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Revenue Cycle Trends To Watch This Year

Posted on July 13, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Revenue cycle management is something of a moving target. Every time you think you’ve got your processes and workflow in line, something changes and you have to tweak them again. No better example of that was the proposed changes to E/M that came out yesterday. While we wait for that to play out, here’s one look at the trends influencing RCM strategies this year, according to Healthcare IT leaders revenue cycle lead Larry Todd, CPA.

Mergers

As healthcare organizations merge, many legacy systems begin to sunset. That drives them to roll out new systems that can support organizational growth. Health leaders need to figure out how to retire old systems and embrace new ones during a revenue cycle implementation. “Without proper integrations, many organizations will be challenged to manage their reimbursement processes,” Todd says.

Claims denial challenges

Providers are having a hard time addressing claims denials and documentation to support appeals. RCM leaders need to find ways to tighten up these processes and reduce denial rates. They can do so either by adopting third-party systems or working within their own infrastructure, he notes.

CFO engagement

Any technology implementation will have an impact on revenue, so CFOs should stay engaged in the rollout process, he says. “These are highly technical projects, so there’s a tendency to hand over the reins to IT or the software vendor,” notes Todd, a former CFO. “But financial executives need to stay engaged throughout the project, including weekly implementation status updates.”

Providers should form a revenue cycle action team which includes all the stakeholders to the table, including the CFO and clinicians, he says. If the CFO is involved in this process, he or she can offer critical executive oversight of decisions made that impact A/R and cash.

User training and adoption

During the transition from a legacy system to a new platform, healthcare leaders need to make sure their staff are trained to use it. If they aren’t comfortable with the new system, it can mean trouble. Bear in mind that some employees may have used the legacy system for many years and need support as they make the transition. Otherwise, they may balk and productivity could fall.

Outside expertise

Given the complexity of rolling out new systems, it can help to hire experts who understand the technical and operational aspects of the software, along with organizational processes involved in the transition. “It’s very valuable to work with a consulting firm that employs real consultants – people who have worked in operations for years,” Todd concludes.

3 Key Steps to Driving your Revenue Strategy

Posted on July 9, 2018 I Written By

The following is a guest blog post by Brad Josephson is the Director of Marketing and Communications at PMMC.

For healthcare providers struggling to accurately collect reimbursement, developing a revenue strategy based off a foundation of accuracy is the most efficient way to ensure revenue integrity throughout the revenue cycle.

Currently, many hospitals operate under multiple systems running for their different departments within the organization. This type of internal structure can threaten the accuracy of the analytics because data is forced to come into multiple systems, increasing the chances that the data will be misrepresented.

By maintaining revenue integrity, not only does it give hospitals assurance that the data they’ve collected is current and accurate, but it also provides invaluable leverage with the payer when it comes time to (re)negotiating payer contracts.

Let’s begin by starting from the ground up…

Here are the 3 steps needed for maintaining revenue integrity:

  • Creating a foundation backed by accurate analytics
  • Breaking down the departmental siloes
  • Preparing ahead of time for consumerism and price transparency

Accuracy Drives Meaningful Analytics

The first step toward maintaining revenue integrity is to assess whether your data is accurate. We know that accurate data drives meaningful analytics, essentially functioning as the engine of the revenue cycle.

And what happens when you stop taking care of the engine regularly and it no longer works properly? It not only costs you a lot of money to repair the engine, but you may also have to pay for other parts of the car that were damaged by the engine failure.

What if, however, you were able to visualize pie charts and bar graphs on your car’s dashboard that showed the current health of the engine to inform you when it requires a maintenance check?

You would be better informed about the current state of your engine and have a greater urgency to get the car repaired.

This same principle applies to healthcare organizations looking to increase the accuracy of their data to drive meaningful analytics. While some organizations struggle to draw valuable insight from pieces of raw data, data visualization tools are more efficient because it allows the user to see a complete dashboard with a drill-down capability to gain a deeper and clearer understanding of the implications of their data analytics.

