Free EHR, EHR and Healthcare IT Newsletter Want to receive the latest updates on EHR, EMR and Healthcare IT news sent straight to your email? Get all the latest EHR News for FREE!

RelayHealth Financial Automates Creation, Management and Tracking of Denied Claim Appeals

RelayAssurance Appeals Assist helps improve revenue health by increasing collection rates on denied claims

ALPHARETTA, Ga., June 27, 2016RelayHealth Financial today introduced RelayAssurance™ Appeals Assist, a new tool that lets providers quickly and easily identify, create, file, and track appeals for denied claims. Now hospital and health system CFOs and revenue cycle leaders can enhance their denial prevention strategy with a way to expedite the appeals process– helping to reduce the associated time and costs, and improving the collection rate on initially denied claims.

While an estimated 6.4% of all provider-submitted claims are initially denied by payers1, two thirds of those claims are recoverable2. Yet many healthcare providers do not appeal denied claims at all, while others dedicate in-house staff or enlist outsourcing firms, which can result in lost revenue, wasted productivity due to manual processes, and significant expense. With RelayAssurance Appeals Assist, denied claims are flagged, the appropriate appeal forms are assembled and completed, and their progress is tracked–all within the same RelayAssurance Plus workflow used to monitor and manage claims.

“Despite providers’ best efforts to submit clean claims, a substantial number still get denied,” said Marcy Tatsch, vice president and general manager, Reimbursement Solutions, for RelayHealth Financial. “An effective denial prevention strategy doesn’t just focus on pre-submission, but also on the other points along the claims continuum. RelayAssurance Plus already offers the robust editing, claim status, and lifecycle visibility capabilities that are essential to denial prevention, and now builds on that functionality with the ability to track a claim’s progress and quickly respond when help is required.”

RelayAssurance Appeals Assist complements the RelayAssurance Plus claims management suite by offering:

  • Integrated Denial Management–Users can quickly and efficiently identify that an appeal is needed, then create, print, and file that appeal and track its progress directly within the same RelayAssurance Plus workflow where claim status/tracking takes place.
  • Forms Library–Built-in standard Medicare appeal forms, templates and letters, along with state-by-state appeals submission requirements help reduce the time and effort required to file appeals.
  • Appeals Dashboard–Visual icons indicate the status of appeals (Created, Submitted, Denied, Succeeded), whether an appeal follow-up has been established based on payer-specific time thresholds, and alert users to filing deadlines–all to ensure active management of appeals.

RelayAssurance Appeals Assist is the latest module available to users of RelayAssurance Plus, RelayHealth Financial’s cloud-based, analytics-driven claims and remittance management solution. Other modules available to complement RelayAssurance Plus include: the new Status Amplifier™, which automatically tracks down, inspects, and reports accurate reasons for non-payment on claims; RelayAssurance™  Medicare Direct Entry, for integrated Medicare claim processing, and automatically-generated secondary claims; Host Integration Services, which helps reduce the need to manually post transmitted claim status information; and Eligibility Claim Edits to monitor for insurance changes.

For more information on RelayHealth Financial’s revenue cycle management solutions, visit our website, learn from our experts at the RelayHealth blog, or follow us on Twitter at @RelayHealth.

For more information on McKesson Health Solutions, please visit our website, hear from our experts at MHSdialogue, follow us on Twitter, like us on Facebook, or network with us on LinkedIn.

1 2015 RelayHealth data

2 “An ounce of prevention pays off: 90% of denials are preventable” Advisory Board, 2014

June 27, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

AMIA Urges CMS to Rethink Informatics Policies as New Models of Care Emerge

Outcomes-oriented payment policy should enable more outcomes-oriented informatics policy

(BETHESDA, MD) — In comments submitted to the Centers for Medicare & Medicaid Services (CMS), the nation’s leading data scientists in healthcare urged federal officials to use new payment policies to reassess how providers are required to use informatics tools, and rethink how quality is measured in a digital world. Officials from the American Medical Informatics Association (AMIA) said new and novel ways to deliver care will rely on dynamic uses of information technology (IT) and other informatics tools, so government policies dictating the use of IT should be flexible and evolve as more experience is gained with new care models.

