this face-to-face time is crucial. It helps patients avoid feeling like a number. It makes them feel like you care about their health – which you should. You’re paying someone to focus on the business aspects of your business while you emphasize patient care.
After hiring a medical consultant, many physicians realize they have significantly more time to spend with patients. They can spend business hours meeting with patients instead of doing paperwork. You can limit the length of time patients spend in the waiting room.
When you hire a healthcare consultant, you’re paying someone to make your business run more efficiently. The consultant provides actionable advice – or implements real solutions – that improve your business.
Whether running a small practice or working for a larger organization, physicians can benefit from healthcare consulting in countless ways.
Hire a healthcare consultant with decades of experience today by contacting HMI, LLC and discover actionable ways to improve your organization.
The American Association of Professional Coders (AAPC) is America’s largest medical coding training and credentialing organization for healthcare contract coders.
Today, we’re explaining the importance of hiring a licensed medical contract coder for your organization.
Sometimes, outsourcing a job to a remote worker leads to issues with quality or security.
Medical organizations, of course, cannot afford to compromise on quality or security.
That’s why good licensing is crucial. Good licensing ensures your outsourced medical contract coders meet a certain minimum set of requirements for quality and security.
At the same time, these outsourced specialists cost significantly less than in-house employees. Your organization is saving money with no discernable drop-off in quality. That’s a net win for any organization.
Some licensing requirements are too broad to be genuinely effective. The AAPC, however, provides multiple types of certification to address multiple aspects of the healthcare industry.
Types of AAPC certification available today include:
· Medical coding certification
· Medical billing certification
· Medical auditing certification
· Medical documentation
· Medical compliance certification
· Practice manager certification
· Specialty medical coding certification
Healthcare has become increasingly complex. Specialized AAPC certifications help licensed medical contract coders stay on top of the latest changes.
Instead of hiring a generalist to do a specialized job, it’s now easier than ever to hire a specialist to perform a specialized job.
Medical coding is one of the fastest growing professions in the United States. Job growth for medical records and health information technicians, which includes medical coders, is projected to grow 13% by 2026, according to the U.S. Bureau of Labor Statistics Occupational Outlook Handbook. That’s significantly higher than the average growth rate among all other applications.
Of course, this high growth rate is a double-edged sword.
The high projected growth rate for medical coders will force organizations to compete for high-end medical contract coding talent. As demand rises, there could be an influx of inexperienced, unlicensed medical coders into the marketplace. Organizations desperate for medical coders may take a risk by hiring unlicensed coders – only to face serious consequences in the future.
Medical contract coders may work for your organization remotely, but they still have to abide by HIPAA requirements.
When you hire an unlicensed medical contract coder, you’re increasing the possibility of a HIPAA violation. Most licensing courses, including AAPC licensing courses, cover HIPAA in-depth to ensure licensed medical contract coders remain compliant.
As with many licensing organizations, the AAPC offers ongoing licensing opportunities to help medical coders stay relevant.
The organization allows medical coders to subscribe to lectures throughout the year, for example, and access ongoing continuing education courses.
Put simply, a certified medical coder is a more efficient medical coder. Certified and licensed coders can ensure:
· Coding accuracy and specificity that translates to more efficient processes at every stage of the organization
· Ongoing internal audits to identify high-risk areas and areas of improvement
· Compliancy and security from top to bottom
Other things employers need to know about licensed medical contract coders include:
When searching for a licensed coder, look for the following designations:
CCS-P: Certified Coding Specialist – Physician Based
CCP: Certified Professional Coder
COC: Certified Outpatient Coder
CRC: Certified Risk Adjustment Coder
CPPM: Certified Physician Practice Manager
CPCO: Certified Professional Compliance Officer
CDEO: Certified Documentation Expert – Outpatient
CPMA: Certified Professional Medical Auditor
In some industries, there are multiple licensing organizations and it can create confusion among employers. Fortunately, medical coding has one clear licensing organization: the AAPC.
The AAPC is the world’s largest training and credentialing organization for the business of healthcare. It has more than 190,000 members worldwide.
The next time you need to hire a medical contract coder, make sure the coder is licensed by the AAPC. Otherwise, you’re exposing your organization to significant risk – and missing out on all the benefits listed above.
At HMI Corp, every coder must be credentialed as one of the following: RHIA, RHIT, CCS, or COC.
Because of our credentialing requirements – and for many other reasons – our medical coding specialists are qualified to assist clients quickly and efficiently in a variety of settings. Our team has a proven ability to identify and solve complex medical coding issues.
Our medical coding services specialists are experienced in the use of TruCode, Meditech, VISTA, 3M, McKesson, Cerner, Epic, and CHCS/CHCSII. Contact HMI Corp today to discover how our licensed medical contract coders can optimize your healthcare organization.