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Some Alexa Health “Skills” Don’t Comply With Amazon Medical Policies

Posted on July 18, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

It’s becoming predictable: A company offering AI assistant for scheduling medical appointments thinks that consumers want to use Amazon’s Alexa to schedule appointments with their doctor. The company, Nimblr, is just one of an expanding number of developers that see Alexa integration as an opportunity for growth.

However, Nimblr and its peers have stepped into an environment where the standards for health applications are a bit slippery. That’s no fault of theirs, but it might affect the future of Amazon Alexa health applications, which can ultimately affect every developer that works with the Alexa interface.

Nimblr’s Holly AI has recently begun to let patients book and reschedule appointments using Alexa voice commands. According to its prepared statement, Nimblr expects to integrate with other voice command platforms as well, but Alexa is clearly an important first step.

The medical appointment service is integrated with a range of EHRs, including athenahealth, Care Cloud and DrChrono.  To use the service, doctors sign up and let Holly access their calendar and EHR.

Patients who choose to use the Amazon interface go through a scripted dialogue allowing them to set, change or cancel an appointment with their doctor. The patient uses Alexa to summon Holly, then tells Holly the doctor with whom they’d like to book an appointment. A few commands later, the patient has booked a visit. No need to sit at a computer or peer at a smartphone screen.

For Amazon, this kind of agreement is the culmination of a long-term strategy. According to an article featured in Quartz Alexa is now in roughly 20 million American homes and owns more than 70% of the US market for voice-driven assistants. Recently it’s made some power moves in healthcare — including the acquisition of online pharmacy PillPack. It’s has also worked to build connections with healthcare partners, including third-party developers that can enrich the healthcare options available to Alexa users.

Most of the activity that drives Alexa comes from “skills,” which resemble smartphone apps, made available on the Alexa store by independent developers. According to Quartz, the store hosted roughly 900 skills in its “health and fitness” category on the Alexa skills store as of mid-April.

In theory, externally-developed health skills must meet three criteria: they may not collect personal information from customers, cannot imply that they are life-saving by names and descriptions and must include a disclaimer stating that they are not medical devices — and that users should ask their providers if they believe they need medical attention.

However, according to Quartz, as of mid-April there were 65 skills in the store that didn’t provide the required disclaimer. If so, this raises questions as to how stringently Amazon supervises the skills uploaded by its third-party developers.

Let me be clear that I’m not criticizing Nimblr in any way. As far as I know, the company is doing everything the right way. My only critiques would be that it’s not clear to me why its Alexa tool is much more useful than a plain old portal, and that of the demo video is any indication, that the interactions between Alexa and the consumer are a trifle awkward. On the whole, it seems like a useful tool and will likely get better over time.

However, with a growing number of healthcare developers featuring apps Alexa’s skills store, it will be worth watching to see if Amazon enforces its own rules. If not, reputable developers like Nimblr might not want to go there.

This Futurist Says AI Will Never Replace Physicians

Posted on June 6, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Most of us would agree that AI technology has amazing — almost frightening — potential to change the healthcare world. The thing is, no one is exactly sure what form those changes will take, and some fear that AI technologies will make their work obsolete. Doctors, in particular, worry that AI will undercut their decision-making process or even take their jobs.

Their fears are not entirely misplaced. Vendors in the healthcare AI world insist that their products are intended solely to support care, but of course, they need to say that. It’s not surprising that doctors fret as AI software starts to diagnose conditions, triage patients and perform radiology readings.

But according to medical futurist Bertalan Mesko, MD, Ph.D., physicians have nothing to worry about. “AI will transform the meaning of what it means to be a doctor; some tasks will disappear while others will be added to the work routine,” Mesko writes. “However, there will never be a situation where the embodiment of automation, either a robot or an algorithm, will take the place of a doctor.”

In the article, Mesko lists five reasons why he takes this position:

  1. Empathy is irreplaceable: “Even if the array of technologies will offer brilliant solutions, it would be difficult for them to mimic empathy,” he argues. “… We will need doctors holding our hands while telling us about life-changing diagnoses, their guide to therapy and their overall support.”
  2. Physicians think creatively: “Although data, measurements and quantitative analytics are a crucial part of a doctor’s work…setting up a diagnosis and treating a patient is not a linear process. It requires creativity and problem-solving skills that algorithms and robots will ever have,” he says.
  3. Digital technologies are just tools: “It’s only doctors together with their patients who can choose [treatments], and only physicians can evaluate whether the smart algorithm came up with potentially useful suggestions,” Mesko writes.
  4. AI can’t do everything: “There are responsibilities and duties which technologies cannot perform,” he argues. “… There will always be tasks where humans will be faster, more reliable — or cheaper than technology.”
  5. AI tech isn’t competing with humans: “Technology will help bring medical professionals towards a more efficient, less error-prone and more seamless healthcare,” he says. “… The physician will have more time for the patient, the doctor can enjoy his work in healthcare will move into an overall positive direction.”

