Saturday, April 9, 2022

5 VBC adoption habits centering on data

In the U.S. healthcare system, the transition from quantity-focused care provision of the fee-for-service model to a more nuanced model that rewards quality patient outcomes requires innovative approaches. As the journey to value-based care (VBC) delivery continues its long trajectory, providers and payers are leveraging healthcare data of all kinds for all purposes. Five VBC adoption habits put data front and center for stronger exchange, greater fluidity, easier accessibility, and more informed decision-making.


Powering healthcare decisions with data


Just a decade or two ago, most of the U.S. healthcare system was rooted in paper. Clinicians regularly shuffled through cabinets full of charts, piles of faxes, overstuffed in-bins, and back-pocket prescriptions. In many ways, we’ve celebrated a successful transition to EMRs, but in the larger sense, we haven’t fully recognized the power these collected data points hold.

There’s a great opportunity in the wealth of digital clinical and claims data: by leveraging information, better decisions result. Physicians require comprehensive clinical history at their fingertips to provide the best possible experience and care to their patients. From a payer perspective, insurance companies want their members to receive holistic care at the lowest possible cost. In leveraging use cases for this purpose, they must have the right data in the right format. From a contracting standpoint, they must also use the available data to clarify the costs of taking care of individual members. For all stakeholders of VBC, the most successful outcomes originate in data.

Removing data silos


As any clinical provider knows, a lot of the waste in healthcare is a result of siloed data. VBC simply demands better. For example, if a hospital’s system isn’t integrated with a specialist in another health network, the hospital provider may decide to order a laboratory or imaging test a second time. A lack of fluidity generates a significant amount of administrative work, leading to communication difficulties and medical errors/waste.

Despite the commitment of many providers to modernize systems for better interoperability overall, hurdles caused by legacy systems persist. Governance challenges—including a lack of support, lack of trust in the data, training difficulties and resource limitations—also hinder progress. Numerous initiatives, platforms, and strategies ensure data flows more smoothly between systems. By seeking them out, providers put themselves in a better position to access and leverage the data needed to make critical healthcare decisions.

Making data accessible



From a data accessibility standpoint, health systems, health plans, and patients must be able to gather relevant information regarding the management of care. While the former two have typically had considerable access, the 21st Century Cures Act—which requires that healthcare providers give patients access to all of the health information in their EMRs without delay—has furthered patient access to their digital medical records data.

Additional stakeholders requiring access to health data include the CMS, ONC, and innovators in the health technology space creating solutions and platforms that seek to overcome interoperability obstacles. Due to privacy standards and concerns, vendors continue to face challenges regarding medical data access as they attempt to remedy system problems.

Augmenting clinical data with SDOH


Social determinants of health (SDOH) are the non-medical factors that influence health outcomes.1 Last year, CMS issued guidance to state health officials designed to drive the adoption of strategies that address SDOH2 as part of its efforts to advance VBC. This is an important step forward, the data providing clinicians with a much clearer picture of the whole patient.

When driving a care management plan, providers can consider how SDOH may impact the patient’s ability to adhere to the program and tailor the plan—or the means to which they can achieve it—accordingly. This benefits all stakeholders as patients whose socioeconomic factors are appropriately addressed experience improved health outcomes, typically at a lower cost to the overall system.

Operationalizing data for risk stratification


Just as data enables patient connection to resources that will support wellness, it can also inform providers about who is most at risk for nonadherence to treatment plans. Using this information, providers choose which patients may likely benefit from specific interventions and apply them optimally.

From the payer point of view, the VBC model encourages interest in specific risk levels associated with a member versus focusing on how many visits they may have had. Detailed analysis of chronic conditions, for example, will further inform the development of a holistic care management plan. Innovators in the field are taking a consultative approach to help providers and payers operationalize data to treat at-risk populations.

As VBC encourages more efficient healthcare processes through best practices, the industry will continue to experience how data informs decision-making. Innovators who help data flow freely between health systems, health plans, and patients will remain integral to VBC’s success.

