Revenue Cycle Management

Are EMRs Going To Generate Billing Audits?

As readers are likely to know, EMRs have already begun to get a bad rap among some payers — most prominently Medicare — as leading to upcoding and padding of services performed on the E/M side of medicine. It may seem a bit unfair for CMS to push for EMR adoption then waggle the finger of disapproval when they lead to billing changes, but that’s how the cookie crumbles.

The thing is, we’re not just talking about disapproval and public chastisements over billing patterns. HHS has gone a step further than public tut-tutting. In the 2013 work plan for the HHS Office of the Inspector General, the OIG has specifically targeted EMR documentation for E&M services as an area for study and possible audits:

We will determine the extent to which CMS made potentially inappropriate payments for E/M services in
2010 and the consistency of E/M medical review determinations. We will also review multiple E/M
services for the same providers and beneficiaries to identify electronic health records (EHR)
documentation practices associated with potentially improper payments. (emphasis mine)

According to Betsy Nicoletti, a prominent coding consultant who chatted with me this week about this topic, the OIG is going all out this year, looking at Medicare A, B, C, D and just about every type of provider you can imagine (such as, for example, skilled nursing facilities). Private payers are also getting particularly aggressive in looking for suspect billing patterns, particularly profiles that don’t fit with other physicians in a given specialty.

From what she told me, it’s not that EMRs are automatically suspect, but rather, that EMRs can create inconsistencies and red-flag billing patterns through the use of templates and forms. For example, CMS may very well notice and audit your practice, she says, if the use of templates leads to using the same code too often (something CMS frowns upon, as it assumes patients’ conditions will vary widely).

If you want to get ahead of possible OIG audit problems, she suggests physicians read the work plan and self-audit in areas that are relevant to their medical practice. Better safe than sorry, no?

Top 5 Revenue Cycle Management Issues

Like Jennifer, I’m going to be heading to AHIMA 2012 as well. She correctly identifies that ICD-10 is a major AHIMA topic and Upcoding is the topic de jour, but another topic which I think continues to sit under the radar at AHIMA is revenue cycle management.

In many ways this makes sense when you consider that the ICD-10 has such an influence on revenue. Upcoding is all about revenue. Even healthcare documentation is dominated by a discussion of its impact on revenue (Yes, we could discuss why this should be about patient care in a future post). While many don’t want to admit it, humans need to get paid to survive and they want to get paid as much as they can get. Last that I checked doctors were human.

What then are the challenges that doctors face with revenue cycle management (or revenue integrity which many like to call it)? Here’s a great list of RCM challenges as listed by Ruth Zwieg on LinkedIn:

1. Managing the revenue cycle of a practice starts with good Practice Management (PM) software; one that has an easy to use scheduling tool for the front desk and that can determine insurance eligibility before the patient arrives so that the practice can collect the correct co-pay and/or out-of-pocket expenses up front before seen by the physician. This increases A/R and saves time instead of spending resources collecting after the fact which is time consuming and expensive.

2. The PM software must be easy to integrate with their existing or new EMR so that the physician group can show meaningful use and get that incentive money. Many practices still think they have to get new Practice Management software when they start looking at EMRs and many EMR companies try to sway them this way so they can get the sale for their PM software and their EMR.

3. ICD-10 – Need I say more – you have written about this in detail. Some Practice Management systems have a coding assistant built in but most do not. Coding correctly determines payment.

4. Staff training is very important from the beginning of the revenue cycle (scheduling, verifying insurance) to managing the patient once he/she checks in to when the physician sees them to check out and billing/collecting. Just like every other business, time has to be managed and time is money, especially a physician’s time. The more efficient the staff and their use and understanding of the software, the more patients the physician can see.

5. Many hospitals have and still are purchasing physician practices because the physician either does not know the business side of running a practice or just wants to be on salary and get rid of the headaches. Billing for physician practices is different than hospital billing. Hospitals are realizing that their hospital staff may not be doing the best job of that. In addition, the hospitals are realizing that their hospital system’s EHR does not have the desired functionality that a physician group needs or worse, they have multiple physician practices all using different EMRs that the hospital now has to manage or integrate into one.

I find this list really interesting and does speak to many of the revenue challenges healthcare faces. If we could solve these five challenges we’d have done a lot of good for doctors.

Primary Docs See Hope For Stronger Financials With EMR

Apparently, some primary care physicians are optimistic about the financial impact EMRs will have on their practice, according to a new survey.