CMS issued a request for information (RFI) in October asking for stakeholder input on how best to implement a range of policies required by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 (PL 114-10). The Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) established by MACRA will replace the current Fee-For-Service payment model for Medicare by 2017 and 2019, respectively. This system of reimbursement will rely heavily on electronically-specified clinical quality measures (eCQMs) to pay physicians based on how well their patients recover, rather than the number of services delivered. In comments, AMIA said it supported this move to value-based reimbursement, but voiced concern with the industry’s ability to generate accurate and complete eCQMs, and urged more focus on outcomes-oriented quality measurement.

“AMIA supports the overall direction of moving to an outcomes-based payment system, predicated on demonstrating value for payment,” the organization said in comments. “As we transition away from fee-for-service payment, so too must we move away from the quality measurement paradigm underlying that system. Despite earnest efforts, quality measurement has not become ‘a by-product of care delivered,’ as envisioned, and we are concerned the current mode is insufficient to enable this.”

To improve the current approach, AMIA urged officials to devote more resources to testing both the accuracy of the measure calculation, as well as the feasibility of the data collection requirements, and pilot all new eCQMs before their release for use. CMS should also establish a regular cadence of updates/revisions to eCQMs, ensuring adequate time is allowed for implementation of revisions by both the vendor and provider. Further, AMIA suggested these policies create new opportunities to develop better outcome measures, rather than relying on current process measures.

Additional questions posed by the RFI sought input on how officials should implement policies that require the use of certified EHR technology, and whether new certification criteria are needed to help providers succeed within new payment models. AMIA recommended federal officials avoid overly prescriptive requirements to determine how providers use informatics tools within APMs, but rather focus on the outcomes sought by the use of such tools.

“Ours is a dynamic environment of innovation and invention,” said Blackford Middleton, MD, MPH, MSc, FACMI and current AMIA Board Chair.  “AMIA sees policy development for MIPS and APMs as not just an opportunity to change our payment system, but as an opportunity to revisit policies meant to spur adoption and guide use of health IT.”

AMIA President and CEO Douglas Fridsma, MD, PhD, FACP, FACMI continued, “In much the same way that fee-for-service era policies skewed incentives and provider behavior, overly prescriptive documentation and ‘use’ requirements of the same era have influenced how health IT is developed, implemented and leveraged to improve care.  We must evolve both sets of policies if we are going to succeed in this new paradigm.”

Click here to read AMIA’s full comments to the CMS RFI regarding implementation of MIPS and promotion of APMs.

###

AMIA, the leading professional association for informatics professionals, is the center of action for 5,000 informatics professionals from more than 65 countries. As the voice of the nation’s top biomedical and health informatics professionals, AMIA and its members play a leading role in assessing the effect of health innovations on health policy, and advancing the field of informatics. AMIA actively supports five domains in informatics: translational bioinformatics, clinical research informatics, clinical informatics, consumer health informatics, and public health informatics.

November 16, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

M*Modal Launches Comprehensive Outpatient Medical Coding Services

Outsourced coding enables healthcare providers to optimize HIM resources and manage transition to ICD-10

Franklin, Tenn. – September 10, 2014 – To help the healthcare industry address medical coder shortages in advance of the ICD-10 mandate, while preserving accurate revenue realization, M*Modal today announced the availability of comprehensive outpatient medical coding services. M*Modal’s technology-enabled services program combines coding experts with advanced cloud-based solutions to deliver quality results with fast-turn-around time, enabling organizations to offload high-volume outpatient coding, increase productivity and improve their cash flows.

Outpatient services is the fastest growing healthcare segment in terms of spending, according to the Health Care Cost Institute. Using AHIMA-certified coding experts, M*Modal’s outpatient coding program delivers high-quality, accurate coding for all outpatient areas, including Observation, Ambulatory Surgery, Emergency Department/Urgent Care, Specialty and Diagnostic.

“Qualified coding professionals are in short supply, and HIM departments face an ongoing challenge to stay ahead of coding and ICD-10 demands,” said Matt Jenkins, SVP and General Manager of HIM Services at M*Modal. “M*Modal’s outpatient coding services offer a cost-effective way for organizations to offload routine coding and move their existing coding resources onto critical inpatient and ICD-10 preparation programs.”

In a recent AHIMA and eHealth Initiative survey of healthcare providers, 50% identified lack of staff as a top concern to meet ICD-10 demands. ICD-10 is a revised standard that reflects a seven-fold increase in the number of potential code assignments. Many organizations lack the coding staff to manage their discharged not final billed (DNFB) coding requirements, as well as support the dual-coding and end-to-end testing programs needed to prepare for ICD-10’s rollout in October 2015.

