AGS Health, a leading provider of tech-enabled revenue cycle management (RCM) solutions and strategic growth partner to healthcare providers across the U.S., announced today the release of Intelligent Authorization, a single-source solution that automates and optimizes the financial clearance process and avoids prior authorization-related denials.
Part of AGS Health’s AI Platform, Intelligent Authorization streamlines and expedites processes by up to 90% through a variety of configurable automation solutions that improve operational efficiency, reduce costs, and enhance the patient experience.
“Half of all denials can be traced back to prior authorization and other front-end revenue cycle issues, jeopardizing provider organizations’ financial health and negatively impacting the patient experience by limiting transparency and delaying access to care,” said Matt Bridge, senior vice president of RCM Services, AGS Health. “Intelligent Authorization addresses the underlying issues causing prior authorization-related denials while streamlining and accelerating financial clearance processes. Customers report doubling production volumes and tripling the number of days in advance their patient access teams can secure authorizations, which in turn expedites appointments to better support patient needs and fill open time slots – resulting in improved revenue growth and an enhanced patient financial experience.”
A platform-agnostic solution, Intelligent Authorization prevents denials, reduces aged A/R, improves net revenue reimbursements, and increases clean claim rates across a variety of specialties, including radiology, oncology, occupational and physical therapy, surgery, and infusion/diagnostics. Compared to manual processes, it enhances productivity and reduces the time required for financial clearance activities, delivering:
75%-85% faster eligibility and benefit determinations
85%-90% improvement in authorization determination time
65%-80% less time spent on authorization initiations
75%-85% shorter authorization follow-up times
Up to 80% faster price estimations
Intelligent Authorization achieves these outcomes by automating eligibility and benefits determination processes, including order entries, scheduling, rescheduling, and monthly and annual re-verification processes. It automates authorization status via robotic process automation (RPA) and generates good faith estimates based on the fee schedule and embedded payer- and client-specific rules, which are then transferred back to the EMR.
Finally, Intelligent Authorization offers insightful and actionable analytics including self-service reports, customized dashboards, and flexible data management that enables users to view insights across different dimensions, create action plans, and make decisions faster.
“Smart workflow tools feature fast, flexible data transfers to the EMR through HL7, simplified task management and automated case assignment, and enhanced document management and accessibility, all of which come together in Intelligent Authorization to eliminate financial clearance issues created by error-prone, time-consuming manual processes,” said Suhas Nair, director of product management, AGS Health. “By leveraging the latest advances in RPA and AI technologies, Intelligent Automation helps healthcare organizations implement the tools needed to strengthen their financial footing and better service their patients.”
Harris Data Integrity Solutions, the leading provider of best-in-class patient data integrity services and software, announced today the appointment of Eric Helbig as vice president of sales.
He brings more than two decades of executive leadership to his role overseeing sales operations and designing and implementing sales strategies to expand the firm’s footprint among the nation’s leading hospitals and health systems.
“Eric’s expertise in change management, strategic marketing and sales planning, and performance optimization make him a great addition to the Harris Data Integrity Solutions leadership team,” said Lora Hefton, executive vice president of Harris Data Integrity Solutions. “His impressive track record of designing highly effective sales strategies and optimizing team performance are an asset as we continue to focus on expanding the reach of our innovative data integrity services and solutions.”
Helbig has deep roots in advanced sales, operations, Entrepreneurial Operating System (EOS), leadership team management, and national sales. Previously, he was director of enterprise sales and strategic partners for MedPro Inc., where he launched two new product verticals, expanded the company’s business and government process outsourcing footprints, and increased overall revenues by 19% in one year.
Past positions also include executive vice president with Pharma Logistics, regional franchise management-Midwest sales for ClearPayFS, and regional director of sales for EMG-First American Payment Systems. He holds a bachelor’s degree in international business management from Saint Louis University and is Six Sigma Yellow and Green Belt certified, as well as Sandler Sales Certified Silver and Bronze.
