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.
The push to develop and deploy electronic health records (EHRs) over the past 15 years has brought many changes to the healthcare industry, but the work to fully realize their benefits — and harness their true potential — is not done.
The goal was to decrease costs and improve healthcare quality. While noble in concept and a notion that could revolutionize healthcare, fifteen years later, has it lived up to its promise?
Electronic records have resulted in tremendous benefits to both patients and providers. However, there is still an opportunity to continue to fully embrace the power of technology and data to improve patient outcomes and simplify the patient experience, especially regarding EHRs.
Electronic records have helped ensure that patients are educated about their medical history and that doctors have the information to make crucial — and potentially lifesaving — decisions. EHRs are no different from any new technology; there is always an opportunity to improve.
EHRs improved the patient experience
Over the past decade-and-a-half, the flow of information in our daily lives has hastened, and the desire to see information in real-time has extended to the medical industry.
Before EHRs, the doctor would have to wait for lab results, review them and then contact the patient to discuss the implication. Now, patients and doctors can quickly communicate the impact — such as the treatment plan and potential prescriptions — through the portal.
Previously, if patients had a post-appointment question, they might have a problem. They could call the office and hope it didn’t start a game of phone tag; if it did, they might not confirm an answer to their question until their next in-person appointment.
EHRs power patient portals, allowing patients to go online to assess and review their medical records, and if they have a question, they can post it and retain a digital record of the questions and answers. It also allows patients to see their appointment history and medications, request refills and schedule appointments.
The portal saves time for both patients and providers. Phone calls are now portal messages, and the time formerly expended on back-and-forth phone calls allows both sides to be more productive and informed.
Another benefit of EHRs is the portability of records.
Before, if patients wanted to change doctors, they needed to request printed copies of their records to take to their new provider — and many providers charged. Certified EHRs are required to generate a continuity of care document (CCD) that can be shared electronically.
Verifiable, an API-first innovator to the antiquated provider network management software category, has raised $27 million in Series B funding led by Craft Ventures to accelerate its next stage of growth and product innovation.
Verifiable’s comprehensive suite of network management solutions and real-time verifications empower healthcare organizations to expedite credentialing from multiple weeks to a matter of days. For customers, these efficiency gains can directly translate into millions of dollars of cost savings and added revenue capture, while also helping mitigate compliance risk, meet audit requirements, and improve the overall provider experience.
Verifiable will use this funding to scale go-to-market teams and expand its extensive verifications infrastructure to further differentiate the company’s best-in-category provider credentialing, compliance and network management solutions. The funding will also further accelerate Verifiable’s collaboration with Salesforce. Along with Craft Ventures, Highland Capital Partners, 137 Ventures and Cooley participated in the round, as well as existing investors The Altman Fund and Struck Capital.
“Credentialing isn’t a new challenge—it’s an administrative bottleneck that’s been costing healthcare organizations billions while negatively impacting provider experience and eroding the bottom-line,” says Nick Macario, CEO of Verifiable. “What is new is Verifiable’s integrated approach that truly automates the underlying operations through real-time verifications and workflows to drive speed and efficiency. Some of our largest competitors in the space are also customers of our platform, which speaks to the unique solution and value we bring to market. This is where Verifiable is built different.”
The advent of telehealth has been a groundbreaking step in the global healthcare ecosystem, and even more so in the wake of the COVID-19 pandemic. Treatments targeting autism spectrum disorder (ASD) have been demonstrated to benefit significantly from telemedicine.
ASD is a complicated neurodevelopmental disease that profoundly affects social interaction and behavior. Historically, geographical location, availability of specialists, and limited resources have been substantial barriers to timely diagnosis and treatment. However, telehealth is successfully addressing these challenges, expanding access to autism services, and enabling early intervention.
The Growing Demand for ABA and Telehealth Services
ASD has been identified in approximately one in 36 children in the United States, and early intervention is extremely important for improving long-term outcomes. Applied Behavior Analysis (ABA) is a widely used and recognized therapeutic approach that helps improve social, communication, and learning skills through positive reinforcement.
Unfortunately, the increasing demand for ABA services has strained the limited supply of specialists. As the global pandemic reshapes healthcare delivery, telehealth is emerging as a respected means to bridge these access gaps, providing a lifeline to those who need it most.
How Does Telehealth Work in Autism Treatment?
