Financial/Revenue Cycle Management

Family Medical Specialists in Florida is using care management technology to get paid under CPT code 99490, and the practice has already gotten buy-in from almost every eligible patient.

Advanced analytics and machine learning technologies are critical to pinpointing problems in large datasets that could be losing providers money. That’s why some organizations are investigating every single denied claim to better understand trends. 

Hospitals are starting to hire younger, more diverse people to handle the new coding. The shift will likely benefit healthcare organizations in time, but it won’t happen overnight.  

Analysts say that with less focus on meaningful use and ICD-10 settling down, many healthcare organizations are turning their attention to revenue cycle technologies amid the shift to value-based care.

Looking into its crystal ball – or perhaps digital spreadsheets – PiperJaffray analysts see big plays in the RCM market. That potential is so large, in fact, that Cerner alone has a $40 billion opportunity, and it ranks fifth in market share.

Caleb Anderson says changing payment models are likely to make hospital executives rethink revenue cycles, and consider outsourcing services to Cerner or one of its competitors, including athenahealth, eClinicalWorks, NextGen, Conifer and others.

Arguing that too many well-meaning providers are facing financial penalties from meaningful use, the American Hospital Association called on the Centers for Medicare and Medicaid Services this week to offer more flexibility. Specifically, AHA says hospitals that meet 70 percent of meaningful use requirements should be deemed as having complied with the program. With the current "all-or-nothing approach," writes Ashley Thompson, AHA's senior vice president of public policy analysis and development, "failure to meet any one of the requirements under the Medicare and Medicaid EHR Incentive Programs has meant a provider would not receive an incentive payment; more recently, it has meant a provider would be penalized." [Also: Hospitals press HHS on meaningful use] Given the huge complexity and high hurdles of meaningful use, the fact that a hospital missing a given threshold by small amount leads to overall failure is "unfair to providers that make good faith efforts to comply," according the March 22 letter to CMS Acting Principal Deputy Administrator Patrick Conway, MD. CMS has told AHA that it doesn't have the statutory authority to offer anything less than that absolutist approach, according to the letter. But AHA offers a legal analysis that suggests that's not true: "We believe that CMS possesses the authority to eliminate the all-or-nothing approach to meaningful use and that the agency should do so." Among the arguments put forth by CMS for the necessity of an all-in requirement: The law requires more stringent MU measures to improve quality over time; certain measures capture policies, such as health information exchange, that are specifically required by statute; use of a "qualified EHR" must meet all the requirements, not some, in order to meet the law's objectives. The agency has also argued that a more flexible framework wouldn't reduce providers' reporting burden anyway – a contention with which AHA "respectfully disagrees" but points out isn't statutorily binding anyway. "We strongly believe that CMS is not legally required to maintain its  all-or-nothing approach to meaningful use," AHA argues, but instead has "ample legal authority" to adopt a more forgiving approach like the 70 percent threshold it suggests. "This flexibility would support providers who have implemented IT functionality but may not have optimized each function sufficiently to meet the full set of requirements in the EHR Incentive Program in order to avoid a payment adjustment." Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

The National Quality Forum has published its guidance for the new Merit-Based Incentive Payment System. NQF's Measure Applications Partnership examined some five-dozen MIPS performance measures, proposed for implementation in 2017, from which data would be collected to track eligible providers' performance in 2019. "As the U.S. healthcare system increasingly shifts to a performance-based payment system, MAP’s role (is to serve) as an impartial advisor bringing stakeholders together from across the healthcare spectrum," NQF’s chief scientific officer Helen Burstin said in a statement. To that end, MAP offered some suggestions to the U.S. Department of Health and Human Services for better aligning with multiple federal healthcare programs, namely the Medicare Shared Savings Program. [Also: Meaningful use will still be part of MIPS reimbursement, CMS official says] Chief among those was that aligning of measures should be a top priority, and not just for MIPS programs and alternative payment models, but across all federal programs and with states and the private sector where possible. Indeed, NQF found that gaps still exist across clinician-level programs – most notably in patient-centered areas such as patient-reported outcomes, functional status and care coordination. These measures should go beyond patients' experience with the healthcare system to the impact of healthcare on patients' health and well-being. Meanwhile, MAP urged continued exploration of the impact of socioeconomic status and other demographic factors on measure results, noting that the program should be taking into account when providers are caring for high-risk populations. NQF also weighed in on measures for public reporting on CMS' Physician Compare website. With regard to those most useful for consumers and patients, MAP expressed a preference for those focused on care coordination, population health, appropriate care and on outcomes – especially those that are patient-reported. Twitter: @MikeMiliardHITN

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LAS VEGAS – Newly expanded health IT vendor CPSI has introduced nTrust, a program designed to help community hospitals and skilled nursing facilities improve financial operations while moving into an electronic health records system with no upfront costs, CPSI said. The vendor unveiled the program last week at the 2016 Annual HIMSS Conference and Exhibition. “There are many providers that are unhappy with their EHR, but they don’t have the financial capability to make a switch,” said Boyd Douglas, CPSI president and CEO. “With nTrust, we help providers in acute and post-acute settings improve business operations via our TruBridge management services, while at the same time funding the purchase of their EHR with no advance payment required.” Through nTrust, hospitals and senior care facilities outsource revenue cycle management operations to TruBridge business services, which recently has been strengthened by the addition of revenue cycle management tools from Rycan Technologies, CPSI said. As a result of this business relationship, proceeds are allocated to finance the purchase and ongoing support of either Evident’s EHR system for acute care providers or American HealthTech’s EHR for post-acute care facilities. [Also: See photos from Day 3 of HIMSS16] CPSI is the parent of Evident LLC, TruBridge LLC, Healthland Inc., American HealthTech Inc. and Rycan Technologies. “nTrust gives customers a pathway to a better-performing EHR without upfront costs, with a partner that is taking a stake in their success,” Douglas said. “We will help you achieve the improved cash flow and increased financial efficiency in your operations that will help pay for an EHR that fits your needs for the complex and shifting healthcare environment. We are making a financial investment in the ongoing success of our clients who choose to take advantage of this program.” Sharkey-Issaquena Community Hospital entered a relationship with CPSI that began with TruBridge services to improve the hospital’s business operations, explained John Hodnett, RN, director of clinical systems at the hospital. “To further enhance our ability to effectively serve our patients and our community, the Thrive EHR from Evident was implemented simultaneously,” he said. “This business venture was without a big upfront expense.” The partnership aspect of the nTrust approach is invaluable and made the goal of implementing a new electronic health records system financially obtainable, Hodnett added. Douglas added the nTrust program was specifically designed to be of value to rural and community hospitals and senior care facilities. “We understand how today’s complexities associated with revenue cycle management has put increasing pressure on community healthcare providers that are already financially stressed,” he said. “TruBridge brings proven operational expertise and industry leading tools to bear to greatly enhance the efficiency and effectiveness of managing the revenue cycle process.” Douglas said nTrust is the first of many product and service offerings emerging from the recent blending of the Evident, TruBridge, Healthland, American HealthTech and Rycan businesses. Twitter: @SiwickiHealthIT This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.