AGS Acquires Offshore Patient Access BPO Unit From Availity

Patrice Wolfe

AGS Health, a leading provider for tech-enabled revenue cycle management (RCM) solutions and strategic growth partner to healthcare providers across the U.S., announces the acquisition of the India-based patient access outsourcing business unit of the Florida-based healthcare technology company Availity.

With more than half of U.S. hospitals anticipating a year of negative margins, achieving full and accurate reimbursement for services has never been more critical. With this expansion, AGS Health is positioned to provide faster, more flexible financial clearance solutions at an even greater scale to help increase customers’ first-pass reimbursements rates.

“At AGS Health, our focus is greater financial freedom for healthcare organizations, allowing them to reinvest in their vision for superior patient care,” said Patrice Wolfe, CEO of AGS Health. “With this acquisition, we can better equip our customers with the tools and expert services necessary to help overcome payer complexities, reduce denial rates, mitigate revenue leakage, and accelerate cash flow on the back end.”

The acquisition allows AGS Health to expand the capabilities of the AGS AI Platform with new technology to enhance accuracy and scalability and further streamline patient access operations. The technology platform is capable of automatically determining, submitting, and verifying the status of prior authorization requests. Additionally, estimates of the patient’s out-of-pocket cost can be automatically generated based on payer rules set by the healthcare organization.

The move will also add approximately 200 patient access service team members to AGS Health’s global team of more than 11,000 college-educated, trained RCM experts. With labor shortages devastating all areas of the healthcare system, outsourced services are more critical than ever – particularly as financial clearance performance depends on access to qualified, skilled labor.

“This acquisition is just part of our continued investment in our customers’ success with automation technology and expert teams,” Wolfe adds. “As growth partners, we are committed to equipping our customers with flexible, modern solutions to mitigate risk and adapt to change. This is part of what we call ‘AI with a human touch’.”

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6 Crucial Technologies To Help Seniors Monitor Their Health

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Health monitoring technologies are a healthier and safer way for seniors, especially those who want to age in place. It improves older adults’ quality of life while making them more independent, boosting their self-esteem. Health monitoring technologies help enhance seniors’ safety, mainly those with dementia or cognitive impairment. They have simple-to-use features that senior citizens can quickly learn and adopt.

These technologies offer connections to assistance, ensuring peace of mind for the older adult’s loved ones and caregivers. This article outlines six crucial technologies to help seniors monitor their health.

1.   Wearable technology

Wearable technology consists of smart electronic devices worn on the skin’s surface to detect and study information regarding different bodily functions. Wearable devices for the elderly can help monitor your health, letting you remain active while feeling safe. They have small sensors that record even the most minor body changes, including increased heart rates, with new details displaying every few minutes or seconds.

Wearable technologies that track your health enable you to share information with your doctor, including your mobile dentist, loved ones, and home support workers to ensure they’re always aware of your health condition and any unexpected medical emergency. Fitness trackers, GPS technology, smart watches, personal alarms, and heart rate monitors are wearable devices you can invest in to monitor your health.

2.   Telemedicine technology

Attending regular doctor appointments can be challenging for the elderly, especially those with restrictions or who are homebound, which makes it hard to leave home. Telemedicine or telehealth leverages telecommunication and electronic technology to offer medical care remotely. It provides seniors with alternatives to manage complex health issues, access care whenever needed, and minimize the burden on their caregivers.

Telehealth technology promotes convenient access to clinical care. It also supports remote symptom monitoring where health data, including cardiac stats, blood pressure, respiratory rates, and oxygen levels, is reported, gathered, and assessed. Telemedicine technology features allow the storage and sharing of medical data, such as X-rays, MRIs, CAT scans, and texts, videos, and photo-based patient data.

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Pumping New Life into Healthcare Information: The 21st Century Cures Act Drives Unlocks the Power of Data

Andrew A. Brooks, M.D.

By Andrew A. Brooks, M.D., chief medical officer, TigerConnect.

Information is the healthcare industry’s core, from paper to digital record keeping. Healthcare organizations and physicians have relied on charts, treatment plans and other means of records to provide the highest quality of care they can offer. In the 21st century, providers need unrestricted access to holistic data to streamline record-keeping, reduce costs, and better collaborate as treatment teams advance patient care. This access to vital information is becoming more critical as digital healthcare information rises along with the rise in EHR integration.

By current estimates, nearly 30 percent of the world’s data is being generated in healthcare – with no signs of slowing down, this figure is expected to reach 36 percent by 2025. According to a 2019 Centers for Disease Control (CDC) survey, almost 90 percent of office-based physicians responded that they are leveraging EHR systems in their office-based practice. Information availability is only part of the healthcare equation. Data accessibility and interoperability are another.

