Healthtech Security
Article | November 29, 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.
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Health Technology, Digital Healthcare
Article | September 8, 2023
The healthcare industry is experiencing rapid shifts. Some of this is due to the current pandemic, but much of this evolution was happening even before the COVID-19 outbreak. Understanding and embracing the introduction of new technology into the market will be important for healthcare professionals and patients alike. Here are some of the trends worth keeping tabs on:
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Health Technology, Digital Healthcare
Article | July 14, 2023
The healthcare industry has become a prime target for cybercriminals in recent times.
According to The State of Ransomware in Healthcare 2023 report from Sophos, six in 10 healthcare organizations have been hit by ransomware in the last 12 months, up from 34% in 2021.
Among this uptick have been several headline-grabbing attacks. For example, Shields Health Care Group became the subject of the single-largest breach affecting any organization globally in April 2023, when 2.3 million patients of the Massachusetts-based medical services provider had their personal data stolen after a cybercriminal gained unauthorized access to the organization’s systems.
Meanwhile, in the UK, a ransomware attack on the University of Manchester occurred in June, affecting an NHS patient data set holding information on 1.1 million patients across 200 hospitals.
Critically, the wealth of data housed in healthcare networks, and the potential impact of data unavailability in healthcare, make the industry both attractive and lucrative to threat actors.
It’s no coincidence that the Sophos report shows the rate of encryption in the healthcare sector is at its highest level in recent years. Of those healthcare organizations which suffered a ransomware attack in 2023, 73% had their data encrypted – up from 61% in 2022. When cybercriminals can successfully take down hospital systems and/or encrypt patient data so it can’t be used, they can blackmail health service providers, demanding significant sums before reinstating systems and/or data availability.
Considering healthcare's critical role as the highest-stake industry in our society, where people's lives depend on its success, the likelihood of attackers achieving their goals is greater than in other sectors, as confirmed by the Sophos report. Indeed, of the 73% of healthcare organizations that had their data encrypted, 42% reported that they paid the requested ransom to recover data.
DSPT and the compliance burden
Without question, the security-related challenges in healthcare are mounting. Right now, industry organizations are operating against a backdrop of unprecedented operational and workforce pressures, spiralling demand for care and industrial action.
Moreover, there is a growing regulatory burden, with organizations continually asked to comply with evolving cybersecurity rules, battling with multiple compliance mandates at any given time.
Take the NHS as an example. According to the 2023 NHS Providers’ Regulation Survey, just over half (52%) of respondents said the regulatory burden on their trust had increased. And this is expected to ramp up further in the future, with the UK government setting out a new 2030 strategy aimed at bolstering cyber resilience in healthcare.
Among the compliance burdens that the NHS faces is the challenge of meeting the requirements of the newly updated Data Security and Protection Toolkit (DSPT).
Mandated to minimize cyber risks and enable healthcare providers to maintain a robust information security posture, the DSPT is not a simple checklist of security controls, but a comprehensive toolkit to evaluate current security maturity and establish a risk management programme.
Indeed, in more recent times, DSPT has moved away from being a guide for achieving certain levels of assurance, and toward a mandatory evidence-based system which demands NHS organizations align with 10 precise National Data Guardian (NDG) standards: 1. The organization assures good management and maintenance of identity and access control for its networks and information systems. 2. The organization closely manages privileged user access to networks and information systems supporting essential services. 3. The organization ensures passwords are suitable for the information being protected. 4. Process reviews are held at least once a year where data security is put at risk and following security incidents. 5. Action is taken to address problems as a result of feedback at meetings. 6. All user devices are subject to anti-virus protections, while email services benefit from spam filtering and protection deployed at the corporate gateway. 7. Action is taken on known vulnerabilities based on advice from NHS Digital, and lessons are learned from previous incidents and near misses. 8. The organization has a defined, planned and communicated response to data security incidents impacting sensitive information or key operational services. 9. The organization has demonstrable confidence in the effectiveness of the security of technology, people, and processes relevant to essential services. 10. The organization securely configures the network and information systems that support the delivery of essential services.
Reducing Compliance Challenges with the Right Solutions
Taken individually, these standards may not seem too strenuous to adhere to. However, to be compliant with DSPT, all 10 items need to be completed and deemed ‘satisfactory’.
To tick all 10 key boxes in the most effective and efficient manner simultaneously, organizations should consider their strategy carefully. This could involve embracing supportive tools to accelerate and enhance their compliance journey.