I don’t have much to add to his analysis. I largely agree with what he has to say.

I do think he may be wrong about the world needing physicians to make all diagnoses – after all, a sophisticated AI tool could access millions of data points in making patient care recommendations. However, I don’t think the need for human contact will ever go away.

Recording Doctor-Patient Visits Shows Great Potential

Posted on June 1, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Doctors, do you know how you would feel if a patient recorded their visit with you? Would you choose to record them if you could? You may soon find out.

A new story appearing in STAT suggests that both patients and physicians are increasingly recording visits, with some doctors sharing the audio recording and encouraging patients to check it out at home.

The idea behind this practice is to help patients recall their physician’s instructions and adhere to treatment plans. According to one source, patients forget between 40% to 80% of physician instructions immediately after leaving the doctor’s office. Sharing such recordings could increase patient recall substantially.

What’s more, STAT notes, emerging AI technologies are pushing this trend further. Using speech recognition and machine learning tools, physicians can automatically transcribe recordings, then upload the transcription to their EMR.

Then, health IT professionals can analyze the texts using natural language processing to gain more knowledge about specific diseases. Such analytics are likely to be even more helpful than processes focused on physician notes, as voice recordings offer more nuance and context.

The growth of such recordings is being driven not only by patients and their doctors, but also by researchers interested in how to best leverage the content found in these recordings.

For example, a professor at Dartmouth is leading a project focused on creating an artificial intelligence-enabled system allowing for routine audio recording of conversations between doctors and patients. Paul Barr is a researcher and professor at the Dartmouth Institute for Health Policy and Clinical Practice.

The project, known as ORALS (Open Recording Automated Logging System), will develop and test an interoperable system to support routine recording of patient medical visits. The fundamental assumption behind this effort is that recording such content on smart phones is inappropriate, as if the patient loses their phone, their private healthcare information could be exposed.

To avoid this potential privacy breach, researchers are storing voice information on a secure central server allowing both patients and caregivers to control the information. The ORALS software offers both a recording and playback application designed for recording patient-physician visits.

Using the system, patients record visits on their phone, have them uploaded to a secure server and after that, have the recordings automatically removed from the phone. In addition, ORALS also offers a web application allowing patients to view, annotate and organize their recordings.

As I see it, this is a natural outgrowth of the trailblazing Open Notes project, which was perhaps the first organization encouraging doctors to share patient information. What makes this different is that we now have the technology to make better use of what we learn. I think this is exciting.

AI Software Detects Diabetic Retinopathy Without Physician Involvement

Posted on April 27, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The FDA has approved parent company IDx to market IDx-DR, the first AI technology which can independently detect diabetic retinopathy. The software can make basic recommendations without any physician involvement.

Before approving the software, the FDA reviewed data from a clinical study of 900 patients with diabetes across 10 primary care sites. IDx-DR accurately identified the presence of diabetic retinopathy 87.4% of the time and accurately identified those without the disease 89.5% of the time. In other words, it’s not perfect but it’s clearly pretty close.

To use IDx-DR, providers upload digital images of a diabetic patient’s eyes taken with a retinal camera to the IDx cloud server. Once the image reaches the server, IDx-DR uses an AI algorithm to analyze the images, then tells the user whether the user has anything more than mild retinopathy.

If it finds significant retinopathy, the software suggests referring the patient to an eye care specialist for an in-depth diagnostic visit. On the other hand, if the software doesn’t detect retinopathy, it recommends a standard rescreen in 12 months.

Apparently, this is the first time the FDA has allowed a company to sell a device which screens and diagnoses patients without involving a specialist. We can expect further AI approvals by the FDA in the future, according to Commissioner Scott Gottlieb, MD. “Artificial Intelligence and Machine Learning hold enormous promise for the future of medicine,” Gottlieb tweeted. “The FDA is taking steps to promote innovation and support the use of artificial intelligence-based medical devices.”

The question this announcement must raise in the minds of some readers is “How far will this go?” Both for personal and clinical reasons, doctors are likely to worry about this sort of development. After all, putting aside any impact it may have on their career, they may be concerned that patient will get short-changed.

