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Study Says Overcharging by the Hospital Might Be Overstated

Despite concerns first raised a few years ago, hospitals do not seem to be abusing their electronic data systems to generate bigger bills and boost their income — at least according to authors of a large study released Tuesday. Other leaders in the field say the jury’s still out.

The concern over possible misuse of records grabbed headlines in 2012 after an investigation by the Center for Public Integrity and the New York Times found that some hospitals using electronic records were billing Medicare for significantly more than hospitals that still used paper records.

After the stories appeared, the Departments of Justice and Health and Human Services sent hospitals a strongly worded letter warning them against misusing the ease of electronic forms to pad their bills.

Source

What an interesting study. I especially like the part of the article where they suggest that hospitals aren’t charging more for their services because of EHR because the hospitals had already been maximizing their revenue for a long time before EHR. It’s a fine point that’s worthy of consideration. I don’t think it’s as true in some ambulatory practices, but in the hospital world they’d made a lot of efforts to maximize their revenue even without EHR.

One angle the article above doesn’t cover is that many people were suggesting that this EHR over billing of services was fraud on the part of these organizations. I’ve always thought that was ridiculous. Sure, fraud exists and is facilitated by technology in many cases. However, what the majority of hospitals are doing to maximize revenue isn’t anywhere close to fraud. The problem is that Medicare and other payers have been able to avoid paying for services that were rendered, but never billed. If EHR has increased claims (and this study suggests it hasn’t), then I’d submit it was because hospitals are finally charging for all of the services their rendering.

What do you think? Does EHR increase the cost of healthcare by charging for all of the services provided? Does EHR facilitate fraudulent claims?

August 1, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

4 Tips on How to Improve Your Patient Accounts Receivables (A/R)

Many systems and provider groups think they are handling patient receivables management well, but the reality is that most of them have a very antiquated patient revenue cycle management strategy. In today’s medical landscape, a proactive approach is not just preferred, it is essential.

With ANI 2014 just around the corner, I’m sure I’ll be covering this a lot more. In the mean time I thought that readers might find a whitepaper with 4 tips to significantly increase patient payment revenue useful.

The whitepaper highlights something that I’ve seen as well. Most hospital leaders think that they’re handling their patient receivables management really well. The reality is usually very different than their perspective. Once they dig into the numbers, they realize really quickly that there’s a lot that they can do to improve it.

The great part is that the 4 tips aren’t rocket science. They are all easy to understand and implement. Sometimes all you need is to read a blog post and see a whitepaper with the tips to remind you to check it out.

May 12, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Health Exchanges Pose Added Stress For Hospital IT Departments

There’s no doubt that hospital IT departments have their hands full already, what with Meaningful Use and ICD-10 hovering over them like a huge black cloud. But as one Information Week story reminds us, there’s another big project in the wings which could add even more to their plate.

The IW story, which offers intelligence from the American Hospital Association and several consultants, notes that the coming of health exchanges and the accompanying Medicaid expansion in some states will have a substantial effect on hospital IT departments.

For one thing, the story reports, with a flood of newly insured Americans arriving at the door, hospitals will need to enhance their revenue cycle management systems, as the number of health plans with which they do business should rise meaningfully.

Hospitals will need to deal with the fact that some patients who buy insurance on the exchanges will have high deductibles and copayments, in some cases as high as $5,000 or $6,000. Given these deductibles, it will be crucial for hospitals to determine what kind of coverage patients have. Many hospitals will end up upgrading their RCM systems to better interface with managed care plans.

Unfortunately, even that won’t assure payment. As the IW story points out, even a direct connection to the insurance company in question may not do the job, as eligibility information from health plans is often 30 – 90 days out of date. “So if patients miss two premium payments and are no longer covered — but the data says they are covered, and the hospital proceeds accordingly — the bill never gets paid,” according to Thad Glavin, senior director of the Advisory Board’s RCM division, who spoke with the magazine.

Still, hospitals will need more and better connections with health plans even if the information they get in return is questionable. Sure, despite the risks that come with the change in insurance under the Affordable Care Act, I wager that hospitals’ steely focus on Meaningful Use and ICD–10 will leave RCM projects shortchanged at first. But as the high-deductible bills keep building up, hospitals will squeeze in new RCM system development. I give it six months to twelve months, max.

September 30, 2013 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.

American Health Network Reduces Denial Management Time by 75 Percent, Realizes ROI of 200 Percent

Ever since I first attended HFMA’s ANI conference, I’ve been fascinated by the opportunities available in managing a hospitals revenue. There are so many areas where even a small change to your operations directly effect your bottom line. That’s the beauty of any revenue solution.

Thus, I was quite interested to read this whitepaper about American Health Networks experience reducing claim denials. American Health Networks realized an ROI of 200 percent and recovered $1.4 million by changing their denial management practices.

I especially like how American Health Networks chose to roll this out first as a pilot program to a small subset of doctors. Then, after evaluating the results they chose to roll it out to the whole organization. Far too often I see organizations try to go all in with a solution and then fail miserably. There’s a lot of value of rolling out any IT solution to a small set of engaged users before applying them to the whole organization. One of the biggest values of this is the pilot group of users becomes the product champions once you’re ready to roll it out to the whole organization.

