4 Quick Tips for Getting COVID-19 Claims Paid Promptly

4 Quick Tips for Getting COVID-19 Claims Paid Promptly
Lillian Phelps, Sr. Director of Product Management, Availity

As the COVID-19 pandemic has gripped the world, many providers have adopted an all-hands-on-deck approach and mentality for treating COVID-19 patients, stretching their resources to the breaking point. 

We have heard about the frontline heroes who have sacrificed their own health and safety to treat patients and, in less-fortunate scenarios, comfort patients in their last moments as they were quarantined from loved ones. 

What has been less recognized is the work and sacrifice put forth by providers’ back-office staff. Many back-office workers have had to transform their operational practices after shifting to “work-from-home” mode to avoid potential exposure and minimize traffic to hospitals and physicians’ offices. 

In addition to working in new environments, some of these back-office administrators who help process claims, receive reimbursements, check eligibility and manage denials are also seeing a higher volume of claims that are more complicated in nature due to the severity and complexity of managing COVID-19 symptoms in patients. Others are working with bare-bones staff as elective procedure volumes have decreased. 

The biggest challenges with COVID-19 claims
While many aspects of the pandemic are beyond providers’ control, proper coding of COVID-19 claims is one area they can focus on to help ensure efficient operations and revenues. Of course, that is easier said than done. The following are just a few challenges providers have been facing with COVID-19 claims.

Increased complexity: Due to the complexity of COVID-19 cases, which affect many elderly patients and those patients with chronic conditions and comorbidities, associated claims often take longer to code, file and process compared to more straightforward cases. More complex COVID-19 cases lead to longer hospital stays, which can create delays in submitting claims, resulting in delays in receiving reimbursements.

Continued shift to electronic transactions: While many hospitals and provider groups have shifted to submitting claims electronically, many processes, including prior-authorizations, eligibility and estimation requests and grievances, and appeals, rely heavily on manual intervention. These processes frequently require access to faxed or paper documents. Administrative staff members have had to quickly learn new systems and processes.

Difficulties with reimbursement for the uninsured: Through the Coronavirus Aid, Relief, and Economic Security Act (also known as the CARES Act) and other legislation, the federal government has appropriated funding earmarked for providers that deliver COVID-19 testing and treatment to the uninsured. While this was certainly a welcome gesture at a time when many have lost their health insurance due to unemployment, the support has come with some administrative strings attached that lead to challenges for providers. 

For example, before submitting a claim, providers must show they have gone through an attestation process and document their efforts to find other medical coverage for the patient. Then providers essentially have just one shot at submitting a clean claim, as there is no appeals process for denials deemed inappropriate or unjustified. In cases of denials, providers themselves have little recourse for obtaining reimbursement and end up with a loss in revenue and increased costs. Although the efforts to help uninsured patients with COVID-19 testing and treatment are well-intentioned, providers must follow specific steps to realize the benefits.

Processing COVID-19 claims more efficiently
It has become clear that COVID-19 claims, though in many ways similar to traditional claims, have unique impediments that create difficulties for hospital and provider administrators. We have observed this in our own data. When comparing COVID-19 claims to non-COVID-19 claims, the COVID-19 claims have demonstrated a greater error rate (9-12% compared with 5-7%) and a longer time to submit (45 days compared to 30 days).

Despite these challenges, providers can implement the following steps to manage the workload, process COVID-19 claims efficiently, and work within the constraints of their new “work-from-home” offices.

1. Leverage technology that identifies errors and provides upfront edits to all COVID-19 claims. Automated revenue cycle solutions should contain updated functionality to properly review claims and flag potential issues prior to the claim being submitted to a payer.

2. Move coverage discovery to the front end of the billing process and ensure it is performed for all patients. There are many solutions that will search for insurance coverage across both commercial and government payers. When identified, the payer information can be reviewed and added to a patient’s billing information.

3. Review analytics within the revenue cycle management system to identify COVID-19 claims. Analyze these claims by payer, claim amount, and number and severity of services rendered. Scrubbing and editing claims in advance will ensure accuracy while also highlighting anomalies to review and fix prior to submitting the claim.

4. Constantly review claims for inpatient stays to ensure that all charges are recorded and all medical records are updated and attached. Getting all documentation ready and prepared in advance will save time on the backend.

Though we all hope that the pandemic winds down and we soon return to some sense of normalcy, it takes more than hope for providers to get their COVID-19 claims reimbursed accurately and quickly. Following the tips above will help keep administrative processes running smoothly and alleviate burdens that will inevitably occur once patients are treated and the billing cycle continues. 


About Lillian Phelps

Lillian Phelps is the senior director of product management for Availity, the nation’s largest health information network.


UnitedHealth Group Acquires Change Healthcare to Combine with OptumInsight for $13B

Change Healthcare Acquires Credentialing Tech Docufill to Improve Administrative Efficiency

What You Should Know:

– UnitedHealth Group has reached an agreement to acquire
Change Healthcare in a deal valued at more than $13 billion, marking the first
major acquisition of 2021.

– Change Healthcare will be combined with OptumInsight to
advance a more modern, information, and technology-enabled healthcare platform.


UnitedHealth Group’s
has reached an agreement to acquire
healthcare technology leader Change
Healthcare
for more than $13B. As part of the acquisition, Change
Healthcare will be combined with OptumInsight
to provide software and data analytics, technology-enabled services and
research, advisory and revenue cycle management offerings to help make health
care work better for everyone. The acquisition marks one of the largest deals
for UnitedHealth Group as it continues to expand it’s health services under the
Optum division.

Financial Details of Acquisition

UnitedHealth will pay $25.75 a share in cash, the companies said in a joint statement, a 41% premium over Change Healthcare’s closing price Tuesday of $18.24. The $13 billion valuation includes more than $5 billion in debt owed by Change Healthcare. Shares of Change Healthcare were up 31.72% at $24.02 in trading on Wednesday. UnitedHealth shares were up 0.6% at $346.67.

“Together we will help streamline and inform the vital
clinical, administrative and payment processes on which health care providers
and payers depend to serve patients,” said Andrew Witty, President of
UnitedHealth Group and CEO of Optum. “We’re thrilled to welcome Change
Healthcare’s highly skilled team to create a better future for health care.”

Acquisition Impact for Providers and Patients

The combination of OptumInsight and Change Healthcare is expected to simplify services around medical care to improve health outcomes and lower costs

– help clinicians make the most informed and clinically
advanced patient care decisions, more quickly and easily. Change Healthcare
brings widely adopted technology for integrating evidence-based clinical
criteria directly into the clinician’s workflow, while Optum’s clinical
analytics expertise and Individual Health Record can strengthen the evidence
base needed to deliver effective clinical decision support at the point of
care. This can ensure appropriate sites of care and consistently achieve the
best possible health, quality and cost outcomes.

– well-positioned to make health care simpler, more efficient and more effective. A key opportunity is to enhance with insights drawn from billions of claims transactions using Change Healthcare’s intelligent health care network, combined with Optum’s advanced data analytics. This will support significantly faster, more informed and accurate services and processing.

– Change Healthcare’s payment capacities combined with
Optum’s highly automated payment network will simplify financial interactions
among care providers, payers and consumers and accelerate the movement to a
more modern, real-time and transparent payment system. This will ensure
physicians get paid more quickly, accurately and reliably, and provide
consumers the same simplicity and convenience managing their health care
finances they experience with other transactions.

“This opportunity is about advancing connectivity and accelerating innovations and efficiencies essential to a simpler, more intelligent and adaptive health system. We share with Optum a common mission and values and importantly, a sense of urgency to provide our customers and those they serve with the more robust capacities this union makes possible,” said Neil de Crescenzo, President and CEO of Change Healthcare.  Upon closing, Mr. de Crescenzo will serve as OptumInsight’s chief executive officer, leading the combined organization.

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Teladoc Health and Livongo Merge

2020’s Top 20 Digital Health M&A Deals Totaled $50B

The combination of Teladoc Health and Livongo creates a
global leader in consumer-centered virtual care. The combined company is
positioned to execute quantified opportunities to drive revenue synergies of
$100 million by the end of the second year following the close, reaching $500
million on a run-rate basis by 2025.

Price: $18.5B in value based on each share of Livongo
will be exchanged for 0.5920x shares of Teladoc Health plus cash consideration
of $11.33 for each Livongo share.


Siemens Healthineers Acquires Varian Medical

2020’s Top 20 Digital Health M&A Deals Totaled $50B

On August 2nd, Siemens Healthineers acquired
Varian Medical for $16.4B, with the deal expected to close in 2021. Varian is a
global specialist in the field of cancer care, providing solutions especially
in radiation oncology and related software, including technologies such as
artificial intelligence, machine learning and data analysis. In fiscal year 2019,
the company generated $3.2 billion in revenues with an adjusted operating
margin of about 17%. The company currently has about 10,000 employees
worldwide.

Price: $16.4 billion in an all-cash transaction.


Gainwell to Acquire HMS for $3.4B in Cash

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Veritas Capital (“Veritas”)-backed Gainwell Technologies (“Gainwell”),
a leading provider of solutions that are vital to the administration and
operations of health and human services programs, today announced that they
have entered into a definitive agreement whereby Gainwell will acquire HMS, a technology, analytics and engagement
solutions provider helping organizations reduce costs and improve health
outcomes.

Price: $3.4 billion in cash.


Philips Acquires Remote Cardiac Monitoring BioTelemetry for $2.8B

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Philips acquires BioTelemetry, a U.S. provider of remote
cardiac diagnostics and monitoring for $72.00 per share for an implied
enterprise value of $2.8 billion (approx. EUR 2.3 billion). With $439M in
revenue in 2019, BioTelemetry annually monitors over 1 million cardiac patients
remotely; its portfolio includes wearable heart monitors, AI-based data
analytics, and services.

Price: $2.8B ($72 per share), to be paid in cash upon
completion.


Hims & Hers Merges with Oaktree Acquisition Corp to Go Public on NYSE

Telehealth company Hims & Hers and Oaktree Acquisition Corp., a special purpose acquisition company (SPAC) merge to go public on the New York Stock Exchange (NYSE) under the symbol “HIMS.” The merger will enable further investment in growth and new product categories that will accelerate Hims & Hers’ plan to become the digital front door to the healthcare system

Price: The business combination values the combined
company at an enterprise value of approximately $1.6 billion and is expected to
deliver up to $280 million of cash to the combined company through the
contribution of up to $205 million of cash.


SPAC Merges with 2 Telehealth Companies to Form Public
Digital Health Company in $1.35B Deal

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Blank check acquisition company GigCapital2 agreed to merge with Cloudbreak Health, LLC, a unified telemedicine and video medical interpretation solutions provider, and UpHealth Holdings, Inc., one of the largest national and international digital healthcare providers to form a combined digital health company. 

Price: The merger deal is worth $1.35 billion, including
debt.


WellSky Acquires CarePort Health from Allscripts for
$1.35B

2020’s Top 20 Digital Health M&A Deals Totaled $50B

WellSky, global health, and community care technology company, announced today that it has entered into a definitive agreement with Allscripts to acquire CarePort Health (“CarePort”), a Boston, MA-based care coordination software company that connects acute and post-acute providers and payers.

Price: $1.35 billion represents a multiple of greater
than 13 times CarePort’s revenue over the trailing 12 months, and approximately
21 times CarePort’s non-GAAP Adjusted EBITDA over the trailing 12 months.


Waystar Acquires Medicare RCM Company eSolutions

2020’s Top 20 Digital Health M&A Deals Totaled $50B

On September 13th, revenue cycle management
provider Waystar acquires eSolutions, a provider of Medicare and Multi-Payer revenue
cycle management, workflow automation, and data analytics tools. The
acquisition creates the first unified healthcare payments platform with both
commercial and government payer connectivity, resulting in greater value for
providers.