Data visualization allows healthcare providers to quickly identify meaningful trends. Here are the 4 key benefits of implementing data visualization:

  • Easily grasp more information
  • Discover relationships and patterns
  • Identify emerging trends faster
  • Directly interact with data

Figure 1: Payer Dashboard

Removing Departmental Siloes  

While data visualization does generate helpful insight into current and future trends, it begins with storing the data in one integrated system so that different departments can easily communicate regarding the data.

System integration is crucial to maintaining revenue integrity because it dramatically lowers the likelihood of data errors, missed reimbursement, and isolated decisions that don’t look at the full revenue picture. Here is a list of other issues associated with organizations running revenue siloes:

  • No consistent accuracy metrics driving performance and revenue.
  • Different data sources and systems drive independent and isolated decisions without known impact on the rest of the revenue cycle.
  • Departments cannot leverage analytics and insight into contract and payer performance.

In the spirit of the recent international World Cup games, think of revenue siloes like playing for a professional soccer team.

Similar to the structure of a hospital’s revenue team, soccer teams are large organizations that need to be able to clearly communicate with each other quickly in order to make calls on-the-spot. These quick decisions can be the difference in turning the ball over to the other team or scoring a goal in the final minutes so it’s crucial that everyone knows their role on the team.

If other players don’t understand the plays that are being called, however, then mistakes will be made that could cost them the game. Each player on the team needs to study the same playbook so they stay on the same page and decrease the chances that a costly mistake will be made.

A hospital’s Managed Care department works in a similar way. If Managed Care is preparing to renegotiate payer contracts, they need to fully understand and have insight into underpayment and denial trends across multiple payers.

Preparing Now for Consumerism and Price Transparency

Now that we know the reimbursement rate is accurate, how do we communicate an accurate price to patients in order to encourage upfront payment?

Studies have shown that by increasing accuracy in pricing estimates, it increases the likelihood that patients pay upfront, which can help your organization lower bad debt.

In an effort to migrate to a more patient-centric approach, these accurate online estimates also enable hospitals to address the patient’s fear of the unknown with healthcare of ‘how much is this procedure going to cost?’ By giving the patient more control over their financial responsibility, hospitals can become a leader in pricing transparency for their entire community while expanding on their market share.

At the end of the day, what this all comes down to is maintaining accuracy to help drive your revenue strategy. By integrating all data into a single system, the hospital is positioned to identify trends more quickly while increasing the accuracy of their patient estimates, ultimately driving your revenue strategy to new heights.

With many healthcare organizations still making the transition away from the traditional fee-for-service model, now is the time to prepare for consumerism and value-based care. Take some time to evaluate where your organization currently stands in the local market as well as any pricing adjustments that need to be made.

About Brad Josephson
Brad Josephson is the Director of Marketing and Communications at PMMC, a provider of revenue cycle software and contact management services for healthcare providers. Brad received a Bachelor of Arts, Public Relations and Marketing Degree from Drake University. He has worked at PMMC for over three years and has a deep knowledge of hospital revenue cycle management tools which improves the financial performance of healthcare organizations.

Mobile App Streamlines Physician Query Process

Posted on June 28, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Most physicians would tell you that they already spend too much time on documentation and coding. Adding insult to injury, after the coding job is done we often have to explain their decisions to medical coders, a process which can take as long as 20 minutes, according to vendor Artifact Health.

Artifact hopes to take the pain out of the burdensome physician query process. It offers a mobile app allowing doctors to answer coding queries which it says allow them to resolve problems within just three clicks. Physicians can also access the platform on the desktop.

Its approach bears some relationship to a new product from vendor Change Healthcare, which has just launched RCM technology which helps doctors address claims documentation requests. Change’s Assurance Assist Module, which is part of its Assurance Reimbursement Management suite, can anticipate the documentation needs of eight payers, the company said.

I am interested in both of these approaches because I know that physicians are already struggling to manage medical coding within their own practices. Hospital queries are a challenging part of that mix and feels like a major chore for providers. In fact, if Artifact’s research is correct and each traditional query takes 20 minutes to resolve, physicians could conceivably end up a little time to do anything else.

