Category: Ignore junk below

7 Advantages of Hiring a Case Management Service Provider

A good case management service providers in Healthcare, optimizes multiple aspects of your operation. Today, we’re highlighting some of the most important advantages of hiring a case management service provider in Healthcare.

 

Improved Processes at Every Stage

The first and most important benefit of a case management service is that it improves processes at every stage of your operations.
A well-designed case management system implemented by a knowledgeable team is a guaranteed way to improve internal processes.
Customizable dashboards, for example, allow an organization to create a system that works for its unique needs. Instead of shoe-horning an outdated solution into your organization, a well-designed case management dashboard can improve organizational efficiency significantly.
Many organizations use customizable dashboard to highlight items that need immediate attention, for example, and keep patients flowing at an optimal rate.

 

Meaningful and Efficient Information Organization

Good case management services present all relevant information in a coherent way. Patient information from multiple specialists, healthcare systems, and organizations can be presented within one convenient dashboard.
When employees have all of the information available within a single case file, it allows them to work efficiently on every patient while equipped with the knowledge they need.
You wouldn’t want a carpenter to build a house using a half-empty toolbox. So why would a healthcare provider work on a patient without having all available information?
Instead of having to search through a database or find a paper document, employees can view information at-a-glance from an efficient, all-in-one dashboard. Better information management leads to smarter, more confident, and more accurate decision making.

 

Improved Chargemaster Services

The hospital chargemaster is the heart of an organization’s revenue cycle. A good chargemaster service keeps that heart pumping smoothly.
Improved chargemaster services and case management services make every aspect of an organization more efficient.
A good chargemaster service contains a complete list of prices for every procedure along with the service, supply, prescription drugs, diagnostic tests, fees, room charges, and more. This list must be up-to-date with the organization’s in-house standards, but it must also be compliant with the latest medical billing and coding lists – including coding lists from the American Medical Association (AMA) and other organizations.
Failure to maintain an accurate, up-to-date list of codes and prices for services rendered means organizations are letting revenue escape.
With improved case management comes improved chargemaster services, and that means a more effective revenue stream for your organization.

 

Better Compliance and Reduced Risk of Errors

Manual processes increase the risk of compliance errors. Running a medical organization is already complex. Manual processes exacerbate this complexity.
Good case management services take significant manual labor out of the hands of employees, reducing the risk of compliance lapses. Thanks to effective case management, organizations are giving themselves the best possible opportunity to remain compliant.

 

Effective Code Review

Case management service providers can conduct code reviews to ensure your organization stays secure, compliant, and competitive.
Code reviews are critical for healthcare organizations seeking maximum efficiency. When an organization fails to maintain an accurate code list, it can cause the organization to quickly lose its competitive edge.
A third party code review from a case management service can ensure your organization is performing at its best while staying competitive with other regional providers.

 

Optimized Revenue Cycle Services

A good case management services provider can analyze your organization’s revenue cycle services to ensure efficiency at every stage of the cycle.
Integrated revenue cycle management systems, for example, can integrate directly with your case management system, allowing seamless end-to-end billing and improved patient accounting management.

 

Better End Results Via Better Decision Making

Ultimately, a good case management system leads to better decision-making at both the individual and group level.
When staff have the information they need in front of them at the right time, it allows them to make the best possible decisions.
Better decision making leads to better end results and better health outcomes. It’s that simple.

 

Final Word

In recent years, the healthcare industry has used case management to create a more optimized healthcare experience from start to finish.
With a good case management system, your organization can make the best possible decisions while ensuring every employee is equipped with the best possible information.
Does your case management system need to be reworked? Contact HMI Corp. We have 30 years of experience implementing modern case management solutions into organizations across the United States.

Unique Strategies Today’s Top Medical Organizations Use to Maximize Revenue Using Revenue Cycle Management Consulting Services

Smart medical organizations do everything in their power to maximize revenue – from implementing new technologies to minimizing unnecessary costs.
Today, we’re highlighting some of the unique strategies America’s top healthcare organizations are using to maximize revenue by Revenue Cycle Management Consulting Services

They Get E/M Coding Right

The evaluation and management (E/M) patient visit is a crucial part of any healthcare organization.

Good healthcare organizations can maximize revenue by understanding how to properly document and code E/M patient visits.

Proper documentation and coding does more than just boost revenue; it also reduces the stress of audits and boosts the efficiency of staff.
A July 2019 article published in Medical Economics highlighted four ways healthcare organizations can boost revenue by getting E/M coding right, including:
Ensure the E/M code supports the specific patient encounter. Not every patient with asthma, for example, will justify reporting CPT code 99213.
Refer to E/M guidelines when assigning codes. Assigning E/M codes is not a subjective process. Many physicians under-document E/M level 4 and 5 visits for new patients, for example. Follow E/M guidelines for coding and billing.
Use copy and paste functionality carefully. Some healthcare organizations get into trouble by over-utilizing the copy and paste functions. A physician who automatically copies and pastes historical information from a previous encounter into a current note, for example, may accidently inflate the E/M level.
Be cautious with pre-populated EHR templates. Pre-populated templates can lead to upcoding – say, when certain body systems are always indicated as having been reviewed even when they’re not relevant to the current encounter. These templates can also lead to contradictions that lead to red flags with payers – say, if a physician diagnoses a patient with strep throat and uses a default ear, nose, and throat exam template, opening the door for a post-payment audit.
Implement better E/M coding practices into your healthcare organization to boost revenue.