Price: $1.3 billion valuation


Radiology Partners Acquires MEDNAX Radiology Solutions

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Radiology Partners (RP), a radiology practice in the U.S., announced a definitive agreement to acquire MEDNAX Radiology Solutions, a division of MEDNAX, Inc. for an enterprise value of approximately $885 million. The acquisition is expected to add more than 800 radiologists to RP’s existing practice of 1,600 radiologists. MEDNAX Radiology Solutions consists of more than 300 onsite radiologists, who primarily serve patients in Connecticut, Florida, Nevada, Tennessee, and Texas, and more than 500 teleradiologists, who serve patients in all 50 states.

Price: $885M


PointClickCare Acquires Collective Medical

2020’s Top 20 Digital Health M&A Deals Totaled $50B

PointClickCare Technologies, a leader in senior care technology with a network of more than 21,000 skilled nursing facilities, senior living communities, and home health agencies, today announced its intent to acquire Collective Medical, a Salt Lake City, a UT-based leading network-enabled platform for real-time cross-continuum care coordination for $650M. Together, PointClickCare and Collective Medical will provide diverse care teams across the continuum of acute, ambulatory, and post-acute care with point-of-care access to deep, real-time patient insights at any stage of a patient’s healthcare journey, enabling better decision making and improved clinical outcomes at a lower cost.

Price: $650M


Teladoc Health Acquires Virtual Care Platform InTouch
Health

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Teladoc Health acquires InTouch Health, the leading provider of enterprise telehealth solutions for hospitals and health systems for $600M. The acquisition establishes Teladoc Health as the only virtual care provider covering the full range of acuity – from critical to chronic to everyday care – through a single solution across all sites of care including home, pharmacy, retail, physician office, ambulance, and more.

Price: $600M consisting of approximately $150 million
in cash and $450 million of Teladoc Health common stock.


AMN Healthcare Acquires VRI Provider Stratus Video

2020’s Top 20 Digital Health M&A Deals Totaled $50B

AMN Healthcare Services, Inc. acquires Stratus Video, a leading provider of video remote language interpretation services for the healthcare industry. The acquisition will help AMN Healthcare expand in the virtual workforce, patient care arena, and quality medical interpretation services delivered through a secure communications platform.

Price: $475M


CarepathRx Acquires Pharmacy Operations of Chartwell from
UPMC

2020’s Top 20 Digital Health M&A Deals Totaled $50B

CarepathRx, a leader in pharmacy and medication management
solutions for vulnerable and chronically ill patients, announced today a
partnership with UPMC’s Chartwell subsidiary that will expand patient access to
innovative specialty pharmacy and home infusion services. Under the $400M
landmark agreement, CarepathRx will acquire the
management services organization responsible for the operational and strategic
management of Chartwell while UPMC becomes a strategic investor in CarepathRx. 

Price: $400M


Cerner to Acquire Health Division of Kantar for $375M in
Cash

Cerner announces it will acquire Kantar Health, a leading
data, analytics, and real-world evidence and commercial research consultancy
serving the life science and health care industry.

This acquisition is expected to allow Cerner’s Learning
Health Network client consortium and health systems with more opportunities to
directly engage with life sciences for funded research studies. The acquisition
is expected to close during the first half of 2021.

Price: $375M


Cerner Sells Off Parts of Healthcare IT Business in
Germany and Spain

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Cerner sells off parts of healthcare IT business in Germany and Spain to Germany company CompuGroup Medical, reflecting the company-wide transformation focused on improved operating efficiencies, enhanced client focus, a refined growth strategy, and a sharpened approach to portfolio management.

Price: EUR 225 million ($247.5M USD)


CompuGroup Medical Acquires eMDs for $240M

2020’s Top 20 Digital Health M&A Deals Totaled $50B

CompuGroup Medical (CGM) acquires eMDs, Inc. (eMDs), a
leading provider of healthcare IT with a focus on doctors’ practices in the US,
reaching an attractive size in the biggest healthcare market worldwide. With
this acquisition, the US subsidiary of CGM significantly broadens its position
and will become the top 4 providers in the market for Ambulatory Information
Systems in the US.

Price: $240M (equal to approx. EUR 203 million)


Change Healthcare Buys Back Pharmacy Network

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Change
Healthcare
 buys
back
 pharmacy unit eRx Network
(“eRx”),
 a leading provider of comprehensive, innovative, and secure
data-driven solutions for pharmacies. eRx generated approximately $67M in
annual revenue for the twelve-month period ended February 29, 2020. The
transaction supports Change Healthcare’s commitment to focus on and invest in
core aspects of the business to fuel long-term growth and advance innovation.

Price: $212.9M plus cash on the balance sheet.


Walmart Acquires Medication Management Platform CareZone

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Walmart acquires CareZone, a San Francisco, CA-based smartphone
service for managing chronic health conditions for reportedly $200M. By
working with a network of pharmacy partners, CareZone’s concierge services
assist consumers in getting their prescription medications organized and
delivered to their doorstep, making pharmacies more accessible to individuals
and families who may be homebound or reside in rural locations.

Price: $200M


Verisk Acquires MSP Compliance Provider Franco Signor

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Verisk, a data
analytics provider, announced today that it has acquired Franco Signor, a Medicare Secondary Payer
(MSP) service provider to America’s largest insurance carriers and employers.
As part of the acquisition, Franco Signor will become part of Verisk’s Claims
Partners business, a leading provider of MSP compliance and other analytic
claim services. Claims Partners and Franco Signor will be combining forces to
provide the single best resource for Medicare compliance. 

Price: $160M


Rubicon Technology Partners Acquires Central Logic

2020’s Top 20 Digital Health M&A Deals Totaled $50B

Private equity firm Rubicon Technology Partners acquires
Central Logic, a provider of patient orchestration and tools to accelerate
access to care for healthcare organizations. Rubicon will be aggressively driving Central Logic’s
growth with additional cash investments into the business, with a focus
on product innovation, sales expansion, delivery and customer support, and
the pursuit of acquisition opportunities.

Price: $110M – $125 million, according to sources


Elation Health Nabs $40M for Clinical-First Solution to Power Independent Primary Care

Elation Health Nabs $40M for Clinical-First Solution to Power Independent Primary Care

What You Should Know:

– Elation Health, which provides an easy-to-use and
affordable clinical technology platform for more than 7 million independent primary
care clinicians serving 14M+ patients – including an EHR raises $40M in Series
C funding from Al Gore’s sustainable investment firm, Generation Investment
Management.

– Elation’s API-enabled platform also allows
organizations to transform the patient and provider experience and implement
their own models of data-driven, value-based care.

– Company will surpass a milestone this year of
delivering more than 20 million in-office and virtual visits through their
provider network.


Elation
Health
, a clinical-first technology company powering the future of
independent primary care, today announced a Series C financing round of $40
million led by Al Gore’s Generation Investment
Management
, a firm that invests in sustainable businesses accelerating the
transition to a more healthy, fair, safe, and low-carbon society. The round
also included participation from existing investors, including Threshold Ventures and Kapor Capital.

Clinical-First Commitment to Independent Primary Care

Independent primary care is one of the few areas in healthcare where upfront investment leads to significant savings in the long term. For every dollar spent on primary care, studies suggest that as much as $13 in downstream healthcare costs are avoided. Increased spending on primary care is also associated with fewer emergency department visits and reduced total hospitalizations and specialty interventions for chronic conditions such as diabetes, high blood pressure, and congestive heart failure

Elation Health was founded in 2010 after siblings Kyna and
Conan Fong struggled to help their father transition his solo primary care
practice from paper charts to a digital system. Born from that experience,
today Elation Health powers the largest network for independent primary care,
with 14,000 independent clinicians caring for seven million patients. The
company offers an EHR
solution, enterprise APIs, revenue cycle services, patient engagement app, and
access to interoperability partners.

The company surpassed a milestone this year of delivering more than 20 million in-office and virtual visits through its provider network. In addition to serving small practices, Elation has partnered with primary care innovators such as Crossover Health and Cityblock Health to provide the underlying clinical platform for technology-enabled, team-based care.

Helping Intendent Practices Shift to Virtual Care Amid The
COVID-19 Pandemic

In 2020, Elation Health’s customer base of independent
practices has faced significant business challenges as primary care shifts to
virtual settings and the pace of insurance and government policy change has
accelerated. The company has responded by expanding its role as a critical
technology partner — including adding HIPAA-compliant telehealth to its core
offering, deepening support for Medicare and Medicaid quality programs, and
delivering new patient engagement capabilities for patients to schedule
appointments and interact with practices. Elation’s API-enabled platform also
allows organizations to transform the patient and provider experience and
implement their own models of data-driven, value-based care.

Expansion Plans

In the year ahead, Elation Health will continue to invest in
its core platform, while adding new capabilities to support business operations
for independent primary care. The company has plans to develop solutions in
billing and payment collection, patient population management, interoperability,
and quality reporting — ensuring practices have the tools to drive high-quality
patient outcomes and business success.

What is Revenue Cycle Management?

There is no question that providers’ bottom line has been hit hard this year, and a new surge in COVID-19 is bound to threaten hospital finances once again.

As healthcare providers look to supercharge their payment velocity during these uncertain times, it’s worth taking a step back to examine the revenue cycle management process as a whole: what it is, how it works, and the clear actions providers can take to improve the process overall.

Below is an overview of healthcare revenue cycle management and how specifically providers can improve their bottom line now and after the pandemic subsides.

What is revenue cycle management?

Any business, regardless of industry, needs to develop successful processes and strategies for remaining financially healthy. For hospitals and health systems, that process is revenue cycle management. To run a successful healthcare organization, providers must employ and manage accurate and efficient billing processes. Without it, these organizations will likely have to close their doors and will, as a result, no longer be able to provide quality care for their patient population.

How revenue cycle management works in healthcare

To put it simply, in order to generate revenue for their organization, providers need to collect payments for services rendered. The process of doing this, however, isn’t always as straightforward and simple as it seems.

Think of healthcare revenue cycle management like a journey. It starts when a patient schedules an appointment and ends when all patient payments for medical service(s) received have been collected. As we move through the journey, providers have a lot to manage, starting first with front-end intake process, moving all the way through the back-office operations to ensure payment is ultimately secured.

Phases of the revenue cycle management life cycle

The revenue cycle management life cycle spans several phases:

  • Schedule visit and secure estimate. To kickstart the process, a patient will book an appointment with a provider or specialist and administrative staff will handle insurance eligibility verification and ultimately establish a patient account for that organization. This is also an opportunity for providers to offer price transparency and provide an estimate for services to be rendered.
  • Registration and check-in. An early and vital step for optimizing the entire revenue cycle management process, this is where providers capture details like medical history, insurance coverage and other patient demographics. Ensuring correct patient information on the front end reduces the errors that cause rework in the back office.
  • Ensure care is authorized by the payer. Still on the front end, this is where provider staff checks whether prior authorization is required for a particular procedure or service. Not securing authorization in advance of service can lead to costly denials, rework, operational inefficiencies, and a poor patient experience.
  • Receive treatment and discharge. Once the patient is discharged, the services provided will be translated into billable charges and a medical billing code will be assigned to the claim. It is crucial to the revenue cycle that these claims be accurately coded, as the re-work for incorrect codes and subsequent claim rejections can be costly and a drain for productivity.
  • Medical claims submitted. The claim must then be submitted to the payer. Submitting accurate and timely claims maximizes the revenue collected and prevents delays in reimbursement. Rejected claims directly affect an organization’s revenue cycle, making it all the more important to get the claim right before it makes its way to the payer. Even if a claim is denied, is important it be resubmitted as quick as possible.
  • Patient payments and collections. Once insurance reviews the claim and provides their reimbursement, patients are presented with their out-of-pocket costs for services rendered. On-time payments made in full are preferable for a healthy revenue cycle, but that isn’t always feasible for patients, especially now given the current environment with COVID-19. This is where quality collections practices can really help to optimize patient payments and reduce bad debt.

