Client News Coverage

FutureRx (FRx) announced today the launch of its first-of-a-kind healthcare platform for health plans and pharmacy benefits managers (PBMs) that combines modular technology solutions and, if needed, seamless access to pre-vetted fully integrated service providers on a single platform. FRx is a cloud-based, modular, user-configurable technology platform that was built from the ground up to meet complex and continuously evolving compliance requirements in today’s Medicare and Medicaid environment. As such, it is 100% compliant with government-sponsored regulations out of the box.

Once on the platform, health plan and PBM users can select from a full range of technology modules – including Rx Prior Authorization, Appeals/Grievances, Part D Stars, Drug Management Programs (DMP) and more – that are preconfigured out of the box with workflow and letters, and fully integrated with SureScripts and CoverMyMeds, as well as fax, phone, email, and mail capabilities that eliminate costly and time-consuming implementations.

Efforts to identify the right path forward for healthcare’s patient matching problem are gaining a foothold as stakeholders from across the spectrum come together to remove obstacles and implement effective solutions. Most notably, in 2022, efforts by industry organizations like Patient ID Now led to the temporary removal of Section 510 from the U.S. House and Senate Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) appropriations bills. While it was ultimately reinserted in the final version, its initial removal by the Senate was the first time that chamber had done so in 20 years – a significant achievement in the fight to eliminate the outdated rider barring funding of research into a national patient identifier.

Meanwhile, the Office for the National Coordinator (ONC) through its Project US@ collaboration with standards development organizations and other stakeholders issued the

A healthy, stable revenue cycle is crucial to every healthcare organization’s success. However, managing the revenue cycle takes experienced coders, complete documentation, and timely resolution of denials.

Administrative processes account for about 30% of U.S. healthcare costs, which means that all areas of a patient encounter, from check-in to billing and claims, are potential targets to obtain greater efficiency.

In its comments to the ONC on the draft QHIN, Participant and Subparticipant Additional Requirements SOP, the EHR Association recommends workforce authentication requirements be applied only to the Qualified Health Information Network workforce, with specific consideration given to participants and sub-participants who are not HIPAA-covered entities.

WHY IT MATTERS

The Office of the National Coordinator for Health Information Technology (ONC) is accepting comments on proposed requirements for QHINs, participants and sub-participants under its Trusted Exchange Framework and Common Agreement developed by the enlisted Sequoia project.

Industry groups and watchers have wide respect for the accomplishments over the past two decades of the Office of the National Coordinator for Health Information Technology.

Despite concerns about achieving interoperability across the industry and sometimes overly optimistic expectations about the industry’s ability to manage change, there’s widespread appreciation for the amount of change accomplished by the federal office.

The Office of the National Coordinator for Health Information Technology (ONC) has grown in its understanding, over time, about the breadth of technical capabilities and maturity of organizations that must implement regulations and technical requirements to achieve national goals.

This is not an easy process and ONC has shown a willingness to be open and learn about infrastructure capabilities across the healthcare ecosystem. This is particularly true in the pursuit of national interoperability, where a variety of health information technology (HIT) will be involved in the management and dissemination of all electronic health information.

Data governance was one of the major trends that shaped analytics in 2022.

Data governance isn't glamorous like augmented intelligence, machine learning or natural language processing. It's the grunt work of analytics.

But after many organizations suddenly realized the importance of data-informed decision-making at the start of the COVID-19 pandemic -- and have continued to recognize its value as world events like the war in Ukraine and repeated supply chain disruptions have resulted in ongoing economic uncertainty -- data governance is starting to be a critical need.

Leaders from EHR vendors such as Oracle Cerner and Meditech were named to the Electronic Health Record Association's executive committee for 2023.

Becker's Health IT»

Congress was full of good intentions when it directed the Department of Health and Human Services to make sure patients get their test results as soon as they’re available.

But the implementation of that directive has set off a battle between doctors on one side and HHS and patient advocates on the other, and raised a fundamental question: How should patients get bad news? The debate underscores how medicine’s digital transformation is changing the doctor-patient relationship and upending ingrained practices.

As 2022 draws to a close, many healthcare organizations are dealing with a unique double whammy – both on supply and demand. That’s according to our 2022 MDaudit Annual Benchmark Report, which found that as consumers cut discretionary healthcare spending and postpone medical visits, patient volumes began falling dramatically in physician office visits and hospitals. The 3rd quarter of 2022 saw declines as steep as 33% relative to the first two quarters.

Healthcare organizations are also under tremendous pressure to reduce compliance risk and optimize revenue flow, a feat that will require flawless optimization for billing compliance, coding, revenue cycle, and revenue integrity capabilities. Amidst the challenges, however, our analysis also revealed many opportunities for health systems to accelerate digital initiatives and drive sustainable value with analytics, automation, collaboration, and upskilling people.

This month’s roundup of surveys and reports from around the industry includes the 2022 National Healthcare Quality and Disparities Report, the No Surprises Act prevents more than 9 million surprise bills since January 2022, caregivers in financial precarity, uncertainty of healthcare costs deters 35% of American from seeking care for themselves, and more!

Health IT Answers»

In today's digital age, technology leaders possess a unique opportunity to drive growth and innovation by adopting certain traits and transformation strategies – ways of working and leading that provide real value and make a direct impact on outcomes for the team and organization.

Most importantly, success at driving innovation (IT or otherwise) hinges on whether leaders possess several skills, some of which might be surprising to see. Based on my experience, two are most critical. The first skill of effective IT leaders is working toward becoming a bilingual strategist with well-rounded business and technology acumen.

Every organization, regardless of its level of success, must continuously evolve and transform. It is a necessity for any organization that seeks to grow, but when the focus is on transformation through IT innovation, the results are particularly powerful.

Leaders driving the digital agenda require a holistic mindset of understanding the market and industry needs and executing digital initiatives that are oriented towards both the growth and value agendas that drives business outcomes. No longer is it enough for the CIOs and CTOs to define technology stacks, manage costs and select software vendors and tools. They must now also possess a strategic mindset to collaborate with business leaders as they reimagine their business models and execute digital transformations.

Healthcare organizations are always looking for ways to save money — so what if they could retain 15%-25% of overall revenue? It’s possible, using workflows designed to resolve issues in billing and coding before claims are submitted.

According to MDaudit research, claim denials increased across the board in 2022, both in terms of number of denials and the average amount of each denial. More than half of denied claims are never reworked – translating into $3.5 billion left on providers’ tables – and the price tag is hefty for those that are. The average cost to rework a claim is $25-$31. Consider the number of denied claims in a month and multiply that number by $25 to get a rough estimate of the additional funds your organization is spending to rework claims.

ICD-10-CM coding guidelines state that all documented conditions coexisting at the time of an encounter that require or affect patient care treatment or management must be coded as a diagnosis. As such, physicians must clearly and precisely document each diagnosis based on clinical medical record documentation from a face-to-face encounter, which means that diagnoses cannot be completely determined from test results and a patient’s past medical history.

For example, well-documented progress notes include the history of present illness, review of systems, and physical exam. They also detail the medical decision-making process. Each diagnosis must be documented in an assessment and care plan. To ensure this is the case, many organizations use the “MEAT” criteria—monitoring, evaluation, assessment, treatment—for their documentation practices, along with hierarchical condition category (HCC) assignments and ICD-10-CM diagnosis coding.