They Optimize Charge Capture Services with Artificial Intelligence

A recent study showed most healthcare executives believe charge capture is essential, yet 40% discuss it just once a month or less and only 8% discuss it daily.
Charge capture is obviously critical for revenue generation within healthcare organizations.
That’s why some leading healthcare organizations have started using unique strategies to optimize charge capture services: they’ve started to implement artificial intelligence.
AI-powered charge capture audit services are helping to boost staff efficiency for providers while also encouraging greater self-sufficiency for consumers.
It’s part of a widespread trend of healthcare organizations using AI to enhance revenue. Today, AI is helping companies revamp everything from registration to scheduling to billing.
Artificial intelligence automates significant parts of the charge capture service cycle, freeing staff from tasks that are important – but also time-consuming and redundant. Thanks to the latest AI technology, organizations have reduced labor costs and recovered leaked revenue while focusing on both high-dollar and low-dollar accounts.

They Comprehensively Maintain the Chargemaster to Prevent Revenue Leakage

The hospital chargemaster is the heart of a hospital’s revenue generation. That’s why it’s so surprising to see some healthcare organizations fail to adequately maintain their chargemaster.
Inadequate or poorly-maintained chargemasters can lead to overpayments and underpayments, claims rejections, and compliance violations, among other issues.
Chargemaster maintenance is a continuous process that ensures all services are accurately charged. Good maintenance involves reviewing and updating the chargemaster to ensure the hospital is compliant with government pricing regulations, for example, and ensuring the organization receives accurate reimbursement.
As public and private payers continuously update or change coding and reimbursement rules, chargemaster maintenance can become particularly challenging. Smart healthcare organizations, however, solve these challenges to optimize revenue.

They Confirm Compliance with CMS and Regulations

Poor compliance can quickly lead to poor revenue. Smart organizations confirm compliance regularly to ensure revenue flow remains strong.
One of the best ways to confirm compliance is to conduct a code review.
HMI Corp specializes in code reviews for inpatients, outpatients, and E/M coding to ensure compliance. We can comprehensively review your organization for compliance issues, then explain exactly what needs to be changed to optimize revenue.

Final Word

One of the best ways to maximize revenue, of course, is to minimize costs. Medical organizations can minimize costs in all different ways.
Discover how your healthcare organization can minimize costs and maximize revenue. Schedule a consultation with HMI Corp today. We have proven expertise offering healthcare revenue cycle management consulting services and chargemaster reviews among other revenue-boosting services.

How Does Medical Coding Work? What Does a Medical Coder Do?

Medical coding is an in-demand profession at healthcare organizations across the country. Despite the surging demand for medical coders, however, many people do not understand how medical coding works.
Today, we’re explaining what medical coding is, how it works, and how a medical coder adds value to an organization.

What is Medical Coding?

Medical coding traces its origins all the way back 17th century recordkeeping in England. During this time, clinics kept crude records for each patient, using specific numbers and ‘codes’ to track the treatment received by each patient.
Today, the American Academy of Professional Coders (AAPC) defines medical coding as, “the transformation of healthcare diagnosis, procedures, medical services and equipment into universal medical alphanumeric codes.”
In other words, medical coders translate important medical information into simple codes to document medical records and inform accurate medical billing.
Thanks to a standard coding system, medical records can be seamlessly transferred from one organization to another.

What Does a Medical Coder Do?

A medical coder is the individual responsible for translating a physician’s report into useful medical codes.
The coder will look at the physician’s report and determine the treatment that was provided to the patient. Then, the coder will translate all pertinent information into code. This code is used when referencing the treatment in the future and for billing purposes.
A medical coder’s job varies depending on the setting.
A medical coder working at a hospital will document and assign codes for each medical procedure received by a patient, for example.
A medical coder working for an insurance company, meanwhile, will verify the accuracy of incoming claims, checking to make sure the patient received treatment according to his or her insurance plan.
Some medical coders work remotely from home. Many medical coding jobs can easily be performed entirely over a computer and an internet connection, making the need for an on-site office irrelevant.

Why Do We Need Medical Coding?

Without medical coding, doctors would use common language to describe each patient’s treatment plan. That may sound good in theory. However, common language is too inexact to give an insurance company the accurate details it needs.
That’s why a specific set of codes has been developed to define medical procedures. The medical coder’s job is to translate common language into code so information can be efficiently transferred around a hospital and between organizations.

Where Do Medical Coders Work?

Medical coders can work in all types of healthcare organizations, but they can also work in a number of other settings, including all of the following:
• Hospitals and doctors’ offices
• Healthcare consulting services
• Educational institutions
• Home offices
• Insurance agencies
• Law firms
• Government agencies
Obviously, people expect to see medical coders in hospitals, clinics, and urgent care facilities. But many people are surprised to see medical coders in other settings as well – from home offices to law firms to insurance agencies.

What Kind of Training Do Medical Coders Go Through?