Challenges in revenue cycle management

Any process with this number of touch points is bound to come with challenges, but two major challenges seem to stand out: claims and collections.

Navigating healthcare claims is complex and costly. Providers and facilities often get stuck in a cycle of inaccurate claim submissions, denials, corrections and rebilling that delays reimbursement and negatively impacts financial performance.

A lot of denials can be traced back to errors within the claim submission: improper coding, issues with insurance eligibility, missing or inaccurate patient information, or duplicate claim submission. Errors like this on the front-end are a major cause of the headaches experienced by providers further down the line.

After claims are submitted, provider staff will monitor and keep track of claim status. Surprisingly, many still use a manual process not only for this, but for managing any claims that are ultimately denied. Without any kind of automation, this is a drain on productivity, time and resources and it becomes more difficult for providers to respond to denied, pending or returned claims in a timely manner for reimbursement.

Another prominent challenge in the revenue cycle is collections, notably collecting from patients before or at the point of service. Providers would prefer to collect from patients prior to them leaving the office, but it’s not always possible, and for a few reasons.

Patients are increasingly unable to pay their medical bills, more are presenting as self-pay (maybe now more than ever during the pandemic), and some may not be aware of subsequent coverage or that they qualify for charity assistance, all which directly impact providers’ abilities to collect. A lack of price transparency for services can make it even more difficult for patients to prepare financially.

Benefits of revenue cycle management

Despite its challenges, when done right, there are many benefits of revenue cycle management in healthcare.

Effective revenue cycle management not only improves the patient experience but improves staff satisfaction as well. Automating the process (billing, coding, claims management, etc.) reduces a lot of the associated administrative burden, which allows providers to focus on the delivery of quality care.

An optimized revenue cycle will also lower the rate of denials. As errors and redundancies are addressed and prevented on the front end, fewer claims will be denied.

Maybe one of the most obvious benefits of a healthy revenue cycle is maximized collections and revenue, and faster collection processes, especially when the process is automized. The entire collections process can be expedited, lowering administrative burden while also improving accuracy.

How to improve your revenue cycle management

We recommend providers take a holistic approach to improving revenue cycle management, focusing largely on automating the process and within the following four areas:

Automate access
Patient access is the starting point for the entire revenue cycle process. Ensuring correct patient information on the front end reduces the errors that cause rework in the back office. patient access.

With an automated, data-driven workflow, providers can reduce the errors that lead to claim denials while simultaneously improving access to care for patients through capabilities like online scheduling. Access is further improved by reducing the friction around patient billing by leveraging real-time eligibility verification to deliver accurate patient estimates at registration.

Increase collections
There is a definitely a delicate balance between ensuring that debts are collected and fostering a positive patient financial experience. It is imperative providers find a way to maximize patient collections while also increasing patient satisfaction. Patient access staff must be the patient’s advocate while also improving the organization’s ability to collect from the patient and payer.

By leveraging a data-driven approach, staff can verify patient identity and insurance coverage as well as provide an accurate estimate of payment responsibility ahead of service. Staff even can review data to assess ability to pay and evaluate various payment plan and/or financial assistance options.

The further upstream the revenue cycle can be managed the more effective the process will be to ensure the patients are informed prior to service, so they can make their portion of their payment responsibilities as early as possible to accelerate the cash collections for providers and to reduce the need to put significant effort into late stage collections.

Streamline claims
Providers can improve financial performance with automated, clean and data-driven medical claims management.

By integrating claims management software with customized edits into the workflow system, providers can thoroughly review every line of every encounter and verify that each claim is coded properly and contains the correct information before the claim is invoiced and submitted for reimbursement.

Encounters can be processed in real time with automatic alerts for incorrect codes or other potential issues before the claims submission. Responses include a detailed explanation of why a claim was flagged, so any necessary modifications can be made prior to submission.

Increase reimbursement
Healthcare organizations that don’t stay current on payer policy and procedure changes risk payment delays and lost revenue. It can also be difficult for providers to verify the accuracy of payment received from third-party payers.

With automated access to the right data, providers can be reimbursed more accurately and quickly, while also strengthening their relationships with payers.

Providers can avoid payment delays and lost revenue with automated payer policy and procedure change notifications. Solutions that continuously audit payer contract performance can assure that collections align with negotiated terms.

The key for successful revenue cycle management

Technology, specifically data and automation, is key to the success of the healthcare revenue cycle. Automation ensures problems don’t continue to effect productivity, and data can be matched precisely to predict, model and optimize financial results. Both can also be used to highlight a patient’s financial situation, as well as their propensity to pay, allowing providers to optimize collection strategies from the start and get patients on the right programs.

Explore Experian Health’s revenue cycle management solutions.

The post What is Revenue Cycle Management? appeared first on Healthcare Blog.

Healthcare M&A: DAS Health Acquires Randall Technology Services

DAS Health Acquires Health IT and Medical Billing Conglomerate

What You Should Know:

– DAS Health Ventures acquires healthcare
and managed IT company Randall Technology Services (RandallTech).

– This acquisition adds Allscripts® PM
and EHR solutions to the DAS portfolio of supported products, and DAS Health
has now added additional staff in Texas that will create opportunities for
greater regional support of its entire solutions portfolio.


DAS Health Ventures, Inc., an industry leader in health IT and management, announced today it completed the acquisition of Randall Technology Services, LLC (RandallTech) healthcare and managed IT company based in Amarillo, TX. As part of DAS’ growth strategy, this most recent expansion further strengthens its position in the US healthcare technology space.

Acquisition Enhances DAS Health Market Reach

DAS Health actively serves more than 1,800 clients, and
nearly 3,500 clinicians and 20,000 users nationwide, with offices in Florida,
Nevada, New Hampshire and Texas, and a significant employee presence in 14 key
states. This acquisition adds Allscripts® PM and EHR solutions to the DAS
portfolio of supported products, and DAS Health has now added additional staff
in Texas that will create opportunities for greater regional support of its
entire solutions portfolio.

Increased Support for Existing RandallTech Clients

Randall Technology’s clients will gain an increased depth of support, and a substantially improved value proposition, as DAS Health’s award-winning offerings are robust, including managed IT / MSP services, practice management, and EHR software sales, training, support and hosting, revenue cycle management (RCM), security risk assessments (SRA), cybersecurity, MIPS/MACRA reporting & consulting, mental & behavioral health screenings, chronic care management, telemedicine, and other value-based and patient engagement solutions.

Financial details of the acquisition were not disclosed.

M&A: CompuGroup Medical Acquires eMDs for $240M

M&A: CompuGroup Medical Acquires eMDs for $240M

What You Should Know:

– CompuGroup Medical (CGM) acquires eMDs, Inc. (eMDs), a
leading provider of healthcare IT with a focus on doctors’ practices in the US,
reaching an attractive size in the biggest healthcare market worldwide.

– CGM is building an attractive platform for future
growth through complementary product portfolios and the ability to provide
comprehensive solutions for doctors’ practices.


CompuGroup
Holding USA, Inc.,
a 100 % subsidiary of CompuGroup Medical SE &
Co. KGaA announced it has acquired
eMDs, an Austin, TX-based provider of electronic health records
(EHRs),
practice management software, revenue cycle
management
solutions, and credentialing services for physician practices
and enterprises. The acquisition is structured as a reverse triangular merger
under U.S. law. eMDs’ key products are Ambulatory Information Systems and
outsourcing services for medical accounting.

Financial Details

With this acquisition, the US subsidiary of CGM
significantly broadens its position and will become the top 4 providers in the
market for Ambulatory Information Systems in the US. The consideration to be
paid to the current shareholders of eMDs is based on an enterprise value of $240M
(equal to approx. EUR 203 million), which will be adjusted inter alia for
amounts of cash, financial debt and net working capital (compared to a
reference amount) as of the closing date. In the fiscal year 2019/2020 (ended
03/31/2020), eMDs had revenues of approximately EUR 81 million and an adjusted
EBITDA of approximately EUR 12 million with more than 60,000 healthcare
providers.

Founded by physicians, the company is an industry leader for
usable, connected software that enables physician productivity and a superior
clinical experience. eMDs’ customer base today consists of more than 60,000
providers in more than 70 disciplines. eMDs is operating in the highly
attractive US healthcare IT market that shows a high equipment rate with IT
solutions for healthcare professionals. eMDs has more than 1,400 employees at
locations in the United States and India.

“The fit with our existing product portfolio is perfect. We have established a solid foundation in the United States in recent years and are already number 2 in the important field of Laboratory Information Systems for Physician Owned Labs (POLs) and Reference Labs,” said Frank Gotthardt, founder and CEO of CompuGroup Medical SE & Co. KGaA. The Germany-based corporation is one of the leading providers for eHealth solutions worldwide. “We are firmly convinced that both CGM and eMDs customers will benefit from this transaction through complementary product strengths.”

Hospital Sustainability Demands that Revenue Integrity Move Front and Center

Hospital Sustainability Demands that Revenue Integrity Move Front and Center
Vasilios Nassiopoulos, VP of Platform Strategy and Innovation, Hayes

Razor-thin operational margins coupled with substantial and ongoing losses related to COVID-19 are culminating in a perfect storm of bottom-line issues for U.S. hospitals and health systems. A study commissioned by the American Hospital Association (AHA) found that the median hospital margin overall was just 3.5% pre-pandemic, and projected margins will stay in the red for at least half of the nation’s hospitals for the remainder of 2020. 

The reality is that an increase in COVID-19 cases will not overcome the pandemic’s devasting financial impact. An internal analysis found that, in the first half of 2020, client organizations documented more than 1.2 million COVID-19 related cases. At least one study suggests that $2,500 will be lost per case–despite a 20% Medicare payment increase. And notably, a positive test result is now required for the increased inpatient payment.

The healthcare industry must face its own “new normal” as the current path is unsustainable, and the future stability of hospitals in communities across the nations is uncertain. If financial leaders do not act now to implement systems and embrace sound revenue integrity practices, they will face unavoidable revenue cycle bottlenecks and limit their ability to capitalize on all appropriate reimbursement opportunities. 

The COVID-19 Effect: A Bird’s Eye View

The financial impact of COVID-19 is far-reaching, impacting multiple angles of operations from supply chain costs to lost billing opportunities and compliance issues. Findings from a Physician’s Foundation report released in August suggest that U.S. healthcare spending dropped by 18% during the first quarter of 2020, the steepest decline since 1959.

Already vulnerable 2020 Q1 budgets were met with substantial losses when elective procedures—a sizeable part of income for most health systems—were halted for more than a month in many cases. Many hospitals continue to lose notable revenue associated with emergency care and ancillary testing as patients choose to avoid public settings amid ongoing public safety efforts. 

Outpatient visits also dropped a whopping 60% in the wake of the pandemic. While a recent Harvard report suggests that numbers are back on track, the reality is that a resurgence of cases could make consumers wary of both doctor visits and elective procedures again.

In addition, the supply chain quickly became a cost risk for health systems by Q2 2020 as the ability to acquire drugs and medical supplies came at a premium. Meeting cost-containment goals flew out the window as did the ability to create value in purchasing power.

