From the Consultant’s Corner 12/19/17

Revenue Integrity – A Critical Factor for Revenue Cycle Success

Most healthcare organizations recognize the need for improving the efficiency and effectiveness of their revenue cycle operation. Efficiency refers to reducing the operational costs associated with billing and collections. Staffing and systems are the major expense categories. Effectiveness relates to maximizing cash collections and improving the timeliness of which that cash is collected. Revenue Integrity adds a third dimension to the discussion of revenue cycle performance. Revenue Integrity refers to the thoroughness, timeliness, and accuracy of the charge capture and coding processes.

An effective revenue integrity program ensures that every billable clinical activity is properly captured, coded, and billed in a timely manner. This starts the process by which clinical services are converted into cash.

The benefits of a revenue integrity program include:

• Reduction in lost or missing charges resulting in enhanced charge volumes.
• Reduction in charge and claim lag resulting in accelerated cash collections.
• Improved clean claim rate resulting in reduced costs of collections and accelerated cash collections.

Traditional revenue cycle operations have historically been split between “front-end” or patient access-related activities (i.e. registration, scheduling), and “back-end” billing and A/R management functions. A revenue integrity program incorporates clinical workflow, and the actions and concerns of physicians and nurses into the revenue cycle. Clinical documentation, diagnostic and procedural coding, and the submission of charges are all generated within the clinical workflow, yet performance often appears on back-end revenue cycle reports. The result too often is that accountability falls on the billing office, yet the real performance improvement opportunity rests outside of a billing director’s direct control. Engagement of clinical staff into the overall revenue cycle truly integrates clinical operations and financial performance, assigns accountability to the proper source, and provides appropriate and actionable education to capitalize on improvement opportunities that benefit the entire organization.

As revenue integrity programs have matured, revenue cycle and financial leadership have incorporated new Key Performance Indicators to monitor the integrity of their revenue. These metrics provide a more granular analysis of common measures such as denial rates and A/R days, in order to address performance improvement opportunities directly at their source. Examples of metrics used to measure revenue integrity performance include:

• Medical Necessity Denial volume and charges.
• Charge lag and claim lag, and the degree of manual intervention to resolve pre-bill coding and claim edits.
• Discharge Not Final Billed.
• Documentation that supports 100 percent of all charges.

As referenced earlier, monitoring these indicators would be a fruitless exercise if physicians and nursing staff were not engaged in the process. Billing managers alone would have minimal ability to reduce medical necessity denials resulting from lacking diagnosis information. Reviewing this information with physicians, informing them of the financial impacts of lacking information, and engaging the EHR teams to optimize clinical documentation tools would be a much more effective approach that benefits all parties, including the patient.

To develop a sustainable revenue integrity program, or to improve the effectiveness of an existing RI program, I recommend the following activities:

• Define goals, objectives, and scope for the program.
• Develop a project plan.
• Track and implement the project plan.
• Design the organizational chart, with resource requirements.
• Define roles, skillsets, and workflows within RI.
• Create relevant RI job descriptions for human resources.
• Identify and acquire tools needed for the department’s optimal performance; e.g. software coding references, library of coding books.
• Develop RI workgroups and a steering committee to include key leaders from IT, clinical operations, compliance, RCM, and finance. (Depending on specific objectives, you may want to include RI SME’s and analysts.)
• Identify and train RI charge capture resources (Charge Guardians) by departments and/or clinical product lines.
• Develop best practice RI policies and procedures, to be reviewed annually and revised as needed.
• Define baseline benchmarks and performance indicators to measure and trend performance over time.
• Develop and implement RI training program content and timelines for RI analysts and auditors.

Brad Boyd is president of Culbert Healthcare Solutions.

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News 12/18/17

Top News

An Atlanta business paper updates a story it published on Greenway Health’s layoffs last week, clarifying that the EHR vendor is only closing its Atlanta offices but will keep its Carrollton, GA offices open. Five hundred Greenway Revenue Services employees and those with other customer-facing functions will continue their work in Carrollton. The company will also hire another 100 RCM employees for that location in the next few weeks, and is hiring for its Tampa office.

Not to be deterred by conflicting layoff reports, the company announces top KLAS ratings for ambulatory RCM services among small clinics.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Denver-based house call company DispatchHealth brings its app-initiated services to Las Vegas. The company has raised nearly $35 million since launching as True North Health Navigation in 2013. Co-founders Mark Prather, MD and Kevin Riddleberger both seem to have spent overlapping time at ITriage, a consumer healthcare app acquired by Aetna in 2011.

Not to be outdone by the mega mergers of their hospital peers, Florida-based Primary Partners and Central Florida Affordable Care merge to form an independent group of 90 PCPs.