Vendor Hello Health recently completed a survey of 100 practicing physicians without EMRs to discuss their attitudes about key business issues. Not surprisingly, 37 percent of respondents said EMR adoption was their number one challenge at present; an equal percentage said that financial issues were their biggest worry.

Here’s what, to me, is the most interesting part of the study. Among doctors for whom practice financial health was a primary concern, 51 percent felt that implementing an EMR would help solve their problems.

Their theory was that EMRs would help by improving coding and documentation to substantiate claims, as well as improving efficiencies and reducing costs.

Of doctors who didn’t think EMRs would help their financial situation, 46 percent felt that the systems would lead higher costs and overhead, and 15 percent felt productivity would decrease.

Now, I’m going to go all cynical on y’all.

I was pretty surprised to read that some doctors feel EMRs will actually improve their financial situation. Sure, improving coding and documentation itself is certainly a worthy financial goal. The thing is, that’s not exactly what EMRs are designed to deliver.

As for improved efficiencies and reduced costs, well, I don’t find that very credible at all. Not that some practices don’t achieve this goal, but if the respondents had anything near-term in mind they’re likely to be quite disappointed.

Realistically, if I wanted to invest in technology that improved my coding, I’d go with a computer-assisted coding or souped-up billing system. And I’d begin gunning my ICD-10 engines right away. Getting psyched about my pending EMR is nice, but probably setting oneself up for a letdown.

Study: ICD-10 Could Slam Operations

We all know physicians are dreading the ICD-10 deadline. Who wouldn’t be a bit blue around the gills if they had to switch from a system with 17,000 codes to one with about 141,000 codes? Now, a study by practice management vendor Nuesoft has given us some specifics as to just what worries them.

Nuesoft surveyed 480 physicians, administrators, office managers and billers in their survey, “Attitudes Toward the Transition to ICD-10 and ANSI-5010.” All told, they found that 96 percent of respondents were concerned about the transition, with 60 percent reporting that they were “highly” or “significantly” concerned.

As the Nuesoft chart below details, physicians are a bit freaked out over impact of ICD-10. As the chart below indicates, roughly one-third of the physicians questioned were “highly concerned” about the impact of the ICD-10 transition, and another 20-odd percent were “significantly concerned.”

Thirty percent of physicians expect that the ICD-10 transition will affect their operations very negatively, and 45 percent “somewhat negatively.” The results were more or less the same for the other categories, which included finances, staff state of mind and personal state of mind (physician).

Thanks to Nuesoft for delving further into the headache that will dominate medical practice for years to come. Now, though, Nuesoft, how about a follow up? What I’d love to know, personally, is what differentiates those doctors who weren’t worried from those that are. That could prove to be an eye-opener. Maybe we have something to learn from them?

P.S. Now, as a treat for those who made it to the bottom of this piece, here’s Nuesoft’s hip hop video on the subject:

Increasing Revenue Through Clinical Connectivity

As most of you know, I’ve been working hard to create more content related to revenue in healthcare. My interest in this has grown even more since I had the chance to attend the ANI 2012 conference in Las Vegas where I got the chance to talk to people like Rishi Saurabh from GE Healthcare. It’s amazing how many people (myself included) don’t think that revenue cycle management is sexy since there are so many opportunities in healthcare.

One example of missed healthcare revenue management opportunities has to do with connecting clinical content with the financial data. From my experience, it’s quite rare to see a healthcare institution that does a great job of connecting these two pieces of data. The clinical data is in a silo of its own and it’s only looked at by the clinical people. The financial data is in its own financial data silo and only ever looked at by the financial people.

These silos are a problem and present a really big opportunity for healthcare organizations to increase the revenue of their organization. Although, doing so in an organization is not always easy. It takes great leadership to bridge the two content silos. Plus, you need someone who’s effective at understanding both the clinical and financial point of view. So, it’s not hard to understand why this doesn’t happen more often.

I think the most basic example of what I’m talking about can be seen in the annual checkup. I was talking with a colleague the other day when I told him that I couldn’t remember the last time that I’d been to my doctor. In fact, I honestly don’t even know my doctor’s name (which might beg the question of whether he’s really MY doctor). Why hasn’t my doctor sent me a reminder about the need to do an annual physical exam? Why don’t I have a regular connection with my doctor that helps me to take better care of my health?