References

https://bettermedicarealliance.org/publication/report-innovative-approaches-to-addressing-social-determinants-of-health-for-medicare-advantage-beneficiaries/
https://www.cms.gov/newsroom/press-releases/cms-issues-new-roadmap-states-address-social-determinants-health-improve-outcomes-lower-costs


15% Off Medical Practice Supplies


VIEW ALL



Manual Prescription Pad (Large - Yellow)


Manual Prescription Pad (Large - Pink)

Manual Prescription Pads (Bright Orange)

Manual Prescription Pads (Light Pink)

Manual Prescription Pads (Light Yellow)

Manual Prescription Pad (Large - Blue)

Manual Prescription Pad (Large - White)


VIEW ALL

Posted by at No comments:
Labels: ,

Friday, April 8, 2022

Interoperability: An overlooked solution to staffing challenges

Doing less with more seems to be the way every provider must operate. Dealing with increasingly thin margins, regulatory pressures, changes in reimbursement, increasing patient loads and pandemic challenges all amidst a staffing shortage can feel like the house is on fire. It’s unreasonable to expect providers to apply focus to an eight-syllable word (interoperability) that is still not widely understood and expect them to execute on it. Yet we are quickly approaching a demographic turning point that, if not anticipated, will be catastrophic to an already overburdened healthcare industry.

According to the U.S. Census Bureau in 2030, ALL baby boomers will be older than age 65 and for the first time in U.S. history, seniors will outnumber children. This impending historical milestone could very well be just as important as the devastation around COVID-19 and cannot be overlooked. With age often comes medical complications and comorbidities taxing in time, dollars, and emotions.

This situation requires a set of policies, tools, and procedures which enable the recovery or continuation of vital technology that enables the communication necessary so that the level of care provided is not compromised.

Can your business survive today to see an increased elderly population tomorrow?

We are constantly reading messages on how the path to precision medicine is right around the corner to save us all. In a perfect world, these innovations can take us to a new future of thriving healthcare for all. However, providers and other stakeholders in the healthcare community have not bought into it. Many post-acute providers are simply trying to keep the doors open and the lights on.

We tend to focus on semantic and advanced interoperability, albeit critically important, but meanwhile we have 66% of the transactions appearing on a paper fax machine in post-acute provider offices. Somewhere in the middle, we’ve got something missing.

The key to our survival is a code we have been trying to crack for nearly two decades — interoperability. Interoperability and all that is promised stands to improve care for all through effective data sharing. So many organizations are left behind because the industry has made it prohibitively difficult to understand and to afford the path forward - making effective data sharing feel unattainable. Yet in reality, electronic communication is ubiquitous and continues to be overlooked as a powerful solution that can offer much needed relief to many of the challenges post-acute care providers are experiencing and can ensure their business survives, not only today, but to the year 2030 and beyond.


Interoperability checks all the boxes for post-acute providers




Post-acute care providers will be better equipped to meet the needs of a growing senior population if they embrace interoperability. How do we meet them where they are and help them prepare? Financial incentives will likely not come for the post-acute sector even though the pandemic has shown us that this sector probably has the greatest need for interoperability. Therefore, we need to provide a strong business justification for providers to want to transition to a digitally enabled healthcare organization now.

If I walked into the average provider's office and said becoming more interoperable addresses all of their business issues and more, their ears would perk up. If they become digitally enabled and embrace electronic data sharing, providers will be able to:
  • Do more with less staff because data can now be quickly reviewed and added to the patient record
  • Implement patient matching to automate the filing of patient information to their chart
  • Have visibility into the data and analytics needed to participate with ACOs, thus providing the opportunity for higher reimbursement
  • Eliminate the expense of paper and toner, as well as the time spent performing manual processes when sorting, scanning, attaching, and shredding patient information
  • Improve performance ratings for your organization because you are now equipped with the knowledge about a patient upon arrival, rather than documents getting reconciled days after
  • Attract talent by using technology that fits today’s generational shift towards a millennial and gen z workforce that isn't interested in fax, and more importantly, doesn't even know how to use it


Connectivity is necessary to achieve interoperability


According to a recent KLAS survey, the success rate of interoperability in acute care and ambulatory settings far outweighs that in post-acute care. But does that mean they are complacent with doing things the old-fashioned way? One may think so, but that is not necessarily true. The survey also concluded that when propositioned with the idea of interoperability, they requested help to get them connected.

