Are EHRs Delivering Value-Based Care?

Health Technology

Article | September 12, 2023

Contents 1. Knowing The Basics 2. Importance Of EHR In A Rural Setting 3. Features That An EHR Must Have In A Rural Area Today, we will discuss the crucial featuresof electronic health records (EHR) in rural hospitals. However, before listing out the key components, let us first understand what EHR is and how it can help the smooth functioning of medical treatment in a rural setup. 1. Knowing the Basics! As the name suggests, an electronic health record is a computer file that stores a patient’s medical history, such as diagnosis, treatment, test results, etc. In short, an EHR is a digital version of a patient’s paper health record. It also includes previous appointments, billing details, and other general documentation. The need for an EHR popped up due to its easy and secure availability compared to patients' paper files. In addition, patients and doctors can easily access lab reports through an EHR that is updated in real-time and downloaded on any device with an internet connection. 2. Importance of EHR in a Rural Setting! Healthcare Information and Management Systems Society (HIMSS) defines EHR usability as “The effectiveness, efficiency, and satisfaction with which specific users can achieve a specific set of tasks in a particular environment.' In essence, a system with good usability is easy to use and effective. It is intuitive, forgiving of mistakes, and allows one to perform necessary tasks quickly, efficiently, and with a minimum of mental effort.” A patient's electronic health records can be beneficial in an era of digitization. It can improve patient care by minimizing the chances of medical errors, reducing test duplication, and making doctors and patients well-informed by fetching medical records anytime, thereby reducing delays in treatment. 3. Features That an EHR Must Have in a Rural Area EHRs can prove beneficial in all areas situated far off by accessing the real-time, up-to-date data of patients’ health records and making timely decisions. When the distance between the clinics and specialists is more, an EHR report can easily be sent to look into a patient’s history before delivering treatment. In a rural setup, EHR helps promote health awareness as patients' data can be monitored without needing to be physically present. Software-as-a-Service (SaaS) Solutions can be easily deployed in places with slow internet and help maintain a lightweight EHR that can support immediate patient care and easy documentation. Next comes the option of configuration over coding. At the Rural Health Clinic (RHC), an EHR that the local IT team can handle would be of more use than one that may require a specialist’s check or additional coding. An EHR, equipped with the ability to configure and customize as per the clinic’s workflow, will give more control to the RHCs and enable them to function efficiently. Another significant point of an EHR in a Rural Health Clinic will be the inclusion of applications that support instant communication, like Telehealth and patient portals. These applications enable direct consultation and virtual care of patients and specialists located far off, thereby reducing the dependency of RHCs on city or urban-based facilities. When we are discussing rural hospitals, we need to look for an application that is both affordable and functional, as rural areas mostly struggle with problems regarding budget and resources. Hence, keeping this in mind, RHCs should install a cloud-based EHR that does not require buying servers or employing IT staff. RHCs must use an EHR application with innovative analytic tools to access and develop reports for quick patient care decisions. In addition, the system must be able to pull large chunks of data and generate reports daily. Enjoyed reading this? Want to read more related articles? Click the link for more information! https://healthcare.report/trending-news/electronic-health-records-ehr-software-market-2019-foreseen-to-grow-exponentially-by-2026 Happy Reading!