Some medical coders have bachelor’s degrees or master’s degrees. However, no formal education is required to be a medical coder.
Some technical colleges have introduced medical coding programs that teach coders the intricacies of the profession. These programs take one to two years.
Prospective coders will also seek specialized certifications – which are similar to the ‘graduate degrees’ of the coding world. Specialized certifications make a medical coding applicant stand out.
Popular specialty certifications include Certified Professional Coder (CPC0, Certified Outpatient Coder (COC), Certified Risk Adjustment Coder (CRC), and Certified Inpatient Coder (CIC).

Final Word

As the healthcare industry continues to grow, demand is increasing for medical coders. The Bureau of Labor Statistics expects medical coding jobs to grow at a faster-than-average rate of 13% through 2026.
HMI Corp specializes in contract coding, including inpatient, outpatient, same-day surgeries, ancillary departments, and physician E/M.
All medical coding services are provided by credentialed coding staff based right here in the United States.

Top 5 Ways a Healthcare Revenue Cycle Consulting Service Can Boost your Bottom Line

Today’s leading healthcare organizations rely on healthcare revenue cycle consulting services to be successful.
How can a consulting service like HMI Corp boost your organization’s bottom line? Today, we’re highlighting some of the ways healthcare consulting services can enhance your organization’s revenue.

Intelligent Security Auditing

The security of a healthcare organization is paramount. Security audits can identify weaknesses within all aspects of an organization’s operations.
A security audit can identify problems with premises security, for example, and the ways in which malicious individuals might attempt to access facilities.
Or, the audit could identify digital security issues, including how the employees respond to phishing attempts.
Without regular security audits, a healthcare organization can trick itself into thinking it’s secure. When a healthcare revenue cycle consulting service performs a security audit, however, it can indicate what works – and what needs to be improved – for maximizing revenue.

Risk and Compliance Assessments to Identify Potential Problems Before They Become Expensive

Smart healthcare organizations anticipate risks before they impact the organization. In a recent report from consulting firm Crowe, healthcare researchers defined a risk as, “anything that might impede the organization’s ability to achieve its goals in critical areas such as patient care, regulatory compliance, operations, strategic growth, and financial performance.”
One of the major benefits of hiring a healthcare revenue cycle consulting service is that you can identify risks and take action early.
A consulting service might identify compliance issues, for example, that could enhance the risk of audits and challenges from insurance companies. Chargemaster issues, on the other hand, could raise the risk of disruptions to the care and billing process.

Comprehensive Cybersecurity Analysis for Enhanced Protection

Healthcare organizations that ignore cybersecurity expose themselves to significant risk. The healthcare industry is increasingly under attack by all types of bad actors. Hackers might try to access patients’ medical records, for example, creating a compliance nightmare for an organization.
A cybersecurity analysis can identify your organization’s strengths and weaknesses. It can spot security holes before bad actors find them.
Some cybersecurity analyses can even involve penetration tests – or pen tests. These tests show how your organization responds to a real threat. This pen test could involve a bad actor physically entering the hospital to access data on an unsecured, for example, or a hacker testing your organization’s digital defenses.
For all of these reasons and more, healthcare organizations conduct regular cybersecurity analyses to identify and resolve security weaknesses as quickly as possible.

More Efficient Medical Coding Services

Efficient medical coding is the difference between good and bad healthcare organizations. Picture medical coding like the railroads and highways of a healthcare organization: when the infrastructure is smooth, efficient, and fast, it improves the entire organization.
Consulting services offer contract coding and coder quality reviews to improve the efficiency of an organization.
HMI Corp can make sure your organization has accurate coding for inpatient, outpatient, same-day surgeries, ancillary departments, and physician E/M, among other medical services. Medical coding and code reviews are performed by U.S.-based credentialed coding staff.

Improved Chargemaster Services

The chargemaster is the heart of a healthcare organization. Unfortunately, many healthcare organizations spend too little time maintaining their chargemaster.
Many organizations think they have compliant and accurate chargemaster services until it’s too late.
Over time, a lack of chargemaster maintenance leads to compliance issues, billing disruptions, and poorer patient care. Ultimately, it impacts the organization’s revenue.
Understandably, healthcare revenue cycle consulting services focus considerable attention on optimizing an organization’s chargemaster services. By fixing chargemaster issues today, the consulting service can implement real solutions that improve revenue generation.

Final Word

Major healthcare revenue cycle risks in 2019 include charge capture, coding, and denial management, among other issues.
By hiring a good healthcare revenue cycle consulting services today, you can identify these risks within your organization, then take action to limit their impact on revenue.

How Healthcare Revenue Cycle Consulting Services Help Maintain Compliance

With today’s complex regulatory requirements, compliance is more important than ever for healthcare organizations.
That’s why leading healthcare organizations hire healthcare revenue cycle consulting services to help maintain compliance.
Today, we’re explaining how healthcare revenue cycle consulting services help organizations maintain compliance at every level of a healthcare organization.

What is Healthcare Compliance?

Compliance means meeting or exceeding the standards set for legal, ethical, and professional operation of healthcare organizations.
Any organization handling electronic protected health information (ePHI) is required to maintain compliance by implementing appropriate processes, policies, and procedures.