So far, Artifact seems to be rolling along impressively. The vendor says that more than 50 hospitals have come on board with its technology, including five institutions from Johns Hopkins Medicine. According to the vendor, these hospitals solve physician response rate of almost 100% and average response time within 48 hours for all periods.

Meanwhile, the hospitals found that the time it took for claims to get paid (days in Accounts Receivable) fell substantially, Artifact reports.

Lest it sound like I’m an Artifact investor, let me raise the questions I ask every time I get a look at a new health IT startup:

  • What does the software cost?
  • How long does it usually take to go live with the platform?
  • How much man- or woman power will it take to install and maintain the software?

At the moment I don’t know. As we all know, not only the initial investment, but also implementation and maintenance can catch hospitals by surprise.

The truth is, it’s likely any vendor addressing aspects of hospital RCM will be somewhat expensive and somewhat complex to install. I wish there were workable benchmarks giving hospital leaders a preliminary sense of their potential investment.

Regardless, this is a worthwhile area for RCM vendors to attack. Even if all this technology did was give doctors some relief, it might reach ROI over time. When you consider that tools like these can help coders get clean claims out of the door, it’s even better.

Hospitals Still Grappling With RCM Tech Infrastructure

Posted on May 18, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While revenue cycle management isn’t the sexiest topic on the block, hospitals need to get it right or they won’t be able to pay their bills. One key element needed to accomplish this goal is a robust tech infrastructure that helps RCM specialists get their job done.

However, it seems that many hospitals are struggling to manage RCM data and pick out the right vendors to support their efforts, according to a report published by Dimensional Insight in collaboration with HIMSS Analytics. To conduct the research, the two organizations reached out to 117 senior-level decision-makers in hospitals and health systems.

According to the survey, more than two-thirds of health systems use more than one vendor for RCM. But that might be a bad idea. The research also found that organizations using more than one RCM vendor seem to face bigger issues with denials than those using only one RCM solution. Regardless, the execs said that denials were the biggest RCM challenge for health systems today.

Pulling together RCM data is a struggle too, respondents said. More than 95% of health systems reported that the way data is collected is a challenge. Also, nearly all respondents said that collecting RCM data from disparate sources is also difficult.

One reason why it’s tough for hospitals to put effective RCM technology in place may be that health information management directors and managers aren’t at the top of the influencer list when it comes to making these decisions.

When asked who the key stakeholders were in RCM. 91.5% said that the CFO was the most important, followed by the head of revenue cycle, who was ranked as important by 62.4% of respondents. Meanwhile, only 48.7% of respondents saw the health IT leaders as key stakeholders in the RCM environment. In other words, it looks like tech leaders aren’t given much clout.

When it came to technical infrastructure for RCM, respondents were all over the map. For example, 34.5% were working with an EMR and 3+ vendors. Another 12.1% used in EMR with one vendor, followed by 11.2% with 3+ vendor solutions, 6.9% using an EMR plus two vendors and 4.3% using two to vendor solutions. Clearly, there’s no single best practice for managing RCM technology in hospitals.

Not only that, some hospitals aren’t doing much to analyze the RCM data they’ve got. According to the survey, 23.9% said that 51 to 75% of the RCM process was automated, which isn’t too bad. However, 36.8% of hospitals reported that less than 25% of the revenue cycle process was driven by analytics. Also, roughly a third of respondents said that collecting data from diverse sources was extremely challenging, which can cripple an analytics initiative.

Taken as a whole, the report data suggests that hospitals need to improve their RCM game dramatically, which includes getting a lot smarter about RCM technology. Unfortunately, it looks like it could be a long time before this happens.

Despite EMR, Revenue Cycle Management Costs Were Still Substantial

Posted on April 26, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While they may not say so out loud, most healthcare organizations bought EMRs largely because they believed they could use them to lower revenue cycle management expenses. If so, they may be somewhat disappointed. A new study has concluded that at least in one case, the presence of a certified EMR didn’t make much of a dent in these costs.