There are a lot of places where revenue is figuratively leaking out of healthcare organizations. For many organizations, claim denials is one of those places. I’d love to hear what solutions people have implemented to address claim denials in their organizations.

August 29, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Study: Most Health Organizations Are Implementing HIEs

A study by revenue cycle management vendor Emdeon has concluded that most hospitals and medical practices are getting involved with HIEs, and that a majority of providers were implementing automated medication reconciliation, e-prescribing and EMRs.

To conduct the study, researchers spoke with 147 people from hospitals, large practices and small practices about their HIT practices, according to Becker’s Hospital Review.

Eighty-eight percent of hospitals surveyed had fully implemented or were in the process of implementing health information exchange, Emdeon found.  Large practices were even more involved, with 94 percent of those surveyed having fully implemented or begun the process of implementing HIEs.  Even smaller practices were largely on board, despite their resource constraints, with 72 percent having fully or partially implemented HIE connectivity.

As for the other health IT initiatives studied, here’s a quick overview of what Emdeon found (stats courtesy of Becker’s):

Hospitals

* 77 percent have implemented or are on the way to implementing automated medication reconciliation
* 85 percent have partially or completely implemented EMRs
* 61 percent have partially or completely rolled out e-prescribing

Large Medical Practices

* 57 percent are implementing or have completed rollout of automated medication reconciliation
* 74 percent have partly or completely implemented EMRs
* 82 percent have partly or fully implemented e-prescribing

Small Medical Practices

* 55 percent have partly or fully implemented automated medication reconciliation
* 62 percent have partly or completely rolled out EMRs
* 62 percent have partly or fully rolled out e-prescribing

April 23, 2013 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.

EMR Overbilling Investigations Sling Mud At Meaningful Use Program

In the wake of an expose in The New York Times claiming that upcoding and overbilling was increasing with the use of EMRs, and members of Congress riding the claim, I guess ONC had no choice but to take the allegations seriously.  So fearless leader Farzad Mostashari, M.D. has asked the advisory HIT Policy Committee to study whether providers are using EMRs to upcode Medicare bills.

I suppose you can tell from how I put that that I’m far from convinced EMRs are generating massive amounts of illegitimate bills, but the idea is “out there” now and dangerous to the future of HITECH objectives. So I suppose it’s a good thing that ONC is investigating.

Dr. Mostashari wants to find out whether EMRs tend to foster the use of higher billing codes by encouraging doctors to cut and paste information from one patient encounter to another, according to an interview with the Center for Public Integrity. He’s also asking the policy committee to determine whether some EMR functions prompt physicians to overbill.

All of this leaves me sort of uneasy.

Don’t get me wrong, I’m not suggesting that EMRs aren’t generating any upcoding issues at all. We all know that many physicians feel pressured to cut and paste text in an effort to get through their heavy workloads, particularly if they’re not otherwise comfortable with their system.

Also, I can’t deny that there are bad apples in every profession, including medicine, who could conceivably be taking advantage of the newness of the technology to reap a profit.

No, my concerns are more that countless providers will have one more thing to worry about as they use the new technology, and that policymakers will view EMRs with a level of suspicion they hadn’t before.  We’re at a tricky point in the overall EMR adoption curve, and bad vibes and publicity are the last thing we need. Meaningful Use compliance is tough enough as it is.

October 31, 2012 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.

Top HIS Vendors By 2011 Revenue: Cerner Corp. (CERN)

Today it’s back to our countdown of the top five HIS vendors, with data courtesy of HealthDataManagement magazine. Today we’re focusing on Cerner, which according to the magazine’s calculations ranks second for HIS sales, edged out only by McKesson.

Cerner claims to be the top EMR vendor in the U.S., despite competitor McKesson’s much larger size, since McKesson is in so many other lines of business. As with McKesson, we’re going to share a very quick overview of Cerner’s position in the overall HIS market, which as noted previously embraces not only clinical tools like EMRs, but also HIM, revenue cycle and access tools.

Cerner holds a very tasty 18 percent of the HIS market, by HDM consultants’ calculations. More interesting, to this audience at least, is that it’s gotten there with a big helping hand from its suite of EMR products. Here’s more to chew on, below.

-Anne

Cerner Corp. (CERN)
2800 Rockcreek Parkway
North Kansas City, MO 64117
Phone: 816-221-1024

Products:  For the purposes of this discussion, let’s just be cute and say “everything HIT.”  That includes its popular Millennium suite of EMR products which are really seeing a big uptake in community hospitals, especially its remote hosted solutions.

2011 HIS Revenue: $2.2 billion

2010 Revenue: $1.85 billion

Summary:  From 2010 to 2011, Cerner’s  HIS revenue grew by 20 percent as Millenium sales yielded annual revenues of $2.2 billion.  Cerner’s overall profit margin for last year was, wait for it, just about 14 percent — and over the last 52 weeks its stock is up 34.3 percent. Yeah, yeah, I’ve been an editor for 20 years but now I know I’m in the wrong business.

Interesting facts:  Cerner has a strong international presence, from Belgium to Bangladesh, the Middle East and South America. Also, it now is offering “Community Works” to Critical Access Hospitals under 25 beds (a move your editor wouldn’t have expected given the predictably high cost of solutions from a company that size).

April 23, 2012 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.