Consulting Services Help Maintain Compliance in 7 Targeted Areas

The Department of Health and Human Services (HHS) and the Office of the Inspector General (OIG) have identified seven areas where healthcare organizations should focus for compliance. By focusing on these areas today, organizations can avoid healthcare issues in the future.
An effective healthcare compliance audit program must, at the very least, address the following seven areas:
• Development, distribution, and implementation of written standards of conduct and written policies and procedures that explain the organization’s commitment to meeting and exceeding legal and ethical standards of compliance
• Designation of a chief compliance officer and other appropriate committees and individuals dedicated to maintaining compliance at every level
• Development and delivery of effective employee education programs
• Development and maintenance of effective lines of communication for reporting of compliance concerns
• Development and implementation of an effective response system or discipline system when compliance issues are identified with specific employees
• Development of internal auditing and monitoring system to observe and maintain compliance
• Creation of appropriate response system to quickly fix detected compliance issues
Consulting companies – including HMI Corp. – can help organizations develop or improve all seven of these areas.

How Healthcare Organization Compliance Assessments Work

A consulting company can perform a compliance assessment on your organization. An assessment determines where your strengths and weaknesses lie. Then, experts work to correct those weaknesses and improve those strengths.
During an assessment, experts will answer all of the following questions:
• How does the healthcare organization collect, receive, store, and transfer data?
• What does the current security system cover?
• What does the current security system not cover?
• What potential threats or vulnerabilities could disrupt the organization?
• What are the chances of a threat being carried out against the organization?
• How much would an attack cost if an attack were to occur?

Healthcare Organizations Are Required to Conduct Assessments Annually

Compliance assessments are not optional for healthcare organizations. The HIPAA Privacy Rule requires healthcare organizations to undergo assessments like the one above annually.
Healthcare organizations must collect this information, then compile a report on their findings.

Common Compliance Changes Required for Healthcare Organizations

Healthcare organizations have different compliance needs. Some of the most common areas of improvement required for healthcare organizations, however, include:
Standardizing Policies and Procedures: Healthcare organizations may have a mess of policies and procedures for different departments. This makes things difficult for staff. It’s more than just a compliance issue – it can also be an efficiency issue. Standardizing password management, PHI storage and usage, encryption, privacy, and other elements can vastly improve compliance.
Reviewing Access Control Clearance: Compliant healthcare organizations carefully limit access to sensitive files and patient data on the network. An assessment might recommend limiting access to data only to those who require data to do their jobs, for example.
Contract Coding and Medical Coding Issues: Liability issues related to coding can be significant. Coding and reimbursement are so complex and vital that healthcare organizations devote significant resources to doing it correctly. Unfortunately, many healthcare organizations still expose themselves to liability with various medical coding issues.
Claims Reviews: Many compliance issues involve problematic claims. This type of misconduct can be prosecuted civilly under the False Claims Act or under a range of criminal statutes – including healthcare fraud. Claims fraud cases are common targets for regulators and prosecutors, which is why it’s particularly important to review claims issues for compliance.

Good Compliance Saves Organizations

Compliance is crucial in any industry, but it’s particularly important in the healthcare space.
Every organization thinks they have good compliance standards until it’s too late.
Order a compliance assessment from HMI Corp today and determine exactly how and where your organization can improve all aspects of compliance.

The Best Strategies Small, Rural Hospitals Are Using to Survive

Millions of Americans depend on small, rural hospitals for healthcare. Unfortunately, due to several challenges, many of these small hospitals are struggling to survive.
Between 2010 and 2014, 47 rural hospitals across America stopped providing inpatient services, according to a report by the Rural Health Research Gateway. An additional 673 rural hospitals are at-risk for closure.
Today’s climate may seem daunting for small, rural hospitals – but it doesn’t have to be. Today, we’re highlighting some of the best strategies today’s small, rural hospitals are using to survive.

Conduct Top-to-Bottom Financial Analyses, Audits, and Assessments

Good hospital management starts with good data. One of the smartest things a small hospital can do is to conduct a 360-degree financial analysis using at least five years’ worth of data.
An objective third party – like HMI LLC or other medical consulting organizations – can pore over the data to issue concrete recommendations. You can see how your hospital compares to other organizations with a similar size and market.
Financial audits can reveal surprising problems with smaller, rural hospitals, including:
• Revenue cycle issues
• Denials management issues
• Longer lengths of stays compared to other hospitals
• Outdated systems still in use
• Medical coding and compliance issues
• Billing and purchasing problems
A top-to-bottom financial analysis can show a small, rural hospital what they’re billing and buying and how the hospital is doing it. It can identify key problems at every stage of the organization, including areas of missed revenue expectations, the best areas of potential improvement, and actionable changes the organization can implement today.