Further exacerbating the situation is an expected increase in denials as healthcare organizations navigate a fluid regulatory environment and learn how to interpret new guidance around coding and billing for COVID-19 related care. For example, while telehealth has proved a game-changer for care continuity across the U.S., reimbursement for these visits remains largely untested. History confirms that in times of rapid change, billing errors increase—and so do claims denials.

While there is little that can be done to minimize the impact of revenue losses and supply chain challenges, healthcare organizations can take proactive steps to identify all revenue opportunities and minimize compliance issues that will undoubtedly surface when auditors come knocking to ensure the appropriate use of COVID-19 stimulus dollars. 

Holistically Addressing Revenue

Getting ahead of the current and evolving revenue storm will require healthcare organizations to elevate revenue integrity strategies. Hospitals and health systems should take four steps to get their billing and compliance house in order by addressing:

1. People: Build a cross-functional steering committee that will drive revenue integrity goals through better collaboration between billing and compliance teams.

2. Processes: Strategies that combine the strengths of both retrospective and prospective auditing will identify the root cause of errors and educate stakeholders to ensure clean, timely filed claims from the start. 

3. Metrics: Best practice key performance indexes are available and should be used. Clean claim submission, denial rate, bad debt reduction and days in AR are a few to consider.

4. Technology: The role of emerging technologies that use artificial intelligence cannot be understated. Their ability to speed identification of risks, perform targeted audits, identify and address root causes and most importantly, monitor the impact of process improvements is changing current dynamics. For one large pediatric health system in the Southwest, technology-enabled coding and compliance processes resulted in $230 million in reduced COVID-related denials and a financial impact of $2.3 million. 

Current manual processes used by many healthcare organizations to assess denials and manage revenue cycle will not provide the transparency needed to both get ahead of problems and identify areas for process improvement and corrective action in today’s complex environment. 

About Vasilios Nassiopoulos

Vasilios Nassiopoulosis the Vice President of Platform Strategy and Innovation at Hayes, a healthcare technology provider that partners with the nation’s premier healthcare organizations to improve revenue, mitigate risk and streamline operations to succeed in an evolving healthcare landscape. Vasilios has over 25 years of healthcare experience with extensive knowledge of EHR systems and PMS software from Epic, Cerner, GE Centricity and Meditech. Prior to joining Hayes, Vasilios served Associate Principal at The Chartis Group. 

M&A: Medsphere Systems Corporation Acquires Micro-Office Systems

M&A: Medsphere Systems Corporation Acquires Micro-Office Systems

What You Should Know:

– Medsphere acquires Micro-Office Systems (MOS),
developer of systems integration and communication tools. MOS will retain its
name and will serve as a division of Medsphere moving forward.


Medsphere Systems
Corporation 
today announced the acquisition
of Micro-Office Systems (MOS)
in a move that will even further enhance the value and usability of Medsphere’s
affordable healthcare IT solutions and services. With over 30 years of healthcare IT
experience, MOS focuses on creating the in-between technology that streamlines
the functionality of various platforms and applications to the benefit of
administrators, clinicians, and patients. The acquisition enhances Medsphere’s
platform with the integration of custom medical practice and healthcare IT solutions.

MOS Product Portfolio

The MOS product portfolio includes numerous interfaces to
improve communication and integration among solutions; system migration tools
and strategies to smooth and hasten the transition from one system to another;
and the Patient Communications Gateway, a comprehensive, modular system that
empowers healthcare organizations to effectively communicate with patients.

“The entire healthcare IT industry, with as many products as there are, has evolved to the point where the connective tissue is just about as important as the muscle and bone,” said Medsphere President and CEO Irv Lichtenwald. “Even when healthcare IT was in its relative infancy, Micro-Office Systems was improving communication among platforms and making localized systems work better for all users. This is a tremendous addition to Medsphere’s solution suite and we have every confidence that our clients will recognize and appreciate the enhanced performance MOS enables.”

Recent M&A Activity

The acquisition
of MOS is only Medsphere’s most recent move to expand company offerings. In
recent years Medsphere has added ambulatory healthcare IT solutions provider ChartLogic; healthcare IT consulting and
outsourcing provider Phoenix
Health Systems
; robust revenue cycle management systems developer Stockell
Healthcare, which now operates under the Medsphere banner; and the top-rated
Wellsoft emergency department information system.

As part of the acquisition, MOS will retain the Micro-Office
Systems name with the added modifier, “A Division of Medsphere.”

Nuance Sells Off Transcription and EHR-Go-Live Services Businesses to DeliverHealth

Nuance Sells Off Transcription and EHR-Go-Live Services Businesses to DeliverHealth

What You Should Know:

–   Nuance announced that it’s planning to sell
two sections of its healthcare business – Health Information Management (HIM)
and Electronic Health Record (EHR) Go-Live Services – to a new independent
company, called DeliverHealth, in early 2021.

– Nuance will be a minority shareholder of DeliverHealth
and continue to provide its technology to the company.

Nuance
Communications, Inc.,
today announced the planned sale
of the Health Information Management (HIM) Transcription business and the
Electronic Health Record (EHR) Go-Live Services business to a new independent
company, DeliverHealth Solutions LLC
(DeliverHealth),
formed by Assured
Healthcare Partners® (AHP®)
in partnership with Aeries Technology Group (Aeries).  


Transaction Details

The HIM Transcription business includes both Nuance Transcription Services (NTS) and the eScription technology platform. The transaction is expected to be completed in early 2021. As part of the self-off, Nuance will be a minority shareholder of DeliverHealth and will continue to provide its technology to the company. DeliverHealth plans to build on HIM, transcription, technology and EHR services already in place while expanding into intelligent, technology-enabled revenue cycle automation and clinical documentation improvement services within the EHR’s workflow in 2021. DeliverHealth will include both Nuance Transcription Services (NTS) and the eScription technology platform. Financial details of the transaction were not disclosed.


Sell-Off Accelerate Growth as Conversational AI Market
Leader

 The sale
demonstrates Nuance’s continuing execution to focus R&D investments in the
healthcare and enterprise markets – where the company has substantial
competitive advantages and opportunities for growth and value creation. In
2019, for example, Nuance sold its document imaging business to Kofax and
spun-off its automotive business into Cerence, Inc., an independent,
publicly-traded company.

Nuance’s goal with the sale is to enable:

– Existing customers with continued service quality, newly
expanded offerings, and enhancements from DeliverHealth in close collaboration
with Nuance

– Nuance to focus its innovation and market resources as a
pure-play conversational AI market leader while providing continuity of EHR
Go-Live Services and HIM Transcription businesses to existing and new customers
via DeliverHealth

– DeliverHealth to leverage a leading position in healthcare
professional and technology-enabled services, expand global market share,
advance growth plans for the EHR Go-Live and Optimization Services, and provide
enhanced HIM technology and services to a worldwide market in partnership with
Nuance

Nuance’s growth and market leadership in healthcare are
driven by the accelerating adoption and development of its core cloud-based AI
solutions, including the Nuance® Dragon® Ambient eXperience™ (Nuance DAX™)
ambient clinical intelligence (ACI) solution, Nuance Dragon Medical One, Nuance
CDE One, and its array of diagnostic imaging solutions such as PowerScribe One™
and PowerShare™.


“The dramatic acceleration in the digital transformation of healthcare continues as organizations deploy the power of conversational AI and deeply integrated cloud-based solutions at scale to address physician burnout, expand patient access, and improve system efficiencies and the revenue cycle,” said Mark Benjamin, CEO of Nuance. “With this strategic transaction, we’re aligning our resources to increase our market and technical leadership position in high-growth, high-impact areas that help our customers in a transformative way to improve patient care and operational performance. At the same time, we’re enabling the medical transcription and EHR Go-Live Services businesses to reach their full potential as a separate, focused company benefiting from the enhanced investment and operational experience of AHP and Aeries and technology support from Nuance.”


Providence Taps Nuance to Develop AI-Powered Integrated Clinical Intelligence

Nuance Integrates with Microsoft Teams for Virtual Telehealth Consults

What You Should Know:

– Nuance Communications, Inc. and one of the country’s
largest health systems, Providence, announced a strategic collaboration,
supported by Microsoft, dedicated to creating better patient experiences and ease
clinician burden.

– The collaboration centers around Providence harnessing
Nuance’s AI-powered solutions to securely and automatically capture
patient-clinician conversations.

– As part of the expanded partnership, Nuance and
Providence will jointly innovate to create technologies that improve health
system efficiency by reducing digital friction.


Nuance® Communications, Inc. and Providence, one of the largest health systems in the
country, today announced a strategic collaboration to improve both the patient
and caregiver experience. As part of this collaboration, Providence will
build on the long-term relationship with Nuance to deploy Nuance’s cloud
solutions across its 51-hospital, seven-state system. Together, Providence and
Nuance will also develop integrated clinical intelligence and enhanced revenue cycle
solutions
.

Enhancing the Clinician-Patient Experience

In partnership with Nuance, Providence will focus on the clinician-patient experience by harnessing a comprehensive voice-enabled platform that through patient consent uses ambient sensing technology to securely and privately listen to clinician-patient conversations while offering workflow and knowledge automation to complement the electronic health record (EHR). This technology is key to enabling physicians to focus on patient care and spend less time on the increasing administrative tasks that contribute to physician dissatisfaction and burnout.

“Our partnership with Nuance is helping Providence make it easier for our doctors and nurses to do the hard work of documenting the cutting-edge care they provide day in and day out,” said Amy Compton-Phillips, M.D., executive vice president and chief clinical officer at Providence. “The tools we’re developing let our caregivers focus on their patients instead of their keyboards, and that will go a long way in bringing joy back to practicing medicine.”

Providence to Expand Deployment of Nuance Dragon Medical
One

To further improve healthcare experiences for both providers
and patients, Providence will build on its deployment of Nuance Dragon
Medical One with the Dragon Ambient eXperience (DAX). Innovated by Nuance and
Microsoft, Nuance DAX combines Nuance’s conversational AI technology with
Microsoft Azure to securely capture and contextualize every word of the patient
encounter – automatically documenting patient care without taking the
physician’s attention off the patient.

Providence and Nuance to Jointly Create Digital Health
Solutions

As part of the expanded partnership, Nuance and Providence
will jointly innovate to create technologies that improve health system
efficiency by reducing digital friction. This journey will begin with the
deployment of CDE One for Clinical Documentation Integrity workflow management,
Computer-Assisted Physician Documentation (CAPD), and Surgical CAPD, which
focus on accurate clinician documentation of patient care. Providence will also
adopt Nuance’s cloud-based PowerScribe One radiology reporting solution to
achieve new levels of efficiency, accuracy, quality, and performance.

Why It Matters

By removing manual note-taking, Providence enables deeper
patient engagement and reduces burdensome paperwork for its clinicians. In
addition to better patient outcomes and provider experiences, this
collaboration also serves as a model for the deep partnerships needed to
transform healthcare.

M&A: RxVantage Acquires onPoint Oncology to Expand Offering to Oncology Practices

M&A: RxVantage Acquires onPoint Oncology to Expand Offering to Oncology Practices

What You Should Know:

– RxVantage has acquired onPoint Oncology to provide cancer care teams with on-demand access to educational resources, reimbursement data, and analytics.

– The acquisition of onPoint Oncology builds on
RxVantage’s rapidly expanding digital offerings for providers. In April,
RxVantage launched Virtual Meetings to help providers reestablish access to
life science experts amidst the disruptions caused by COVID-19.