Many electronic health record (EHR) systems have interoperable data sharing capabilities, yet providers simply don’t realize they are connected and just need to enable electronic communication. It doesn’t help that we use a language of acronyms and tech talk that is foreign to providers. Many EHRs rename the functionality, using terminology specific to their product and unfamiliar to others, creating a barrier to the universal use of data sharing outside of their particular institution.

We need to use language they understand and meet them where they are. People don’t care how they communicate; they just want it to happen. Let’s use the mobile phone as an example. Many don’t care how it works, what network they’re using, where it goes, or what wireless protocols are used. They just want to make sure they have it, it sticks and stays, and they can communicate.

5 Simple steps to add electronic data sharing to your survival tool kit


We touched on a simple, pragmatic way to share data that can help them keep the doors open for businesses to take care of our ever-increasing aging population and here it is. To close this gap in interoperability here are five simple steps post-acute care providers can take now:
  1. Find out what you have: Contact your EHR to understand what electronic communication capabilities are available. More specifically, find out if you have Direct Secure Messaging, an encrypted “email-like” message with attachments.
  2. Get a Direct address: You will not be able to receive messages until you have an address. Allow the information to show up in an inbox rather than your fax machine.
  3. Learn how to use Direct: Have your EHR account rep point you to a knowledge-based article or video on how to use Direct messaging. Ensure all personnel receive training and are clear about your goal to transition off of fax over to Direct.
  4. Publish your address: Be sure others can find your organization in the National Provider Directory by making sure your Direct address(es) are published.
  5. Notify others in your community: Call or email the providers you exchange with the most to notify them that you’d like to transition away from fax to Direct Secure Messaging. Provide your Direct address and see if they know theirs.

Providers don’t need to take an all-or-nothing approach. Start with the largest concentration or highest volume. Fifty percent of a provider’s volume in post-acute may be with organizations who use a specific EHR, or 40% of their referrals may come from a single entity. Transitioning off of fax, over time, will bring tremendous relief to providers right now.


15% Off Medical Practice Supplies


VIEW ALL



Manual Prescription Pad (Large - Yellow)


Manual Prescription Pad (Large - Pink)

Manual Prescription Pads (Bright Orange)

Manual Prescription Pads (Light Pink)

Manual Prescription Pads (Light Yellow)

Manual Prescription Pad (Large - Blue)

Manual Prescription Pad (Large - White)


VIEW ALL

Posted by at No comments:
Labels: , ,

Thursday, April 7, 2022

4 Ways to improve claims efficiency for rural providers

The Centers for Medicare & Medicaid Services (CMS) subsidizes healthcare in defined rural environments, paying encounter rates for provided services provided and the overhead required to provide them.

However, it’s not free money. Rural health clinic (RHC) leaders must keep track of the services provided and submit yearly totals. They also must submit and process claims differently for patients and services covered under the rural health initiative and those submitted as fee-for service engagements.

These differences can present challenges for rural practices, which may not have the level of billing and coding expertise that suburban and urban practices enjoy. When days in accounts receivable (A/R days) pass three weeks, physicians are more likely to need to dip into personal funds to make payroll, placing additional pressures on rural practices.

Understanding coding differences, submitting clean claims the first time, and editing claims as close as possible to rejection can go a long way toward returning rural practices to their core goal of taking the best possible care of patients.