Implement Better Debt Management

Many of America’s small, rural hospitals are at risk because of outstanding debts. If the hospital can learn to effectively manage this debt, it can be the difference between surviving and shutting down.
Debt management strategies vary between organizations but can include all of the following:
Judicial Reorganization: Judicial reorganization is a bankruptcy handled through the court. There are pros and cons to this type of debt management. Reorganizations can trigger default on bonds, making them due immediately, for example. Bankruptcy can also lead to the loss of revenue streams from CMS and other payors. However, for some small hospitals in certain situations, it’s the best path forward.
Debt Structure Refinancing: Refinancing hospital debt may be a smart option when interest rates are low or a hospital’s credit rating improves. However, it’s not the right choice for all hospitals in all situations.
Non-Judicial Reorganization: With non-judicial reorganization, hospitals restructure their debt and payment plans with debtors outside of the court. Good reorganization can create additional time for the small hospital without resorting to bankruptcy.
Selling: Putting a hospital on the market is one option for smaller hospitals overwhelmed by debt. This option can be particularly challenging, as larger systems will naturally absorb the patient flow after a hospital closes even if they don’t buy the facility.

Identify New Revenue Streams

Generating new revenue is a great way to revitalize any business. With smaller hospitals, it’s easier said than done. However, small hospitals that want to become financially sustainable will need to develop new revenue sources – especially the hospitals that cannot cut or refinance their way to a solution.
One of the most common ways for small, rural hospitals to create new revenue is by teaming up with outpatient healthcare providers. A smaller hospital can make its facility available to the group and setup a revenue sharing program.
Many hospitals have successfully setup behavior health programs, for example, because Medicare and Medicaid now cover behavioral health services. It’s a new revenue stream that also provides a valuable service to the community.

Increase Residency Programs and Partnerships

There are approximately 80 primary care physicians (PCPs) per 100,000 people in the United States, although there are only 68 PCPs per 100,000 people in rural areas.
With that in mind, many smaller hospitals have achieved success by increasing residency programs and partnerships. It’s not just about training new doctors: it’s about keeping them long-term.
Here’s how one report explained the benefits of better rural residency programs:
“Medical residents who train in rural settings are two to three times more likely to practice in a rural area; especially those who participate in rural training tracks.”

Implement Telehealth Services

Smaller, rural hospitals may not have specialists on-site for every patient’s needs. That’s why a growing number of smaller hospitals are using telehealth to fill the gaps.
Telehealth can fill the gaps in subspecialist care, eliminating the need for patients to travel long distances to see a qualified healthcare provider.
Telepharmacy is one growing area of telehealth. Telepharmacy gives patients the convenience of remote drug therapy monitoring and authorization for prescriptions. Patients can also remotely access pharmacy counseling to maintain compliance with prescriptions.
There’s also telepsychiatry, which provides behavioral health services to patients who would otherwise have to drive hours to see a mental health provider.

Build Hospital Loyalty

Most people prefer to shop local. Just like a small business, a small hospital must build brand loyalty with the community.
By strengthening ties with consumers, physicians, and the local community, hospitals can keep their brand in the front of patient’s minds. Create a hospital-branded mobile app, for example, or sponsor local events.

Eliminate Waste and Redundancy at All Stages

Smaller, rural hospitals don’t have the resources of larger providers, so they need to compete in other ways.
An in-depth consultation or assessment can reveal surprising insight into missed revenue opportunities and inefficiencies within a hospital.
Some smaller hospitals have long wait times, which means patients are turned away and forced to visit other providers, leading to lost revenue every year.
Other hospitals have inefficient or outdated systems, increasing the number of steps taken before every treatment.
By eliminating steps in payroll processing, contract management, and other organizational systems, hospitals can save time and money, leading to lower costs and better patient care.

Final Word

Hundreds of small, rural hospitals across America are at risk of shutting down. However, even hospitals teetering on the edge of bankruptcy or closure can change their course by implementing smart solutions today.
Contact HMI LLC to discover the best options available to your small, rural hospital. Our team has combined decades of experience solving complex problems for medical providers across America.

What’s Involved in a Revenue Cycle Assessment? How Do Revenue Cycle Experts Maximize Medical Profits?

A good revenue cycle assessment will help your organization become more profitable.
But what’s involved in a revenue cycle assessment? How can revenue cycle experts maximize medical profits? What actionable steps will revenue cycle assessment experts help you implement? Today, we’re explaining everything you need to know about what’s involved in a revenue cycle assessment.

Areas of Revenue Cycle Assessments

Some organizations perform a revenue cycle assessment on their overall organization, hiring a consulting company to conduct a bottom-to-top assessment.
Other organizations request specialized revenue cycle assessments in one or more areas of the organization.
Typically, revenue cycle assessments focus on the organization’s core areas, including:
• Pre and post-system implementation
• Organizational structure
• Process flow and design
• Vendor performance
• Staff and team performance
• Denials prevention and management
• Functional office metrics
• Key performance indicators

