Client News Coverage

Identity queue management is an important aspect of an effective value-based care strategy. It lays the foundation for establishing an effective person index, minimizing overlays, and facilitating streamlined care coordination. Left unresolved, backlogged work queues can have costly implications for patient care and safety, as well as revenue integrity.

However, many provider organizations are struggling to stay ahead of burgeoning identity error queues, with health system clients reporting that weekly error tasks have more than doubled. At one health system, the volume of potential overlays queue swelled from 2,000 per week to more than 5,000 per week over the course of just a few months, while another organization found itself dealing with a backlog of 100,000 identity interface errors. The health information management (HIM) director at a third health system shared that his team evaluated up to 400,000 potential overlay tasks in the last year to identify just 60 true overlays.

Optimizing financial clearance and other patient access operations is an important aspect of any strategy to offset revenue cycle issues that are behind more than half of all claim denials. Healthcare organizations struggle to do so, however, thanks to staffing and technology limitations that impede efficient operational processes and increase front-end authorization errors.

Those barriers are starting to crumble as artificial intelligence (AI) and automation become more deeply embedded in healthcare revenue cycle management (RCM). Of particular note is the emerging subset of tools designed to streamline and expedite aspects of financial clearance operations, including eligibility and benefits determination and prior authorization processes. Early adopters of these intelligent authorization tools are reporting rapid return on investment (ROI), including 70% to 85% faster eligibility and benefit determination and 85%-90% improvement in authorization determination time.

The Office of the National Coordinator for Healthcare Technology has completed its final health IT certification rules and the U.S. Health and Human Services Agency has sent the document to the Office of the Federal Register for publication.

The Health Information Management Systems Society and Electronic Health Record Association weighed in with initial thoughts on the industry's concerns voiced during the comment period.

With approximately half of all denials resulting from front-end revenue cycle issues, optimizing patient access operations – in particular financial clearance processes – is crucial to the financial health of today’s hospitals and health systems. For many, achieving that goal has been hindered by staffing and technology limitations that impede efficient operational processes and increase front-end authorization errors.

However, as artificial intelligence (AI) and automation make their way deeper into healthcare revenue cycle management (RCM), we are seeing an emerging subset of tools capable of streamlining and expediting many aspects of financial clearance operations including eligibility and benefits determination and prior authorization processes.

The finding from the latest “MDaudit Annual Benchmark Report” found that external payer audits rose significantly compared to last year as Recovery Audit Contracts (RACs) and Medicare Administrative Contractors (MACs) sought to reign in overpayments made over the last two to three years. Additional Documentation Request (ADR) letters also became longer, with some providers reporting ADR letters over 100 pages long.

The report said long ADR letters can make it challenging for providers to parse and file appeals in a timely manner, putting healthcare revenue at risk.

MDaudit recently released its 2023 Benchmark Report on the trends, challenges, and opportunities being encountered by healthcare organizations in the United States.

Crucial needs emphasize that healthcare systems must proactively navigate an evolving landscape with cross-functional collaboration, technological innovation, and increased artificial intelligence (AI) investments to safeguard revenues. Going into 2024, operational excellence is the table stakes for healthcare organizations to improve bottom lines – and where AI and automation can provide a boost in productivity and costs.

MDaudit announced today the release of Service Provider Workflow. This latest enhancement to its industry-leading billing compliance and revenue integrity platform supports billing when rendering providers differ from service providers, reducing audit risks related to the billing of split/shared services.

Under changes to its Evaluation and Management (E/M) guidelines, the Centers for Medicare and Medicaid Services (CMS) require split/shared services — which are performed jointly between a physician and a non-physician practitioner (NPP) in the same group and in a facility setting — to be reported by the clinician who performs the substantive portion of the patient visit.

Wellesley, MA — November 3, 2023 — External payer audits quadrupled in volume in 2023, making timely responses more challenging than ever for resource-strapped healthcare organizations. Though patient volumes and surgeries have begun to recover from COVID-19 declines – with a 23% and 27% increase over 2022 – inflation, staffing shortages, reimbursement, and regulatory issues continue to jeopardize the financial health of healthcare organizations nationwide. These were among the key findings of the 2023 MDaudit Annual Benchmark Reportreleased today by MDaudit, an award-winning provider of technologies and analytic tools that enable the nation’s premier healthcare organizations to minimize billing risk and maximize revenues.

