Client News Coverage

Revenue integrity has become harder to maintain as audits grow in volume and complexity. Payers are increasing scrutiny and regulatory agencies are reinforcing fraud mitigation. Navigating this evolving terrain requires a reimagined, automated approach to billing compliance, coding, and HIM, optimizing accuracy and efficiency to protect revenue.

We sat down with Dana Finnegan, Director of Market Strategy with MDaudit, to discuss what’s behind the scenes of reimagining revenue integrity and the role automation can play in achieving success.

What's Trending NOW is the intersection of artificial intelligence, automation, analytics, and professional services in medical coding. Host Shahid Shah is joined by with Conrad Coopersmith, General Manager, AGS Health, a company focused on revenue cycle management in healthcare. Conrad shares insights of the use of technology and AI in the coding automation journey.

Healthcare NOW Radio»

Various forms of automation have long been present within healthcare revenue cycle management (RCM). However, advances in artificial intelligence (AI) have brought the industry to a significant inflection point, where the use cases for AI tools are expanding as rapidly as their capabilities.

We sat down with Thomas Thatapudi, chief information officer of AGS Health, to discuss the current and future state of AI in RCM and what healthcare organizations need to know about effectively integrating it into workflows.

There are a lot of components to consider and talk about in regards to interoperability and data sharing. The inventive ideas and possibilities of where it can go and what it could do, the rules and regulations surrounding this area of healthcare, the privacy and concerns, etc. Today we are going to focus on the innovative technologies and standards that are currently being employed to make our dreams of a better system of interoperability and data sharing a reality.

We reached out to our brilliant Healthcare IT Today Community to ask, what innovative technologies and standards are being employed to enhance interoperability and data sharing, and how are these advancements influencing the accessibility and quality of healthcare services? The following are their answers.

A crucial aspect of health care is data integrity—ensuring that health information is high quality, accurate, and complete. Not only does this information affect the immediate care patients receive, but it also can influence their future health care. Additionally, high-quality data can be integral in implementing positive public-health efforts and reducing health care costs.

For The Record»

Among the many weaknesses laid bare by the COVID-19 pandemic was the lamentable state of web accessibility. According to the Bureau of Internet Accessibility (BOIA), 90% of US adults said the internet was “essential” during the pandemic. However, more than 97% of homepages tested by BOIA in 2021 had identifiable issues preventing them from conforming with the Web Content Accessibility Guidelines (WCAG), the international standard for digital accessibility.

This accessibility disconnect puts people with disabilities at a significant disadvantage; unable to schedule vaccines, communicate with their providers, or schedule appointments. Correcting this is one reason why web accessibility—declared a human right by the United Nations in 2016—has been elevated to a high-priority social determinant of health (SDOH).

While having different choices and options is an important part of life, some levels of standardization are easier, if not necessary. For example, we all have a favorite gas station based on where we live and what our price and snack preferences are, this is an area where having different choices is great. However, no matter what gas station you visit, all gas pumps have the same standard gas options with standardized octane levels, this standardization makes our lives so much easier and is crucial to having our cars work. In healthcare, being able to pick and choose which vendors, third parties, and technologies to use in our organization is very important. This freedom of choice allows us to customize our organizations to better serve our patients and staff. However, all of these different systems make it difficult to securely and reliably exchange data. Creating a standard for data exchange would make our lives significantly easier, but creating that standard isn’t going to be easy. Exchanging data isn’t something that we can merely measure out and agree on set parameters as we can for octane levels in gas. There are a lot of factors in play that make this much more complicated, but what exactly are those factors?

High-quality, reliable data is crucial to getting most things done in healthcare, especially for healthcare interoperability. However, having the data alone isn’t enough – we need to be able to share our data between healthcare entities. Without having the same data sets, how else are our organizations and different healthcare entities supposed to work together seamlessly? We’ve made some great strides in improving interoperability, in no small part due to the Trusted Exchange Framework and Common Agreement (TEFCA).

So let’s take a moment to check in and examine the current state of healthcare – how is interoperability in healthcare advancing and what role does TEFCA play in facilitating seamless data sharing among healthcare entities? We reached out to our brilliant Healthcare IT Today for their insights into this question, the following is what they had to share.

A patient’s risk within social determinant of health (SDOH) domains is typically assessed by social care and healthcare professionals through either conversation, standard screening questionnaires, or validated testing instruments. The challenge is the lack of consensus on which specific domains should be assessed for patients – and how they should be assessed.

Artificial Intelligence and Machine Learning are two vast topics of discussion as we work on implementing these tools into a multitude of areas in the healthcare space. So lets narrow that down a bit and focus on Revenue Cycle Management. We reached out to our brilliant Healthcare IT Today Community and asked them – where is true AI and machine learning being used to improve revenue cycle management? The following are their answers.

Making well-informed decisions is very important in the healthcare space, especially for areas that are necessary for your organization to function, like revenue cycle management (RCM). The best way to make sure that we have all of the information we need to make the best possible decisions is through data analytics and business intelligence tools. To get more insights on how these tools impact RCM, we reached out to our talented Healthcare IT Today Community to ask them – how does the integration of data analytics and business intelligence tools contribute to proactive decision-making in revenue cycle management, and what key performance indicators are being monitored to assess financial health? The following is what they had to share.

One of the leading causes of burnout in the healthcare industry is the overwhelming amount of tasks that need to be completed without nearly enough time to do them. And unfortunately, this is a problem that only compounds on itself. The more that you have to do, the more overworked and overwhelmed you get, which means you start to make mistakes and therefore have more work that needs to be done as you now need to go back and re-do your previous work, and the cycle continues until something breaks. This is why implementing advanced technologies and automation into healthcare is crucial for your staff’s and your organization’s wellbeing. So what does that look like for revenue cycle management?

In the aftermath of the cyber-attack on Change Healthcare by the BlackCat ransomware group, a renewed interest has emerged in protecting operations and ensuring contingencies are in place.  For impacted providers, the financial fallout from the attack is estimated at $500 million to $1 billion per day and climbing, driving home the fact that business continuity is everything in the aftermath of a cyber-attack.

Presently, many healthcare organizations remain in limbo after the attack, which exposed 6 terabytes of sensitive patient data, without access to important services such as claim processing for prescriptions, and daily workflows around auditing and reporting. While Change is working to fully restore the more than 100 applications across pharmacy, medical record, clinical, dental, patient engagement, and payment services it was forced to disconnect, recovery will be a long, slow, painful process for all

Efficient patient access is paramount for physician practices in today’s evolving health care environment. When patient access and financial clearance processes are outdated, the resulting inefficiencies create delays in the patient’s journey from initial contact to care access – delays that contribute to revenue leakage and can impact patient satisfaction.

Yet many physician groups are struggling to streamline and improve patient access operations, thanks in part to chronic staffing shortages, rising patient volumes, and more complex prior authorization requirements. As a result, they are falling short of core financial clearance benchmarks.

The prior authorization process has evolved in complexity as the healthcare industry transitions from fee-for-service to value-based care. At the same time, payers are expanding the number of services subject to prior authorization to establish medical necessity and appropriateness. It’s a one-two punch that leaves providers and provider organizations struggling under the weight of a prior authorization burden that, left unaddressed, can have long-term revenue cycle impacts.

Today’s prior authorization process involves time-consuming steps, including gathering and submitting medical documents to insurance companies and waiting for approval. It also often involves dealing with denials and appeals – all while guidance around required documentation becomes stricter.