How a Revenue Cycle Assessment Works

During a revenue cycle assessment, our experts analyze key areas of a medical organization to determine areas of improvement. Our experts use their combined decades of industry experience to solve your organization’s revenue issues.
Here’s a more detailed breakdown of how each step of our revenue cycle assessment will work:
Coding and Documentation Reviews: Good revenue management starts with good coding and documentation. Our experts will analyze your organization’s documentation and coding to ensure billed services are supported while adhering to payer mandates and guidelines.
Self-Pay Strategy: Our experts will analyze your organization’s performance for self-pay and self-pay after insurance collections. We’ll assess reporting, point of service collections, liability estimators, patient contact strategies, and third party vendor management, among other areas.
Denials Management: By analyzing your organization’s denials management, we can reduce write-offs and revenue leakage. Our team will help identify clinical and operational denials, outline identify process and workflow improvement opportunities.
Case Management & Utilization: By assessing your case management and utilization, our experts can identify process gaps that could lead to fatal level-of-care denials.
Charge Capture: Many organizations are surprised by the problems that charge capture analysis can reveal. Good revenue starts with a good chargemaster.
Patient Access: How does your organization perform for insurance eligibility, registration accuracy, centralized scheduling, prior authorization, and point of service collections? Our team will assess your patient access to identify areas of improvement.
Coding & Hierarchical Condition Categories: HMI LLC employs experienced coding consultants who assess your organization’s reimbursement risk related to coding. Every day, medical organizations across the country lose reimbursement because of coding and HCC issues.
Accounts Receivable: We can analyze your accounts receivable, then provide support and training to maximize revenue.
Job Shadowing: Revenue cycle assessment can involve employee shadowing and management training, ensuring your organization is capturing revenue from the lowest levels of the organization to the top.
Negotiations with Payers: We can negotiate with payers for increased reimbursement carve outs, enhancing organization revenue.
Dedicated, Long-Term Revenue Cycle Team: After the revenue cycle assessment is complete, we can form a revenue cycle team dedicated to tracking the revenue of your organization long-term.

Outcome of a Revenue Cycle Assessment

The goal of a revenue cycle assessment is to give the client actionable advice they can implement today to boost revenue. Some of the concrete deliverables created by a revenue cycle assessment include:
• A strategic roadmap for improving the client’s overall operational performance
• Identification and breakdown of current revenue cycle issues
• Identification and quantification of opportunities for improvement
• Detailed recommendations for improving key revenue cycle function areas
• Comparison of an organization’s metrics in relation to overall industry benchmarks

Schedule a Revenue Cycle Assessment with HMI Today

HMI LLC specializes in performing revenue cycle consulting for medical organizations across the United States.
Our team has a unique blend of industry, consulting, and system experience, allowing us to analyze your operations and identify ways to improve your performance.
A healthy revenue cycle is critical for organizational success. Schedule a revenue cycle assessment with HMI LLC today.

10 Benefits of Remote Revenue Cycle Management Programs

The remote revenue cycle management industry has been booming in recent years. A growing number of healthcare organizations are making the switch.
Should your organization make the switch to a remote revenue cycle management (RCM) program? These third party service providers make big promises – but do they actually live up to these promises?
Today, we’re exploring the benefits of remote revenue cycle management programs.

Fewer Denied Insurance Claims

Insurance claims may be denied because of inaccurate coding or other chargemaster issues. Good remote revenue cycle management services can reduce denied insurance claims. 90% of claim denials are preventable, and yet they still occur at every organization. Remote RCM services can mitigate the issues that lead to denied claims.

Fewer Billing Errors

Billing and coding errors increase the number of claim denials. Remote revenue cycle management services solve these bottlenecks, helping organizations capture revenue and avoid denied insurance claims.

Improved Employee Satisfaction

Cleveland Clinic claims its remote revenue cycle management program has improved employee satisfaction by enabling employees to telecommute. Employees can perform pre-registration and financial counseling remotely, helping save money and improve employee satisfaction. One executive said the work-from-home program increased productivity 113%, for example, while also reducing employee turnover and absenteeism.

Improved Quality of Information

Patients and insurers have better access to information with remote revenue cycle management services. Instead of old, manual, paper billing processes, for example, new systems use modern electronic processes to boost performance.

Better Interoperability

Aging, legacy systems can make interoperability painful. Remote revenue cycle management services can lead to better interoperability between health systems, enabling the seamless transfer of data.

Streamlined Denial Management

Remote RCM services offer streamlined denial management. Good RCM services make it easy to determine the cause of denials, mitigate the risk of future denials, and get paid faster. Common claims denial management obstacles include managing different payer rules, using manual processes, and making simple mistakes – and remote RCM systems can help avoid all of these issues.

Automation and AI Processes

Automation and AI continues to become closely integrated into the healthcare space. Remote revenue cycle management programs are increasingly using automation and AI to get ahead of the competition. The best remote revenue cycle management programs rely on AI to boost revenue and performance across organizations.

Better Regulatory Compliance

Increased government regulations in recent years have made compliance more difficult for healthcare organizations. It’s difficult for healthcare organizations to follow regulatory mandates for the adoption of electronic health and medical records, for example.Remote revenue cycle management programs improve regulatory compliance, making it easier for organizations to stay up-to-date with the latest regulations.

Better Patient Data Management

Remote revenue cycle management programs offer complete patient billing solutions. Failure to maintain necessary HIPAA and HL7 compliance and protect the patient’s data from a breach can lead to serious liability issues. Healthcare organizations are turning to remote revenue cycle management companies for better, safer patient data management.

Outsourcing Doesn’t Mean Losing Control

Remote revenue cycle management companies are aware that healthcare organizations don’t want to lose control. That’s why many make control a key issue.By choosing the right remote revenue cycle management program, companies can avoid losing control over crucial aspects of their organization. Today’s leading RCM companies emphasize a ‘win-win’ solution – and they’re increasingly living up to that promise.