Net Health’s management team will acquire the specialty-focused EHR company alongside financial partners Level Equity and The Carlyle Group. Terms of the deal were not disclosed. Net Health CEO Anthony Sanzo spent 11 years prior heading up TeleTracking Technologies.

Government and Politics

Texas practices in areas impacted by Hurricane Harvey will not be subject to MIPS penalties thanks to the successful lobbying efforts of the Texas Medical Association.

Per the 21st Century Cures Act, OCR launches several new resources to help providers and patients better understand HIPAA and its role in sharing and protecting a patient’s mental and behavioral health information.

Telemedicine

An Australian nurse becomes his own patient when he begins experiencing chest pains while manning a telemedicine clinic in the remote area of Coral Bay. After calling an ambulance and prepping his own adrenalin and shock pads, he called in to a physician in Perth using the Emergency Telehealth Service. Bea Scichitano, MD was on her first ER shift when she took the video call. “I think it probably took me a few seconds to cotton on to the fact that he was the nurse and the patient at the same time,” she said, “so that was a bit of a shock.”

Other

No spoilers please: While I haven’t yet seen The Last Jedi, I am relieved to know that astronauts aboard the International Space Station will receive a digital copy they can watch via laptop or their on-board projector. Fun fact: The ISS has a digital library of over 500 movies (yes, including 2001: A Space Odyssey).

NHS researchers highlight the need for easy-to-understand patient educational materials when it asks nine year-olds to write up leaflets explaining the before, during, and after of hip surgery. Turns out statements like “Your hip is old and rotten” and “Coca Cola, fries, and chocolate are not allowed before surgery” are easier for patients to understand than the reading proficiency level used to write most patient-facing health pamphlets. Healthcare facilities in the US have also faced their fair share of health literacy miscommunications, with the HHS calling low health literacy levels an ongoing public health priority.

Bellevue Family Practice (NE) staff members get in the holiday spirit with an office decorating contest. I’d love to highlight more festive office spaces. Email me holiday-themed photos from your or your customer’s practice for inclusion in a post later this week.

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Population Health Management Weekly Wrap Up 12/17/17

The Chartis Group adds Carol Chouinard (Deloitte) as director of IT strategy and Tonya Edwards, MD (Impact Advisors) as a principal and member of the company’s Physician Leadership Institute.

Pennsylvania-based Penn State Health and Highmark Health cite development of advanced population health management capabilities, analytics, and care models as among the reasons they will pursue development of a $1 billion healthcare network that will see Highmark move under the PSH umbrella.

ApolloMed and Network Medical Management complete the merger they announced in December 2016. ApolloMed CEO Warren Hosseinion, MD and NMM CEO Thomas Lam, MD will become co-CEOs of the combined company, which will operate under the ApolloMed name.

The Medical Society of Delaware chooses HealthEC’s population health management system and services for its 900-doctor clinically integrated network.

Social determinants of health-focused care coordination technology vendor Healthify acquires community services software company Purple Binder. Healthify co-founders Eric Conner and Alex Villa graduated the startup from the Blueprint Health accelerator in 2013, and raised $6.5 million in a Series A funding round led by BlueCross Blue Shield Venture Partners last summer.

Wellness for Life will leverage Vital Incite’s population health analytics to help its workplace health centers and direct primary care clinics better understand and act on patient healthcare utilization patterns.

Population health management software vendor VirtualHealth raises $7 million in a Series B funding round.

Philips acquires Netherlands-based, 200-employee population health management software vendor VitalHealth Software, co-founded by Mayo Clinic and Noaber Foundation in 2006. The company expands the informatics work Philips started with its acquisition of Wellcentive in 2016. Philips acquired Netherlands-based interoperability software vendor Forcare last week.

To better serve its Medicaid members, Care1st Health Plan Arizona will leverage Equality Health’s CareEmpower care coordination technology and SDOH-focused services.

Citing an inability to come to agreement terms, Evolent Health decides not to purchase the insurance arm of Premier Health (OH) as announced last month.

Population health management systems vendor SymphonyCare acquires Influence Health’s Empower patient portal business.

In Maryland, the Howard County Health Department leverages Healthify’s SDOH-focused care coordination software as part of its new CAREAPP (Community Access to Resources via Enhanced technology Applications for Providers and Public) project.

A six-month chronic disease management pilot study conducted within the Massachusetts General Hospital primary care network finds that care improved more when specially trained population health coordinators with access to clinical registries were a part of the primary care team.

Sponsor Updates

• AdvancedMD is named a leader in Gartner’s “FrontRunners for Mental health” quadrant.

