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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 play unfair games with Medicare observation status

Posted on November 14, 2011 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 hospital visitors don’t care a whole lot whether they’re classed as inpatients or outpatients  — unless it affects the size of their bill. But lately, many patients are getting hit with unexpected fees after spending days in a hospital, thanks to tricks hospitals are playing in an effort to lower their readmission rate numbers, a newly-filed lawsuit contends.

These days, hospitals are under intense pressure to lower readmission rates, as such rates figure into their ratings on various types of quality scales.  In some cases, of course, they have no direct control of this number, as readmissions often have far more to do with the care they receive from community physicians and their willingness to comply with discharge instructions.

But ever-resourceful administrators have found a loophole that allows them to rejigger the admissions numbers. Under Medicare rules, they’re allowed to keep patients on “observation status,” deliver care and let patients go without ever classing them as inpatients. All of which might be well and good, except that if patients are in a hospital for days, they rack up a big bill — one they’re expected to pay far more of if the visit is billed as outpatient care under Medicare Part B.

Even more delightful for these patients, the fact that they haven’t logged three or more “real” inpatient days means that Medicare won’t pay for follow-up in a skilled nursing facility after discharge. So seniors either do without, or end up having the state pay through Medicaid.

Nice way to look out for patients, guys. Being old and sick and scared isn’t bad enough; now seniors have to wonder if their hospital costs are paid for even with Medicare coverage in place.

With this kind of mumblety-peg becoming fairly common, a consumer group called Center for Medicare Advocacy has filed a lawsuit to call a halt to the fun. The group is asking CMS to simply end observation status as a billable category.

While I sympathize with hospitals to some degree, who are also hoping to dodge scrutiny from the RECs by avoiding inpatient claim reviews, setting up seniors for high costs by playing unfair games is bad for you, the industry and the patient. Cut it out.