Final Word:Remote RCM Continues to Grow

The market for remote revenue cycle management programs is expected to grow to $90 billion by 2022, up from $51 billion in 2017.
As more healthcare providers recognize the benefits of remote revenue cycle management programs, remote revenue cycle management isn’t expected to slow down anytime soon.

Revenue Cycle Management (RCM) Trends for 2020

Revenue cycle management has experienced ups and downs in recent years. What lies ahead for revenue cycle management?
Last year, we saw the continued rise of automation and AI. We also saw battles over price transparency.
Continuing the trend from previous years, we also saw healthcare organizations contend with patient expectations, government regulations, and a growing number of technology options.
Let’s take a look at some of the revenue cycle management (RCM) trends we’re preparing for in 2020.

Continued Battles Over Healthcare Pricing Transparency

Healthcare pricing transparency battles occurred across the country in 2019. Expect battles to continue into 2020.
A Waystar survey released in August 2019 found that lack of price transparency was the biggest factor to a negative patient experience. Governments are pushing for increased healthcare transparency, and healthcare organizations are adapting.
Last year, we saw healthcare organizations implement strategies to better manage the patient financial journey. In 2020, we expect healthcare organizations to take the next step.
Some organizations have published the chargemaster online, giving patients full transparency over how much services cost. However, because chargemaster prices are not necessarily the prices charged to the patient, these resources can be difficult for patients to interpret.
In June 2019, the Trump administration signed an executive order mandating that health systems provide out of pocket cost estimations to patients upfront.
Look for increased transparency and better patient access to prices as we move through 2020.

Higher Demand for Revenue Cycle Management RCM Outsourcing

Revenue cycle management outsourcing is becoming increasingly popular among healthcare organizations – and it’s been a trend for several years.
The trend towards revenue cycle management outsourcing is expected to continue into 2020.
Revenue cycle management companies advertise benefits like sharing the risk and reward, which creates a win-win solution for partner organizations. Healthcare organizations can create a sustainable, high-performing engine while still enjoying growing cash flow.
As revenue cycle management outsourcing companies become more competitive, outsourcing is an increasingly attractive option for healthcare organizations.

More Cybersecurity Battles and Ransomware Attacks

Cybersecurity has been a priority for healthcare organizations for over a decade, and this trend is expected to continue into 2020.
Cybersecurity attacks aren’t stopping anytime soon. Healthcare organizations need a coherent cybersecurity strategy to stay competitive.
In April 2019, the United States government reported 44 healthcare data breaches, which was the highest number of healthcare breaches reported in a single month since the government started tracking healthcare breaches in 2010. The previous record was set in April 2018, when there were 42 breaches.
Ransomware attacks are particularly common. Last year, Carbon Black released a study showing that 66% of healthcare organizations experienced a ransomware attack within the last 12 months.

Higher Volumes and Patient Revenue

Hospitals nationwide ended 2019 with an increase in hospital profitability. The increase was linked to surges in net patient revenue and service volumes. Hospitals were treating more patients – and making more money from those patients – than ever, according to a report by RevCycle Intelligence.
This profitability increased despite a slight increase in supply expenses, increases in bad debt, increases in charity care, and mixed performance on expenses.
Over 800 hospitals across the country saw particularly high volumes in adjusted discharges, emergency department (ER) visits, and operating room (OR) minutes.
It was a positive trend after a tough year. The December 2019 increase was the first year-over-year operating EBITDA margin increase in six months. Hospital operating margins also increased by 171.8 basis points compared to November 2019.
Overall, EBITDA margins rose 136.9 basis points year-over-year in December 2019. It’s possible this trend will continue into 2020.

CFOs Are Becoming More Involved

The role of the healthcare CFO has been changing in recent years. 2020 might be the year it becomes even more evident.
CFOs are expected to continue taking a leading role at every level of the healthcare organization. Modern healthcare CFOs don’t just listen: they act.
Healthcare IT Leaders Revenue Cycle Lead, Larry Todd, recently recommended that CFOs go beyond listening and start implementing:
“…any implementation will affect the revenue of the organization so it’s very important for CFOs to be involved in the implementation project and to be informed of key parts of the project that could put the organization and its revenue at risk.”
In the same article, Linda Hoff of Legacy Health described how CFOs need to take a specific interest in not just financials, but also patient satisfaction and quality. All metrics are closely intertwined:
“You have a passion for what you’re doing within your facilities, how you’re interacting with patients. You have to be as interested in patient satisfaction and quality as you are in the financials. If you don’t have that passion for all those aspects, you’re really not going to land yourself in a CFO role especially today.”

Surprise Billing Will Continue to Be Attacked

Surprise billing took a beating at the end of 2019. In December, members of Congress announced the expansion of a bipartisan investigation into supress billing practice. Because of that expansion, the investigation will now look at physician staffing companies and health insurers.
That same month, a Health Affairs study found that annual healthcare spending for patients with employer-sponsored health insurance would drop by $40 billion if specialists were not able to bill out-of-network.
A Kaiser Family Foundation report released in June, meanwhile, found that one in six Americans received a surprise medical bill in 2017 despite being covered by health insurance.
As surprise billing continues to make media headlines nationwide, surprise billing practices will continue to be attacked.
Look for these trends and more to make headlines across the revenue cycle management field in 2020.