­To conduct the study, researchers conducted interviews with 27 health system administrators and 34 physicians at a large academic medical center. The interviews took place in 2016 and 2017. The research team used the feedback to create a process map charting the path of an insurance claim through the RCM process.

Using this data, the researchers calculated the cost of each major billing and insurance-related activity, as well as a total cost of processing a claim from end to end. The data included costs for five types of patient encounters, including primary care visits, discharge ED visits, general medicine inpatient stays, ambulatory surgical procedures and inpatient surgical procedures.

The team concluded that estimated processing times and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged ED visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure and 100 minutes and $215.10 for an inpatient surgical procedure.

To put these numbers in perspective, the research team noted that billing costs represented an estimated 14.5% of professional revenue for primary care visits, 25.2% for emergency department visits, 8% for general medicine inpatient stays, 13.4% for ambulatory surgical procedures and 3.1% for inpatient surgical procedures.

There are more than a few unfortunate things to be seen in these numbers.

One is that primary care practices spent a very high percentage of revenue on RCM, which could be crushing given their typically low margins. Given that PCPs are already being squeezed by patients who can’t afford to meet their high deductibles, this is a recipe for financial disaster.

It’s also troubling to see that that the academic medical center in question was spending more than 25% of its ED revenue chasing insurance payments. I found myself wondering whether ED prices might drop to a reasonable level if it was easier for these departments to collect from insurers.

It’s scary to think that these numbers might’ve been higher before the academic medical center installed its EMR. As things stand, if the EMR is lowering RCM costs, it doesn’t seem to be having a major impact. But I’m just guessing here — what do you think?

RCM Tips And Tricks: To Collect More From Patients, Educate And Engage Them

Posted on November 1, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Hospitals face particularly difficult challenges when trying to collect on patient bills. When you mix complex pricing structures, varied contracts with health insurers and dizzying administrative issues, it’s hard to let patients know what they’re going to owe, much less collect it.

Luckily, RCM leaders can make major progress with patient collections if they adopt some established (but often neglected) strategies. In short, to collect more from patients you need to educate them about healthcare financial issues, develop a trusted relationship with them and make it easy for them to pay that bill.

As a thought exercise, let’s assume that most patients want to pay their bills, but may need encouragement. While nobody can collect money from consumers that refuse to pay, you can help the willing ones prepare for the bills they’ll get. You can teach them to understand their coverage. In some cases, you can collect balances ahead of time. Toss in some smart patient engagement strategies and you could be golden.

What will that look like in practice? Check out this list of steps hospitals can take to improve RCM results directly, courtesy of a survey of hospital execs by Becker’s Hospital Review:

  • Sixty-five percent suggested that telling patients the amount due before they come to an appointment would be helpful.
  • Fifty-two percent believe that having more data on patients’ likelihood to pay could improve patient collections results
  • Forty-seven percent said that speaking to clients in different ways depending on the state of the finances would help improve patient collections.
  • Forty-two percent said that offering customers payment plans would be valuable.

Of course, you won’t be doing this in a vacuum, and some of the trends affecting patient financial responsibility are beyond your control. For example, unless something changes dramatically, many patients will continue to struggle with high-deductible health coverage. Nobody – except the health insurers – likes this state of affairs, but it’s a fact of life.

Also, it’s worth noting that boosting patient engagement can be complicated and labor-intensive. To connect with patients effectively, hospitals will need to fight a war on many fronts. That means not only speaking to patients in ways they understand, but also offering well-thought-out hospital-branded mobile apps, an effective online presence and more. You’ll want to do whatever it takes to foster patient loyalty and trust. Though this may sound intimidating, you’ll like the results you get.

However, there are a few strategies that hospitals can implement relatively quickly. In fact, the Becker’s survey results suggest that hospitals already know what they need to do — but haven’t gotten around to it.

