MDaudit Annual Benchmark Report Reveals 82% of Claim Denials Are Associated With Medicare

With 82% of 2022 claims denials associated with Medicare, and third-party audit volume rapidly climbing, hospitals and health systems are under intense pressure to protect and grow revenues.

These were among the key findings of the 2022 MDaudit Annual Benchmark Report released today by MDaudit, the healthcare technology company that harnesses the power of analytics and its proven track record to allow the nation’s premier healthcare organizations to retain revenue and reduce risk.

Peter Butler

“Our analysis suggests that the post-pandemic era has given rise to a new phenomenon for healthcare. Medical spending is more discretionary for consumers impacted by inflation, driving dramatic reductions in revenues generated by physician office and hospital visits for the third quarter of 2022,” said Peter Butler, president and CEO, MDaudit. “Exacerbating this situation is the need to successfully defend against more third-party audits amidst chronic personnel and resource shortages.”

Driving Smarter Audits

Payers are investing in predictive modeling and artificial intelligence (AI) tools to scrutinize claims more closely before adjudication to reduce improper payments. The 2023 Department of Health and Human Services budget requests $2.5 billion in total investments for the Healthcare Fraud and Abuse Control and Medicaid Integrity Programs, $900 million of which is allocated for discretionary spending to advance technologies to scrutinize payment accuracy — up $26 million from 2022.

This should be a concern for healthcare organizations – and the push compliance leaders need to find more efficient ways to retain at-risk revenues. Per the MDaudit analysis:

Defending Revenues

A key element of a successful revenue defense is to help compliance teams become more efficient in managing external payer audit requests to retain at-risk revenues. The role of billing compliance needs to be increasingly data-driven and cross-functional, as well as serving as a business partner to other teams including coding, revenue integrity, finance, pharmacy, and clinical, to meet changing and more complex risks. The MDaudit analysis also found that:

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Closing the Education Gap: Integrating AI Into Your Practice

Ronny Shalev

By Ronny Shalev, PhD, CEO and co-founder, Dyad Medical, Inc.

Artificial intelligence (AI) is a driving force in the future of technology, often enhancing the speed, precision, accuracy and effectiveness of human efforts. As a result, AI has had a tremendous impact on nearly every working industry, including healthcare and its specialties. In recent years, there has been an increased adoption rate of AI in the healthcare industry.

Although this growth may be related to the need for telehealth and other remote tools as a result of the COVID-19 pandemic, recent estimates predict a more than tenfold growth in the market for AI in medical imaging over the next decade.

Although there is a projected growth for AI in healthcare, if this technology cannot be efficiently implemented into existing daily workflows, then these AI tools will not be practical in a real-life setting. Understanding how healthcare practitioners use AI in a clinical setting and how AI can help solve real-life challenges are crucial to increasing further adoption rates. This will ultimately drive innovation around this technology and will lead to improved quality of patient care.

What clinicians want from AI-powered technology

A recent survey by the American College of Radiology (ACR) indicated that 30% of respondents use AI to enhance image interpretations across all modalities. The modalities most commonly identified were  computed tomography (CT) scans and mammography scans. When asked what they would specifically like AI technologies to do to enhance their clinical practices, respondents indicated that lesion detection (73%) and anatomic measurements (71%) were most important.

These responses indicate that clinicians are most interested in reducing the need for manual tracing and measurements of medical imaging, which takes a significant amount of time and effort. The survey’s findings also indicate that respondents would prefer additional support, or a “second opinion”, when detecting and identifying lesions – a task known to be difficult. The clinicians’ responses also indicated that the development of a method to evaluate an AI algorithm within the workplace setting before purchase is of utmost importance.

With these findings in mind, software developers need to prioritize building technology to help provide a practical solution to clinicians’ most important needs. The use of artificial intelligence may be the best way to ensure clinicians’ needs are met in an effective and practical manner. With the use of AI, the software can continuously learn from collective insights of multiple experts, effectively offering practitioners thousands of “second opinions.”