What Role Does a Hospital Chargemaster Play in Revenue Cycle Management?

The hospital charge description master, or hospital chargemaster, communicates medical bills to payers and patients.
The hospital chargemaster plays a crucial role in revenue cycle management: it’s the heart of the healthcare revenue cycle. It’s the central point from which all billing gets sent to patients and insurers.
Organizations that fail to maintain the chargemaster face enormous problems. Poor chargemaster maintenance leads to revenue leakage. It can also lead to inaccuracies, non-competitive fees, and claim rejections.

What is the Chargemaster?

The hospital chargemaster is a list of all the billable services and items to a patient or patient’s health insurance provider.
The chargemaster lists the costs of each product and service offered by the healthcare organization, including any procedures, services, supplies, prescription drugs, and diagnostic tests provided by the hospital. The chargemaster lists the cost of everything related to that service, including any equipment fees and room charges.
When a patient receives service from a hospital, the healthcare provider documents the encounter in the medical record. Then hospital staff – like professional coders – assign the service a code for reporting and claim submission.
The codes are sent to the chargemaster. Each code is matched with a specific product or service and a fixed rate. Then, the charges are billed to the patient, creating a claim for payers – like insurance companies – to pay.

What’s Included in the Chargemaster?

Hospitals use chargemasters to keep track of the cost of all products and services offered by the organization.
Each product or service offered by the hospital – like a diagnostic test or specific surgery – gets its own entry in the chargemaster.
Each chargemaster entry includes the following:
Item Number: This number is assigned by the facility and is unique to that product or service.
CPT or HCPCS Codes: Current Procedural Terminology (CPT) codes or Healthcare Common Procedure Coding System (HCPCS) codes help keep track of each product or service in a standardized way.
Item Description: Each entry has a brief text description of the product or service.
Revenue Code: A unique code based on the revenue of that item.
Charge Amount: The fee assigned to the item.
Alternative CPT or HCPCS Codes: Sometimes, codes overlap. Or, some insurers may require additional codes.
Numeric Designation for Department: A unique code describing the department where the product or service took place.
Ledger Number: A general number for organization accounting purposes.
A hospital may offer thousands of products or services. There’s a chargemaster entry for each one.

Patients Rarely Pay the Chargemaster Rate

Healthcare transparency battles raged throughout 2019. In response, some organizations are making chargemasters more transparent.
However, it’s easy for patients to get confused about chargemaster prices. The prices displayed on the chargemaster are rarely the prices paid by customers.
In fact, most patients do not see the chargemaster price from their hospital visit unless they are uninsured and must actually pay the chargemaster rate.
Why are chargemaster rates so different from real prices? It’s because of markups.
Chargemaster services are heavily marked up to make negotiations with insurance companies easier. One recent study found that the average hospital in the United States had a charge-to-cost ratio of 4.32, which means the hospital charged $432 when the service really only cost $100.
Maintaining marked up chargemaster prices also makes it difficult for patients to compare prices between organizations.
Hospitals defend this practice, claiming that markups help hospitals stay open and competitive. However, there’s been a push for transparency in recent years, and hospitals have started changing how they treat the chargemaster.

Why is Inadequate Chargemaster Maintenance a Problem?

Inadequate chargemaster maintenance is a serious issue. Even the best healthcare organizations experience chargemaster-related issues, and these issues lead to lost revenue.
Accurate chargemaster maintenance is crucial for revenue integrity. A lack of maintenance leads to revenue leakage.
Poor chargemaster maintenance can lead to overpayments or underpayments. It can also lead to claim rejections from insurance companies, poor patient experience, or compliance violations.
Many organizations are surprised to discover they have been significantly undercharging or overcharging for specific treatments because of poor chargemaster maintenance. A chargemaster audit can reveal surprising results.

Tips for Maintaining Accurate Chargemasters

Hospital chargemaster maintenance is crucial to revenue cycle management. Here are some tips to help your organization manage.
First, the American Academy of Professional Coders (AAPC) recommends maintaining chargemaster lists by following the three C’s: correct, complete, and compliant codes.
Correct Codes: Chargemaster coordinators should check that the correct codes are billed. There may be differences between what is captured in the order entry system or EHR and what is reported on the chargemaster. Someone may assign an unlisted HCPCS code when a specific code is available, for example, or the entry may be missing HCPCS codes for separately paid drugs.
Complete: Chargemaster code sets need to be complete. Hospitals need to capture the charges for all the services and items provided to patients. Failure to maintain complete code sets can lead to missed payments and revenue leakage.
Compliant: Chargemasters must also be complaint with coding standards and federal, state, and commercial payer rules. Failing to adhere to regulations can lead to significant issues, including repayments to payers, healthcare fraud, and healthcare abuse.
Ultimately, all of these issues can be solved with frequent chargemaster code reviews. Check your chargemaster code to ensure it’s correct, complete, and compliant to ensure good revenue cycle management.