Vyne Medical today announced the launch of its new Refyne platform. Purpose built for healthcare, Refyne is designed with the look and feel of a modern consumer-facing app and features to help optimize administrative workflows and maximize reimbursements for hospitals and health systems.
This initial release of the cloud-based platform features Refyne Audits which simplifies the process of receiving and responding to audit requests from the Centers for Medicare & Medicaid Services (CMS). In fiscal year 2020, CMS estimated the improper payment rate for Medicare fee-for-service at 6.27 percent, representing $25.74 billion in improper payments.
“Our nearly 10 years of experience as a leading CMS-Certified Health Information Handler tells us that managing government audits plays a significant role in effective denials management.” said Marcy Tatsch, president of Vyne Medical. “That experience coupled with the Refyne Audits solution enables us to add immediate value for both new and existing clients.”
Refyne Audits facilitates the electronic transmission of supporting documentation to assist providers in filing timely audit responses and appeals. The solution enables participation in the CMS Electronic Submission of Medical Documentation (esMD) initiative with the Electronic Medical Documentation Request (eMDR) functionality necessary for efficient audit management.
“With Refyne Audits, providers can automate workflows and supply the solicited evidence necessary to fight government audits well within strict timelines,” said Scott Overholt, chief business officer at Vyne Medical. “Hospitals can quickly submit hundreds of pages of documentation to demonstrate appropriate levels of care and most importantly, they can track their submissions to prove timely responses.”
Medical coders are health information professionals that analyze and translate medical procedures and records into standard codes. Medical coders work on diagnoses, treatment procedures, supplies, and other valuable medical information that government agencies, insurance companies, and healthcare organizations can utilize.
Medical coders work on ICD-10, CPT, and HCPCS coding systems. The excellent work of medical coders helps these organizations and agencies to educate members of the public, allocate resources and aid medical research and studies.
Healthcare providers use different abbreviations and terminologies when writing reports which they will later submit to insurance companies when filing insurance claims. To simplify the process, medical coders analyze and translate these terms and abbreviations into standard codes that all healthcare organizations use.
Medical coders make the back and forth between healthcare providers and insurance companies easier and quicker. Medical coders are also known as clinical coders, clinical coding officers, diagnostic officers, and medical coders and billers. Physician Offices, hospitals, insurance companies, and other healthcare organizations employ the services of medical coding specialists.
How Do I Become a Medical Coder?
Wondering how to become a medical coder? With a high school diploma or its equivalent, you can obtain a diploma or an associate degree in Medical Coding.
A diploma or associate degree in Medical Coding will help you stand out amongst other applicants. It will also prepare you to work in the healthcare system without challenges. During the program, you will learn the billing codes for filing claims, medical terminologies as well as the fundamentals of Physiology and Anatomy.
Most employers require medical coders who at least have the basic knowledge of medical coding, even for entry-level positions. As a result, it is beneficial to pursue your program with a credible institution.
The Ultimate Medical Academy offers diploma and associate degree programs with adequate training on coding, use of computers, medical terminologies, basics of physiology and anatomy, workplace practices, communication skills, and every other thing you need to excel as a Medical Coder. After a successful program with UMA, you will find it easy to blend into the healthcare system. The program is comprehensive, detailed, and learner-centered.
Will Medical Coders Stay Relevant?
Longevity is one of the qualities of a great career path. You will get that if you choose to pursue a career as a medical coder. According to the Bureau of Labor Statistics, in the next eight years, the demand for medical coders will increase by ten percent.
The American Association of Professional Coders (AAPC) pegs this increase in demand at twenty-two percent by 2022. Insurance companies, hospitals, and other healthcare organizations require the services of medical coders, so coders are here to stay.
From the above analysis, it is clear that medical coders will stay relevant for a long time. Do you want a career change, and you want a career that will remain relevant for a long time? Would you like to contribute your quota to the medical field without having to deal directly with patients or be on the frontline? Do you have excellent organizational skills? If your answer to these questions is yes, you might want to consider becoming a medical coder.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that mandates the creation of national standards to protect delicate and private patient medical history and health information from being disclosed to other parties without their knowledge.
HIPAA focuses on patient privacy, record keeping, and employees in the medical field. It is a landmark piece of information for every player in the healthcare industry and had a lot to offer everyone in the healthcare industry and patients.
Why Is HIPAA Important?
HIPAA is the law, and the penalties for breaking this law can be severe. Violations of this law can lead to fines of up to $25,000 per every record compromised. All players in the healthcare industry, including business associates, are required to abide by this law.