This type of technology can also help to provide interpretations and analyses of medical imaging, significantly reducing the amount of time it takes for clinicians to measure and trace these images. With less time and effort spent on interpretation and analysis, clinicians are able to spend more time with patient facing tasks – ultimately leading to higher quality care for a lower cost while reducing employee burnout.

Although these solutions exist, there are still several barriers that prevent the successful implementation of AI in clinical practices from occurring. For example, clinicians want to ensure that the AI is safe, effective and solves specific needs before the technology is purchased. However, of those providers who currently use AI in their practice, most were satisfied with their overall experience and found that AI provided value to them and their patients. Therefore, it seems that education about the potential benefits of AI in all practice types will continue to be important (Allen et al, 2021).

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How Managed IT Services Drive Healthcare Efficiency

Healthcare operations can be extensive, and proper medical data management entails multi-layered security to protect patients and the business. Many aspects of healthcare operations involve manual and repetitive tasks. However, this is currently changing due to the advancement in digital technology.  

Healthcare facilities and organizations use sophisticated software and hardware systems to automate as many tasks as possible to improve efficiency. But safeguarding healthcare networks and data requires advanced technical expertise. And that’s when managed IT services come into play. 

What Are Managed IT Services? 

Managed IT services refer to outsourcing information technology services to a third-party company to improve operations and reduce overhead costs and other business expenditures. In the healthcare industry, managed IT services streamline the operations of healthcare organizations. They promote workforce transparency and address key challenges, such as compliance, scalability, and mobility, for healthcare efficiency. 

Learn how managed IT services drive healthcare efficiency by reading this article.  

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5 Ways To Leverage Technology In Your Aesthetics Practice

The aesthetics industry is constantly evolving, requiring you to keep up with trends. Your capability to provide your clients with treatments that use the latest and most effective technology is crucial for your practice’s financial success. With the right technology and training for your team, you can stay ahead of the competition while keeping your customers happy, satisfied, and coming back for more.

Technology can help reduce variability, improve performance, boost customer experience, and enhance customer satisfaction. Here are five ways to leverage technology in your aesthetic practice.

1.   Streamline payments

Cloud-based payment platforms specifically meant for aesthetic practices combine smart, simple, and seamless payment options, improved customer service, and practice data analytics to increase customer retention and loyalty. The aesthetic market is filled with coupons and discounts that drive clients to price shop, resulting in reduced customer loyalty and retention. A cloud-based payment platform can replace your one-and-done transactions with a more profitable and valuable relationship model.

It ensures detailed reporting to help you understand your business’s health with sales and transaction data across all your services and products. These payment platforms have customizable checkout options to improve consumer experiences. They also offer low processing fees, which increases your aesthetic practice’s transaction value while providing trackable purchasing history insights. You can learn more about cloud-based payment platforms before adopting them into your practice.

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The Main Advantages of Online Pharmacies

Free Photo Medication Pills on White Plastic Container Stock Photo

Health problems periodically occur in a person, regardless of his age, social status, and gender. But on the way to timely access to medicines, there are a number of difficulties – lack of time, a sudden deterioration in well-being, bad weather, or the need to look after other family members. You can solve this problem with the help of a service such as an online pharmacy and non prescription ed meds. Round-the-clock operation and the availability of targeted delivery allow you to get the required medicines at any time.

The acquisition of medicines and other similar products has become a necessity for many. It is good when you can do without such funds, but not everyone has such an opportunity. Therefore, the search for a quality pharmacy, where you can find a large assortment and affordable prices, becomes an urgent issue. They offer the best conditions. Therefore, you can buy almost any medicine, hygiene products, and everything else.