They probably don’t need to worry, though. According to an article in the MIT Technology Review, a recent research project done by Google Cloud suggests that AI won’t be replacing doctors anytime soon.

Jia Li, who leads research and development at Google Cloud, told a conference audience that while applying AI to radiology imaging might be a useful tool, it can automate only a small part of radiologists’ work. All it will be able to do is help doctors make better judgments and make the process more efficient, Li told conference attendees.

In other words, it seems likely that for the foreseeable future, tools like IDx-DR and its cousins will help doctors automate tasks they didn’t want to do anyway. With any luck, using them will both save time and improve diagnoses. Not at all scary, right?

Comprehensive Health Record Vs. Connected Health Record

Posted on March 26, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The “comprehensive health record” model is quite in vogue these days. Epic, in particular, is championing this model, which supplants existing EHR verbiage and integrates social determinants of health. “Most health systems know they have to go beyond their walls,” Epic CEO Judy Faulkner told Healthcare IT News. A number of other EMR vendors have followed Epic’s lead.

To date, however, most clinicians have yet to embrace this model, perhaps because they’re out of patience with the requirements imposed by EHRs. What’s more, the broader healthcare industry hasn’t reached a consensus on the subject. For example, a team of experts from UCSF argues that healthcare needs a “connected health record,” a much different animal than vendors like Epic are proposing.

The authors see today’s EHR as an “electronic file cabinet” which is poorly equipped to handle health activities and use cases such as shared care planning, genomics and personalized medicine, population health and public health, remote monitoring and sensors.

They contend that to create an interoperable healthcare ecosystem, we will need to move far beyond point-to-point, EHR-to-EHR connections. Instead, they suggest adding connections with patients and family caregivers, non-clinical providers such as school clinics for youth and community health centers. (They do agree with Faulkner that incorporating data on social determinants of health is important.)

Their connected health record ties more professionals together and adapts to new models of care. It would foster connections between primary care physicians, multiple specialists, hospitals, clinics, pharmacies, laboratories, public health registries and new models of care such as ACOs. It would be adaptive rather than reactive.

For example, if the patient at home with cancer gets a fever, her temperature data would be transmitted to her primary care physician, her oncologist, her home care nurse and family caregiver. The care plan would evolve based on the recommendations of team members, and the revised vision would be accessible automatically to the entire care team. “A static, allegedly comprehensive health record misses the dynamics of an interactive, learning health system,” the authors say.

All that being said, this model still appears to be at the vision stage. Perhaps given its backing, the comprehensive health record seems to be getting far more attention. And arguably, attempting to integrate a good deal more data on patients into an EHR could be beneficial.

However, both models are largely untested, and both beg the question of whether building more content on an EHR skeleton can lead to transformation. On the other hand, while the concept of a connected health record is attractive, my sense is that the components needed to this happen have not matured yet.

Ultimately, it will be clinicians who decide which model actually works for them, not vendors or abstract thinkers. Let’s see which model makes the most sense to them.

New Program Trains Physicians In Health Informatics Basics

Posted on January 18, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new program has emerged to help physicians make better use of the massive flow of health information they encounter on a day-to-day basis. With any luck, it will not only improve the skills of individual doctors but also seed institutions with clinicians who understand health IT in the practice of medicine.

The Indiana Training Program in Public and Population Health Informatics, which is supported by a five-year, $2.5 million award from the National Library of Medicine, focuses on public and population health issues. Launched in July 2017, it will support up to eight fellows annually.

The program is sponsored by Indiana University School of Medicine Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis and the Regenstrief Institute. Regenstrief, which is dedicated to healthcare quality improvement, supports healthcare research and works to bring scientific discoveries to bear on real-world problems.

For example, Regenstrief participates in the Healthcare Services Platform Consortium, which is addressing interoperability issues. There’s also the Regenstrief EHR Clinical Learning Platform, an AMA-backed program training medical student to cope with misidentified patient data, learn how different EHRs work and determine how to use them to coordinate care.

The Public and Population Health training, for its part, focuses on improving population health using advanced analytics, addressing public health problems such as opioid addiction, obesity and diabetes epidemics using health IT and supporting the implementation of ACOs.

According to Regenstrief, fellows who are accepted into the program will learn how to manage and analyze large data sets in healthcare public health organizations; use analytical methods to address population health management; translate basic and clinical research findings for use in population-based settings; creating health IT programs and tools for managing PHI; and using social and behavioral science approaches to solve PHI management problems.

Of course, training eight fellows per year is just a tiny drop in the bucket. Virtually all healthcare institutions need senior physician leaders to have some grasp of healthcare informatics or at least be capable of understanding data issues. Without having top clinical leaders who understand informatics principles, health data projects could end up at a standstill.