“I am thrilled to be joining Harris Data Integrity Solutions and working to expand its footprint in the critical patient data integrity market,” said Helbig. “Not only are patient identification and patient the foundation of quality patient care and safety, but a clean MPI is integral to effective revenue cycle management and advancing interoperability, as well as optimizing the impact of advanced health IT. I’m honored to have the opportunity to continue raising the profile of Harris Data Integrity Solutions and its ground-breaking suite of advanced technology solutions and services that address the many challenges associated with patient matching and data integrity.”
By Portia Cole, emergent threat researcher, Avertium.
Labeling ransomware attacks as a matter of life and death may seem exaggerated, but in the realm of healthcare, it has proven to be a harsh truth. In recent years, cases of patients whose death have been linked to ransomware attacks have started to emerge. With recent trends indicating a surge in attacks on the industry, it is possible the human toll could only grow.
That toll does not take a single shape. If past cyberattacks are any indication, ransomware attacks can lead to compromised care or no care at all, and studies have found even neighboring facilities can be negatively impacted. Here is an overview of what healthcare organizations and their patients have suffered thus far, and what your organization can do to protect itself.
Cyberattacks with huge costs
In what has been called the “first alleged ransomware death,” an Alabama woman arrived at Springhill Medical Center in July 2019 to give birth, unaware that the hospital had fallen victim to a ransomware attack the week prior. It had yet to be resolved, and as a result, the equipment that monitors vital signs wasn’t transmitting information to the nurses’ desks, leaving staff unaware that the baby was in distress.
The infant was born with the umbilical cord wrapped around her neck and suffered severe brain damage; she died nine months later. The delivering doctor expressed that had she been shown the monitor’s readings, she would have opted for a cesarean section; in a text to a nurse manager about the unfolding situation, she wrote, “This was preventable.” The mother filed a malpractice lawsuit.
A 2021 ransomware attack led to a different kind of death—the death of a hospital. St. Margaret’s Health in Spring Valley, Illinois, was the victim of a ransomware attack. After the attack, the hospital was unable to submit claims to Medicare/Medicaid or insurers for months, contributing to a financial crisis. The hospital announced it would close its doors in June 2023.
To maintain smooth operations, high-quality patient care, and regulatory compliance in the healthcare business, effective staff management is crucial. Time and attendance tracking is essential for any healthcare management team. This article delves into how the CloudApper AI TimeClock may revolutionize healthcare organizations’ time and attendance management using UKG (Ultimate Kronos Group) solutions, leading to more productivity and contentment on the part of staff.
Time and attendance can be difficult to keep track of in the healthcare industry due to the varying shift schedules and constant nature of operations. Inaccurately recording hours worked can have serious consequences for both payroll and patient care. By synchronizing efficiently with UKG Time and Attendance systems, CloudApper AI TimeClock provides a state-of-the-art answer to this problem.
Ensuring Compliance
It is of the utmost importance that healthcare facilities adhere to all applicable labor rules and regulations. To assist healthcare institutions maintain compliance and prevent expensive legal concerns, CloudApper AI TimeClock provides precise tracking of working hours, breaks, and overtime.
Reducing Administrative Burden
Administrative duties, such as manual time tracking and addressing attendance problems, consume a significant portion of healthcare HR professionals’ work. In order to free up HR professionals’ time for more strategic endeavors that boost patient care and staff happiness, CloudApper AI TimeClock automates these routine tasks.
Enhancing Employee Experience
In a field focused on patient health, a happy workforce is essential. With CloudApper AI TimeClock, medical personnel may clock in and out quickly and easily through the use of biometric verification, QR codes, or near field communication (NFC). The ease will boost morale and participation among workers.
Real-time Tracking for Better Decision-making
The CloudApper AI TimeClock provides up-to-the-minute access to attendance records. Managers in the healthcare industry may see how their staff’s attendance is trending over time, pinpoint problem areas, and make data-driven choices to better serve their patients.