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Role of AI In The Pharmaceutical Industry

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Artificial intelligence (AI) has the potential to generate $100 billion across the healthcare and pharmaceutical industry, according to Mckinsey. The use of artificial intelligence in drug manufacturing, cell culture process development, and research improves efficiency, cost-effectiveness, and decision-making. At present, Artificial intelligence is helping the following corner of the pharmaceutical industry to stay competitive.

1.   Drug Discovery Process:

Drug discovery is an expensive and competitive process. Pharma companies are using artificial intelligence to their advantage for staying in the competition. AI has the ability to recognize patterns in large data collection and it also helps in establishing the best drug compositions for diseases. Top pharmaceutical industry players are using the MIT-machine learning consortium to increase the efficiency of their drug discovery process. The players include Pfizer, Bayer, Lilly, and Novartis. This consortium called Machine Learning for Pharmaceutical Discovery and Synthesis is also working on insights for the optimization and designing of drug synthesis.

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The Future of Pharmaceutical IT

As Pharmaceutical Companies Tackle IT Modernization What Should They Know?

Digitalization is everywhere including in the healthcare industry. Global spending on digital technologies like IOR logistics, manufacturing, and wearable technology will increase by 2.8 trillion dollars by 2025. Innovations and creativity keep the world moving.

To stay relevant in the modern world, the pharmaceutical industry will also need to mold with it. The IT in the pharmaceutical industry is mainly related to increasing the efficiency and quality of drug development, its distribution in the population, and health care provision. Future IT innovations have to potential to provide the following benefits.

1.   Better Patient Experience:

According to a survey, more than 90 percent of patients believe that SME technology will improve the patient experience. To make the patient experience better, a customer-oriented approach to the use of technology in each case would be implemented. Technological innovations will increase customer loyalty to the pharmaceutical industry. The ability of a patient to order medicines from the company directly via mobile and websites will make it a hassle-free experience.

2.   Online Information:

Technology can help in spreading information and awareness about various drugs and treatments online. Digital technology is the shortest and easiest way to reach a customer directly. The pharmaceutical industry can post the side effects, contradictions, and relevant information about a drug online to make it easier for patients to find reliable sources of information online.

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Concerned About Your Unborn Baby? What You Need to Know About Genetic Anomalies

A genetic disorder is a medical condition that is brought on by changes in one’s genes or chromosomes. There are between 20,000 and 25,000 genes in every human body, and these genes determine which traits will be passed down to succeeding generations. If a genetic mutation occurs in one of those genes, it can alter a person’s appearance, personality, and intellectual or physical development.

Oftentimes, inherited diseases result from a change in DNA that is handed down from one generation to the next. It is possible for parents to unknowingly carry a chromosomal or gene mutation without experiencing any symptoms.

Some common ailments – like sickle cell anemia, Down Syndrome, and cystic fibrosis – may occasionally be traced back to a mutation in a single gene. If you’re worried about your unborn child’s risks because of your family history, it’s important to educate yourself as much as possible so that you can make informed decisions.

Increased Risk Factors for Genetic Anomalies

Causes of congenital abnormalities (CAs) range from environmental factors to genetics. Depending on when an individual is exposed to a potentially harmful environment in a pregnancy, the fetus may be at risk for miscarriage or birth abnormalities.

The most damage can be done by diseases and medications when exposed between two and ten weeks after conception. However, genealogical ties are only one example of how members of the same family tend to share characteristics with their surroundings and way of life. Consider them all together, and you may be able to see signs of a familial ailment. 

If you have a well-maintained record of familial disease history, doctors can assess an individual’s, their family’s, and future generations’ susceptibility to disease by looking for family history clues. Variables such as lack of prenatal care, overwork during pregnancy, poor dietary habits, and alcohol usage might increase the likelihood that your child will be born with a genetic disorder.

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What Doctors and Nurses Say They Need For An Effective Digital Transformation of Healthcare

Jan Herzhoff

By Jan Herzhoff, president, Elsevier Health Global Markets.