I think at least part of the answer to this is that the clinical is not tied to the financial. If the clinical were tied to the financial, then the doctor could provide a care plan for me and my specific health needs. Then, the financial could ensure that I’m following that care plan. Imagine the revenue implications of me visiting the doctor regularly as part of a well defined care plan.

I’m sure that many of you out there are likely skeptical about whether patient reminders will actually change behavior. Certainly in many cases, these reminders will be discarded or ignored. However, a certain percentage of those reminders will be followed. This will mean your patients get better care and your clinic increases their revenue. Plus, maybe we need to take a deeper look at the care plans that we offer patients. If large percentages are ignoring the suggestions, then maybe we need to rethink the plan or how we’re communicating that plan to the patient.

There are certainly plenty of other medical examples where a follow up doctor visit would make sense and improve the health of your patients. In fact, you could get really sophisticated with how you reach out to your patient population.

I believe the key to success of this type of program is to integrate the clinical data with the financial data. It creates tremendous power and amazing opportunities.

Revenue Cycle Management Interview with Rishi Saurabh – GE Healthcare

As most of you know, I had the chance to attend the ANI 2012 conference in Las Vegas that’s put on by HFMA. This conference is a hospital CFO’s home since all of the major players in the healthcare financial management space were in attendance. Around every corner was another Hospital CFO it seemed.

While at the conference, I was able to corner the Global Product Marketing Manager at GE Healthcare, Rishi Saurabh, for a short video interview about revenue cycle management. In the video Rishi provides his insights into the biggest challenges facing hospitals today and also provides some insight into how GE plans to approach these challenges. I hope you enjoy the video:

Will Billing Separate EMR Winners From Losers?

The other day, I was speaking with a sales exec from a medical billing company, who commented that his company interfaces with about 200 of the leading EMRs. His comment got me thinking.

I believe we haven’t thought enough about billing when we consider what will drive consolidation in the EMR market. Whether vendors offer it through offering their own practice management system or an easy-to-work-with infrastructure, billing counts a great deal. And the EMRs that aren’t integrating seamlessly aren’t exactly in the driver’s seat in medical practices.

Vendors aren’t in the easiest position when it comes to being a good billing partner. They can offer a suite with practice management available as an add-on, but doctors may not want the whole thing. They can offer an EMR + PM suite that’s already integrated, but what if the practice doesn’t like one of the two? Some vendors are partnering with companies that make third-party billing applications, but if the other party were to pull out abruptly that strategy could enrage customers.

Still, vendors that balance these factors right have a powerful advantage. After all, practices WANT to get Meaningful Use dollars, but they NEED to get paid. I know that billing would be one of the first things I’d consider if I was shopping for a medical office EMR.

What I’m really saying here is that while most of us agree that a big EMR firm consolidation is coming, we haven’t talked much about the role of strong billing support in an EMR’s market viability. I think we should. I’d love to know if you’ve seen medical office software that really has a strong billing approach, and what you like about it. Thoughts, anyone?

HFMA ANI Las Vegas: That’s a Wrap

Though it was only my second time attending the annual HFMA ANI show, I think it’s fast proving to be my favorite when compared to HIMSS – at least when both are held in Las Vegas. The shorter exhibit hall hours; a smaller, more manageable venue; and a general feeling of being less rushed to accomplish every task I set myself was a welcome contrast to the breakneck speed at which we all seem to attend HIMSS.

Though the ANI show had a more laid back vibe, it was by no means any less meaningful to its attendees and exhibitors. Some of the exhibitors I spoke to noted that while booth traffic wasn’t as brisk as they’d have liked, they were having deeper, more meaningful conversations with the folks that did stop by. Others told me that it didn’t seem like many members of the hospital C-suite were in attendance, and decided to send their seconds-in-command instead. (Perhaps they were too busy back home attending to projects related to any of the following healthcare IT acronyms – EMR, HIE, ACO, CPOE, ICD-10, SCOTUS.)

I didn’t get a chance to attend any educational sessions, but from the tweets that I saw, most folks really enjoyed keynotes from Olympian Carl Lewis and renowned pilot Sully Sullenberger. Speaking of tweets, the volume of chatter on Twitter was pretty dismal. There were a few devoted tweets around the #ANI2012 hashtag of course, but for the most part, Twitter (and social media in general) was non-existent.