By Marvin Luz, senior director of revenue services, Greenway Health.
Nearly all medical practices face the complex challenge of ensuring patient satisfaction while maintaining the engagement and well-being of their staff. The reputation and success of a practice hinges on continuous improvements being made to heighten patient satisfaction, however the service provided by the front office staff at each practice plays a significant role in ensuring performance goals are regularly exceeded and quality patient care is delivered.
To foster an environment that strengthens the importance of both increased patient satisfaction and staff fulfillment, it is important to first look within. Outlined in this article are three simple tips from Greenway Health that providers can implement for their front office staff members to boost staff morale and patient satisfaction.
Emphasize the importance of excellent customer service
According to MGMA, 52% of medical groups report scheduling or customer service as the top front desk training challenge. While great customer service is extremely important for medical practices, it is not always top of mind. The front office staff are the first people to connect with patients, so their focus should be on creating an excellent experience. Take the time to train front office staff on how to properly greet patients, handle requests, and communicate successfully.
To take it a step further, try cultivating a patient-centered approach. Encourage the front office staff to actively listen and show genuine interest in patient concerns. Additionally, consider implementing enhanced accessibility tools to the current healthcare service offerings like online appointment scheduling, patient portals, and telemedicine. By simplifying these front office administrative practices, patients will appreciate the user-friendly and accessible nature the practice has to offer.
As the healthcare industry continues to evolve, the integration of artificial intelligence (AI) has emerged as a powerful tool with the potential to revolutionize the way medical professionals work. Contrary to popular concerns, AI will not replace doctors and nurses; rather, it will complement their skills and make them more productive and effective. One significant area where AI will disrupt and bring about transformative change is the “back office” of hospital operations, where manual and outdated processes, along with fragmented systems, have been wasting countless hours of clinicians’ time.
The potential for AI to streamline and optimize various aspects of healthcare administration is vast. One key advantage lies in dramatically reducing the time physicians spend on researching and keeping up with their Continuing Medical Education (CME) and Maintenance of Certification (MoC) requirements.
Traditionally, physicians devote significant amounts of time to stay updated with the latest medical research and advancements, which can be an arduous and time-consuming task. AI-powered platforms can swiftly process vast volumes of medical literature, journals, and clinical trials, providing doctors with curated and relevant information tailored to their specific areas of expertise. This will not only save valuable time but also enhance the accuracy and quality of patient care.
Healthcare leaders can also leverage AI to offer more personalized employee experiences at scale. By analyzing vast amounts of data on individual clinicians’ preferences, work patterns, and career aspirations, AI can create tailored development plans and support systems. This personalized approach can boost job satisfaction and engagement, ultimately leading to higher retention rates among clinical staff.
Gone will be the days of a one-size-fits-all approach to workforce management, as AI empowers organizations to cater to the unique needs of each clinician, thereby fostering a more conducive and fulfilling work environment.
Harris Data Integrity Solutions, the leading provider of best-in-class patient data integrity services and software, has been engaged by University Hospitals (UH) to undertake a comprehensive cleanup of UH Lake Health’s Master Patient Index (MPI) in preparation for the facility’s migration to Epic. In addition to eliminating duplicate and crossover patient records, Harris Data Integrity Solutions will support UH in clearing the hospital’s Roster Management Engine (RME) error queue.
Lake Health, which joined the Cleveland-based University Hospitals health system in April 2021, consists of UH Lake West Medical Center, UH Beachwood Medical Center, and UH TriPoint Medical Center. It is currently migrating to UH’s Epic electronic health record (EHR) system. However, prior to its patient information being integrated into the EHR, Lake Health’s MPI must be analyzed for and subsequently cleaned of any duplicate and potential crossover patient records that may exist across the UH system.