In addition, health systems need to train front-line IT staffers to better understand clinical issues — or hire them if necessary. That being said, finding healthcare data specialists is tricky at best, especially if you’re hoping to hire clinicians with this skill set.

Ultimately, it’s likely that health systems will need to train their own internal experts to lead health IT projects, ideally clinicians who have an aptitude for the subject. To do that, perhaps they can use the Regenstrief approach as a model.

Ophthalmologists Worry That EHRs Decrease Productivity, Boost Costs

Posted on January 16, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study has concluded that while EHR use among ophthalmologists has shot up over the last decade, most of these doctors see the systems as lowering their productivity and increasing their office costs, according to a survey published in JAMA Ophthalmology.

To conduct the study, the researchers emailed surveys to 2,000 ophthalmologists between 2015 and 2016. The 2,000 respondents, whose responses were anonymous, were chosen out of more than 18,000 active US members of the American Academy of Ophthalmology.

The researchers involved found that the EHR adoption rate for ophthalmologists, which is about 72.1%, was similar to rates among other specialties. Nonetheless, it’s a big jump from 2011, when only 47% of the 492 respondents reported using EHRs in their practice.

Most respondents were devoted solely to ophthalmology and had an average of 22 years of practice. They had an average of 5.3 years of EHR use, but nearly the entire group had previously used paper records. Eighty-eight percent of those currently using EHRs had been present for the transition from paper records to digital ones, researchers found.

Not surprisingly, given typical EHR acquisition and maintenance costs, the mean number of ophthalmologists in a given practice was higher among those with an EHR in place than practices without one. Researchers found that when practices were part of an integrated health system, a government health system, the higher the odds of their having adopted an EHR.

While the adoption rate has increased, ophthalmologists actually seem less happy with EHRs than they had been before. For example, many reported that they felt EHRs were undermining both their productivity and financial situation.

For example, more than half of respondents in 2016 reported that their patients seen per day had fallen since adopting EHRs. That’s an unfortunate change in perceptions since in 2006, more than 60% of ophthalmologists saw an increase in productivity after their EHR system was implemented.

Meanwhile, respondents were ambivalent about the impact of EHR use on revenue, with 35% reporting that revenue had remained the same after adoption, 41% a decrease and almost 9% an increase.

Despite concerns that EHRs were undercutting practice productivity, researchers reported that three previous studies of academic ophthalmology practices found no change in patient volume after EHR adoption.

There also seems to be a disconnect between what ophthalmologists think their patients want technically and what they want.  While 76% reported that their patients felt mostly positive or neutral toward EHR use, 36% of ophthalmologists would return to paper records if they had the chance.

That being said, ophthalmology practices do seem to see the benefits in keeping their EHR systems in place. For example, despite the fact that 68% saw paper documentation as faster, 53% of respondents felt their EHRs were generating net positive value.

All told, it seems that ophthalmologists’ concerns about EHR use are working themselves out. However, it also seems as though the doubts we see documented here are deeply rooted and may not go away quickly.

AI Project Could Prevent Needless Blindness

Posted on January 11, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

At this point, you’re probably sick of hearing about artificial intelligence and the benefits it may offer as a diagnostic tool. Even so, there are still some AI stories worth telling, and the following is one of them.

Yes, IBM Watson Health recently had a well-publicized stumble when it attempted to use “cognitive computing” to detect cancer, but that may have more to do with the fact that Watson was under so much pressure to produce results quickly with something that could’ve taken a decade to complete. Other AI-based diagnostic projects seem to be making far more progress.

Consider the following, for example. According to a story in WIRED magazine, Google is embarking on a project which could help eye doctors detect diabetic retinopathy and prevent blindness, basing its efforts on technologies it already has in-house.

The tech giant reported last year that it had trained image recognition algorithms to detect tiny aneurysms suggesting that the patient is in the early stages of retinopathy. This system uses the same technology that allows Google’s image search photo and photo storage services to discriminate between various objects and people.

To take things to the next step, Google partnered with the Aravind Eye Care System, a network of eye hospitals based in India. Aravind apparently helped Google develop the retinal screening system by contributing some of the images it already had on hand to help Google develop its image parsing algorithms.

Aravind and Google have just finished a clinical study of the technology in India with Aravind. Now the two are working to bring the technology into routine use with patients, according to a Google executive who spoke at a recent conference.

The Google exec, Lily Peng, who serves as a product manager with the Google Brain AI research group, said that these tools could help doctors to do the more specialized work and leave the screening to tools like Google’s. “There is not enough expertise to go around,” she said. “We need to have a specialist working on treating people who are sick.”