I walked the show floor Tuesday to see if I could spot any technologies tied into EMRs, and didn’t find much to choose from – at least not as many as I came across last year. I did have some interesting conversations with the folks at Nuance about new solutions being sold under the Dragon Medical umbrella.

Population health management was a phrase I heard (or saw) a number of times, as was predictive analytics and the ubiquitous “Big Data” – all three of which tie together in the world of hospital CFOs. In my mind, it seems that it will be necessary from a financial standpoint for hospitals to get a firm grasp of what “Big Data” means to their organization, and then how to use predictive analytics to derive meaning from that data in their population health management programs, especially if they plan on successfully participating in any sort of coordinated or accountable care program. MedAssets is doing some interesting work around this concept that I hope to learn more about once I get back home and settled.

I’d be interested to hear your thoughts about the show, especially if you were an attendee. How did it compare to last year? Did you think, like me, that many folks were seduced by the lure of the pools at Mandalay Bay to the detriment of folks working the exhibit booths? Gather your thoughts while you peruse a few pictures I took on the show floor:

I stopped by the MedAssets booth to talk population health management with Carol Romashko, Director of Marketing.

AfterHours UR intrigued me with its pleasant logo and hospital utilization review service founded by nurses.

The folks at Executive Health Resources had a catchy come-by gimmick with a caricaturist creating portraits on etch-a-sketches.

EnableComp definitely had kid-friendly schwag. I'm still kicking myself for not going by there during the last hour of the show.

Emdeon's Cash Stacker games seemed to be a big hit on the show floor.

HumanArc knows that creativity really does pay off, at least when it comes to attracting passers by with Lego-inspired logos.

It was interesting to me, being an Atlanta native, to note how many Georgia-based revenue cycle management clients MediRevv has.

My favorite part of the Nuance booth was the tag line "Use it for Good."

Objective Health, formerly known as McKinsey Hospital Institute, had a very inviting booth. It was nice chatting with their CEO, Dr. Russ Richmond.

I didn't see any "whack a mole" type attractions, but this game from PNC definitely grabbed attendees' attention.

I didn't get a chance to stop by the Premier booth, unfortunately, but it was certainly eye-catching.I heard several interesting customer success stories from the Protiviti team, which I hope to cover in greater detail in the near future.

The VisiQuate booth impressed me with its high-tech feel.

It certainly wasn't all work and no play. I enjoyed Dell's evening event at the Shark Reef Aquarium with Stephen Outten, Content Marketing and Social Media Strategist at Dell, and Amanda Woodhead, Manager of Corporate Communications at Emdeon.

A HFMA ANI Postcard is Worth a Thousand Words

I’m heading back to Vegas this weekend, as the world of healthcare finance, compliance and IT gets ready to converge at Mandalay Bay for the annual HFMA ANI show. It seems like I was just there for HIMSS, somewhat under the weather the entire time thanks to East Coast jet lag. Hopefully this time around the warmer weather and smaller event (and hopefully better wifi throughout) will help me to spend more time on the show floor, checking out EHR-related technologies and clever marketing gimmicks. (I still remember the Captain Jack look-alike from last year’s show, and the great caricature I got at Paragon Revenue’s booth.) I might also end up showing our fearless leader John Lynn around, as he attends for the first time.

I’ve been stockpiling postcards from vendors as they’ve arrived in my mailbox, sending out a tweet here and there if one strikes my fancy for no particular reason. (I didn’t receive a single one prior to HIMSS, oddly enough.) I’ve culled a few that caught my attention, either for their EHR tie-ins or marketing schtick. Here are a few of my favorites, with additional details in case you feel like stopping by their booths.

EHR-Related

Microsoft Dynamics for Healthcare
Booth #1163
Solution: MazikCare, an EMR/ERP Solution built on Microsoft Dynamics AX2012
My take: Since they picture the EMR on a mobile phone, I’ll likely stop by to have a larger conversation around mobile health. I might even see if they’ve got a new Surface tablet just lying around, waiting to be tested.
Giveaway: Windows phones, free training

M*Modal
Booth #750
Solution: an EHR that helps maximize value, according to the postcard
My take: I’d be interested to learn just HOW their EHR maximizes value.
Giveaway: $500 donation to the charity of your choice

Cutest

TransUnion
Booth # 528
Solution: Smart revenue cycle solutions
Giveaway: potentially an iPad 3, provided you play their trivia game first