When roadblocks to information are present, it can create unnecessary challenges for hospitals and treatment teams to do their jobs. These challenges in treatment and care can lead to poor clinical communication and collaboration – reducing the quality of patient care and driving costs upward. In an industry such as healthcare, smooth communications are essential both between providers and patients as they attempt to navigate doctor’s offices, hospitals, and other care facilities. Unfortunately, interoperability and access to information aren’t easy.

Information Blocking and its Impacts on Patient Care

Information blocking often refers to the interference of access, use or exchange of electronic health information. In most cases, information blocking is caused by the use of proprietary technology systems that are unable to interoperate or communicate with one another. When information blocking does occur, patient data necessary for care can be sent or received in an untimely manner or can be transmitted inaccurately. The fact is that most electronic data is still locked in silos across disparate providers. According to a study reported on by the AJMC, nearly 75 percent of physicians feel they lack sufficient information about their patients. The demand for seamless access to healthcare information is one of the driving forces behind the 21st Century Cures Act – which expanded its scope in October.

The 21st Century Cures Act & The Power of Data to Improve Patient Care

When healthcare providers have access to data, they can dramatically improve patient care. This is why many are asking the Department of Health and Human Services (HHS) for additional clarity on new federal information blocking regulations set in motion in October.

The original 21st Century Cures Act held health IT vendors, providers, and health responsible for information exchanges to better provide patient access to health records with 3rd party applications – banning the blocking of health information sharing. But this applied only to a limited set of data. Under the expanded regulations, patients will get electronic access to their records without limitations. So, what do providers and patients need to know, and how can they better align with these new regulations?

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New Financial Platforms Aim to Fix a Confusing Healthcare Payment System

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Bob Chin

By Bob Chin, chief information officer, PayMedix

Employers who shift more healthcare insurance payments to employees to keep costs down risk increasingly discontented employees who struggle with growing out-of-pocket (OOP) costs compounded by a flood of overly complicated bills.

The widespread shift of workers into high-deductible health plans (HDHP), in particular, have hit employees hard financially, as nearly one-third of American workers were enrolled in such plans in 2021. It is a trend that is expected to grow.

This shift has also exposed employees to more complex medical bills and statements that rarely add up. What is and is not covered by their plan isn’t clear, nor how much they owe and to whom.  In fact, recent studies show that 58% of healthcare consumers were surprised about a bill they received due to confusion about what they owed, and 48% of consumers said they were late on payment for the same reason.

Worse yet, higher OOP costs combined with this billing confusion is causing many employees to postpone or forgo the care they need. A recent survey from Gallup found that 38% of Americans reported that they or a family member had delayed medical care in the prior 12 months because of cost. Additionally, 27% of those surveyed said that they or a family member had put off treatment for a very or somewhat serious condition.

A New Consumer-Focused Payment Approach

But there is reason for hope. New kinds of healthcare payment platforms are entering the market specifically designed to address employee healthcare payment challenges. Many are point solutions, addressing a specific financial issue such as self-pay patient management, easier electronic statements, or access to healthcare payment cards.

Some platforms also apply game theory to create optimal dual-party agreements with multiple providers in the complex billing ecosystem to determine how they all can be compensated by the patient.

At the high end are platforms that provide a more holistic approach in addressing both the financing needs of consumers and the revenue needs of healthcare providers. The most advanced platforms combine advanced technologies with a payment model to create a simpler approach to healthcare billing based on proven analysis of consumer behavior. For example, they utilize AI and statistical modeling to analyze billions of dollars of existing medical payment data and other data to create a payment capacity model that’s balanced and affordable for the employees.

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What Are RPA Bots? Using RPA To Drive Profitability

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Brian Cafferty

By Brian Cafferty, vice president of RPA development, Tebra.

Robotic process automation (RPA) is a software technology that uses “bots” to replace repetitive, rule-based tasks and processes. In everyday life, people use RPA technology anytime they rely on form auto-fills, credit card payments, call center menus, or banking automation.

While the hyper-automation trend has taken root in most industries, bots are just starting to catch on in medical practices. The average practice performs many time-consuming and repetitive administrative tasks that require large amounts of data to be pulled, categorized, summarized, and reported. However, these tasks don’t require specialized knowledge. RPA can provide task automation across the organization, from front-office tasks to operational processes to patient interaction and bill payment. In addition, minimizing manual processes can reduce error rates that cost time and money.

