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Revenue Cycle Management Self Help

Accounts Receivable is one of the less popular items of business on the agenda at any practice meeting. Money owed is a disheartening subject.

Administrators have the often thankless task of preparing AR reports for meetings, and this regular task can take a large portion of a work day.  Additionally, determining the status of claims in progress can be difficult when trying to collate report information, or when just finding out where you stand with regard to certain claims. This can involve long hours on the phone, being placed on hold for extended periods, being passed around departments, or waiting for the person on the other end to track down the information you need. This is frustrating and inefficient. Thankfully, this does not always have to be the way it goes.

With the swing toward technological solutions many claims payers are now realizing the benefits to them and their clients of providing easy access to claims information through dedicated claims web portals. If your claims payer has such a thing, it  makes following up a breeze. Simply go to the web site and log in, then enter the claim number(s), and real-time claims data is pulled live from the database ready to read or print. This can eliminate the need to pick up a phone and wait, potentially saving many hours of frustrating and wasteful time on hold. It is more flexible, more responsive, and more accurate. Quick answers to simple questions are often only a few keystrokes away.

New claims portals are coming on line each month as insurers realize they need to keep up with their technology or risk losing business. It is worth checking with your own payer(s) to determine whether they already have a portal, or if they are planning to launch one, and when. If they do, you could save yourself some a lot of time and effort. If not, you may add your voice to those of others making the same request of them: Give us a portal. Such customer pressure will likely encourage more urgent attention to the matter. If not, you may choose to investigate your options and see if you can take your business elsewhere, and self-help your practice to better AR results.

2016 HHS Budget Highlights

The Department of Health and Human Services (HHS) budget for 2016 runs to 158 pages. Available in full as a PDF from the HHS web site it covers the entire spectrum of healthcare expense and was presented at a recent press conference by Secretary Sylvia M. Burwell. At 158 pages the entire budget is far too complex to analyze in a blog post, so here is a handy graphic, provided by the HHS, which breaks out the gross overall percentages.

budget2015As expected, the lion's share of the budget is given over to the Medicare and Medicaid incentive programs. During her delivery Secretary Burwell advised the expectation that the proposed changes in this budget would, across the board, save the American public $250 billion over the next ten years. The budget states that the Affordable Care act remains a prime focus and aims to offer health insurance coverage to millions more Americans than would otherwise be able to afford it. Growth in technology and healthcare infrastructure will ensure that all those additional millions of Americans will also be able to access it easily.

Significant funding has been earmarked for Health Centers, the Children's Health Insurance Program (CHIP), and a $14.2 billion investment which aims specifically to "bolster the nation’s health workforce and to improve the delivery of health care across the country." An additional $1 Billion has been requested for research and development into new technologies, cyber security, new medicine, and the expansion of the Centers for Disease Control (CDC). Along with many other new initiatives, the budget includes provision for reforms to the Graduate Medical Education program grant system, with a focus on teaching hospitals and facilities, quoting investment support for over 13,000 residents over the next 10 years.

An extra $6.3 billion has been allocated to extending the enhanced Medicaid reimbursement rate for primary care services through to December 31 2016, to encourage provider participation. Noticeably exempt to this funding program are emergency department care units. The Medicare primary care incentive program, which was until now set temporarily at a figure of 10 percent, has been made permanent.

Practical Patient Portals for Better VDT

Meaningful Use Stage 2 this year introduces the core requirement for participating hospitals and physicians to provide ways for patients to access their personal health information online. Specific and separate targets are set for patients to View, Download, and Transmit (VDT) their health data. In other words, practices and hospitals must provide a way for patients to use the Internet to VDT their information.

This is often achieved using a dedicated web site, known as a patient portal. However, not all portals are created equal. Some are poorly laid out and confusing. Some use illegibly small fonts and navigation. Some bury important relevant information so deep inside the portal they make it hard for visitors to easily find the data they require. Some use unnecessarily complex and convoluted verbiage that makes comprehension difficult for most, and particularly so for those of limited education, reading ability, or undergoing a wide range of medical treatments.

The challenge for any portal is to make the patient experience simple enough for non-technical patients to use, while at the same time protecting their security. This is not easy. Think of the many web sites you personally visit. Think which are a joy to visit, and then think of those that frustrate and confuse, the ones you swear you will never return to. More so than any other demographic, site accessibility should be considered a priority for your patients. And for your own bottom line.

Take for one practical example a patient with poor eyesight. It is important that that patient is able to read the pages they visit. Large, clear text will help here. Sites can also be coded specifically to enable their pages to be read aloud screen reading programs. Use of drop down menus rather than type-in-text fields will assist those with dexterity, dyslexia, or other issues. Use of point-click date entries will speed things along, ensure correct data input, and also make things easier for the user. In the example of patients with behavioral or mental health issues, clarity of text and clearly laid out content will prove invaluable. Do not overcomplicate unnecessarily. All these small things combine to turn an annoyingly frustrating patient portal into one that is a pleasure to visit, one that will encourage your patients to use it and keep coming back.

Simply providing a portal is not sufficient. Getting patients to visit your portal is not sufficient. To meet those all-important VDT requirements, practices and hospitals need to ensure that their visitors can go beyond the first page and successfully view, download, and transmit the information they came in search of. If they cannot, or do not, MU Stage 2 VDT requirements will not have been achieved no matter how many patients actually visit the portal. And this will cost your organization some valuable incentive payments.

Re-examine your patient portal through the eyes of your patients to determine what can be done to rework and redesign your patient portal to better suit their needs, and you will maximize patient usage and thereby your VDT numbers.