Rural medical practices can improve the efficiency of their operations with the right claims software that helps them take these four steps:
  • Process claims in dual billing environments
  • Enhance UB-04 edits
  • Get early denial alerts


Leverage faster EOB determinations

Process claims in dual billing environments

Rural health clinics often operate in two conflicting worlds, with UB-04 claims for Medicare and 1500 claims for fee-for-service visits for patients who are not covered by the rural health initiative. The claim forms are very different, so your staff must be bilingual coders who understand both sets of claims.

Often, RHCs use different billing software or billing services for each claim type, which drives up costs and presents training challenges for staff. Any turnover among billing staff compounds the pain, likely reducing the pace of claims submissions that can slow vital reimbursements while new staff are hired and increasing the likelihood of incomplete and/or rejected claims.

RHCs should look for billing software that allows easy submission of both UB-04 and 1500 claims, reducing the level of effort required to submit claims and increasing staff efficiency.
Enhance UB-04 edits

Submit an electronic 1500 form for fee-for-service, and the insurer likely will tell you up front if there are glaring errors in the claim, such as a name mismatch. You will need to wait for more subtle rejections such as the wrong CPT code or invalid procedure for someone of a particular gender, but the insurer, at the least, takes a cursory pass at the claim.

Submit a UB-04 claim to Medicare and prepare to wait for 21 days for any type of determination. In this environment, any errors — glaring or otherwise — are compounded by the three-week window before a denial.

Rural health providers need claims software that allows for front-end edits before Medicare receives the claim. Claims software can’t suggest specific CPT codes for particular procedures, but savvy software providers can compare CPT and revenue codes, for example, and identify any mismatches. Software should also flag medically unlikely amounts of supplies or procedures and CPT codes that shouldn’t be billed together.

Get early denial alerts


Much like Medicare waits 21 days to notify rural health clinics of denials, many clearinghouses follow a similar methodology, sending periodic reports that provide a snapshot of claims in that moment in time. Billing staff must pore over the reports to determine any anomalies and dive deeper into rejections. Days may pass between when a report is compiled and when billers have time to interact with the report — days that the practice isn’t getting paid.

Clinics need claims software that serves up denials as soon as they’re identified and as part of normal workflows. Quicker notification of claims that likely will be denied leaves billers more time to examine each anomalous claim and the proactive steps to submit a claim that will be reimbursed properly.

Leverage faster EOB determinations


Just like denials, explanation of benefit (EOB) statements are often periodic, with RHCs receiving them in the mail or billing staff having to download them from the insurer. To understand how EOBs impact revenue, billers need to look at every form to ensure revenue is posted properly and determine whether patients owe additional money because a visit or procedure falls under their deductible.

Clinics need software that examines every EOB, matching claims and returning any anomalies (contractual adjustments and patient responsibility, for example) back to billing staff immediately. Billers, rather than examining every EOB, can look through the returned EOB list to determine why the claim wasn’t paid in full and what the next steps should be. By immediately returning claims that need further work, rural health clinics can shorten the time between patient visit and payment.

RHCs should work smarter, not harder


Often, rural health clinics hold communities together, providing critical services that keep people from traveling greater distances to access healthcare. But staffing can be a challenge, especially finding and training billers and coders who understand the intricacies and nuances of both UB-04 and 1500 claim forms. And lost time submitting, monitoring, and reconciling claims extends A/R days, which can leave RHCs strapped for cash.

Clinics should explore claims software that processes both UB-04 and 1500 claims, provides UB-04 editing capabilities, returns denial alerts as part of normal workflows, and reconciles every EOB to claims expectations.


15% Off Medical Practice Supplies


VIEW ALL



Manual Prescription Pad (Large - Yellow)


Manual Prescription Pad (Large - Pink)

Manual Prescription Pads (Bright Orange)

Manual Prescription Pads (Light Pink)

Manual Prescription Pads (Light Yellow)

Manual Prescription Pad (Large - Blue)

Manual Prescription Pad (Large - White)


VIEW ALL

Posted by at No comments:
Labels: , ,
Subscribe to: Posts (Atom)