Most Clever

Parallon Connect
Booth # 844
Giveaway: Invites to a special HFMA concert featuring Eddie Money, $1,000 Best Buy gift card

Best for Book Lovers

Medical Management Professionals
Booth #1043
My take: Being a book lover, I’m very interested to see what titles their Emergency Medicine Book Club will be reading in the coming months.
Giveaway: “If Disney Ran Your Hospital – 9 ½ Things You Would Do Differently” by Fred Lee

Most Intriguing (and Best for Those with Lots of Dexterity)

Emdeon
Booth # 608
My take: Their Cash Stacker challenges intrigue me. I’ve never heard of the “Tube Topper,” “Stack Nicklaus,” “Popstackle,” “Chopped Nuts,” or “Change it Up,” but perhaps I don’t go to Vegas enough.
Giveaway: iPads and cash

By Far the Biggest

Athenahealth
Booth #1629
My take: The size of the postcard certainly got my attention, as did the blurb about the “athenaCoordinator, athenahealth’s cloud-based care coordination service.”
Giveaway: Kindle 4

Most Charitable

US Bank
Booth #1461
My take: Their partnership with Children’s Miracle Network hospitals will prompt me to definitely stop by their booth, as they’ll make a donation to the network for every business card received.
Giveaway: Warm fuzzies

SPi Healthcare
Booth #1645
My take: While I didn’t receive a postcard from them, the email I did receive caught my attention for its call for attendees to stop by and enter its charity poker chip drawing. For every entry, SPi will donate $1 to Helping Kids Clinic
Giveaway: $100 poker chips

So there you have it, folks! These are just a sneak peek into the many companies that will be exhibiting at the show. I’m looking forward to learning about many more, and sharing my recap in next week’s post. If you’re going to be there, feel free to send me a “let’s connect” tweet via @SmyrnaGirl. I can’t guarantee I won’t be wearing my Elvis glasses.

Is Revenue Cycle Management Getting Transgressed with Meaningful Use Stealing the Focus?

This is the next in a series of posts I’ve been doing focused on Revenue Cycle Management (RCM). It’s been a fun series to do as I’ve explored more of the details of RCM and learned a lot along the way. Although, as is usually the case, the more that I learn the more I realize I still need to learn. I will be attending ANI in Las Vegas later this month, so I’m sure I’ll have plenty more RCM related topics to write about after that event.

This post was inspired by a comment Madelyn made on my Is Revenue Cycle Management Sexy? post:

You’re making a really important point with this story and it’s a topic we’ve discussed at length in my company. The availability of incentive funds is causing so much thought and energy to be focused on EHRs, but if a practice or hospital’s RCM is a mess, they’re losing far more money than the Meaningful Use dollars could ever reimburse them for.

What an extremely important question! I’m afraid far too many clinics are falling into this trap.

Each day I’m amazed a little bit more on the far reaching impacts of meaningful use on healthcare and EHR. There’s been amazing array of unintended consequences that are associated with meaningful use and the EHR incentive money and most of them aren’t good consequences. Sure, there are also some really great benefits to the government EHR stimulus money, but my fear is that they benefits won’t outweigh the negative consequences and the taxpayers will be out a cool $36+ billion.

Why do so many practices and physicians become so irrational when they hear about “free” government money for EHR? This I don’t have an answer to, but I hope by pointing it out more doctors will take a step back and do what’s right for their clinic. I’d expect in most cases this will involve EHR and technology, but Madelyn makes a really important point:

If your RCM is a mess, you could lose far more money than you gain from meaningful use.

M	T	W	T	F	S	S
« Apr
		1	2	3	4	5
6	7	8	9	10	11	12
13	14	15	16	17	18	19
20	21	22	23	24	25	26
27	28	29	30	31

Are EMRs Going To Generate Billing Audits?

Top 5 Revenue Cycle Management Issues

Primary Docs See Hope For Stronger Financials With EMR

Increasing Revenue Through Clinical Connectivity

Revenue Cycle Management Interview with Rishi Saurabh – GE Healthcare

Will Billing Separate EMR Winners From Losers?

A HFMA ANI Postcard is Worth a Thousand Words

Is Revenue Cycle Management Getting Transgressed with Meaningful Use Stealing the Focus?

Top EMR & EHR Posts

Calendar

Recent Posts

EMR and EHR Resources

Recent Comments

Categories