Our customers and early adopters of RPA report that within the first three to six months of implementation, they saw improvements of 50% in operational efficiencies, 200% in claims processing speed, 30% in revenue per clinical encounter, 95% clean claims and only 2-3% claim denial rates.

Automating essential workflow

Onboarding new patients is a process you can automate while improving the patient experience. For example, a bot can provide an integrated data connection between your electronic health record (EHR) and billing platform. As patients complete the intake and insurance forms, this information is automatically entered into your billing platform.

As more patients demand convenient digital touchpoints, bots can maximize back-office efficiency with appointment scheduling. Bots can process patient appointment requests by presenting available time slots and adding selected appointments to the practice’s database. In addition, the RPA tools can assist with patient check-in, validating health plan coverage, and arranging pre-authorizations for planned procedures and treatments. For smaller practices or those with lean office staff, these automations can significantly reduce time spent on non-revenue-generating tasks.

For practices that need to migrate patient EHR data when transitioning from one practice management software to another, bots can initiate keystrokes to create a clinical note for each patient encounter to ensure the patient’s complete medical history is captured accurately.

By reducing the administrative tasks that do not require specialized knowledge or a human touchpoint, your practice staff can focus on delivering better care to improve patient outcomes and grow your practice.

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Digital Health Innovation: The True, Quantifiable Impact On The Industry and Patients

Dr. Harietta Eleftherochorinou

By Dr. Harietta Eleftherochorinou, vice president 0f innovation ventures, IQVIA.

Patients, health systems and CROs are embracing digital health, as indicated by the number of digital health apps, digital diagnostics, digital biomarkers, digital therapeutics and devices being created. At the same time, over a third of these apps don’t survive longer than a year, devices struggle to get regulatory approval, digital biomarkers are yet to be proven, while digital diagnostics and digital therapeutics are not cheaper alternatives to the standard of care. The question skeptics therefore have is “what is the real value of digital health to patients and the healthcare systems?” Below, there are several tangible value-points of digital health in quantified metrics to give an answer.

The digital health innovation market is experiencing exponential growth. Investments of $24 billion were made globally in digital health in 2020 according to the IQVIA Institute Digital Health Trends 2021 report. And according to CBInsights, in 2021, $39.6 billion were invested on digital health alone, out of the total $100 billion invested globally in healthcare startups. These investments are resulting in greater numbers of mobile apps, wearable devices and other digital tools.

Digital apps are redefining the health experience

Multiple types of digital health tools contributed to mitigating the impact of the pandemic and are now established part of the digital health landscape. Consumer apps remain the most widely available and used digital tool with more than 90,000 new digital health apps added in 2020 — an average of more than 250 apps per day — resulting in over 350,000 apps currently available. Apps are increasingly focused on health condition management rather than wellness management, with the former now accounting for 47% of all apps in 2020, up from 28% in 2015, and with mental health, diabetes and cardiovascular disease-related apps accounting for almost half of disease-specific apps. Downloads and use of apps are heavily skewed with 83% of apps being installed fewer than 5,000 times and collectively accounting for less than 1% of total downloads, while a cohort of 110 apps have each been downloaded more than 10 million times and in aggregate make up almost 50% of total downloads.

Moreover, patients have easy, mobile access to health information and quality healthcare. For example, the Moodpath app allows users to track their mental health through cognitive behavioral therapy. At the same time, mobile apps connect doctors with patients who need assistance in real-time, thus easing the burden on healthcare workers. HealthTap is one such mobile app which offers 24×7 virtual assistance to patients by connecting them to certified doctors through call, text, or video call.  .The value is increased patient engagement, patient education on one’s own condition and patient centricity coming to life rather than talked about.

Positive results from digital therapeutics

With the incorporation of technology to assist with the treating, preventing and managing of specific diseases, innovation amongst digital therapeutics and digital care products is increasing. According to the IQVIA report, Digital Therapeutics (DTx), and Digital Care (DC) products — incorporating software to treat, prevent or manage specific diseases or conditions — have been proliferating. Over 250 such products are now identified, including about 150 products that are commercially available, and the rest in development.

Digital therapeutics, which typically focus on a narrow clinical indication and generate evidence of clinical efficacy, follow a development path that typically requires market authorization by a regulatory body and sometimes a prescription from a provider, though some may be exempt. Neurologic and psychiatric conditions are a key focus of both DTx and DCs, making up over two-thirds of all DTx indications and over 40% of DCs, respectively, with DCs also used by patients suffering from endocrinology, oncology and cardiovascular conditions.