The law helps prevent fraud in the healthcare industry and ensures that every piece of health information is secured, and restricts access to health-related data to unauthorized individuals. Introduced in 1996 and enacted in 1997, HIPAA’s first most important order was to make sure employees continued to receive health insurance coverage when they are between jobs.
The HIPAA law later moved on to handle standardized medical record-keeping and patient privacy.
Why is HIPAA Important In the Healthcare Field?
The law introduced a transition from paper records to electronic records of health information. Before HIPAA, it was not unusual to see patient’s health records, x-rays, or photographs lying around an office for everyone to see.
Courier services could deliver paper records between hospitals or offices, and one mishap could reveal embarrassing photographs or patient information that should have been kept private. The transition to electronic records makes patient records more secure, confidential and minimizes the risk of losing vital information.
When it comes to patient’s privacy, some of the questions that one can ask are, should a billing clerk be able to pull up a patient’s height, weight, and family medical history? Does an imaging technician need to view blood test results? The answer is no.
While interoperability has always been one of healthcare’s greatest pain points, the last year or so has emphasized these challenges with the rising demand for data integration and information sharing. The pandemic has required high volumes of data integration, and it’s been difficult for organizations to adapt and respond in an effective and efficient way.
These challenges were further compounded this year with the impending ONC/CMS information blocking rules. With the previous administration’s focus on improving interoperability coinciding with a global health emergency, healthcare organizations had more on their plate than ever. As we look to the future of healthcare in a post-COVID environment, and to the new administration and its healthcare goals, what can healthcare organizations expect?
Healthcare organizations must remain flexible and optimize the organization to be as adaptable as possible. In our interview with Ivan, we explore what healthcare organizations should know about the information blocking rules and the new administration, what is really at the root of the healthcare interoperability problem, and best practices healthcare leaders can employ to set their organizations up for success now and in the future.
How would you define the healthcare interoperability problem?
Interoperability is an evergreen problem across the healthcare industry. As we continue to innovate new capabilities and concepts, we are also constantly expanding our interoperability needs. In a way, interoperability isn’t a problem to be solved. It’s an ongoing practice that has to evolve alongside our other capabilities. For example, there was a time not long ago when social determinants of health (SDoH) were not on anyone’s radar, but as SDoH became more important to healthcare practitioners, it was clear we needed not only to track and store SDoH-related data but also exchange that data across different software systems and organizations. The goal of HL7’s Gravity Project is to build out the standards for exchanging SDOH data using FHIR.
2020 was a tough year in healthcare. The demand for data integration was up, exposing the dire need for better data integration across the healthcare ecosystem. In a world where interoperability wasn’t an issue, how could the pandemic have looked different?
The bad news is that we live in a world where the most reliable COVID vaccination records are stored on paper cards and interoperability is achieved by the patient themselves carrying the card from place to place. In an ideal world, the vaccination would come with an electronic record that the patient could capture on their mobile device and upload to their doctor’s EHR system, their employer’s HR system, and any other third party that needed to see proof of vaccination.
Although we’ve fallen far short of the ideal state, there are some interoperability bright spots to be happy about. For example, we’ve been able to onboard many new sources of lab result data and integrate that into public health departments. This has not always been easy, but because of the ONC’s prior work on the Promoting Interoperability program, we already had agreed-upon standards and an infrastructure in place to move the data from location to location.
Technology is changing every aspect of our lives, including how we manage our health. Healthcare is an $8 trillion industry that has always used technology to advance diagnostic tools, preventive treatment, and quality of care – all with the aim of improving and saving lives.
However, it’s also been criticized for a slow and unsteady embrace of new technology. A pre-pandemic survey noted that only 32 percent of U.S. physicians and 27 percent of U.S. consumers rated their healthcare system as performing well in terms of introducing new digital technologies.
COVID-19 has undoubtedly accelerated the healthcare industry’s adoption and usage of new technologies, and consumers are taking note. Like other sectors, the industry has undergone years of change and challenges in a matter of months, and I predict these changes are here to stay even after the pandemic subsides. Individuals will continue to embrace technology to proactively manage their health, while health institutions will look for new ways to increase quality and improve patient outcomes using advanced technology.
Here are four examples of proven technological innovations that will fundamentally change how healthcare organizations operate and provide care going forward:
There have been many attempted attacks by cybercriminals on US healthcare centers, hospitals, and clinics all over the country. The fear is that a ransomware attack – something that has hit individual hospitals over the past two to three years – could take down many more, leaving patients with no medical history and hospitals with no hope of helping them.