For example, 87% of hospital respondents said they had a problem with collecting co-pays before appointments, 85% said knowing how much patients can pay was important, and 76% of respondents said that simplifying bills was a problem for them. While it may be harder than it looks to execute on these strategies, it certainly isn’t impossible.

When Hospitals Leak Money

Posted on October 20, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A couple of weeks ago I was skimming healthcare business headlines and stumbled across this guaranteed showstopper: You’re probably leaving $22 million on the table. That headline is from a column by Jim Lazarus, who works in the Advisory Board’s Revenue Cycle Solutions division. In his column, he named four ways in which hospitals could recapture some of this lost revenue.

In the article, Lazarus notes that hospitals aren’t following best practices in four key areas, namely denial write-offs, bad debt, cost to collect and contract yield.  Unsurprisingly, Advisory Board benchmarks also demonstrate that median performing organizations are having trouble reducing net days in accounts receivable. The Advisory Board has also found that the overall average cost to collect has worsened by 70 points of net patient revenue from 2011 to 2015.

To turn the stats around, he suggests, hospitals should focus on four critical issues in revenue cycle management. They include:

  • Preventing denials rather than responding to them. “Hospitals are losing, on average, five percentage points of their margin to underpayments, denials and suboptimal contract negotiations,” Lazarus writes.
  • Collecting more from patients by improving their financial experience. According to Lazarus, between 2008 and 2015 the portion of patient obligations being written off as bad debt has climbed from 0.9% to 4.4%. To boost patient collections, hospitals must offer price estimates, convenient payment methods and a positive care encounter, he says.
  • Being sure not to take a hit on MACRA compliance. See that doctors, including those coming on board as employed physicians, get up to speed on documentation performance standards as quickly as possible.
  • Building the value of merged RCM departments. If multiple RCM organizations are being integrated as part of consolidation, look at ways to improve the value they deliver collectively. One approach is to create a shared services organization providing a common business intelligence platform across entities and service lines systemwide.

If you’re an IT leader reading this, it’s probably pretty clear that you have a substantial role in meeting these goals.

For example, if your hospital wants to lower its rate of claims denials, having the right applications in place to assist is critical. Do your coding and billing managers have the visibility they need into these processes? Does senior management?

Also, if the hospital wants to improve patient payment experiences, it takes far more than offering a credit card processing interface to make things work. You’ll want to create a payment system which includes multiple consumer touch points and financing options, which is integrated with other data to offer sophisticated analyses of patient payment patterns.

Of course, the ideas shared by Lazarus are just the beginning. While all organizations leave some money on the table, they have their own quirks as to why this happens. The important thing is to identify them. Regardless, whether you are in RCM, operations or IT, it never hurts to assume you’re losing money and work backward from there.

Predictive Analytics with Andy Bartley from Intel

Posted on September 20, 2017 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.

#Paid content sponsored by Intel.

In the latest Healthcare Scene video interview, I talk with Andy Bartley, Senior Solutions Architect in the Health and Life Sciences Group at Intel. Andy and I talk about the benefits of and challenges to using predictive analytics in healthcare.

Andy offers some great insights on the subject, having had a long and varied career in the industry. Before joining Intel, he served in multiple healthcare organizations, including nurse communication and scheduling application startup NurseGrid, primary care practice One Medical Group and medical device manufacturer Stryker.

In my interview, he provides a perspective on what hospitals and health systems should be doing to leverage predictive analytics to improve care and outcomes, even if they don’t have a massive budget. Plus, he talks about predictive analytics that are already happening today.

Here are the list of questions I asked him if you’d like to skip to a specific topic in the video. Otherwise, you can watch the full video interview in the embedded video at the bottom of this post:

What are your thoughts on predictive analytics? How is it changing healthcare as we know it? What examples have you seen of effective predictive analytics? We look forward to seeing your thoughts in the comments and on social media.

Health IT Preserves Idaho Hospital’s Independence

Posted on February 1, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Most of the time, when I write about hospital IT adoption, I end up explaining why a well-capitalized organization is going into the red to implement its EMR. But I recently found a story in RevCycle Intelligence in which a struggling hospital actually seems to have benefitted financially from investing in IT infrastructure. According to the story, a 14-bed critical access hospital in Idaho recently managed to stave off a forced merger or even closure by rolling out an updated EMR and current revenue cycle management technology.