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Oxygen Therapy Trend and Outlook for 2023

Oxygen therapy, or the administration of medical oxygen, has increasingly been used to treat various medical conditions, such as chronic obstructive pulmonary disease, cancer, and cystic fibrosis. Oxygen therapy is ideal for most patients who can’t receive adequate oxygen volumes from regular breathing. It also helps those who need high concentrations of oxygen for various reasons.

One of the major drivers of hyperbaric chamber sales is the increasing preference and shift from traditional cylinder-based oxygen tanks to portable devices. There’s also a growing preference for portable oxygen units over stationary concentrators. Below are a few oxygen therapy trends and outlooks for 2023 and beyond.

COVID-19’s Impact on Demand for Oxygen Therapy

While the incidence rates of the pandemic have significantly declined, oxygen therapy was a major treatment option for patients diagnosed with COVID-19. Oxygen therapy at high rates was a vital treatment because the disease directly affected the patients’ lungs and breathing abilities.

Interestingly, the market shift from stationary to portable oxygen concentrators slightly slowed in 2020. This is partly because healthcare providers allocated more resources and focused on availing less-costly stationary oxygen cylinders. Very few patients also required portable oxygen devices, thanks to worldwide lockdown measures and stay-at-home orders designed to contain the pandemic.

However, the demand for portable oxygen devices is poised to increase for various reasons. Stationary concentrators witnessed increased demand in 2020 because they were effective in most high-risk situations. However, there’s an increase in the number of aging adults developing respiratory conditions, subsequently increasing the demand for oxygen therapy.

An estimated sixteen million people suffer from COPD, with millions still undiagnosed. Patients with COPD are also prone to other severe respiratory issues, including COVID-19, which has increased the adoption of oxygen therapy and the introduction of advanced delivery methods, such as nasal therapies.

Increased Demand for Remote Oxygen Therapy Monitoring

Besides increasing the oxygen demand, the pandemic also made it crucial to have home-based oxygen monitoring devices. Remote oxygen monitoring devices connect oxygen equipment with smartphone apps. This allows clinicians to monitor various aspects of oxygen therapy remotely.

The trend of improved health data transmission will also grow exponentially with the introduction of wearable technologies, wireless 5G networks, and advances in photoplethysmography sensors. PPG sensors are non-invasive devices that use photodetectors to measure variations in blood. These sensors are positioned at specific body parts, such as fingertips, forehead, and earlobes.

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The Looming End of A Long Redetermination Pause Calls For A Cleareyed Strategy

By Paul Schuhmacher, managing director in the healthcare practice, AArete.

At the onset of COVID-19, public health emergency (PHE) declarations rapidly transformed the healthcare industry and insurance landscape. In the first few months alone, an estimated 7.7 million jobs that provided employer-sponsored insurance were lost, leaving 14.6 million workers and dependents uninsured.

Continuous eligibility provisions through the PHE saw Medicaid enrollment grow by approximately 15.5 million individuals between February 2020 and December 2021, many of whom gained or kept their eligibility due to pandemic-related eligibility changes.

A recent report by the Assistant Secretary for Planning and Evaluation (ASPE) showed a historically low uninsured rate of 8% in the first quarter of 2022, but that number is destined to grow. The looming end of the PHE will be a cause for celebration in many regards. Still, Medicaid health plans are rightly on edge because of the approaching logistical nightmares and financial losses the unwinding period will bring.

The PHE has been extended through January 11, 2023, and the Biden administration has promised to give 60-days’ notice before its conclusion. When it does end, 15 million individuals are projected to leave Medicaid, including 8.2 million who will leave due to loss in coverage and will need to transition to another source of coverage and 6.8 million who will lose coverage despite fulfilling eligibility requirements.

This rapid loss of coverage is also predicted to disproportionately impact Black and Hispanic individuals. The two groups have historically faced significant barriers to accessing quality healthcare and are more likely than white adults to forgo needed care due to cost.

Affordable Care Act provisions have helped reduce disparities these groups face. However, according to the ASPE report, Hispanics make up one-third of those predicted to experience churn and over one-quarter of those who will become ineligible for Medicaid. Meanwhile, Black individuals could comprise 15 percent of those experiencing churn and 14 percent of those expected to lose eligibility.

When taken together, this points toward a tumultuous and overwhelming period — not only for the millions of Americans who will become uninsured but also for the health plans tasked with balancing a deluge of work and the strains of providing timely, quality healthcare options to those who need it.

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Inovalon Adds All-Payer Claims Management Software To The PointClickCare Marketplace

Inovalon WikiInovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, today announced the addition of its EASE All-Payer claims management solution to the PointClickCare Marketplace. Building on a five-year partnership, Inovalon’s newest listing on the Marketplace offers healthcare providers sophisticated revenue cycle management (RCM) tools that are seamlessly integrated into PointClickCare’s Electronic Health Record (EHR).