RxVantage, the
leading digital platform connecting healthcare providers to educational
resources and experts from life science companies, today announced the acquisition
of onPoint Oncology,
the leader in oncology reimbursement data and analytics.

The partnership ensures that care teams will have access to
onPoint’s unique revenue cycle
data and reimbursement insights as well as one-click access to educational
resources and expertise from any life science company, all through the free RxVantage digital platform.

The acquisition of onPoint Oncology builds on RxVantage’s
rapidly expanding digital offerings for providers. In April, RxVantage launched
Virtual Meetings to help providers reestablish access to life science experts
amidst the disruptions caused by COVID-19.

onPoint will operate as a wholly-owned subsidiary of
RxVantage. As part of the acquisition, industry veterans Tracy Lewis and Bobbi
Buell will join RxVantage leadership team. Financial details of the acquisition
were not disclosed.

RxVantage Background

Founded in 2007, RxVantage’s mission is to ensure that every
provider has the most relevant information and data on medications and medical
technologies, in order to deliver the best care to every patient. More than
6,000 medical practices across the US utilize RxVantage to connect and engage
with over 50,000 experts from life science companies.

COVID-19 Underscores Need for Identity Governance Administration

COVID-19 Underscores Need for Identity Governance Administration
Wes Wright, CTO at Imprivata

If you work in healthcare, chances are that the COVID-19 pandemic forced you to quickly scale up or move staff around to manage the onslaught of patients. The demand for clinicians and support staff grew alongside the spread of the virus, making organizations add clinicians or reassign employees with new or modified roles: Ambulatory nurses went down in the Emergency Department or Isolation Ward, revenue cycle folks started doing transport, and so on. In some cases, former staff or retired workers were called back to help with the surge. 

In the midst of these time-compressed changes, organizations remained rightly focused on their number one priority: patient care delivery. In the background, IT professionals were struggling to manage the slew of new digital identities while ensuring fast-access to new applications, workflows, and devices to accommodate remote work. Giving clinicians this access meant having to quickly provision and deprovision access during the staff ramp-up. Inevitably, access became a problem – whether to the systems or applications needed to do their jobs. In worst-case scenarios, organizations had to balance security and compliance with the delivery of healthcare services to patients. Security protocols were also compromised – a trade-off that should never have to happen. 


Pandemic Spotlights Needs for IGA
In response to the identity management challenges presented by the COVID-19 pandemic, healthcare IT  organizations that had and Identity Governance Administration (IGA) systems came to the rescue.  Those that didn’t, well….. IGA systems provide a fast, reliable way to manage digital identities through provisioning, governance, risk and compliance, and de-provisioning for healthcare workers who need access to workstations and applications. This is even more so the case in a crisis environment. A recent study conducted by Forrester Consulting found that an automated system helps organizations manage, streamline, and secure transactions across hypercomplex ecosystems of healthcare users, locations, devices, and locations. What’s more, according to Forrester, automation also saves time and money and results in a higher quality patient experience. 

Fact is, even in the normal times, healthcare organizations rarely excel at tracking personnel moves, especially the adds and changes due to the time and system constraints often involved. That leads to what I call a “stacked shares” situation. These typically involve a person with decades of experience in your organization who has worked in multiple administrative or clinical areas within the organization and has access to about 80 percent of your network shares because she/he was never deprovisioned from ANY shares. In these instances, the network shares just kept getting “stacked,” one on top of the other. That’s probably exactly what happens during the COVID-19 pandemic as people move around to adapt to the ongoing crisis.

Another unexpected challenge created by the pandemic relates to furloughs. What is your healthcare organization doing with them? Are you disabling and then re-enabling accounts? Re-provisioning when/if they come back? What if they’ve come back but in a new role? Again, the “stacked shares” situation arises. You will likely regret it if your organization doesn’t have an automated IGA system to help you keep track of these movements through an integrated GRC system.


Moving to a Remote Workforce
COVID-19 forced many healthcare organizations to rapidly accommodate a remote workforce. Only a few departments worked remotely before the pandemic, so routers, network, architecting, and bandwidth all had to be upgraded. Most health systems also required additional licensing to successfully ramp up services. Above all, the priority was to prevent any serious disruptions for clinicians. 

Here again, health systems faced the challenge of balancing usability with security concerns. Tools like Zoom and Microsoft Teams proved useful, but they created additional risks including diminished safety of our healthcare workers, cybersecurity intrusions, and hacks – like theft of PHI, ransomware, and more. IT staff had to ensure the security of both the devices and the platforms being used, which is also easily managed by solid IGA systems. 

In these cases, IGA systems analyze login data in real-time via Login Activity reports. They weave digital identity and access management, single-sign-on capabilities, and governance into workflows to strengthen security without compromising care delivery. This includes remote identity proofing to enable electronic prescribing of controlled substances (EPCS), as well as ensure compliance with DEA regulations while avoiding in-person interactions. 

We will no doubt be living in a world of both in-person and remote healthcare for some time given the COVID-19 crisis. One lesson we already learned from the big experiment we just completed is that healthcare organizations benefit from having an IGA system in place to help balance their healthcare delivery, efficiency, and safety, as well as security and compliance. Implementing an IGA strategy no doubt makes it easy for clinicians to securely and seamlessly transition between workstations and applications and have their identity follow them.


About Wes Wright

Wes Wright is the Chief Technology Officer at Imprivata and has more than 20 years of experience with healthcare providers, IT leadership, and security. Prior to joining Imprivata, Wes was the CTO at Sutter Health, where he was responsible for technical services strategies and operational activities for the 26-hospital system. Wes has been the CIO at Seattle Children’s Hospital and has served as the Chief of Staff for a three-star general in the US Air Force.


5 Trends Driving The Future of Healthcare Real Estate in 2020 & Beyond

The COVID-19 pandemic has forever changed patient expectations for healthcare delivery, including offered services and health office operations. Although health systems have remained dynamic in adopting telehealth capabilities, their long-term capital, like real estate and supply chain management (SCM) protocols, have not adapted to match these expectations. Health systems must be aware of current trends in both areas to inform their future decisions. 

Divesting in healthcare real estate is also key to reducing unnecessary costs to a health system, especially if optimal use of these spaces is already lacking. The overwhelming costs of ownership and management lock money away in underutilized and obsolete real estate spaces. Divesting provides more capital liquidity, and frees capital to go towards investment in telehealth, diagnostic technology, and emerging specialties, assets that go towards increasing patient and workforce engagement and satisfaction. In addition, eliminating unused real estate assets allows freedom from liabilities and human capital investments, like facility maintenance and upkeep, not to mention the increased frequency of deep cleaning necessary in the post-COVID-19 bi-lateral operations era.

Further, years of mergers and acquisitions in the healthcare industry have left many health systems with the unwanted result of increases in real estate assets. This has led to increased consolidation of these assets, a trend that has been exacerbated by the pandemic pressure on health system funds. Future consolidation and reevaluation of assets should be informed by trends in patient expectations as well as trends in the market.

Here are five emerging trends driving the future of healthcare real estate and assets. Each encourages divestment out of health system real estate ventures or restructuring of existing spaces in order to better cater to forever changed patient expectations.

1. Rise of Telehealth

According to the Department of Health & Human Services, telehealth use is up around 50% in primary care settings since the beginning of the public health emergency and is projected to remain high in the time following. Most recently, in-person visits have increased and as a result, telehealth visits have declined due to the state’s reopening, and thereby some critics posit that this trend may not continue. However, that could not be further from the truth.

Moving forward, despite health system fear regarding long-term reimbursement may be lacking from federal, state, and commercial health plan payers for virtual care delivery, leveraging telehealth to augment traditional healthcare delivery will become a necessity because consumers will demand it and physicians in some studies have shown satisfaction with their video visit platforms. This will no doubt have an impact on office layout and services.

2. Convenience of Outpatient Services

Motivated in part by telehealth utilization, patients seek convenience and accessibility in their healthcare now more than ever. Health system expansion may therefore mean satellite offices in high traffic areas to cater to the patient’s need for accessibility, marking a movement away from the traditional, centralized hospital campuses.

3. Value-Based Care Transitions

As legislation and CMS regulation moves more towards a value-based care system, trends show a natural move towards lower-cost facilities that provide preventive care. These could also contribute to continued trends to more off-campus real estate and planning for alternative care delivery options, for example, mobile vans reaching more vulnerable, at-risk populations for care such as life-saving vaccinations. 

4. Pandemic Precautions

Bilateral operations are likely to be maintained for some time even after more normal operations return, and healthcare real estate, especially with consolidation, will need to accommodate this precaution, and others like it in all locations.

5. Technology

New diagnostic and testing tools are constantly being released, forcing health systems to reevaluate their current assets and make room for new ones which contributes to wasted space. Furthermore, remote monitoring apps will continue to proliferate in the market and become more affordable and accessible to consumers while advancing interoperability standards and federal information blocking requirements will allow information to flow more freely.  

Strategies to Optimize Healthcare Real Estate & Strategy

In order to unlock money trapped in assets, health systems should look to make their assets work better in response to current trends and patient expectations. To accommodate patient demands and changes to health industry regulation and reimbursement, it makes sense to ensure efficient use of all facilities and optimize real estate and assets using the following strategies:

– Divest underutilized assets of any kind: Begin with real estate and move smaller to reduce unneeded capital investment.

– Remove or reduce administrative spaces: Transition non-clinical workforces to partial or complete work from home status, including finance, legal, marketing, revenue cycle, and other back-office functions. Shared space or “hotel” workspaces are popular.

– Reconfigure medical office or temporary care buildings: As these are often empty several days a week, they must be consolidated. 

– Get out of expensive leases for care that can be given remotely or in lower-cost options or by strategic partners: Take full advantage of telehealth capabilities and eliminate offices that have become obsolete. 

Integrate telehealth into real estate only where it makes sense: Telehealth is more applicable to some services and care modalities than others. Offices should reconfigure to meet these novel needs where necessary, even if it means forgoing leases for the near term. 

– Assess other expensive assets: Appraise assets like storage and diagnostic tools. Those not supportive of the new post-COVID-19 care model or prioritized service lines and are otherwise not producing revenues should be sold or outsourced to strategic partners.

– Diversify with off-campus offices: Provide convenient access to outpatient care and new outpatient procedures by investing in outpatient medical offices in high foot traffic locations. 

– Create space for services in high demand: Services like preventive care and behavioral health should be given physical or virtual space in the system to cater to patient needs. 


About Moha Desai

Moha Desai is a Principal of Healthcare Strategy and Transformation where she focuses on driving forward strategic, planning, financial, revenue cycle, operational improvement, and patient engagement healthcare projects for providers, federal government health agencies, and various firms requiring growth, business development, and project implementation and management. She has previously served in leadership roles at Partners HealthCare, Deloitte Consulting, Bearing Point, etc. Moha received her B.A. in Economics and her M.B.A. at Yale University.

Getting Beyond the Telehealth ‘Stop-Gap’ Mentality

Getting Beyond the Telehealth's ‘Stop-Gap’ Mentality
Roland Therriault, President, InSync Healthcare Solutions

Since COVID-19 emerged as a major health threat, virtual care has taken off. As many as 46% of patients reported in late April that they had used telehealth to replace a canceled healthcare visit in 2020, while 48% of physicians said they had started using telehealth to treat patients.  

While a shift in care models was necessary to address business continuity amid the pandemic, these trends also represent positive movements as a growing body of evidence supports the real-life benefits of telehealth. Remote models of care are connected to safe and effective consultations across many use cases, low exposure to viruses, and much-needed access to care.  