Practitioners Favor Revenue Cycle Management

A 2013 Black Book study, 'Top Physician Practice Management & Revenue Cycle Management: Ambulatory EHR Vendors' surveyed over 8000 CFO's, CIO's and administrative support staff from a wide range of hospitals and medical practices.

Results showed that 87 percent of those surveyed agreed their billing and collections systems needed to be upgraded, with the majority favoring the move to an integrated EMR and practice management system that includes RCM features.

42 percent were thinking of upgrading within the year, and an overwhelming 92 percent would only consider a software vendor that provided a complete solution which included EMR, RCM and practice management. Outsourcing of RCM to third-party services was less popular, as many practices moving from paper systems felt they would need all three components, and could actively save money by purchasing integrated systems. 72 percent of practices expected negative profitability due to inefficient manual billing processes and technology.

Black Book statistics showed that the revenue cycle management service industry generates in excess of $12 billion per year. This will increase in 2015.

While many practices have made the move to EHR, practice management and RCM integrated systems, many have still to do so. The market for RCM, whether integrated or outsourced, continues to grow.

Report Says ICD-10 Costs Will Be Lower Than Expected

According to a recent study published in the Journal Of The American Health Information Management Association, ICD-10 implementation costs can be expected to be significantly below previously estimated figures for smaller practices.

The research behind the report was done by the Professional Association of Health Care Office Management (PAHCOM). 276 practices with fewer than six providers were polled. Although 276 is a relatively small sampling in relation to the nation as a whole, PAHCOM has Chapters and members in many US states from coast-to-coast. Across this diverse population they found that ICD-10 implementation costs per provider averaged $3,430, and the costs to the practices themselves averaged $8,167.

PAHCOM Director, Karen Blanchette, said in a prepared statement that "Our members reported actual data on expenses to date and costs still remaining. The PAHCOM survey is the most comprehensive and current data on ICD-10 implementation costs actually being incurred by small physician practices."

While not small numbers, these actual figures fall far below previous theoretical estimates, indicating that real world numbers are very favourable to ICD-10 adoption. These smaller dollar amounts are significantly offset by the incentive payments they bring in. Many practices may cover their costs in the first year. Some may even make a profit. Of course, after the actual implementation costs are covered in the first year, every incentive payment from that point onward  is gravy.

In comparison, a 2014 report by Nachimson Advisors estimated that costs would be in the range of between $22,560 and $105,506. It should be noted that these numbers were estimates, not actual figures, as in the PAHCOM study.

There is much division on the matter of ICD-10 implementation costs. Some strongly believe the ICD-10 transition in October will actually put many doctors and their practices out of business. This report, based on actual reported numbers rather than cost projections, may serve to allay some of those fears.

Much of the cost savings are directly attributable to the recent rapid adoption by smaller practices of electronic health record systems (EHR) which reduce much of the practice work load by automating much of the paperwork and administration required for ICD and Meaningful Use attestation. In effect, they are proving even more effective than initially predicted as more are adopted throughout the healthcare sphere.

Prepare Now For ICD-10 Later

October is closer than you think. The ICD-10 implementation date is only a few months away. Though it is possible there will be a further delay, nobody now really thinks it will happen. Even if it did, it is just delaying the inevitable. So healthcare providers need to be ready. And that goes beyond software.

Most software vendors either already have or soon will transition to accommodate the ICD-10 coding system. The software will be ready. The question then becomes, will those that use the software be ready?

Research shows that dual coding (coding simultaneously in ICD-9 and ICD-10) can be a valuable training tool which significantly increases productivity by allowing coders to absorb the new coding system over time, so that when the October deadline arrives these advance-trained coders will see the change as just another day at the office.

Comparatively, based on studies in other countries which have actually adopted ICD-10, statistics indicate that a productivity loss of between 40 and 60 percent for inpatient coding and 20 percent for outpatients can be expected, where no training has been applied. Translate that into patient throughput and revenue streams and the benefits of advanced ICD-10 staff training become very clear.

Incorporation of a dual coding initiative is one simple way to prepare for the ICD-10 transition, one which can be implemented well in advance of the October deadline, and one which will minimize impact to practices, practitioners and patients alike. Discuss dual coding with your software vendor. It may be far easier to implement than you think and could potentially save you time, money, and unnecessary worry.

Michigan Medicaid Mobile Health App and Portal

In what they claim to be the first of its kind, the Michigan Department of Community Health (MDCH) and CNSI today announced the launch of an interactive mobile app and online portal which will allow members secure access to their health information and medical records. The App, myHealthButton, is now available for free on Android and iOS at the usual locations. The portal, myHealthPortal, provides web browser access to the same medical data via their desktop computers.

To enroll in this new system users must first be registered members of one of the Michigan Medicaid, Children's Special Healthcare, or MiChild programs. Members may register online by visiting https://milogin.michigan.gov and following the instruction there to create a User ID and Password. Questions regarding either the App or the portal should be directed to the Beneficiary Help Line at 800-642-3195.

The MILogin system used for both the app and the portal is secured and managed by the Michigan Department of Technology, Management and Budget (MMDTM). MMDTM Director David Behen said "Meeting the demands of an ever-increasing technology-driven society is a top priority for state government. This innovative approach to providing Michigan residents with easy access to their own personal information is a great example of utilizing technology to meet those needs."

The state of Michigan and CNSI have worked together since CNSI designed and implemented the Michigan Community Health Automated Medicaid Processing System (CHAMPS). The two have since collaborated on other healthcare initiatives including the management of the Medicaid Management Information System (MMIS), as well as leading efforts to comply with the Affordable Care Act, ICD-10 implementation, Medicaid Compliance Program and consumer engagement initiatives.