The statistics will make your heart sink. Doctors and nurses are feeling undervalued and burned out, facing reported and anticipated workforce shortages at the frontlines, all while dealing with the continued impact of the pandemic. It’s been found that 47% of U.S. healthcare workers plan to leave their positions by 2025, with 74% of clinicians globally predicting there will be a shortage of nurses and 68% predicting a shortage of doctors in ten years.

Through global in-depth research of nearly 3,000 doctors and nurses from 111 countries, we asked healthcare professionals to consider the consequences of the pandemic and provide insights on the challenges and opportunities they expect to face over the next decade – many having to do with new and emerging technologies.

The result is Elsevier Health’s Clinician of the Future report, in which we explored the global trends and changes identified in the research, that will impact the future of healthcare and its digital transformation. By listening to the voices of nurses and doctors themselves, and understanding the challenges they are facing, we will help forge a better path forward.

Today, technology plays a crucial role in transforming healthcare. In fact, according to the Clinician of the Future report, 88% of clinicians globally agree that being technologically savvy is more important in their daily role today than it was a decade ago.

Looking ahead 10 years, clinicians believe obtaining “technology literacy” will be their most valuable tool, ranking even higher than “clinical knowledge.” However, clinicians are still acutely aware of the consequences that may result from the recent rapid evolution of digital healthcare. Findings from the report highlight that 69% of the global workforce is concerned the widespread use of digital health technology will become another burden.

Despite these concerns, clinicians still see the potential of technology to help deliver optimal patient outcomes. These insights provide a roadmap for change and point to key trending areas of focus while on our path toward an effective digital transformation of healthcare.

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The Future of Consumer Wearable Technology

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Anna Barnacka

By Anna Barnacka, PhD, CEO and founder, MindMics.

Thanks to the explosion of affordable and miniaturized wearable technology, consumers now have a sizeable increase in awareness of individual health data. In the United States alone, consumer use of wearables has increased from 9% to 33% in just four years, and the industry is expected to continue to grow. We are at the dawn of a new era in which consumers will be equipped with a constant stream of knowledgeable and actionable data.

When wearables entered the consumer market about a decade ago, they were something for “health geeks” – people who were passionate about understanding the functioning of their bodies and who generally knew how to interpret the data they were receiving. Since then, there has been an incredible shift, brought on mainly by consumer electronics companies, towards creating wearables for everyday use. In the last three years alone, we have seen the huge impact that these companies have had with their messaging and marketing; now, wearables are for everyone.

Current wearables on the market can give us data about diabetes, hypertension or cardiac health, such as arrhythmias. With this technology, we can take control of our health and are provided with tools to monitor and change our behavior based on the gathered information. Before wearables, terms like heart rate variability (HRV) rarely – if ever – were mentioned in the mainstream media. Now, this information is available at our fingertips.

Wearables are not only making health information more accessible but also making it more personal. No longer do you need to wait for your annual physical to have a health update – you can take an electrocardiogram (ECG) whenever and wherever you want, using a device on your wrist. Wearables are finally affordable and blend into our lifestyles. More importantly, they allow us an almost constant stream of data to monitor individual health metrics. Wearables allow us to take control of our personal health and that starts with tracking health data on our own initiative.

As we continue to learn about and become more involved with our own health, it is time to use this technology to create change in real-time. Consumer wearables give us feedback on our health, but that feedback – until now – has been provided minutes, hours, or days later. This gives us a chance to reflect on the meaning of the information retroactively but relies on the user to analyze that data – then attempt to implement changes proactively.

Combining breakthrough advances in our understanding of physiology and accurate real-time data gathering from wearables opens a slew of possibilities. For example, we can monitor health data to better understand the reactional effects of our automatic nervous system.  We can observe the physiological impacts of getting particularly stressed during a work meeting with our boss (or an employee). We can build systems that nudge us to take steps to not only calm our anxiety but to more constructively use our stress response overall and to build resilience by developing techniques that help us better prepare for stressful events.

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