Yet the fact that physician adoption isn’t higher suggests two things:

1) Physicians may be taking a ‘wait and see’ approach in the hopes that patients will want to return to in-person care as economies reopen; or

2) Some physicians haven’t yet figured out their long-term telehealth strategy. In truth, many providers are treating telehealth as a “stop-gap” — or temporary — solution until life returns to normal.

But given the increasingly positive data around telehealth as a safe alternative to in-person care, as well as its track record in successfully treating patients, it’s time for providers to reframe their thinking. In the future, practices will need a healthcare strategy that balances virtual with in-person care.

Rethinking Telehealth 

As recently as ten years ago, telehealth reimbursement was largely limited to patients in rural areas, as payers didn’t yet see the value of compensating doctors for virtual encounters. 

Today, most payers and providers recognize the value of telehealth on some level amid rising demand for services and severe professional shortages. In particular, remote care models have proven their worth during the pandemic as an effective means of preventing the spread of disease. Greater acceptance of telehealth is further demonstrated by the recent decision to relax HIPAA requirements by HHS’ Office of Civil Rights (OCR), allowing more providers and patients to virtually connect through FaceTime, Zoom, or other two-way communications systems during the current pandemic. 

This is an important first step, although many providers remain resistant to change for a variety of valid reasons. Some of these include discomfort with remote care models, reimbursement concerns, and the cost of deploying telehealth. 

Performing medicine in a way that doesn’t align with one’s training feels unnatural, and some providers have said that virtual encounters feel less personal. The fact is that most clinicians weren’t trained to diagnose patients remotely or engage over a screen and are simply hesitant to embrace this approach to care.

Also, providers may have trepidation about not getting paid. While CMS and private payers have expanded coverage, multiple healthcare providers have reported that bills are being delayed or only partially paid by health plans. 

With limited insight into the potential return on that investment, concerns over the cost of implementing telehealth are also reasonable. A physician who is consulting with patients remotely through FaceTime, for example, might wonder if the investment in a more secure, robust telehealth platform will make sense in 12 months, should a COVID-19 vaccine materialize. 

Yet by not adopting a more permanent telehealth solution, providers may be hurting themselves down the road. Patients increasingly believe virtual care is highly effective, and some even prefer it. According to a SYKES consumer survey administered in March, 60% of 1,441 respondents said the COVID pandemic has increased their willingness to try telehealth.  

Also, while HHS has relaxed HIPAA enforcement at the moment, there’s no indication this will continue. Healthcare organizations will need to ensure that the platform or program they’re using is designed to keep protected health information (PHI) safe.  

Investing in the Future

Given the upward trajectory of telehealth, it benefits providers to thoughtfully invest in the right strategies and solutions now to extract the greatest value and return on investment down the road. Here are four steps to take, when shifting to a long-term telehealth strategy:  

– Identify needs. Many primary-care practices may have seen a bump in interest in telehealth due to COVID-19, while specialty practices may see increases stay steady, even when fears of the coronavirus fade. When planning long-term, put patient needs first: In what ways can telehealth improve care delivery, going forward? Look at data, such as virtual-visit utilization patterns, to see where there are opportunities to grow telemedicine (e.g., expanding chronic care management) based on needs.

– Consider workflows. The ideal telehealth program doesn’t interrupt clinical workflows – it enhances them. If you’re using a ‘stop-gap’ video conferencing solution to provide telemedicine, is it easy to integrate practice notes with your EHR? Or, do you have to take extra steps to document patient encounters for clinical and billing departments? 

Seek supportive partners. You can use any number of technology platforms to conduct telemedicine encounters, but not all platforms are created equal. When looking at implementing a telehealth platform, consider not only ease of use, and interoperability, but also what a particular vendor is offering: How well the telehealth platform in question can accommodate the needs of a particular specialty? What are existing clients are saying about things like training, vendor support, and the patient experience?

– Proactively engage. Your patients have most likely heard of telehealth, but they may not realize that telehealth is multifaceted and can be used to diagnose conditions such as skin disorders or allergies and can be just as effective as in-person visits. Educating patients about telehealth’s benefits, and making it easy for them to try telehealth, is essential to success.  

Expanding telehealth’s role in the medical practice benefits everyone, from physicians to patients to payers. Moving past the “stop-gap” mentality now will reap greater benefits in the future, regardless of whether we’re in the midst of a pandemic, or simply trying to provide excellent care on a day-to-day basis.


About Roland Therriault

Roland Therriault
is the President and Executive Vice President of Sales at InSync Healthcare Solutions, a provider
of integrated EHR and practice management software, revenue cycle management
services and medical transcription to thousands of healthcare professionals
throughout the United States. Roland Therriault manages all operations of the
company, driving its go-to-market strategy and overseeing all sales activities.
His experience in healthcare and technology includes more than 20 years of
direct and channel sales, strategic planning and business development. Prior to
joining InSync, Roland served as Vice President of Sales for MD On-Line, a
provider of acute and ambulatory clinical and practice management solutions.


TrustHCS, Visionary RCM, T-System, RevCycle+ Merge to Form New Entity CorroHealth

TrustHCS, Visionary RCM, T-System, RevCycle+ Merge to Form New Entity CorroHealth

What You Should Know:

– CorroHealth – a newly-formed entity – combines the services and technologies of TrustHCS, Visionary RCM, T-System, and RevCycle+.

– Under this new entity, CorroHealth is committed to
helping clients navigate regulatory compliance complexities, ease physician burdens
and improve financial outcomes.


Today, four revenue cycle management services and technology organizations have merged together as a newly-formed entity—CorroHealth. TrustHCS, Visionary RCM, T-System, and RevCycle+ have joined forces to provide a greater breadth of reimbursement cycle, risk adjustment, and quality solutions to health systems and payers.

What is CorroHealth?

CorroHealth—driven by helping clients navigate regulatory and
compliance complexities, ease physician burdens and improve financial
outcomes—emerges at a time when financial health is particularly important for
health systems and payers. CorroHealth combines the industry-leading domestic
middle revenue cycle group of TrustHCS, with the full-service global delivery
model of Visionary RCM, the emergency documentation technology solutions of
T-System, and the advanced coding solutions of RevCycle+.

“We knew health systems and plans would have a growing need for our solutions, so we worked hard and found a way to bring all 4,000 employees together as one company, united by our core. It’s been pretty amazing to see this joint venture come together at such a time as this,” said CorroHealth CEO Patrick Leonard.

The four legacy company names will remain through the end of
2020 with a final move to the CorroHealth name across all companies beginning
January 1, 2021.

Global investment firm The
Carlyle Group
owns a majority stake in CorroHealth, with Cannae Holdings,
Inc. (NYSE: CNNE), Sanaka Group, and affiliates of TripleTree Holdings also
serving as investors.

Report: Modern Revenue Integrity Solutions Driving Payment Performance

Report: Modern Revenue Integrity Solutions Driving Payment Performance

What You Should Know:

– New Chilmark Research report on revenue integrity
in healthcare reveals a transitional market making strides to address the new
burdens of modern care economics.

– The ongoing COVID-19 public health emergency underscores
the imperative need for automation and reduced administrative costs even
clearer.


Revenue cycle
has and continues to be one of the most difficult challenges in healthcare.
These issues manifest in the claims process of submission, appeal, and
remittance, but the causes are found much earlier in clinical workflows. Rather
than think of these as separate issues, they should all be considered under a
broader category of revenue integrity. The latest report from Chilmark Research,
Revenue Integrity in Healthcare: Solutions Driving Payment Performance
,
reveals a market in flux as new technologies are applied to old problems,
increasingly complicated by contracts that include performance and reporting
requirements.

Modern Revenue Integrity Solutions Can Improve Financial
Performance

New software and platforms can accelerate, automate, and
improve the accuracy of these activities. Automated outreach, demographic and
eligibility checking, computer-assisted coding, natural-language processing,
and more traditional revenue cycle platforms.

These tools are offered by:

– Electronic Health Records (EHRs)

– Independent Platforms

– Best-of-Breed Solutions from outside the Revenue Integrity
space, but with powerful tools to address payment needs

These activities are essential for healthcare enterprises of
all sizes, scopes, and specialties. They are needed whether the organization is
primarily concerned with fee-for-service (FFS) reimbursement or value-based care (VBC).
The ongoing COVID-19 public health emergency has made the need for automation
and reduced administrative costs even clearer. With appointment volumes
dropping, provider organizations are faced with the need for reliable, accurate
payments for their care activities more than ever. These solutions are equally
valuable for traditional provider care and for modern virtual care solutions
like telehealth.

 “Accounting and revenue cycle work can never fix these issues. They need to be addressed where they occur and prevented from showing up in revenue cycle in the first place. One mistake in patient registration that was easy to fix can cause millions in complicated denials down the road.”– Lead Analyst Alex Lennox-Miller

Each type of solution (EHR, Platform, Best of Breed) is
evaluated based on how they address the needs of provider enterprises. The
report reviews the current state of the market, the maturity of solutions, and
the strengths and weaknesses of each solution type. While the current market is
valued at more than $20 billion, projections within the report show its
expected growth to nearly $35 billion in the next five years. The report shows
which segments of this market can expect annual growth rates exceeding 10% and
which will slow to under 2.5%.

Profile of Leading Revenue Integrity Vendors

In addition to the categorical analyses, this report includes 13 profiles of major and promising vendors: 3M, Allscripts, athenahealth, Cerner, Change Healthcare, Hayes|MDAudit, Medicomp Systems, Optum, PatientMatters, RevSpring, Sift, and ZOLL. Each profile includes an assessment of the vendor’s strengths and challenges, detailed descriptions and evaluations of the product capabilities and market execution, and rankings across 24 categories.

Managers and directors of healthcare organizations looking
for ways to address revenue cycle issues, lower clean claims rates, or improve
strategic revenue projections will appreciate the report’s clear breakdown of
vendor offerings and the impacts on their clinical and non-clinical staff.
Payers, including self-insured employers, and other organizations interested in
the total cost of care will find the market overview and product evaluations of
great value, helping them understand the tools and challenges their partner
organizations will be using.

The report is available to subscribers of the Chilmark
Advisory Service
or may be purchased
separately.

Waystar Acquires Medicare RCM Company eSolutions at $1.3B Valuation

Waystar Acquires Medicare RCM Company eSolutions at $1.3B Valuation

What You Should Know:

– Revenue cycle management provider Waystar acquires eSolutions, a provider of Medicare and Multi-Payer revenue cycle management, workflow automation, and data analytics tools at a $1.3B valuation.

– The acquisition will create the first unified
healthcare payments platform with both commercial and government payer
connectivity, resulting in greater value for providers.


Waystar, a provider of healthcare payments software, today
announced a definitive agreement to acquire Francisco Partners-backed eSolutions, a revenue cycle
technology company with unique Medicare-specific solutions at a $1.3B valuation,
according to sources close to the deal. In bringing these two industry leaders
together, Waystar will be the first technology to unite both commercial and
government payers onto a single payments platform. The transaction is expected
to close later this year, subject to customary conditions and approvals.

eSolutions Background

Founded in 1999, eSolutions’ technology maximizes revenue
collection, accelerates cash flow, and reduces administrative burden across
numerous sites of care. The company has over 6,000 payer connections and
maintains a powerful and growing data set of billions of transactions. In addition
to hospitals and ambulatory providers, eSolutions has deep expertise in serving
the post-acute market across the entire revenue cycle, including skilled
nursing, senior living facilities, home care, hospice, federally qualified
healthcare centers (FQHCs), and durable medical equipment providers. eSolutions
is backed by Francisco Partners.