M*Modal is one of the largest transcription and coding services providers in the U.S., providing credentialed coding resources to hospitals, clinics and practices for nearly 20 years. M*Modal offers essential coding services – including staffing, auditing and education – to hospitals looking outside their organization to manage resources. In addition, M*Modal’s cloud-based technology platform ensures a unified workflow for delivering high-quality, compliant documentation.

“Accurate billing begins with accurate and complete clinical documentation. By partnering with M*Modal for transcription, clinical documentation technology and coding services, HIM departments can optimize a unified workflow which yields superior physician satisfaction, more complete patient information and higher productivity from the revenue cycle process,” said Mr. Jenkins.

About M*Modal

M*Modal is a leading healthcare technology provider of advanced clinical documentation solutions, enabling hospitals and physicians to enrich the content of patient electronic health records (EHR) for improved healthcare and comprehensive billing integrity. As one of the largest clinical transcription service providers in the U.S., with a global network of medical editors, M*Modal also provides advanced cloud-based Speech Understanding™ technology and data analytics that enable physicians and clinicians to include the context of their patient narratives into electronic health records in a single step, further enhancing their productivity and the cost-saving efficiency and quality of patient care at the point of care. For more information, please visit www.mmodal.comTwitterFacebook and YouTube.

September 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

H.I.M. ON CALL Launches Dual Coding Service to Help Hospitals Prepare for ICD-10

ICD-10 Testing Requirement Now Supported by Outsourced Coding Firm

Allentown, PA, March 26, 2013: H.I.M. ON CALL, a technology-driven outsourced services company for health information management (HIM), coding and revenue cycle, announces the availability of its dual coding services for hospitals migrating from ICD-9 to ICD-10. Dual Coding is a precursor to end-to-end testing of ICD-10. Payers want to test with providers that can submit ICD-10 codes. The new, dual coding service from H.I.M. ON CALL provides the people, processes and technology required for dual coding and supports ICD-10 testing with payers. The announcement was made by Manny Peña, RHIA, President, H.I.M. ON CALL.

Expert, outsourced coders from H.I.M. ON CALL perform ICD-10 coding via remote or onsite options; allowing the hospitals’ internal coding team to focus on day-to-day production or ICD-10 training, education and ramp-up.  The firm generates dual coding data output and analytics to identify gaps in clinical documentation for ICD-10. Back-up ICD-9 coding services are also available.

“Dual Coding’s data and analytics support our customers’ clinical documentation improvement (CDI) ramp-up for ICD-10,” explains Peña. Specific documentation weaknesses and target areas for revenue loss under ICD-10 are identified.  Some of the features of the new dual coding service include:

  • Perform dual coding (ICD-9 and ICD-10) for up to one year prior to October 1, 2014.
  • Support end-to-end testing initiatives by providing ICD-10 coded cases.
  • Provide monthly summary, data and analytics of CDI issues (ICD-9 and ICD-10).

“In addition to opening the door for end-to-end payer testing, our data and analytics are a tremendous support to ICD-10 teams,” adds Karen Karaban, RHIT, CCS, Director of Coding Integrity at H.I.M. ON CALL.  Accurate, complete and specific clinical documentation is the foundation for correct reimbursement, quality reporting and continuing care. The H.I.M. ON CALL service provides a summary of documentation findings by ICD-10-CM/PCS chapter, patient type, medical service and physician. The potential financial impact due to the lack of specificity in the documentation is also identified with actual and projected decreases in coding productivity by patient type and medical service.

More information about the firm’s dual coding service can be viewed at the firm’s blog or by contacting Joseph J. Gurrieri, RHIA, CHP, Vice President & COO at: 610.435.5724 Ext. 131.

About H.I.M. ON CALL:

H.I.M.ON CALL is a technology and outsourced services company for health information management (HIM), coding, clinical documentation improvement (CDI) and revenue cycle. They offer data-rich technology tools and outsourcing services to make better coding decisions and prepare for change. Service offerings include coding, coding audits, CDI consulting and ICD-10 education. Their AVIANCE Health™ suite of web-based software applications includes audit management, DNFB management, coding analytics and electronic document management. Founded in 1998 and based in Allentown, Pennsylvania, the company is focused on the future and willing to embrace new ideas; delivering financial value in everything they do.

March 26, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.