UH’s transition to Epic represents its single largest transformation investment. UH has embarked on a multi-year initiative to implement a new and fully integrated Epic-based EHR. This new system will improve the point of care experience for patients and caregivers, better enable patients to access their personal health information, advance its population health analytics, drive quantifiable clinical and revenue cycle benefits, and enable research and academic excellence.
Harris Data Integrity Solutions, an authorized Epic data remediation consultant, will leverage the EHR system’s possible duplicate/crossover report to perform a cleanup of UH Lake Health’s MPI and provide batch files back to UH for processing within the system. Its team of credentialled and highly experienced patient identity experts will also manage remediation using Harris Data Integrity Solutions’ proprietary automated duplicate resolution technology and third-party data sources, as well as manually when necessary.
The Harris Data Integrity Solutions team will also assist UH with resolving patient record discrepancies that cause them to be placed in the EHR system’s RME error queue. This occurs when data such as order results, documents, etc. cannot be filed automatically into the EHR because of a mismatch or fuzzy match on demographic, medical record number (MRN), or other patient-level data points. Without manual review and remediation, the interface does not know where the information should “live” in the patient chart.
“Duplicate and overlaid patient records can broadly impact patient care, safety, and outcomes, as well as increase costs and sap the productivity of clinicians and HIM professionals by diverting their focus away from core responsibilities. We’re thrilled to be helping UH protect their patients and their EHR investment by ensuring the success of Lake Health’s migration to Epic won’t be hindered by a compromised MPI,” said Lora Hefton, executive vice president of Harris Data Integrity Solutions.
Healthcare revenue integrity refers to ensuring correct and compliant billing, coding, and reimbursement procedures within the healthcare sector. Maximizing revenue and reducing financial risks are the two objectives of healthcare revenue integrity, which leads to guaranteed stability and profitability of the finances of healthcare organizations.
Revenue integrity is absolutely critical in today’s complicated world of healthcare payments. Recognizing and avoiding potential sources of revenue leakage, billing mistakes, fraud, and compliance difficulties helps healthcare providers maximize their revenue streams. Effective revenue integrity procedures guarantee that healthcare organizations are paid fairly for their services while adhering to legal requirements.
The Recovery Audit Contractor (RAC) tracker is a crucial tool in this aspect. A RAC tracker is a program or system created to track and examine information on medical claims, spot errors, and help businesses recover lost income. These monitors are essential for finding coding mistakes, dishonest billing procedures, and documentation gaps that might result in revenue losses or audit risks.
Healthcare Revenue Integrity: Opportunities and Challenges
Healthcare revenue integrity is vital on many levels. First, it immediately affects the viability and financial health of healthcare organizations. Organizations can obtain the funds required to provide high-quality patient care, invest in cutting-edge technologies, and onboard talented resources once they ensure accurate and appropriate reimbursement.
Additionally, revenue integrity helps organizations prevent financial losses brought on by underbilling, coding mistakes, inadequate paperwork, or compliance infractions.
Besides, revenue integrity is intimately related to legal and regulatory issues. Government organizations, including Medicare and Medicaid, and private insurers have different billing and coding requirements that healthcare organizations must abide by. Financial fines, legal punishments, and reputational harm may follow noncompliance with these restrictions.
That said, ensuring revenue integrity presents several difficulties too. The complexity of the billing and coding procedures is a significant obstacle. The reimbursement environment for healthcare is complex, with numerous payment methods, coding systems (such as ICD-10 and CPT), and reimbursement regulations. Staying on top of the continual changes and ensuring appropriate coding and invoicing can be challenging and requires ongoing training and experience.
AGS Health, a leading provider of tech-enabled revenue cycle management (RCM) solutions and strategic growth partner to healthcare providers across the U.S., announced today the release of Intelligent Authorization, a single-source solution that automates and optimizes the financial clearance process and avoids prior authorization-related denials.
By Sarah M. Worthy, CEO and founder, 
Harris Data Integrity Solutions