“eSolutions is thrilled to be joining forces with Waystar, a company like ours that relentlessly focuses on delivering exceptional customer service,” said Gerry McCarthy, Chief Executive Officer of eSolutions. “The combination of our technology platforms and data solves a major pain point in revenue cycle management to drive stronger results for our clients, partners, and for healthcare.”

Acquisition Creates Unified Healthcare Payments Platform 

Medicare has become the largest payer in the United
States and as baby boomers age, the mix of insurance coverage is
increasingly shifting to Medicare. Historically, providers have had to leverage
two different systems – one to handle commercial claims, and another to handle
Medicare. For healthcare providers, leveraging a single, end-to-end platform to
manage both private and government payments solves a major pain point and
creates significant efficiencies, freeing up time to deliver care.

“Together, Waystar and eSolutions will deliver unprecedented innovation to the industry, helping healthcare organizations accelerate revenue collection while reducing administrative expenses and repetitive tasks,” said Matthew Hawkins, Chief Executive Officer and board member of Waystar. “Uniting our companies’ data sets will further power Waystar Hubble, our artificial intelligence solution, providing access to even greater insights and value for our clients. We have long-admired eSolutions for its unique Medicare-specific revenue cycle capabilities, which are a perfect complement to the Waystar platform. We are excited to move forward as one team.”

6th Waystar Acquisition Since 2018

Waystar has integrated several other transformational
technologies onto its single instance cloud-based platform since uniting
Navicure and ZirMed in 2017. This marks Waystar’s sixth acquisition in the last
couple years, as the company rapidly expands within the space (not including
their own $2.3B acquisition by two private equity firms last year). 

Recent acquisitions include Recondo, a patient estimation and prior authorization
technology, PARO, a presumptive charity scoring solution, UPMC’s Ovation, a claims monitoring tool, and Connance, leveraging predictive analytics to offer agency
manager, advanced propensity to pay (AP2P), and presumptive charity. Waystar is
backed by EQT, Canada Pension Plan Investment Board, and Bain Capital.

Top 5 RCM Challenges for Healthcare Executives in the COVID-19 Era and Beyond

Top 5 RCM Challenges for Healthcare Executives in the COVID-19 Era and Beyond
Brian Robertson, CEO at VisiQuate,

There have been many memorable “where were you?” events since the 21st century began. But few can match the COVID-19 pandemic, at least from a healthcare perspective. 

The effect on healthcare (and healthcare executives) has been particularly profound since our industry is in the center of everything. From the search for personal protective equipment (PPE) to setting up secure wings and field hospitals to instantly redeploying nurses from other floors to the emergency department (ED), the changes have been profound. 

Yet it’s not just the front-line care areas that have experienced these challenges. They’ve also extended to the core operational functions, such as revenue cycle management (RCM) and business intelligence. 

If there is a silver lining to all the trauma it’s that the pandemic has turned up the volume on the need to remove administrative waste and long-held assumptions. Many in healthcare have been far too comfortable for far too long saying “healthcare is 10 years behind other industries” in terms of business and operational technology. The pandemic has shown us the folly of that sentiment. 

We have the opportunity now to take what we have learned and are constantly discovering and apply it to make hospitals and health systems data-driven paragons of efficient operations. Here are five RCM challenges healthcare executives are currently facing and how the industry can improve on them moving forward. 

1. Allowing some employees to work from home

Prior to the COVID-19 pandemic, work from home was mildly embraced by some and driven more by increasingly expensive and/or unavailable office space.  Many hospital and health system executives believed that RCM personnel were best managed and supported when together in the same building or campus as their managers. As such, few had plans in place to enable a real work-from-home option. 

Then came the pandemic, and the options became A) allow work from home or B) cease RCM activities until the clinical side sounded the “all clear.” 

While there were certainly challenges on the mechanical side, many healthcare organizations quickly discovered that their RCM staff was capable of performing most of their duties effectively while at home.   

As they consider continuing work-from-home options, at least for those who want them, healthcare executives will need to be able to measure the productivity and effectiveness of their RCM staffs. This means they will need to get very good at workforce performance analytics. 

The best analytics will be about performance versus activity and will enable them to gain an auditable, objective measure of the value-based performance of each employee and the department as a whole. They will then be able to set incentives and take a more practical look at workloads and what people can do. For example, if someone is currently working 50 claim exceptions per day with two touches, what can be done to incent them to double that amount? If a biller/collector can do double their current volume and get better yield while working seven hours instead of eight, then they should be paid for performance versus activity.  

Organizations may still need to offer a minimal office environment for those who prefer to work that way. But they will have options that enable them to increase throughput and yield while also increasing employee satisfaction with their jobs. 

2.  Getting good at vendor/partner analytics

Let’s hope that the days when vendors and partners could make up for any mediocrity in their performance by dropping off a bigger box of donuts are long gone. Today, thanks to advanced analytics and data mining, healthcare executives can easily monitor and manage vendor performance to determine who is performing best on which types of issues so they can drive the best outcomes in each area.  The reality is that partners should be measured as much as possible in the same manner as staff members.  In RCM, cash remains king so key measures tied to cash performance, liquidity ratios, yield improvement as well as cost and “quality of touch” are best to measure the quantitative performance of a vendor, partner, or supplier.

3. Replacing dashboards with real-time command centers

If healthcare executives hadn’t already stopped relying on basic dashboards and scorecards by now the pandemic should have demonstrated why they should. Hospitals and health systems have no room for mistakes at present; they must capture every penny they can to make up for the revenue shortfalls driven by the canceling of non-emergent yet essential procedures.

Add to that a landscape that seems to be changing daily, or even hourly at times, and static and stale, dated views of organizational performance are no longer sufficient. It’s like looking at today’s weather forecast in yesterday’s newspaper. 

What they need instead is a robust command center that offers streaming, real-time views of their current performance levels with deep insights including leading indicators into prospective problems, patterns, or other anomalies.  With an RCM based command center, RCM executives can see how the organization is performing in multiple ways including yield, cost, quality, and velocity of payment from third-party payers and patients as well as internal process efficiencies or operational leakage. 

They can compare the effectiveness of staff working in the office versus working from home to determine whether work-from-home is delivering value. They can also slice and dice the data further to determine if individual employees are more productive in the office or at home so they can make even better, more granular decisions. 

The data-driven command center also enables decision-makers to look at what is being written off, where the leakage is occurring, and other factors in real-time so they can preserve and capture as much revenue as possible. The more molecular and atomic they can get at the source data level, the more effective they will be in managing organizational performance when it counts – as it’s happening. A data-driven command center delivers that capability.  A robust data-driven command center also tends to put the spotlight on process problems and where the potential for robotic based automation exists.

4. Getting smarter through AI, Machine Learning & Robotics

There is a huge need right now to remove costs while improving yield. Fortunately, that is what artificial intelligence (AI), machine learning (ML), and analytical process automation (APA) are specifically designed to do because they are rooted in data. 

Much of this is understanding what goes wrong and why claims are stalled or denied. For example, if Payer A requires two touches to resolve a denial or downgrade and the same denials or downgrades require four touches for Payer B, providers should ask themselves “Why?”. It could be a training or systems issue, but it could also be something occurring on the payer side. 

Hospitals and health systems need to understand the patterns so they can ensure they are implementing the proper corrections. They should also be using APA to determine where costly manual labor can be replaced with automated systems. 

When they are looking to increase RCM efficiency via Robotic Process Automation, healthcare organizations often start with authorizations and eligibility. Those are always the obvious places to start but yield improvement and process and cost efficiencies live in many places throughout the revenue cycle. 

Data-driven APA can help them intelligently determine where the greatest potential gains from automation can be realized so they can start there, then work their way down. 

5. Improve compliance efforts

While there will always be some exceptions, most compliance issues are unintentional. Fortunately, the more organizations get molecular and atomic with their data and processes, the more they have controls they can test, giving them full audibility and traceability of potential risk areas. These capabilities will help avoid false claims act violations, improper coding, and other unintentional risk markers. 

More change to come

Although the overall number of daily COVID-19 cases may be trending downward, we are not out of the woods yet. Infectious disease experts are recommending caution for reopening the country; some are even predicting another surge in the fall to coincide with the start of the flu season, which could make the challenges even greater. 

If that scenario takes hold, hospitals and health systems will be further challenged to get patients with chronic conditions who are fearful of the virus to come to the office for regular screenings so they can avoid negative outcomes in these other areas. More data-driven innovation will be required. And as it occurs on the care side, it will need to be matched on the business side so hospitals and health systems can continue to deliver these services. 

The key is understanding not just what is happening but why it is happening so healthcare executives can make intelligent data-driven decisions. Hospitals and health systems would be wise to implement the appropriate technologies now so they are prepared for whatever the next “where were you?” moment brings. 

Murder hornets anyone? 

DAS Health Acquires Managed IT Services and CyberSecurity Company Technology Seed

DAS Health Lands $6M to Accelerate Company Acquisition Strategy

– Both companies’ clients will gain an increased depth of IT and security support, and Technology Seed’s healthcare clients will now have a substantially improved value proposition

DAS Health Ventures, Inc., a provider of health IT and management, announced today it completed the acquisition of Technology Seed, LLC, a managed IT and cybersecurity services company based in Salem, NH. This acquisition strengthens DAS’ position in the MSP sector and significantly advances its growth strategy to build the leading managed IT and services provider to physician groups, hospitals, and healthcare systems throughout the country.

Impact of Acquisition

DAS Health actively serves more than 1,500 clients, 3,000 clinicians, and 15,000 total users nationwide. With its headquarters in Tampa, Florida, a regional office in Las Vegas, Nevada, and a significant presence in Georgia, Illinois, New Jersey, North and South Carolina, Texas, and Wisconsin, DAS Health serves clients throughout nearly all 50 states. The recent acquisition significantly enhances their presence in New England, and as a result, DAS Health has now added a regional office in New Hampshire that will create opportunities for greater regional support of its entire solutions portfolio.

This
is the largest of over a dozen acquisitions in the past several years made
by DAS, which has become known for its ability to
identify quality companies that are a strategic fit and rapidly integrate them
in order to continually enhance the customer experience for clients of both
companies. Cogent Growth Partners assisted DAS in
the acquisition.

Both
companies’ clients will gain an increased depth of IT and security support, and
Technology Seed’s healthcare clients will now have a substantially improved
value proposition, as DAS Health’s
offerings are robust, including practice management and EHR software sales,
support and hosting, revenue cycle management (RCM), managed IT services,
security risk assessments (SRA), MIPS/MACRA reporting & consulting, mental
& behavioral health screenings, chronic
care management, telemedicine, and other value-based and patient engagement
solutions.

“Technology Seed offers an exciting opportunity for DAS to strengthen and expand our managed IT services throughout
the country, and specifically in New England” stated David Schlaifer, DAS Health President and CEO.
“I am pleased to welcome Kurt Simione and his team to the DAS family.
With this strong addition to our portfolio, we look forward to unlocking additional
value for our clients.”

Banner Health to Implement Cerner Revenue Cycle Management Across Enterprise

Banner Health to Implement Cerner Revenue Cycle Management Across Network

What You Should Know:

– Cerner and long-time client Banner Health announced
a new deal to implement a comprehensive suite of revenue cycle management
solutions as part of a long-standing strategic alignment to use health care
technology to drive population health improvement.

– The revenue cycle integration will take place across
Banner Health’s entire system, including 28 hospitals and clinics in six
states.


Banner Health and Cerner,
today announced it is expanding its
relationship to implement an end-to-end, comprehensive suite of revenue cycle
management (RCM)
solutions, building on a multi-year, long-standing
strategic alignment using health care technology to drive population health
improvement. The revenue cycle integration is designed to streamline and
simplify the clinician and patient experience across Banner Health’s entire
system, including 28 hospitals and clinics in six states.