Health Technology, Digital Healthcare

Article | July 14, 2023

Dialysis providers face many of the same financial and operational pressures that affect other provider organizations, including flat or reduced reimbursements, chronic staffing shortages, and increasingly complex insurance requirements. Dialysis centers, nephrologists, and renal pharmacies also grapple with the impact of a growing shift in dialysis care to the home setting. End-to-End Automation Can Reduce Denials, Improve Cash Flow The good news is that despite these challenges, dialysis providers can sustain strong cash flow, reduce costs, and mitigate denials by applying advanced technology to the revenue cycle. Here are six ways technology can help strengthen the dialysis center revenue cycle in the today’s difficult operating environment: Identify undisclosed insurance coverage Because patients often present as self-pay even though coverage exists, determining their true insurance status can be challenging. Yet failure to identify existing insurance can result in significant write-offs. That’s why renal providers need technology solutions that can uncover patient coverage information before care is provided. Change Healthcare’s Coverage InsightTMsolution provides an expansive network and search-and-matching capabilities necessary to identify and confirm patient coverages at the outset of care. The solution uses machine learning algorithms—coupled with access to vast stores of available third-party-data—to develop robust patient profiles, which can then be linked to potential funding sources. Notably, it identifies a variety of indicators, including high probability of disability, income levels and financial status, insurance sources, and other actionable information to help you verify coverage and recover revenue. We can help identify undisclosed coverage for end-stage renal disease (ESRD) patients through Medicare/Medicaid, Disability/SSI, third-party liability, commercial insurance, state and county programs, social programs, and charity. Expedite seamless prior authorizations Streamlining the prior authorization process is essential to help ensure optimal reimbursement for renal care rendered, particularly with commercial insurance and Medicare. But traditional prior authorization processes are frequently time-consuming and labor-intensive and can delay necessary care. Our Clearance Authorization software addresses the chronic problem of prior authorizations with automated functionality that can determine if prior authorization is required and on file with the payer. The solution also will automatically check medical necessity requirements at the time of registration and electronically submit requests to integrated payers. Change Healthcare’s Connected Authorization Services go a step further by deploying pre-authorization experts to handle routine authorizations quickly using intelligent technology while working complex cases by exception to improve authorization efficiency and accuracy. Speed adjudication with electronic attachments As claims management processes have grown more numerous and complex, providers have struggled to ensure that the correct information is provided to the payer at the appropriate time. The result can be delayed, denied, or rejected claims. Assurance Attach AssistTMcontributes to faster reimbursement and reductions in denials, organizational expense, and administrative burden by automating the attachments process to meet payers’ increased demands for additional documentation. Attachments are automatically delivered and matched to the appropriate claim, and once the claim is released, claim and attachment status can be easily tracked. Expedite claims workflow for recurring services Creating claims for ongoing ESRD care requires repeatedly documenting the same details on each claim. Revenue Performance Advisor, an end-to-end medical billing platform, provides automation that allows dialysis staff to save time by quickly replicating unchanged data from prior visits while updating date-of-service and other information to expedite claims processing. Revenue Performance Advisor also includes eligibility and benefits verification and automated claims scrubbing that flags incomplete or incorrect claims prior to submission, resulting in a first-pass clean claim rate of 98%. Accelerate your Medicare claim cash flow Medicare is one of the largest payers of dialysis services, so ensuring a problem-free and expedited Medicare claims submission process is essential to strong cash flow. Our Assurance Medicare Direct EntryTMsolution provides a single system for the real-time submission and processing of Medicare claims. It can help expedite reimbursement, reduce AR days, and speed your Medicare primary claim cash flow by at least one full business day. Assurance Medicare Direct Entry also checks your Medicare claims for eligibility errors using the CMS eligibility transaction system (HETS). Claims needing attention are flagged and posted in Assurance Reimbursement Management for editing. You can quickly correct errors within the system before transmitting the claim directly to Medicare for validation and payment processing. Optimize patient liability Making it easy for patients to receive, understand, and pay their portion of the medical bill is key to ensuring a healthy revenue cycle, mitigating the need for collection services, and improving patient goodwill. With our Patient Billing and Statements solution, Change Healthcare serves as your strategic communications partner, delivering multi-channel, personalized print and digital statements to help expedite patient payment collection. The solution is designed to provide fast, effective statement and invoice processing, printing, and mailing—cutting your costs and getting you paid sooner. Our advanced statement printing allows you to bypass conventional and time-consuming folding, stuffing, and stamping. SmartPayTMconsolidates each step of the billing and payment process into one place, enabling you to collect more patient payments, get paid faster, reduce your collection costs, and lower patient write-offs. With multiple payment channels, including online, mobile, telephone and via mail, SmartPay helps expedite patient payments before, during, and after the encounter. A single, trusted partner Change Healthcare’s deep knowledge of the renal care landscape and our development of disruptive technologies to overcome traditional revenue cycle barriers can help dialysis centers achieve unprecedented revenue cycle excellence. And unlike many point solutions that only address a specific revenue cycle issue, Change Healthcare’s technologies are part of a comprehensive approach delivered through a single, trusted vendor. That translates into improved process integration and continuity, as well as simpler overall accountability.