The Inovalon EASE All-Payer claims management software, powered by the Inovalon ONE Platform, helps providers achieve a 99% first-pass acceptance rate among commercial and Medicare payers. The solution leverages an advanced payer rules engine that validates claims based on the latest requirements from the Centers for Medicare & Medicaid Services and Commercial insurers. The solution also allows users to easily create custom, facility-specific business rules that improve the accuracy of claims processed in each location.

Unlike other solutions, EASE All-Payer automatically checks claim eligibility and historical responses upon submission, enabling users to identify and correct upstream eligibility issues before transmitting to the payer. Additionally, the solution’s integration with Inovalon’s MORE2 Registry enables providers to easily source missing patient information, such as the Medicare Beneficiary Identifier, which can significantly reduce claims denials and improve first pass yield.

Also offered on the PointClickCare Marketplace is Inovalon’s Workforce Management solution, a fully mobile, real-time scheduling and open shift management application that scales from single units to entire enterprises. Inovalon solutions available on the Marketplace allow PointClickCare customers to operate within a single platform to launch, manage, and utilize applications, resulting in greater data accessibility and a unified user experience.

“We are pleased to enter the next phase of our long-standing partnership with PointClickCare supporting thousands of providers with the integrated tools they need to optimize financial and operational performance,” said Julie Lambert, president and general manager of the Inovalon Provider business unit. “Inovalon powers thousands of facilities with its industry-leading solutions, and our latest listing on the PointClickCare Marketplace ensures they are easily accessible to our joint customers.”

To learn more about Inovalon’s revenue cycle management solutions, visit:

To see Inovalon’s Claims Management solution featured on the PointClickCare Marketplace, visit: PointClickCare Marketplace.

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Health Information Network (HIN) Data Exchange Performance Metrics To Date

Particle Health, a developer-friendly API platform for bi-directional healthcare data exchange, announced the availability of its white paper that highlights the most comprehensive view of Health Information Network data performance available to date and provides vital information to gain a true understanding of healthcare interoperability.

The paper, 2023: State of U.S. Healthcare’s National Network Data Exchanges, analyzes not only quantitative comparisons of the data currently exchanged on HINs but also the work that still needs to be done in order to spread the true value of the networks across all stakeholders in the healthcare ecosystem. The report also details critical information on how to successfully leverage HIN data when building digital healthcare tools and operating healthcare organizations or digital platforms.

The recent paper revealed that the nation’s three largest Health Information Networks have indexed healthcare records for the vast majority of Americans, as shown by Particle’s platform finding data across HINs for about nine out of every 10 patients searched for. The CommonWell Health Alliance has access to 29,000 sites and 153 million individuals; Carequality has access to 55,000 sites and 300,000,000 document exchanges per month; and eHealth Exchange has access to 75,000 sites and 120 million individuals. A sample of queryable data found that a plurality (about 45%) of health data available on HINs was generated within the past three years.

To help digital health organizations looking to gain deeper insights into how to search and return patient data more successfully on HINs, Particle Health studied its own technical data from connecting to the three major HINs. By mapping out each network’s endpoints in the U.S., the company was able to rank states by their endpoints per capita. Particle Health found that in 2022, on average:

“No matter who you treat, it’s very likely that your patients’ medical records can be found on Health Information Networks,” explained Troy Bannister, CEO of Particle Health. “Today, clinicians can access these networks. Patients, insurers and other stakeholders may not realize they’ll soon be able to directly obtain relevant records as well. We’re about to enter a game-changing era in healthcare as Health Information Network access expands.”

For this paper, Particle Health also reviewed upcoming HIN improvements and health IT landscape changes that will likely drive a surge in requests for data. Two notable changes include:

A Developer-Friendly Approach to Consolidate Network Access

Direct integration with a HIN is prohibitively difficult for most organizations, as a great deal of specialized work needs to be done to maximize the value of network connectivity. Particle Health was founded to make a wide array of diverse network data accessible and actionable for the many stakeholders and organizations that would benefit from network participation. In its role, the company consolidates each network within a single API implementation, making it manageable to leverage the data from multiple HINs covering over 270 million patient lives.

Bannister said, “Many organizations simply don’t know that this fantasy – a nationwide way to locate and exchange medical records – already exists. With our birds-eye view of different Health Information Networks, Particle Health has seen provider organizations use patient data to efficiently improve outcomes. That’s why we’re working hard to make Health Information Networks more accessible to new digital health participants.”

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