With artificial intelligence (AI) infiltrating nearly every aspect of modern life, the once-revolutionary Industry 4.0 concept centered on AI, automation, robotics, and other technological advances has given way to Industry 5.0 and its focus on resilience, sustainability, and societal versus economic value – including the human-centric nature of putting people at the center of the organization.

Instead of shareholder value, Industry 5.0 emphasizes internal and external stakeholder partnerships within an organization. Internally, this reflects workforce diversity and workflows wherein AI, automation, and other digital tools support rather than replace employees. Externally, it emphasizes the organization’s positive impact on society, its ability to serve rather than merely sell, and its capacity to enhance resilience while delivering sustainable outcomes.

Workflow»

Autonomous coding can help streamline revenue cycle processes and reduce administrative burden, but over half of surveyed healthcare finance leaders are not familiar with it, while others do not fully trust the automated tool.

A survey from the Healthcare Financial Management Association (HFMA), commissioned by AGS Health, asked more than 450 healthcare finance professionals about their knowledge of and expectations for autonomous coding.

Among the key benefits of autonomous coding is its ability to eliminate the potential for human errors that result in missed reimbursement opportunities, backlogs, delays, and claims errors, and its ability to push accuracy levels to near-perfect percentages. All of which can be achieved in near real-time with the right integration pipelines. Autonomous coding is also faster than its human counterparts – it can complete charts in seconds – yet it also understands what it does not know, flagging it for human review.

WASHINGTON, D.C. – October 26, 2023 – Autonomous coding enjoys a high level of trust among healthcare finance professionals who use or plan to use the technology, with 45 percent indicating it often works well and 16 percent placing complete trust in it. Yet despite its emergence as a powerful tool for streamlining and improving error-prone manual coding processes, autonomous coding suffers from an awareness problem, with 52 percent saying they do not know what it is.

Those are the findings of a new survey from the Healthcare Financial Management Association (HFMA) on behalf of AGS Health, a leading provider of tech-enabled revenue cycle management (RCM) solutions and strategic growth partner to healthcare providers across the U.S. More than 450 healthcare finance professionals were surveyed during the 2023 HFMA Annual Conference on their knowledge of and value expectations for autonomous coding, including 60 percent that use or plan to use autonomous coding.

Healthcare organizations are in a precarious financial position. With operating margins still hovering near zero, revenues are at heightened risk because of a surge in third-party audits following the expiration of the public health emergency as well as increased scrutiny by federal and commercial payers alike to identify – and recover – billions in improper payments and penalties.

This sharp uptick in audit activity has many healthcare organizations – even those that have already adopted revenue cycle management (RCM) technologies to streamline workflows – struggling to comply with both the volume of incoming documentation requests (ADRs) and the timeframes within which they must reply.

The Centers for Disease Control and Prevention (CDC) has released the ICD-10-CM code updates for the 2024 fiscal year (FY), which became effective on Oct. 1, 2023. The update includes over 433 diagnosis code changes, including 395 code additions, 25 code deletions, and 13 code revisions. This brings us to a total of 78,044 codes in the ICD-10-CM code set for FY 2024.

It is essential for coding professionals and all applicable team members to keep up-to-date with these annual code changes, understand how to apply them and recognize any new documentation requirements.

ICD 10 Monitor»

Recent upturns in operating revenues haven’t shifted hospital finance executives’ laser-focus on revenue growth and retention, part of which is putting a stop to revenue leakage. That includes rooting out what are often unexpected sources as part of a holistic revenue cycle management (RCM) strategy – like inaccurate patient identification and information.

Patient misidentification issues cost the average healthcare facility $17.4 million per year in denied claims and lost revenue and cost the U.S. healthcare system over $6 billion annually. According to the Ponemon Institute, about 35% of denied claims incurred by hospitals each year can be attributed to inaccurate patient identification or inaccurate/incomplete patient information, adversely affecting both cash flow and AR days.