Boiled down, DSPT demands several key things, including unincumbered visibility of the entire ecosystem, as well as the ability to demonstrate secure access, logs and storage, and essential auditing processes to maintain data security.
Achieving these things might appear complicated, even daunting. However, there are solutions known as Security Information and Event Management (SIEM) systems on the market that can make achieving these capabilities, and in turn DSPT compliance, easy.
Here, we outline some of the key features to look out for to meet compliance: • Log retention: A modern SIEM should be able to provide a centralized log storage and big data platform that scales to any organization’s size. Platforms should be able to provide role-based access to log data, including ‘data privacy’ functionality that can mask sensitive data until approved. Log data should not be modified or removed by users once ingested into the platform, while all data held should also be indexed and fully searchable. • Identifying and disabling unnecessary accounts: A good SIEM will also provide account auditing facilities for Active Directory that allow administrators to quickly identify dormant accounts. They should also be able to remove privileged user access when no longer required or appropriate. More sophisticated platforms will be able to do this in an automated manner. • Easy identification of issues: Clear and easily readable dashboards, alerts and reports for user logging activity should be provided, including failed login, apparent brute-force attempts, and bad password management practices. Further, those using machine learning will be able to identify unusual behavior patterns based on a baseline of activities of users and their peer group. • Integrate with third-party threat feeds: It will also be able to integrate with a wide variety of third-party threat feeds that provide information about specific known threat payloads/hashes and destination domains/addresses.
Meeting the mandate
Of course, having the right features in place is only part of the puzzle. For organizations to be truly successful in embracing tools that enable them to meet DSPT compliance more effectively, they should work to ensure that solutions providers offer them ongoing support – both in terms of ease of deployment and to ensure that they are using key systems in an optimal manner.
Scalability is another important aspect to consider.
Systems should be able to scale and continue to support the organization as data volumes increase and become more complex over time.
In respect of scalability, organizations should take time to think about pricing models, ensuring that these are based on the number of devices (nodes). In doing so, it will become easier to accurately budget future costs, as well as provide greater budgeting certainty over the short, medium and longer term.
A converged SIEM allows organizations to prioritize the big picture over individual tools, enabling them to develop a seamless and easy to use security operations setup. Not only does this approach boost cost transparency and eliminate potential complexities with managing a variety of siloed products – equally, it reduces the burdens on security teams, eliminating complexities over system integration and enhancing performance.
A converged SIEM combines key technologies easily to offer improved security outcomes. In doing so, organizations can easily home in on specific standards and adopt security best practices while reducing the burden on security teams tasked with meeting DSPT compliance.
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Future of Healthcare
Article | December 8, 2020
Ha, ha, ha, it’s me, alcohol hangover syndrome. Oh no, it feels like I have a fire burning through my head, that cannot be put out. What a pain, the hang-over. I can't get up. My eyes are red and blurred. I feel sick and body is tired. My body aches like French fries sizzling in scalding hot oil. Ouch, what a pain it is. Ouch is not a strong enough expression. So I Scream! Damn is the toe nail fungus vomiting too, I am sick. Screaming; oh no my head cannot handle it, it spinning and blazing like fire. My eyes are red, like a red eyed dragon.
Well you are feeling the side effects of drinking excessive amounts of alcohol, referred to as intoxication - hang-over. Alcohol is labeled as the gateway to addiction and may lead to other drugs. The Lancet Medical Journal advises alcohol increases the risk of hypertension, stroke and heart attack.
Alcohol intoxication is the result of high consumption of alcohol increase in the blood stream. The higher the amount of alcohol within blood stream the more impaired you become. According to statistics of 2015 an average of 6 people die each day due to alcohol poisoning or drinking so much that the body become overwhelmed. The body resistance to alcohol intoxication poison aligns in the critical or essential areas of the brain that control heart rate and breathing causing the heart rate and breathing to shut down and can lead to death.
Frequent intoxication can inhibit ones' ability to think, focus, health, work, communicate, behavior and relationships. Frequent intoxication also influences one to become isolated, trying not to disclose habits by lying about drinking to family, friends or associates and even hiding alcohol in some cases whether it be at home or work. Hazardous harm of alcohol poison to the body begin as a craving for alcohol. This chain reaction is similar to the body becoming tired and fatigue and demands sleep which you cannot control, you must get sleep or pass out. Groans are similar to a choking frog that cannot control it voice.