Only a few years ago, Arco, Idaho-based Lost Rivers Medical Center was facing serious financial hurdles, and its technology was very outdated. In particular, it was using an EMR from 1993, which was proving so inflexible that the claims stayed in accounts receivable for an average of 108 days. “We didn’t have wifi,” CEO Brad Huerta told the site. “We didn’t have fiber. We literally had copper wires for our phone system…we had an EMR in a technical sense, but nobody was using it. It was a proverbial paperweight.”

Not only was the cost of paying for upgrades daunting, the hospital’s location was as well. Arco is a “frontier” location, making it hard to recruit IT staffers to implement and maintain infrastructure, staff and servers, the story notes. Though “fiercely independent,” as Huerta put it, it was getting hard for Lost Rivers to succeed without merging with a larger organization.

That being said, Huerta and his team decided to stick it out. They feared diluting their impact, or losing the ability to offer services like trauma care and tele-pharmacy, if they were to merge with a bigger organization.

Instead of conceding defeat, Huerta decided to focus on improving the hospital’s revenue cycle performance, which would call for installing an up-to-date EMR and more advanced medical billing tools. After the hospital finished putting in fiber in its area, Lost Rivers invested in athenahealth’s cloud-based EMR and medical billing tools.

Once the hospital put its new systems in place, it was able to turn things around on the revenue cycle front. Total cash flow climbed rapidly, and days in accounts receivable fell from 108 to 52 days.

According to Huerta, part of the reason the hospital was able to make such significant improvements was that the new systems improved workflow. In the past, he told RevCycle Intelligence, providers and staff often failed to code services correctly or bill patients appropriately, which led to financial losses.

Now, doctors chart on laptops, tablets or even phones while at the patients’ bedside. Not only did this improve coding accuracy, it cut down on the amount of time doctors spend in administrative work, giving them time to generate revenue by seeing additional patients.

What’s more, the new system has given Lost Rivers access to some of the advantages of merging with other facilities without having to actually do so. According to the story, the system now connects the critical access hospital with larger health systems, as the athenahealth system captures rule changes made by the other organization and effectively shares the improvements with Lost Rivers. This means the coding proposed by the system gradually gets more accurate, without forcing Lost Rivers to spend big bucks on coding training, Huertas said.

While the story doesn’t say so specifically, I’m sure that Lost Rivers is spending a lot on its spiffy new EMR and billing tech, which must have been painful at least at first. But it’s always good to see the gamble pay off.

Value Based Reimbursement: Another Challenge for HIM Professionals

Posted on August 3, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

How many times have you heard something along these lines: “HIM professionals must stay relevant and current with the continuous healthcare changes.” I must sound like a broken record to my team but it is absolutely true! HIM professionals provide the bridge between clinical data and reimbursement methodologies through CDI, coding, documentation integrity, and health data analytics to name a few. It has been proven time and time again that these HIM skills are vital to healthcare organizations but these skills must also be adapted and be put to good use each time a new guideline or rule is introduced.

Value-Based Reimbursement is an area that continues to grow with the push for quality patient outcomes and healthcare savings with potential penalties for excessive costs and poor quality of care. Reimbursement incentives that are tied to quality of care make perfect sense and HIM professionals need to take the plunge into these initiatives. By marrying departments and cross-functioning teams, we are able to generate proactive data and improve performance.

At my facility, I oversee the HIM department as well as the Quality department because we work closely together and will continue to have an even closer relationship throughout healthcare reform. This is becoming very common in the industry.

In this roundtable article for the Journal of AHIMA, we each outlined how we are bringing HIM to the table for Value Based Reimbursement initiatives and maximizing the tried and true skills of HIM professionals.

I have said it before and I will continue to say it: Always keep your finger on the pulse of healthcare and stay relevant by taking on these new challenges!

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.