At its core, telehealth leverages digital technology to deliver healthcare services remotely. For children with autism, this translates into receiving ABA therapy from the comfort of their homes, making the experience less stressful for both the child and their caregivers.
Evidence of Success in Telehealth-Based Autism Treatment
Research has shown that telehealth can be as effective or better as traditional in-person therapy for treating ASD. According to research published in the Journal of Autism and Developmental Disorders, children receiving telehealth-based ABA therapy made comparable improvements in their skills as children receiving in-person therapy.
By Branden Neish, chief product and technology officer, Weave.
Economic challenges are causing small healthcare practices to reduce spending and rework balance sheets. Yet, some healthcare leaders are cutting funds in areas that may end up hurting them in the long run, particularly when it comes to digital solutions.
While digital solutions may sometimes end up near the bottom of a practice’s hierarchy of needs when compared to labor, supplies, rent and utilities, they can have a “make or break” impact on patient experience. And as patients are the lifeblood of any practice, their satisfaction will ultimately determine success or failure.
Amid unprecedented labor shortages plaguing the industry, healthcare staff members don’t have time to be bogged down with time-consuming administrative tasks that take away from patient care. As such, the need for digital solutions becomes doubly important to streamline and automate administrative tasks like scheduling, appointment reminders, payment processing and patient communications.
It is crucial to prioritize patient experience, optimize staff workflows and eliminate unnecessary expenses. Healthcare practices should focus on tools that deliver the highest return on investment in terms of time and cost, ultimately enhancing the experiences of both patients and staff.
In AMGA’s newly released 36th annual 2023 Medical Group Compensation and Productivity Survey, medical groups and healthcare organizations report a 6.1% increase in primary care compensation, compared to 1.5% and 1.6% increases for medical and surgical specialties, respectively.
Primary care also had more significant increases in work relative value units (wRVUs) than other specialties.
“We’re seeing that the compensation levels for primary care have increased this past year, greater than in other specialty types, which in our opinion, is evidence that the E/M coding changes that CMS [Centers for Medicare and Medicaid Services] put into effect in 2021 are now being reflected in organizations’ compensation plans,” said Elizabeth Siemsen, AMGA Consulting director. “Survey results indicate that the gains for primary care are evident as the smoke clears from the slow transition to the utilization of new wRVU weights for compensation calculation and the volume swings of the pandemic.”
With data on more than 190 specialties included, the 2023 survey reveals that compared to the compensation increases in primary care, overall physician specialty types show relatively nominal increases in compensation.
Data in the 2023 report indicate a more stable trend for physicians and other providers than seen over the past few years. The overall increase in median wRVUs increased by 2.9% compared to the prior year. Primary care physician wRVUs account for the bulk of that, with an increase of 4.0%, while medical and surgical specialties were limited to 1.7% and 1.4%, respectively. Additionally, more groups reported wRVU data in the 2023 survey. Finally, 2022 was a full year without the pandemic causing a significant impact on volume.
AGS Health, a leading provider of tech-enabled revenue cycle management (RCM) solutions and strategic growth partner to healthcare providers across the U.S., has been named a Leader in Revenue Cycle Management (RCM) Operations by Everest Group for the third consecutive year.
Everest Group Revenue Cycle Management (RCM) Operations PEAK Matrix Assessment evaluated 25 RCM providers’ market impact and ability to successfully deliver services based on subdimensions, including market adoption, portfolio mix, value delivered, and strategic vision and capability. Results were then used to determine each organization’s overall market leadership position – Aspirant, Major Contender, or Leader.
More information on Everest Group RCM Operations PEAK Matrix Assessment can be found here.
AGS Health is more than a revenue cycle management company – we’re a strategic partner for growth. With expert services complemented by AI-enabled technologies and high-touch support, AGS Health is the premier revenue cycle partner for leading health systems, physician groups, and academic medical centers in the U.S.
With expert insight into modern revenue cycle practices, the company pairs cutting-edge technology with college-educated, trained RCM experts to help clients achieve a high-performance revenue cycle to optimize workflows, maintain compliance, and prevent revenue leakage. AGS Health employs nearly 12,000 team members globally and partners with more than 130 clients across a variety of care settings, specialties, and billing systems.
Harris Data Integrity Solutions
In AMGA’s newly released 36th annual 2023 Medical Group Compensation and Productivity Survey, medical groups and healthcare organizations report a 6.1% increase in primary care compensation, compared to 1.5% and 1.6% increases for medical and surgical specialties, respectively.