Client News Coverage

One of the major challenges to maintaining data integrity is accurate patient matching—ensuring that an individual is connected to the correct medical record—which also can directly affect care. “This problem of patient matching has been around for decades,” says Joaquim Neto, chief product officer at Verato. “HIM professionals have been struggling with it for years. The ecosystem of data is so much more complex now. That has only made the record-matching problem worse, despite organizations having sought primary EHRs from a single vendor. Because there are so many innovative technologies that need to integrate with EHRs, the patient-matching problem is bigger than it’s ever been before.”

In part one of this two-part explainer on IT innovation, we focussed on the necessary traits to drive innovation and key strategies to build success. It’s always important to ask a few questions when planning on change and innovation. What are you attempting to create, what do you want to build in service to your organization or customers, and which direction or priority do you desire to take? In so doing, note your team’s achievements, then celebrate them. This time is a great time to determine what is working, what areas missed the mark, and how to take steps to improve.

The best time to rework a denied claim is before the claim is ever submitted.

According to MDaudit research, up to 80% of all denial dollars can be traced to just 20% of claims. Most of these denied claims stem from systemic issues that can be solved through retrospective diagnostics and predictive analytics.

Identifying and correcting issues that impact denials on the front end can help providers protect their revenue streams, which remain under threat from high costs, tight labor markets, and increased federal efforts to scrutinize spending more closely.

A strong business case exists for addressing the financial impacts of social determinants of health (SDoH) and new reimbursement models designed to emphasize health equity. Involving revenue cycle management (RCM) is necessary for any comprehensive SDoH/health equity strategy.

This is because health disparities contribute more than $93 billion in unnecessary medical care costs and more than $42 billion annually in lost productivity. Additional economic losses are a result of premature deaths. Further, according to the W.K. Kellogg Foundation, eliminating these inequities by 2050 may erase more than $150 billion in unnecessary medical care.

Welcome to the weekly edition of Healthcare IT Today Bonus Features. This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job.

With 82% of 2022 claims denials associated with Medicare, and third-party audit volume rapidly climbing, hospitals and health systems are under intense pressure to protect and grow revenues.

These were among the key findings of the 2022 MDaudit Annual Benchmark Report released today by MDaudit, the healthcare technology company that harnesses the power of analytics and its proven track record to allow the nation’s premier healthcare organizations to retain revenue and reduce risk.

With 82% of 2022 claims denials associated with Medicare, and third-party audit volume rapidly climbing, hospitals and health systems are under intense pressure to protect and grow revenues. These were among the key findings of the 2022 MDaudit Annual Benchmark Report released by MDaudit, the healthcare technology company that harnesses the power of analytics and its proven track record to allow the nation’s premier healthcare organizations to retain revenue and reduce risk.

“Our analysis suggests that the post-pandemic era has given rise to a new phenomenon for healthcare. Medical spending is more discretionary for consumers impacted by inflation, driving dramatic reductions in revenues generated by physician office and hospital visits for the third quarter of 2022,” said Peter Butler, President and CEO, MDaudit. “Exacerbating this situation is the need to successfully defend against more third-party audits amidst chronic personnel and resource shortages.”

The Centers for Medicare and Medicaid Services (CMS) has made no secret of its intentions to crack down on fraud, abuse, and waste, throwing more budget dollars into audits, heightening program integrity oversight of Marketplace plans, and exploring new methods of using advanced technology to conduct more rapid and thorough documentation reviews.

Historically, as CMS goes, so do commercial payers, putting healthcare organizations in the crosshairs of an unprecedented level of third-party external audits. To emerge relatively unscathed, organizations need to put in place proven processes that guide immediate and effective actions in the wake of adverse findings.

With potential outcomes such as patient identification errors, repeated care, redundant medical tests, and denied claims, patient record duplication costs healthcare systems billions of dollars each year. This critical hindrance stems from inconsistent naming conventions for patients across disparate health systems and hospitals and poor-quality data sets that lack critical identifying information on a patient. At the same time, the rise of self-registration/scheduling patient portals is hindering tech-driven patient matching algorithms from generating desired results; for instance, untrained users often incorrectly fill required fields, resulting in the aforementioned discrepancies. As a result, most hospitals today face errors in their Master Patient Index (MPI), leading to increased costs and dire complications.

Maintaining patient data integrity is more complicated than ever; cybersecurity threats loom, patients are taking more ownership of their care (self-registration, for example) and health system merger activity is on the rise. It can make the quest for the ever-elusive 1% maximum duplicate rate seem, at times, unattainable.

But a secure, accurate, and duplicate-free MPI/EMPI can be achieved. It just requires a multi-pronged approach to protect data throughout its journey into a health system and at every touch along the way.

David Bucciferro, vice chair of the HIMSS Electronic Health Record Association and co-chair of its Opioid Crisis Task Force, demonstrates how electronic records can help providers keep their patients safe.

Exacerbated by pandemic-induced burnout, resignations, and even terminations¹, chronic coding and revenue cycle management (RCM) staffing shortages have healthcare organizations struggling to find ways to keep revenue flowing despite a lack of qualified professionals to handle critical processes. It is a situation that has been brewing for years, as too few qualified professionals are entering professions that are expanding more rapidly than ever before.

The American Health Information Management Association (AHIMA), the American Medical Informatics Association (AMIA), and the Electronic Health Record Association (EHRA) announced today the release of a final report that examines key issues related to operationalizing the definitions of “electronic health information” (EHI) and “designated record set” (DRS). The report is intended to serve as a resource to assist providers, health IT systems, health information exchanges, and health information networks in complying with the information blocking provisions of the Cures Act Final Rule.

Engage Venture Partners, a Minneapolis-based venture capital firm, recently launched with a focus on early stage medical tech companies. The firm was established to decrease friction between early stage medical tech companies and their investors by bringing its investments to market via special purpose vehicles (SPVs).

Health care organizations are increasingly turning to corrective action plans (CAPs) to address suboptimal audit findings and correct any internal processes and/or billing practices that contributed to identified issues quickly and efficiently.

More than simply road maps to mitigate or remediate the circumstances or conditions that contributed to problematic audit findings, CAPs also help health care organizations reduce future billing compliance risks—and significantly enhance their ability to achieve revenue integrity.