The reason behind these past attacks and the potentially large one that might come is money. The ransomware developers, otherwise known as cybercriminals, use their computing knowledge to find any small area of vulnerability within the hospital’s current IT network and send viruses and other programs through. This essentially holds the entire network to ransom (hence the name) until one of two things happen; either the hospital agrees to the cybercriminal’s demands and pays a large sum of money, or they don’t, in which case the data is deleted, or the sensitive information is leaked to the dark web, enabling other cybercriminals to use it for identity theft, fraud, or even blackmail reasons. It is not thought to be a political move.
In 2018, we at Lenox Hill Hospital found ourselves at a crossroads. Part of New York’s largest healthcare provider, Northwell Health, we pride ourselves on being one of the best hospitals in the region, as named by U.S. News & World Report.
Still, we struggled with key HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) metrics. In the responsiveness domain, we found ourselves in the 19th percentile. For RN communication, we were in the 27th percentile. And for likelihood to recommend, we were just under 50, at the 49th percentile. Our employee engagement scores, meanwhile, were similarly troubling, with engagement scores coming in at 2.54 on a five-point scale.
It was clear that things weren’t working – it’s what our patients were telling us, our employees were telling us, and the data was telling us.
So we identified a two-pronged path to address the issue: One strategy that would update outmoded roles and empower employees, and another that would digitize an established best-practice standard.
Transitioning from Unit Ward Clerks to Patient Serve Facilitators
In 2018, we were still maintaining a role known as a Unit Ward Clerk. While the work done by those team members – providing clerical and administrative support to the entire unit – is still very relevant and necessary, the title, and certain elements of the job description simply didn’t match the modern world we live in.
We evolved this team to become Patient Service Facilitators (PSF). This transformation came through a bottom-up process conducted by a multidisciplinary team that conducted assessments and interviews, analyzed qualitative and quantitative data from sources like HCAHPS scores and patient feedback, examined internal and external best practices, and ultimately designed the new role.
In the end, we wanted our patient service facilitator role to become more proactive – to serve as the face of the unit. We empowered those team members to do that through professional identity branding, as well as technology. Our PSFs are now expected to see every single patient in their unit once a day – and they round on them using tablets and automated rounding scripts, conducted through our patient engagement partner CipherHealth, that allow our hospital to quickly and easily collect information and act on problems as they arise. We tie each element of those rounding scripts to an HCAHPS domain, which allows us to more easily track progress and identify problem areas over time.
Healthcare providers account for some of the most crucial organizations in the country. And while most provide unparalleled care to patients and residents, there is often a disconnect between the quality of care provided, and the management of some administrative functions like policy management.
Mennonite Village, a 275-acre continuing care retirement community in the small northwest Oregon town of Albany, knew this first-hand. With 700 residents and five lines of service, including independent living, nursing/rehab, assisted living, memory care, and in-home services, Mennonite has more than 1,300 policies that are integral to the way the community runs.
But with no comprehensive solution to manage these policies, they were using a combination of a paper binder and Excel spreadsheets, and the management of the policies took an inordinate amount of time. While this may seem antiquated, it’s not unique. It’s also easily remedied using technology, and more healthcare organizations are turning to cloud-based solutions to manage policies than ever before.
The adoption rate of software-as-a-service technologies in healthcare are growing at a rate of 20 percent per year. Also, the cloud computing market is estimated to hit $51.9 billion by 2024 – up from$23.4 billion in 2019. The COVID-19 pandemic has further driven this trend, adding pressure to the need for a remote and flexible solution to manage healthcare policies and maintain compliance.
For Mennonite Village this has been an impactful change.
Setting Out to Reduce Organizational Risk
Even prior to the pandemic, Mennonite Village’s corporate compliance and risk manager, Arielle Schultz, knew they needed to find an effective, efficient way to manage policies and reduce risk. Their internal procedures required that each policy document must be reviewed and approved on an annual basis and before implementing a policy management system, this process took 40 minutes per policy to simply edit, route, and print the file. With 1,300 total policies, that amounted to more than 36 workdays just moving documents around, and if an employee was out for sickness or vacation, the process quickly became backlogged.
Schultz and her team needed a solution that could make their processes more efficient, was easy to use and could hold staff accountable. For Schultz, SaaS technology was the answer.
Vyne Medical today announced the launch of its new Refyne platform. Purpose built for healthcare, Refyne is designed with the look and feel of a modern consumer-facing app and features to help optimize administrative workflows and maximize reimbursements for hospitals and health systems.
The Health Insurance Portability and Accountability Act
By Juan Hoyos, chief commercial officer, 