RCM Implementation
Approach

Banner Health will integrate Cerner’s registration, scheduling, patient billing, practice management solutions, and transaction services with its existing EHR on the Cerner Millennium platform. This integration between the revenue cycle and clinical systems will help connect a patient’s clinicals and financials to one single view across the health system ultimately streamlining billing operations and improving the overall patient experience. Cerner’s open platform also offers a way to more easily integrate third-party applications to help meet Banner Health’s specific needs.  

Why It Matters

To successfully manage
business today, health systems need clinical, financial and operational data
that works together. Cerner’s clinically-drive revenue cycle solution uses a
common, single and integrated platform designed to help improve savings,
cost-effectiveness and build a healthier bottom line for health systems. 

“After comprehensive planning and alignment between our two organizations, we are confident that teaming with Cerner to achieve a fully integrated revenue cycle platform will meet our business needs now and into the future,” said Dennis Laraway, CFO, Banner Health. “Building on our past successful collaborations with Cerner for mainly clinical applications, adoption of their revenue cycle management solution is now a critical next step to streamline both clinical and financial solutions for our patients across the entire Banner Health enterprise.”

This
expansion is expected to better position Banner Health to flexibly adapt to new
payment structures, more quickly adjust to policy and compliance changes,
better coordinate single registration between acute and ambulatory services and
centralize single-source patient charting and reporting across multiple care
locations.

“The integrated approach housed within Cerner Millennium supports a more efficient and cost-effective approach for our providers and enhances the patient care experience as their health information easily follows them across the Banner Health continuum of care,” said Laraway.  

4 Ways Healthcare Organizations Can Establish Partnerships to Drive Innovation

Nebraska Medicine’s experience points to four ways healthcare organizations can establish partnerships with vendors that drive innovation and performance excellence.

With public and private healthcare spending significantly outpacing that of other countries, U.S. hospitals face intense pressure to find new ways to capture greater value. More and more, organizations are finding that partnerships with existing vendors can help unlock next-level performance gains in a transformative environment.

Take Nebraska Medicine, for example. In the early 2000s, the health system created multidisciplinary committees to boost revenue integrity and adopted new revenue cycle management processes that strengthened performance—with strong results. But best practices alone are no longer enough to fuel revenue cycle gains at a time of decreased reimbursement, rising out-of-pocket costs, and staffing issues. “You’ve got to be able to get to the data,” says Jana Danielson, Executive Director, Revenue Cycle for Nebraska Medicine—a $1.8 billion academic medical center with two hospitals, ~450 revenue cycle staff, 913,000 hospital billing claims, and 1.6 million physician billing claims per year. 

“Without real-time access to data and data analytics, revenue cycle teams risk making decisions based on emotions, not facts,” Danielson says. “Our partnership with a vendor enables our revenue cycle team to more effectively use data to identify our pain points and empower team members to take the right steps for improvement.”  

Nebraska Medicine’s experience points to four ways healthcare organizations can establish partnerships with vendors that drive innovation and performance excellence.

1. Look for a partner that will challenge your assumptions around performance

The right partner will dig deeper, not only tracking key performance indicators (KPIs) but also taking a hard look at how these KPIs were calculated. 

For example, in revenue cycle management, there are many ways to track clean claim rates, a measure that reflects the quality of claim data that is collected and reported. Some organizations consider a clean claim rate to be the percentage of claims accepted by the payer on the first pass. Others calculate it as the percentage of claims that pass through the organization’s billing department without manual intervention before being submitted to the payer. Depending on how this metric is calculated, sometimes a percentage that seems to indicate above-average performance in comparison with peers may not reflect breakdowns in processes that have occurred before a claim is submitted.

At first glance, Nebraska Medicine’s clean claim rate in 2017 was strong: 

95.87 percent for a physician billing and 87.59 percent for hospital billing. However, using claims analytics, the health system uncovered a hidden challenge. Some billers were bypassing the claim edits. In those instances, claims were being submitted before corrections were made. The result: a lower-than-expected clean claim rate. 

Nebraska Medicine’s revenue cycle leaders worked with the organization’s vendor to tackle this challenge. The revenue cycle department developed scorecards by individual employees that showed their performance against key metrics, including their rate of bypassed edits, and reiterated expectations for revenue cycle processes. Within three months, the number of bypassed edits significantly decreased. Today, Nebraska Medicine’s clean claims rate averages 93.78 percent—well above the industry standard—for more than 900,000 hospital claims per year.

EXHIBIT ONE:

At Nebraska Medicine, Reduction in Bypassed Claim Edits Drives High Clean Claims Rate 

2. Make sure the vendor has both product knowledge and operational expertise

Many vendors make the business case for partnership based on the quality of their product or system, such as a 99 percent clean claim rate or a 3 percent denial rate. Some back up their product expertise by regularly working with clients to optimize their use of a technology or service—and it’s a solid step toward a true partnership.

But the best vendors also commit to understanding the context in which their products or services are used in your organization. They examine your team’s work processes and draw upon their operational expertise to make suggestions for improvement, even when the modifications they propose fall outside their paid relationship with your organization.

Consider that 90 percent of patients expect out-of-pocket estimates before care is delivered—not surprising, given the rise in high deductibles and patients’ expected contribution toward their healthcare costs. Providing a patient financial “concierge” at the point of contact not only helps patients better understand their out-of-pocket obligation but also bolsters an organization’s ability to:

– Collect copays upfront

– Explore barriers to payment and patient-tailored solutions

– Increase point-of-service collections and revenue

The right vendor will offer both tried-and-true and out-of-the-box suggestions to drive increased efficiency and revenue, regardless of whether this boosts the vendor’s bottom line.

3. Ask bold questions—and expect thoughtful responses

We’re at the tip of the iceberg when it comes to using artificial intelligence (AI) in healthcare. AI offers a massive set of capabilities for innovation and improvement in healthcare, including in revenue cycle. For example, the use of machine learning has the potential to elevate revenue cycle performance by predicting:

– When a claim will be paid—and how much—down to the hour of remittance

– The probability that a claim will be denied payment—and why

– Whether a patient encounter will require prior authorization before the date of service

– Whether new edits need to be incorporated into existing workflows based on payer responses and denials

But is now the right time for your organization to invest in AI for revenue cycle, or are there other, more foundational competencies your team should hone first? The best vendors keep a pulse on the industry’s newest innovations and partner with you in determining the right approach for your organization. They also help make the business case for innovation to senior leaders, when appropriate.

As Nebraska Medicine examines opportunities to leverage AI in revenue cycle, it has worked with a claims analytics vendor to assess how payer behavior affects revenue, both in the short term and long term. At a time when the nation’s biggest health plans vary greatly in their time to payment, instant access to payment trends by individual payers empowers Nebraska Medicine to have more candid conversations with payers around performance. It also strengthens Nebraska Medicine’s contract negotiating power.

“We want to make sure we’re not at the bottom of the pile when it comes to our relationships with payers,” Danielson says. “If we are, we need to be able to dive into the specific issues that need to be fixed to improve performance.”

4. View your vendor as a strategic ally

Sometimes, you don’t know what you need until you see it. Other times, the pain points you’re sure to require dedicated focus turn out to be pebble-sized problems, not boulders. The key to finding a true partner in innovation is to actively seek a vendor that demonstrates not just a superior level of service, but also a strong willingness to listen to clients and share candid feedback.  

For example, senior leaders at Nebraska Medicine once asked revenue cycle leaders to uncover what they viewed as “skyrocketing denials rate.” Danielson partnered with the health system’s claims analytics vendor to drill down, by payer, into first-pass denial rates, partial denial rates, and more to provide a complete picture of denials status. These efforts showed one payer’s clean claim rate was 10 points lower than that of its peers.

However, the payer did not account for significant patient volume, translating to a small impact on revenue cycle performance. Nebraska Medicine determined it could make a bigger difference in lowering denial rates by focusing on the organization’s largest payer—avoiding a complete overhaul to the revenue cycle team’s payer relations approach.

Creating an Innovation Mindset

The bar for revenue cycle performance is rising, especially with continued dips in reimbursement rates, an uptick in challenges to claim payment, and an environment where consumers are the new payer. Moving past the traditional mindset of what a vendor relationship should look like toward an innovation mindset enables leaders to more fully benefit from a vendor’s subject matter expertise and accelerates gains in performance.


About Eric NilssonEric Nilsson joined The SSI Group, LLC (SSI) as the Chief Technology Officer to lead SSI’s long-term technology vision. He brings nearly 30 years of experience in the software industry with the last 10 in healthcare technology. Prior to joining SSI, he served as the chief technology officer at Nextech and Surgical Information Systems (SIS), where he focused on SaaS, on-premise EMR and practice management solutions as well as inpatient and ambulatory surgery providers from large hospital networks to surgery centers.

Allscripts, Microsoft Ink 5-Year Partnership to Support Cloud-based Sunrise EHR, Drive Co-Innovation

Allscripts, Microsoft Ink 5-Year Partnership to Support Sunrise EHR, Drive Co-Innovation

What You Should Know:

– Allscripts and Microsoft sign a five-year partnership extension to support Allscripts’ cloud-based Sunrise electronic health record and drive co-innovation.

– The alliance will enable Allscripts to harness the power of Microsoft’s platform and tools, including Microsoft Azure, Microsoft Teams, and Power BI, creating a more seamless and highly productive user experience.


Today Allscripts and
Microsoft Corp. announced the
extension of their long-standing strategic alliance to enable the expanded
development and delivery of cloud-based health IT solutions.
The five-year extension will support Allscripts’ cloud-based Sunrise electronic health record
(EHR), making Microsoft the cloud provider for the solution and opening up
co-innovation opportunities to help transform healthcare with smarter, more
scalable technology. The alliance will enable Allscripts to harness the power
of Microsoft’s platform and tools, including Microsoft Azure, Microsoft Teams
and Power BI, creating a more seamless and highly productive user experience.

Partnership Impact for Cloud-based Sunrise EHR

Sunrise is an integrated EHR that connects all aspects of
care, including acute, ambulatory, surgical, pharmacy, radiology and laboratory
services including an integrated revenue cycle and patient administration
system. Cloud-based Sunrise will offer many added benefits beyond the
on-premise version that will improve organizational effectiveness, solution
interoperability, clinician ease of use and an improved patient experience.
Client benefits include a subscription model delivering faster implementations
and lower annual upgrade costs, helping organizations leverage the software
without increasing burdens on their internal IT resources.

The cloud-based Sunrise solution will provide enhanced
security, scalability and flexibility, as well as the opportunity to add new
capabilities quickly as business needs and the cloud evolve. The cloud-based
solution will also include expanded analytics and insights functionality that
can quickly engage with the Internet of Things. Finally, the cloud-based
Sunrise solution will include a marketplace that enables healthcare apps and
third parties to easily integrate with a hospital EHR. Allscripts clients will
begin to see these updates by the end of 2020.

Why It Matters

“The COVID-19 pandemic will forever change how healthcare is
delivered, and provider organizations around the world must ensure they are
powered by innovative, interoperable, comprehensive and lower-cost IT solutions
that meet the demands of our new normal,” said Allscripts chief executive
officer Paul Black. “Healthcare delivery is no longer defined by location —
providers need to have the capability to reach patients where they are to truly
deliver the care they require. Cloud solutions, mobile options, telehealth
functionality — these are the foundational tools for not just the future of
healthcare, but the present. Collaborating with Microsoft, the leader in the
public cloud sector, we will efficiently deliver the tools caregivers need to
improve the clinical outcomes of their patients and operational performance of
their organizations.”