U.S. healthcare providers need to collect every dollar owed to them. As their reimbursement models rapidly evolve, you may be asking, “Is it time to replace our revenue cycle management (RCM) solution?” Experts estimate that if U.S. hospitals do nothing to address the swiftly changing financial environment, they could see a 19% drop in margins over the next 10 years. Based in part on the HIMSS AnalyticsTM index and other observations, we developed a checklist of the core components of a healthy financial system. If your RCM solution can’t do these things, it may be time for a change: 1. Offer web services to patients for convenience – Can your patients pre-register, self-schedule and pay bills online? These online conveniences are becoming more important to consumers and help speed the billing process. 2. Verify insurance eligibility in real-time to reduce risk [...]

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Global Healthcare Megatrends: Financial models

There are more than 7 billion people on the planet today. Our growing global population has triggered some of the biggest healthcare challenges we’ll ever face. Listening to clients in Australia, Canada, Singapore, United Kingdom and United States, I believe many of these issues are universal. This is the third post in a five-part series that explores the clinical, population health, financial, regulatory and technical challenges we share as a global healthcare community. Healthcare costs are rising around the world. Financial pressure may be the most uniform challenge we face as a global healthcare community. Every country is trying to find ways to deliver better care at a lower cost. Reimbursement models differ by country Each country has a different way of funding health care. For example, Canada has a single-payer system. Physicians bill the national health insurance plan for [...]

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Payerpath aces an ICD-10 test

Are you ready for October 1, 2014? As most U.S. healthcare providers know, the Centers for Medicare & Medicaid Services (CMS) will only accept claims that use ICD-10 codes after that date. To make sure we’re all ready for this deadline, CMS and its Medicare Administrative Contractors (MACs) recently conducted National ICD-10 Testing Week. Because our Payerpath® solution submits claims to Medicare on behalf of our clients, we participated in the event. We had some great results. Of the 1,852 test claims we submitted, 99% passed ICD-10 related edits. And 100% of our 96 test files got a positive acknowledgement of receipt. This is a great sign that Allscripts Payerpath solution is ready to help clients transition to ICD-10. How the testing process worked Participating clients submitted a small number of test Medicare claims to Payerpath, which contained valid ICD-10 [...]

Robert Wood Johnson University Hospital (RWJUH) in New Brunswick, NJ, has an integrated view of its finances and operations with Allscripts EPSiTM. The organization recovered $4.5 million in underpayments its first two years of using EPSi’s Product Line Analysis Contract Modeling tool. You can read more in a recent case study. Prior to implementing the Allscripts EPSi modules Cost Manager, Product Line Analyst and Enterprise Management Dashboard in September 2011, RWJUH had limited financial and patient data reporting capabilities. Before EPSi “There was always a level of skepticism with our reports back then,” said RWJUH senior financial analyst, Michael Piagentini. “Is that the true fully-loaded cost for that service? It was hard to know for sure.” This uncertainty was particularly difficult when RWJUH negotiated contacts with payers. Contract modeling saves the day at the negotiating table Contract negotiations between healthcare [...]

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Applying analytics to revenue cycle management

In an increasingly complex healthcare environment, physicians must base financial strategies on more than assumptions and anecdotes. They need analytics. Frank Cohen presents a solid case for analytics in a recent Physicians Practice webinar, entitled Analytics Do Nothing for Your Practice’s Health – True or False?. People often use limited information – what they think is true – to make management decisions. This approach can lead to three pitfalls: Failure to observe – assuming you know what the problem is without seeing what is really happening Failure to plan – assuming you know how to fix a problem without first finding out what is causing it Failure to validate – assuming the action you have taken to fix the problem has worked without measuring it Diagnosing financial issues with evidence When physicians first assess patients, they may have some intuitive [...]

To control costs and improve results, many medical groups are evaluating a new generation of outsourced revenue cycle management (RCM) solutions. But wading through RCM solution options can be confusing. One obvious measure is the price of the solution. It’s important to evaluate the total cost of ownership to help make the right decision for your practice. Considerations should include the answers to these questions: 1. Will the solution save staff time by automating time-consuming tasks with easy-to-learn software? 2. Will the solution’s analytics give you insights to help you proactively manage the revenue cycle, provider productivity and benchmark performance? 3. If you decide to make a change in the future, is the solution portable? Or will you need to start a new solution from scratch? 4. Will your staff continue to perform certain tasks internally, or will your partner? [...]

When Allscripts began the process of designing our new Sunrise Financial Manager (SFM), we had the rarest of opportunities…the chance to start over with hindsight. Our plans included moving SFM to the same technology platform as our clinical solutions. Tapping clinical data as part of the revenue cycle is a smart way to boost cleaner claims and more timely payments. More exciting was the chance to do something really special with the solution. The move to the new platform meant essentially starting with a blank sheet, sketching out what to carry forward and what to leave behind from the existing solution. Our goal: to develop a new patient financial system that dynamically addresses the changing health care landscape, now and in the future. So, we looked to the collective knowledge of the people closest to the realities of managing revenue [...]

Do you have the data and insights you need to better manage your practice and improve profitability? Over the years, the business of running a physician practice has become immensely complicated and labor intensive. Health plan rules and government regulations are constantly changing. And while it’s increasingly important to cut costs, increase efficiency and align compensation with productivity, it’s difficult and time consuming for practices to track these and other key success measures, let alone understand how they’re performing versus their peers. To help, today I’m really excited to announce Allscripts Practice Performance, a new business intelligence and comparative analysis tool that responds directly to our customers’ evolving business needs. Leading medical providers have told us they want a new generation of cloud-based solutions that give them actionable business intelligence. Allscripts Practice Performance delivers with a complete analytics and business intelligence solution [...]

Many observers, including the analyst firm IDC Health Insights, have noted the critical role of care management software in accountable care organizations (ACOs). For a closer look at how one health system has used care management technology to create the foundation for an ACO, we recently read this excellent peer-reviewed article (requires download fee or subscription to Professional Case Management) by Linda Stutz, BSN, MBA, Senior Director for Case Management at Banner Health. In the article (“Case Management as a Foundation for an Accountable Care Organization”), Stutz describes how Banner, one of the largest, nonprofit health care systems in the country, implemented “a Case Management Model that demonstrates a strong return on investment for the hospitals in the system and creates the foundation for success under health care reform.” Just what ROI did Banner produce under the new model? An 8-percent [...]

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Four Steps to Physician Revenue Cycle Transformation

Amid all the talk of Stage 2 Meaningful Use, Value-Based Care and ACOs at the HIMSS conference in Las Vegas last week, it was easy to overlook the dominance of the longest lasting trend of all in healthcare IT. Revenue cycle management doesn’t generate as much buzz as health reform but it’s still priority No. 1 for hospitals and physician practices nationwide. It’s easy to see why. As the latest Obama Administration budget indicates, reimbursement from payers including Medicare and Medicaid continues to decline. As a result, self-pay is on the rise, even as it is becoming harder to collect payment from patients, many of whom are struggling just to hold onto health coverage for their families. In this environment, effective revenue cycle management has become more important than ever. For help, many leading medical groups are turning to a [...]