Obviously, we’ll learn far more about the potential of Google’s retinal scanning tech once Aravind begins using it on patients every day. In the meantime, however, one can only hope that it emerges as a viable and safe tool for overstressed eye doctors worldwide. The AI revolution may be overhyped, but projects like this can have an enormous impact on a large group of patients, and that can’t be bad.

Doctor on Demand Stats Offer Insight Into Telmedicine Trends

Posted on January 5, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Recently, direct-to-consumer telemedicine provider Doctor on Demand released some statistics on its performance in 2017. While some of the report was self-congratulatory, I still think the data points are worth looking at, especially for clinicians.

For starters, it’s worth noting that the company now considers itself a fully integrated medical practice. For example, it’s begun offering lab testing services through Quest Diagnostics and Lab Corp. as part of a program to control chronic conditions such as diabetes, high blood pressure and high cholesterol levels.

Another factoid the stats offer is that its physicians are generally in their mid-career; apparently, Doctor on Demand’s average physician has 15 years of experience. The company doesn’t offer any perspective on why that might be, but it suggests to me that clinicians who participate are both confident that they can manage care remotely and comfortable with technology.

Why is that the case? My guess is that this work may not be attractive to younger doctors, who might feel uneasy managing patients online given their lack of experience. It also suggests older physicians, some of whom still consider telemedicine to be a poor substitute for face-to-face care, probably aren’t engaging with telemedicine either.

Other data provided by Doctor on Demand includes the top reasons for visits included treatment of cold and flu, prescription refills and infections, which isn’t surprising. It also notes that mental health visits climbed 240% over 2016, with anxiety, depression and stress being the most common symptoms treated. This is more interesting, as it suggests that among other problems, consumers feel they aren’t getting their mental health needs met in real life.

Meanwhile, when it comes to the company’s self-reported benefit statistics, I’m taking them with a large grain of salt, but I found them to be worth a look nonetheless. The company says it saved its patients nearly $1 billion in healthcare costs and saved over 1.6 million hours that would otherwise have been spent in doctor’s waiting rooms. These results were allegedly generated by a base of 1 million patients, according to the San Francisco Business Times.

I’m not writing this to suggest that Doctor on Demand is better or worse than other telemedicine companies and video services offered by privately-employed physicians or hospital telemedicine services. Still, I got a kick out of learning what trends a well-positioned telemedicine service was seeing in the marketplace. While Doctor on Demand’s results may not reflect the market as a whole, they certainly offer food for thought.

RCM Tips & Tricks: Shortening Length of Claims In Accounts Receivable

Posted on December 21, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

There’s little question that health insurers do little to help your medical practice collect the reimbursement you’re due.  Not only that, ongoing changes in federal laws make improving your collections levels even more difficult.

As a result, physician practices need all the help they can get in shortening the days claims spend in Accounts Receivable, including the seemingly obvious challenge of collecting payment in full from payers, which don’t even honor rates set forth in reimbursement contracts in some cases.

Given these challenges, medical groups need all the help they can get in improving A/R. Here are some tips from medicalbillersandcoders.com:

  • Find claims which might be rejected ahead of time before submitting them to payers. Claims not paid when first submitted are far less likely to ever get paid.
  • Identify such claims using software that can track and respond to rules and regulation changes by payers. This software should also take into account the rate of denials by a given payer for all doctors.
  • Use software (such as practice management tools) to track all payments, and make sure that your practice is paid based on the terms the payer has agreed upon. Insurers pay less than promised for roughly 10% of claims.
  • Create a detailed system to address the aging of receivables, then track those claims by payer, as various payers might have different payment schedules and different procedures for addressing late reimbursement.
  • Make sure you follow up on unpaid claims as quickly as possible, as the sooner your practice follows up with health insurers the more likely you’ll get paid, and the less likely the claim will end up lost or ignored.
  • Using electronic tools, see to it that your A/R workflow is efficient, or your group may endure errors in documentation which slow down reimbursement. Practice management software can be helpful in addressing this problem.

Practices with a large budget may be able to invest in sophisticated, expensive tools which can perform in-depth claims analysis. This can help such practices improve time in A/R for claims.

However, if your practice is smaller and its budget can’t absorb high-end analytical tools, you can still improve your collections by being thorough and having a good workflow in place.

Also, it’s smart to make sure everyone on your staff is aware of your A/R goals. Even if they don’t have direct contact with collections or A/R, they can be the eyes and ears which help the process along.