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Health systems across the country are in various economic states. Some are thriving while many are gasping for air. The pandemic has only complicated matters.
Can technology provide relief for those struggling to maintain financial viability? This month’s E-News Exclusive explores the possibility of organizations employing artificial intelligence to spot where their claims may be falling short.
— Lee DeOrio, editor |
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Taking Hold of the AI Opportunity in Revenue Integrity
By Vasilios Nassiopoulos
Health care is realizing the promise of artificial intelligence (AI) across a broad and seemingly endless range of use cases. The opportunities for using advanced technologies to accelerate labor-intensive processes touch everything from research and operations to supply chain and point-of-care decision making.
Data-hungry revenue integrity and billing compliance functions are no exception. AI tools such as machine learning, natural language search, and anomaly detection are fueling new and expanded insights into revenue integrity, billing compliance, and quality assurance to advance process improvement initiatives. And not surprisingly, the value proposition of these tools is growing rapidly amid COVID-19 as health care organizations try to maximize reimbursements against notable challenges such as revenue shortfalls and rapidly changing regulations.
Getting out in front of the challenge of identifying new revenue opportunities and avoiding claim denials requires a proactive, data-driven approach that drives efficient recognition of issues, actionable insights, and better collaboration between billing, coding, and compliance professionals. Manual efforts will simply not suffice as health care organizations seek to accelerate productivity that mitigates risk, continuously monitors and audits processes, benchmarks against industry norms, and drives process improvement.
Full story » |
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Cerner Rolls Out Cloud-Based Health Records Product for Rural Hospitals
Cerner Corporation has announced a tailored cloud-based technology offering, CommunityWorks Foundations, created to help critical access hospitals reduce financial burdens. This new technology, geared toward smaller and rural hospitals, offers a fixed-fee payment structure with no up-front capital spend to help reduce costs and lengthy implementation processes. CommunityWorks Foundations, a cloud-based version of the Cerner Millennium EHR, is designed to expedite implementation with a six-month kick-off to go-live timeline and will make it easier for small hospitals to better serve their patients. Health care providers in small communities often face challenges such as geographic isolation, workforce shortages, educational disparities, and diminishing resources that can make it harder to deliver high-quality care, and COVID-19 has exacerbated these trends. Learn more »
Solution Helps Providers Handle Price Transparency Rule
Panacea Healthcare Solutions has launched pricing transparency readiness software and consulting services to help providers prepare for and comply with the Centers for Medicare & Medicaid Services (CMS) Hospital Price Transparency Rule requirements. With these new requirements, health systems must make accessible all standard charges in a machine-readable format and for consumers as a list of 300 “shoppable” items—nonurgent, high-volume items and services—on their website or via an interactive tool. Panacea’s Shoppable Disaggregation Algorithm and Report Set will make it easy for hospitals and health systems to process hundreds of thousands of claims and payment data to compile their shoppable list. The software makes building each of these lists painless by processing 100% of the patient population through algorithms utilizing clinical coding and financial logic and proprietary tables to eliminate the records that do not meet the criterion. The software also disaggregates the data into useful categories with tags and filters to facilitate the formation of the shoppable list. Panacea has also automated the process of creating the CMS-required machine-readable file and the consumer display of the shoppable list. Learn more »
Productivity Tool Reduces Documentation Burden
StatNote has developed several productivity tools aimed at reducing one of the primary contributors to physician dissatisfaction: medical documentation. StatNote: Dot Phrases to Expedite Medical Documentation is a book of boilerplate templates, known as “dot phrases,” to help capture the essentials of the office visit while significantly reducing the time spent compiling notes. StatNote also offers the Ninja Stick, a USB loaded with more than a thousand dot phrases and templates that can be used on any computer and with any EHR system. StatNote is now partnering with KaiGenix to create a smart transcription service that can create a clinician’s notes from the doctor-patient interaction. Learn more » |
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Patient-Generated Health Data Under the Microscope
Medical experts are in the process of trying to figure out how best to utilize this information. Read more »
The Evolving Cancer Registry Requirements
Significant changes issued at the beginning of this year have had an impact on departments. Learn how to navigate the nuances. Read more »
Days of Our Lives — A Dive Inside the Intricacies of the Two-Midnight Rule
The Two-Midnight Rule has the innate ability to keep coding departments wishing it was all a bad dream. Read more »
Integrating Telemedicine Into ICU and ED Workflows
By integrating telemedicine into ED and ICU workflows, health care organizations can realize greater benefits. Read more » |
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Nurse’s Lawsuit Alleges Health Department Asked Her to Violate Privacy Laws
A lawsuit alleges a nurse was fired for refusing to give law enforcement the names and addresses of people who tested positive for COVID-19, reports the Belleville News-Democrat.
Staff Accused of Violating HIPAA, Accessing George Floyd’s Medical Records
George Floyd’s medical records were breached multiple times by Hennepin County Medical Center staff members who viewed the information without authorization, according to MPR News. |
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Injection Earns J Code
Baudax Bio, Inc, a pharmaceutical company focused on therapeutics for acute care settings, recently announced that the Centers for Medicare and Medicaid Services (CMS) established a new permanent J-code for ANJESO (meloxicam) injection facilitating reimbursement in the hospital outpatient, ambulatory surgery center, and physician office settings of care. The code, J1738 (Injection, meloxicam, 1 mg), published on the CMS website, will take effect on October 1, 2020, and it is expected to replace the previously issued C-code.
“We are very pleased that ANJESO will have its own product-specific J-code beginning on October 1, 2020,” says Gerri Henwood, president and CEO of Baudax Bio. “This J-code brings us one step closer to ensuring greater patient access to nonopioid alternatives by providing outpatient providers and physician offices with a uniform code and clearer reimbursement pathway when administering ANJESO and further supports our efforts during our ongoing launch.”
Read more » |
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