HEALTHCARE ANALYTICS
Article | May 11, 2022
Mental illness is a fatal illness. Surprisingly, mental health is grossly underfunded all over the world. Despite countries' economic strength, there are still no long-term and solution-driven results for addressing mental health. According to WHO reports, only one in every fifty people receives medical treatment for severe mental illnesses.
The Sustainable Development Goals (SDGs) are a global initiative to create a more equitable and sustainable world. According to the World Health Organization, "there can be no health or sustainable development without proper mental health." As a result, mental health is one of the most critical pillars in creating a sustainable world in the future. In short, if mental health is good, sustainability will follow naturally.
Positive Mental Health = Thriving Sustainability
According to the WHO’s decision-making body, ‘The World Health Assembly (WHA),’ mental health deserves to be at the top of the sustainability agenda because it affects people of all ages.
It means anybody can be diagnosed with a mental illness, which is directly proportionate to sustainable development. So, a similar amount of treatments, diagnoses, and awareness should help people overcome mental illness.
However, on the other hand, according to the WHO's 2020 Mental Health Atlas, only 23% of patients with mental illnesses have been integrated into healthcare systems in developing countries. This highlights the undeniable fact that the world's 280 million people suffering from depression have been kept away from receiving a proper diagnosis, treatment, and care. Moreover, up to 85% of people with mental illnesses are untreated. The numbers are shocking!
Such statistics are enough evidence to create a supportive culture free of the stigma that mental illness is incurable and encourage patients to seek help when they need it. It includes geography-specific mental health resources, proper diagnosis, care, medication, availability, accessibility, other requirements, and adequate support systems.
Global Action is Key to Both
Providers of mental health services cannot do it alone. Instead, it requires a strong global response. In this case, leading companies and legislative bodies should exert influence to promote cost-effective, widely accessible, and evidence-based treatments for mental health disorders.
Some low-cost solutions to this global problem will eradicate it and bring about long-term development to support this point. As a result, the solutions are as follows
Improving social and economic environments as part of sustainable development
Integrating mental health into general primary health care
Providing appropriate care and treatment through trained and supervised community members
Using technology to introduce the most up-to-date solutions for mental health disorders
Wrapping Up
Transformation is essential today, both technically and in terms of humanizing. Otherwise, sustainable development will be impossible to achieve unless the enormous challenge of mental health is addressed. Therefore, healthcare leaders will need to develop transitional plans to increase coverage in real-time to accomplish this. This should include proper diagnosis and progressive tracking of mental health treatments.
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HEALTH TECHNOLOGY
Article | February 19, 2022
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.
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FUTURE OF HEALTHCARE
Article | February 19, 2022
Anesthesia groups face major challenges in the aftermath of the pandemic: Financially strapped hospitals are increasingly unwilling or unable to pay anesthesia subsidies, and a shortage of qualified anesthesiologists and CRNAs is making recruitment extraordinarily competitive.
The good news is that anesthesia opportunities are plentiful in the ambulatory surgery center (ASC) market. As more inpatient procedures migrate to ASCs, anesthesia practices can help meet demand by working with hospitals and ASCs. A dual-contracting approach can help increase revenue, reduce operational risk, enhance recruiting leverage, and present opportunities for equity investments in ASC ventures.
Expanding ASC Case Mix
Multiple factors are driving increased ASC volume.Consumers have long been attracted to the convenience andfast turnaround timesASCs offer, and as the pandemic began to take hold and patients worried about becoming infected in hospitals, theirpopularityincreased.
But even before the pandemic hit, theuse of ASCs was growing,with the number of centers increasing 7.1% annually since 2016.1No doubt this was in part driven by Medicare restricting fewer surgeries to the inpatient only (IPO) setting. This year alone, Medicare is adding 11 orthopedic procedures to the ASC-approved list, including total knee arthroscopy (TKA) and total hip arthroscopy (THA).2Commercial payersare alsofuelingASC volume by promotingthis venue as a lower-cost option to members.Lastly, with more than 90% of ASCs at least partially owned by physicians,providers themselvesare driving moreprocedures to this setting.
Hospitals Become ASC Buyers
For years, hospitals viewed ASCs as direct competition and discouraged or even prohibited inpatient anesthesia practices from contracting with them. But that dynamic is changing as more hospitals become buyers or majority investors.
According to a recent survey, the percentage of hospitals and health systems planning to increase their investments in ASCs rose from 44% in 2019 to 67% in 2020, with 75% of 200-plus-bed hospitals already owning more than one ASC.3Hospitals view these investments as a way to enhance physician relationships and increase surgical capacity.
The Benefits of Practice Diversification
For anesthesia practices that elect to contract with both hospitals and ASCs, a key benefit is improved profitability, since average ASC case reimbursements are higher than average hospital cases due to better payer mix and more efficient room turnover. Groups that work with multiple organizations also reduce their institutional or operational risk by limiting their exposure to potential financial problems associated with a single contracted entity.
Practices likewise gain an edge when it comes to recruiting in today’s highly competitive anesthesiologist and CRNA market. One of the chief benefits of ASC involvement is being in a position to offer a better work-life balance by spreading call responsibilities across a larger physician call pool. The math is simple: If a hospital group has seven physicians, each must provide call coverage once a week. But if the group also contracts with five ASCs and brings on five additional doctors to staff the facilities, individual call responsibilities are reduced to once every 12 days.
The importance of mitigating call duties to improve the work-life balance for both experienced clinicians and new hires can’t be overstated, particularly as hospitals work to streamline OR throughput by increasing the number of surgical procedures. Groups can also explore a range of creative compensation approaches, including essentially selling call opportunities to newly hired or recent graduate anesthesiologists as additional avenues to attract qualified clinicians while easing the burden on senior anesthesiologists.
Equity Opportunities
Among the most intriguing aspects of ASC involvement is the potential for becoming an equity stakeholder in the business. Surgeons traditionally have been the primary drivers in creating ASCs, but new opportunities exist for anesthesiology groups, particularly if their hospital is buying an existing ASC or developing a new ASC venture and looking to diversify the ownership group.
The idea of anesthesia ownership isn’t as crazy as it might sound. Like surgeons, anesthesiologists are integral to the success of an ASC, and like surgeons, they get there early and stay late. It’s no secret that joint ownership can greatly improve relations between the practice and the hospital, since both are now working toward the same objectives.
Groups can also make more money. I met with a surgical group not long ago with a 49% ownership stake in a hospital. That equity generated an additional $80,000 per year for each physician partner. How much you can make, of course, depends on your specialty, your level of ownership, and the volume of business. But you’ll never know until you try.
Outside Expertise
The pandemic has unleashed numerous changes throughout healthcare, and where the dust will eventually settle isn’t entirely clear. But what is certain is that for organizations to remain viable, they’ll need to be flexible and look hard at nontraditional business opportunities. Contracting with both hospitals and ASCs represents one such approach for anesthesia groups.
If you’re interested in exploring this and other business possibilities but don’t know where to start, Change Healthcare can help. Our team of expert anesthesia practice-management consultants have an average of 18 years’ experience in the specialty. We can be engaged on a per-project basis or we can provide our consultant services as part of our turnkey anesthesia-billing solution.
Our anesthesia revenue cycle management services can be deployed either on our own proprietary anesthesia-billing platform or on your hospital billing system. Either way, we’ll provide seamless, end-to-end service.
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DIGITAL HEALTHCARE
Article | February 19, 2022
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.
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