The craving or urge to drink may be triggered by internal or external factors. Attention and insight or consciousness to what triggers urge to drink is an advantage to assist in controlling the (ABV) alcohol beverage volume consumed. Mentioned in the beginning intoxication poison is not pleasurable and intoxication is unhealthy, so has this habit of excessive drinking become an uncontrollable addiction? My rap song is you are hooked and chorus is:
Unforgettable, Unforgettable, Unforgettable
You have made me your number one love
You take me with you like a shadow
You hold me with such a grasping hold of touch
I am yours and you live just to be with me!
Risk Factors of Alcohol
Toxic obstacle of future damage
Reality is a hard hitter and a definite strike out
Consequences and penalties exist!
Many times with a toast, alcohol is the toaster to recognize an individual are group of individuals. Toast with alcohol can lead the way to consumption of more alcohol. There is a chicle that friends don’t let friends drink drunk. Well when the friend is seeing through eyes of alcohol themselves who become the helper? Drinking and drinking is a serious violation of the law. Risk factors are costly, expensive and devastating. Risk factors include but are not limited to:
DUI- (Driving under the influence) Driving under the influence of alcohol is prohibited by law and punishable by law. Consequences for illegally operating a vehicle while under the influence of alcohol can range from imprisonment, fines, community service and limited operating driving privileges. These factors are enforced under Misdemeanor Offense based on the merits, history of the first time offense. If the BAC (Blood Alcohol Concentration) is above .08 consumption
while driving a vehicle one can be arrested.
DWI- (Driving while intoxicated) Driving while intoxicated is also prohibited by law and is punishable by law. DUI and DWI are related and both are violations that have penalties. Multiple DUI’s are DWI’s fines can range from $2000 0r more, are or imprisonment depending on state
which the violation occurred. The violation is governed under Gross Misdemeanor or felony. Factors include subject pass history, accidents and drug use. Related obligations imposed are rate of operating a vehicle insurance increase, storage and towing fees, attorney fees, DUI classes, restitution, possible criminal and court fees, scarred background record, possible driver license suspension or driver license being revoked.
Accidents- According to National Institution on Drug Abuse report “Drinking and driving can add up to tragic ending. In the U.S. about 4300 people under the age 21 die each year from injuries caused by underage drinking, more than 35 percent in car crashes.”
Relationships- Relationships are a valued connection, resource, positive interaction, communication and socially are viewed as binding or a bond. When a relationship becomes troubled an uncomfortable strain effects the stability of comfort and sometimes trust. Drugs for instance can cause damage to a good relationship with family, friends and acquaintances. Relationships should be positive, supported and loving.
Jail- A sentence for punishment of an unlawful crime.
Risk Factors of Alcohol
Divorce – Divorce can carry the burden of a setback. Change is transition and sometimes stressful. An individual can feel pressure and seek relief that may eventually lead to depression anxiety or harmful opioids without medical advice.
License Suspension- A period of time which a valid driver license privilege is suspend temporary.
Financial Burden- Fines, fees, loss of driver privilege and other costly expenses create financial burden or loss of income that may be saved or distribute differently.
Health Issues- Quote your health is wealth has merit and valuable. Your health matters and chemical dependency addiction impairs the body system with side effects such as strokes, hypertension, seizers, respiratory problems and heart failure.
Employment- EAP (Employment Assistance Program) EAP is an employment assistance agency providing services to assist in personal, financial and work related occurrences.
Court Ordered Rehabilitation – The risk factors associated with alcohol related court can be positive. The individual who takes advantage of this opportunity could overcome alcohol addiction and improve his or her behavior to become a more productive citizen. This also helps one to rebuild their lives. Alcohol rehabilitation also allows people to heal from addiction and dependence issues. Most people prefer alcohol rehabilitation programs to avoid a Criminal sentencing and to get their lives back on track. Risk factors can work out very well for one and help one redeem his or her positive life back.
Children Neglect- Family and especially children struggle and suffer as they learn to live without your guidance. Being absent in your children life signal a lack of love and trust for them.
They begin to doubt themselves despite your habit of addiction.
Grief – Regret and self-emotional punishment for the injury, harm or death inflicted upon another while impaired by the use of alcohol (Drinking and driving)
Don’t drive and drink is a safety factor that should not be ignored!
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