Blog Posts

• Fighting Cancer with CAR T and Big Data (Medicomp Systems)
• How Haitian high schoolers made me a better healthcare consultant (Nordic)

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News 12/14/17

Top News

Arizona Attorney General Mark Brnovich’s office will oversee the settlement of a lawsuit against Theranos brought under the state’s Consumer Fraud Act. Over 75,000 Arizona residents who received lab-testing services from the now defunct company between 2013 and 2016 will receive checks for about $60. Theranos will also pay $200,000 in civil penalties, $25,000 in lawyer’s fees, and will be subject to civil penalties. As readers may remember, Theranos went down in flames after a series of Wall Street Journal investigative articles prompted CMS to revoke its operating rights. The company admitted earlier this year that it’s lab didn’t deliver all that was promisedx.

Announcements and Implementations

Coinciding with its first anniversary, mobile health app collaborative Xcertia releases draft guidelines for app quality, safety, and effectiveness. Comments are due by the end of January. I’m still a little fuzzy on the value of such guidelines, other than as a branding/marketing tactic app developers will use in a fashion similar to “Energy Star” (though that at least is backed by a governmental body.) Xcertia seems to be doing its best to avoid using the word “certification.”

From the PRM Pro: Top 5 Technological Advances Improving Primary Care Communication

Top 5 Technological Advances Improving Primary Care Communication
By Jim Higgins

The relationship between a patient and their providers is the foundation upon which great healthcare is built. Strong patient relationships not only lead to higher ratings for physicians, but better outcomes for patients. Such widespread integration of technology in the healthcare world inevitably has an impact on the patient management of every practice—no matter the size. Technology is often painted as a cold, unemotional process that distances us from those around us. Because of this, many practices are hesitant to take advantage of the benefits it provides. Fortunately, however, nothing could be further from the truth. As noted in this article, multiple studies have shown that patients not only tolerate, but actually prefer medical practices that take advantage of modern technology.

The successful implementation of any healthcare technology is dependent on choosing the right technology. Practices must find ways to keep the human touch when using technology to connect with patients. Communication is one of the most important aspects of the patient-provider relationship. Technology should enhance, not take away, from patient communication. The following are five technological advancements that improve communication and help you meet your patient relationship goals.

Automation of communication. It can be challenging to communicate with patients at the right pace. You don’t want to under-communicate, but patients may not want you to over-communicate either. Automating communication allows you to ensure you have critical touch points while being considerate of patient preferences. Touch points such as appointment reminders, recall messages, birthday messages, and post-visit feedback can all be automated. Automation may seem like it eliminates the personal feel that is so important in healthcare, but the opposite is actually true. Automation ensures that no one will be forgotten. Messages can be crafted in such a way that they still provide that warm, friendly feel. And, finally, the pace can be set to consider the patient’s preferences.

Customized, on-going education. A critical method of ensuring positive health outcomes is on-going education. Every practice should send out regular newsletters and emails sharing health tips with patients. Customization of this on-going education can lead to even better results. Modern technology allows practices to group patients based on varying criteria. For instance, if you have a group of patients who all have diabetes, you can send out specific educational pieces on diabetes to only these patients. By making your educational pieces more targeted, you significantly increase the odds that patients will comply.

Online self-scheduling. Implementing self-service options gives patients more control over their healthcare, and improves patient satisfaction and health outcomes. One of the most effective self-service options is online self-scheduling. An Accenture survey noted that 77 percent of patients say that being able to schedule appointments online is important to them. Not surprisingly, it is expected that by 2019, around 66 percent of practices will offer online self- scheduling. This capability gives patients control over when and where they schedule an appointment. If an issue arises at 7pm, patients no longer have to wait until the next day to see if they can be fit in for an appointment. Their likelihood to return to a practice improves.

Digital Check-In. The growth of check-in tablets and kiosks has exploded. Self-service kiosks have become a regular feature in a variety of industries including retail, travel, entertainment, finance, and others. Healthcare is no exception. Kiosks give patients a sense of control. Seventy-five percent of patients in a recent study found that using a kiosk for check-in was faster than going through the receptionist. The majority wanted to use one again. Kiosks enable patients to save time and update information easily in a way that is comfortable and familiar to them. 

Telehealth. Studies consistently show the benefits of telehealth. One of the greatest advantages is the increased access to care for those in areas with a shortage of healthcare professionals – a phenomenon that is becoming all too common in rural parts of the country that already face a physician shortage.

Providing excellent healthcare depends on many factors, one of which is the ability to maintain strong, healthy relationships with patients. Beyond insurance affiliation, office location, and academic credentials, patients are looking for ways to connect with their provider. Technology provides the tools necessary to do just that.

Jim Higgins is the CEO and founder of Solutionreach in Lehi, UT.

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