Digital Healthcare

Article | November 29, 2023

As competition for patients intensifies, more hospitals and health systems are embracing a consolidated, single-bill approach for services rendered. Creating a single bill for the patient’s portion of inpatient or outpatient services can help eliminate confusion and reduce the ill will that frequently results when patients receive multiple invoices for a single care event. Yet incorporating anesthesia charges into a consolidated invoice is often problematic due to the unique nature of the anesthesia billing compliance. Anesthesia Billing Service Hurdles A few weeks ago, I met with the CEO of a 300-bed hospital. We discussed anesthesia billing, and he explained that his hospital traditionally outsourced this portion of its billing due to the more complex nature of anesthesia coding and the need to collect anesthesia minutes for billing. Unlike most inpatient services, anesthesia charges are not directly derived from CPT codes but instead utilize minutes and modifiers unique to the specialty. That means coders must use a CPT crosswalk to account for ASA codes, base and time units, emergency- and physical-status monitors, split anesthesia units reflecting CRNA involvement, and other specialty-specific nuances. Most coders and hospital billing staff are not trained in these complexities, and hiring and retaining capable staff in today’s competitive market can be difficult. Moreover, many billing platforms are simply not equipped to incorporate all the variables necessary to produce an accurate anesthesia bill. As a result, producing a consolidated patient bill that includes anesthesia is tricky. Yet leaving anesthesia off a single bill can undercut its value since, after facility and surgical charges, anesthesia often is one of the largest cost items patients incur. Fortunately, we at Change Healthcare know how to roll anesthesia charges into existing hospital billing systems to produce an accurate and timely single patient bill. Helping to Reduce Costs The benefits of consolidated billing extend beyond an improved patient experience. Producing just one bill reduces costs and repetition at both the front and back end of the revenue cycle management process. It can also ease staff burden when collecting on self-pay accounts, since there’s only one bill per patient. Finally, consolidated bills can help increase revenue by simplifying collections when patients present for follow-up care. Here’s an example: When the patient comes back for post-surgery physical therapy, a hospital employee at the registration desk can remind them that they still owe $150 for anesthesia and ask if they’d like to take care of that now. In my experience, patients usually hand over their credit card and settle their bill on the spot when asked at the time of care about a balance due. System-Agnostic Billing Across Hospital Platforms Change Healthcare has a long history of providing full-service, outsourced anesthesia-billing services to hospital and health-system clients. Unlike most other billing vendors, we’ve developed what we call a system-agnostic approach. That means we’ll provide billing services on our proprietary system or on the hospital’s existing billing platform, regardless of type, to generate accurate anesthesia-billing results. In practical terms, we’ll function as part of your billing team and use the same system your coders and billing staff rely on to generate anesthesia charges that can be included in a single patient bill. System-agnostic billing also allows us to provide clients with custom anesthesia reporting that wouldn’t otherwise be available with an outsourced billing solution. This helps clients gain far greater visibility and insight into anesthesia-billing charges. And by incorporating our anesthesia coding and billing capabilities into your existing billing system, you’ll be spreading the platform’s fixed costs across a greater number of departments. The bottom line? It’s not a heavy lift for us to virtually embed our trained anesthesia coders and billing professionals into your system. Our specialists will review your existing platform and provide, at no obligation, a return-on-investment analysis that can help you determine whether outsourcing anesthesia billing to capture claims on a single hospital bill makes sense for you. We expect the answer will be yes. Not only will you enjoy greater system efficiencies, but you’ll be in a position to produce a single bill that truly reflects the entire episode of care.

Article | April 11, 2020

Over the past twenty-five years most businesses have been revolutionized by the easy availability of cloud and mobile-based computing systems. These technologies have placed power and access into the hands of employees and customers, which in turn has created huge shifts in how transactions get done. Now the companies with the highest market value are both the drivers of and beneficiaries of this transition, notably Apple, Facebook, Amazon and Alphabet (Google), as well as their international rivals like Samsung, Baidu, Tencent and Alibaba. Everyone uses their products every day, and the impact on our lives have been remarkable. Of course, this also impacts how businesses of all types are organized. Underpinning this transformation has been a change from enterprise-specific software to generic cloud-based services—sometimes called SMAC (Social/Sensors/Mobile/Analytics/Cloud). Applications such as data storage, sales management, email and the hardware they ran on were put into enterprises during the 80s and 90s in the client-server era (dominated by Intel and Microsoft). These have now migrated to cloud-based, on-demand services.