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E-Newsletter • October 2024 |
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Reorganizing the HHS
Artificial Intelligence can help streamline revenue cycle management. Jim Bohnsack, chief strategy officer for Aspirion—a technology-leading revenue cycle management company that addresses hospital denials, underpayments, and complex claims—looks at the challenges and solutions.
In addition to reading our e-newsletter, be sure to visit For The Record’s website at www.fortherecordmag.com. We welcome your feedback at edit@gvpub.com. Follow For The Record on Facebook and X, formerly known as Twitter, too.
— Kate Jackson, editor |
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Denied Claims Harm Patients and Providers — How AI Can Help Heal the System
By Jim Bohnsack
Hospital finance executives are grappling with three pressing revenue cycle management (RCM) challenges: staffing shortages, a surge in claims denials, and the convoluted prior authorization process.
These issues not only strain financial resources but also jeopardize the quality of patient care. Leveraging advanced technologies like artificial intelligence (AI) and automation, health care providers can address these hurdles, streamline operations, and ensure timely and effective patient treatment while securing financial stability.
In June, the American Medical Association (AMA) House of Delegates laid out its priorities for reforms to a health care system plagued by troubles with inflation—made worse by claims denials, prior authorizations, and staffing uncertainties that hinder providers as they try to manage costs and run their operations efficiently. Priorities include the following:
• ensure the clinical validity of care and offer patients continuity;
• offer transparency and fairness from the prior authorization process;
• approve claims in a timely manner; and
• offer alternative options for care in case of a denial.
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This program has been approved for 1.0 continuing education unit(s) (CEUs) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting of Approved CEUs from AHIMA does not constitute endorsement of the program content or its program provider. |
Epic Driving Change Toward New Medical Records Exchange
Epic Systems, which has been involved in the federal government’s establishment of the Trusted Exchange Framework and Common Agreement, aims to move all its customers to the network by the end of 2025.
Physicians Role in Information Blocking
The rules of information blocking, according to the American Medical Association, now apply to physicians who participate in some Medicare programs.
PETs-Enabled Solutions
Medical Economics reports on the privacy-enhancing technologies that let providers get patient information in a secure way and have the ability to improve patient outcomes.
Misconceptions About AI
AI can be a great advantage in health care, particularly in revenue cycle management, but not everyone knows how to use the technology properly. What’s often missing, according to an article in HealthLeaders, is accountability and oversight. |
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| Have a coding or documentation question? Get an expert answer by sending an email to edit@gvpub.com. |
AI Guide
AI Agents for Healthcare, an eBook from Cognigy, offers a guide to the ways artificial intelligence is revolutionizing the delivery of patient care and the management of operations. Learn more »
Dental Terminology
CDT 2025 Current Dental Terminology, from Libman Education’s eLearning Library, offers all the resources needed for meeting the Medicare Advantage Supplemental Dental Services Reporting Requirement. Learn more »
A Tool for Strategic Growth
HSG Advisor’s HSG Dashboard is a data information and visualization solution that empowers health care leaders to uncover new opportunities for strategic growth, improve operational efficiencies, and increase patient retention. It unifies complex data sets from internal and external sources, including the company’s proprietary all-payer health care claims data, providing clients with insights into competitive dynamics related to markets, service lines, providers, and patients. Learn more »
A Coder’s Guide to MS-DRG Changes
To prepare coders for fiscal year 2025 Inpatient Prospective Payment System updates that took effect October 1, Haugen Consulting Group offers a webinar, 2025 Hospital Payment Update: A Coder’s Guide to MS-DRG Changes. It breaks down the most relevant MS-DRG shifts, updates to the complication or comorbidity/major complication or comorbidity list, and the latest procedures with new technology add-on payments. Learn more »
Fathom Autonomous Medical Coding Available in Epic Toolbox
Fathom’s technology is now available in Epic’s Toolbox program within the Fully Autonomous Coding Category. This technology empowers health systems and other provider organizations to overcome chronic workforce challenges and strengthen both top and bottom lines. It delivers an average successful automation rate higher than 90%—nearly double that of any other technology in the market—across a broad set of medical specialties, generating industry-leading return on investment. With Fathom, providers benefit from reduced costs, increased coding accuracy, reduced denials, improved revenue capture, and accelerated cash flow. Learn more » |
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