The saying “you cannot manage what you cannot measure” applies to all aspects of healthcare delivery, but it is especially true in value-based care. After all, payers, providers, and the patients they care for need to know what high-value care looks like at an individual level – and how it can be applied at the population level. Delivery and technology infrastructure. All too often, data is captured in disparate systems, forcing administrative staff – or, worse, physicians and nurses – to
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RCM: How Coding Gray Areas Skew Healthcare Data
Clinical reality, the ICD-10-CM classification system, and considerations of reimbursement are three distinct worlds that are sometimes in conflict. We don’t like it when financial considerations intrude on the purity of coding, but there’s no escaping this intrusion when coding serves as both the representation of the clinical picture in healthcare data and as the basis for reimbursement. Sepsis Definitions at Odds Sepsis provides a great illustration of a coding gray area that can
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3 Barriers Stalling AI Adoption in Revenue Cycle Management
AI technology is quickly evolving and already surpassing human decision-making in certain instances; sometimes, in ways, we can’t explain. While many are alarmed by this, AI is producing some of the most effective and dramatic results in business today. Adoption of AI in healthcare is growing, but there are still barriers to overcome AI can be defined in many ways but, broadly, it is the ability of a machine to perform cognitive functions we associate with human minds, such as
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Equality Health Launches Social Determinants Program to Tackle Health Disparities
What You Should Know: - Equality Health launches Social
and Cultural Risk Assessment (SCRA™) program to address social determinants of health
(SDoH) - With Equality Health’s SCRA program, social determinants act as any other quality metric, with a far less
burdensome reporting process. Equality Health, a whole-health delivery
system, has pioneered a comprehensive cultural care program that enables
providers to identify and
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Give Your EHR a Makeover—Not a Do-Over
EHRs have long been blamed for fueling clinician frustration and burnout. According to a recent study published in the Journal of Informatics in Health and Biomedicine, 70 percent of clinicians reported experiencing stress related to the use of health information technology. In an effort to address those issues, healthcare organizations have spent countless hours and revenue to rip out inefficient clinical systems and replace them with new technologies—yet clinician satisfaction hasn’t
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RCM Myth: Healthcare Billing Is Just A Back-Office Job
Historically, there was a belief in healthcare that revenue cycle management (RCM) was only a job for the back office. But today, medical practices are well-aware all staff members are critical to the revenue cycle. This responsibility extends through every aspect of a practice, from the front office to back office with the clinical staff in between. The front office, for example, plays a role in generating revenue, because they can optimize scheduling and collect patient and insurance
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Charges for All Hospitalized COVID-19 Patients May Reach Up to $1.4 Trillion
What You
Should Know: - FAIR Health brief finds the total costs for all hospitalized COVID-19 patients range from a low of $362 billion in charges and $139 billion in estimated allowed amounts to a high of $1.449 trillion in charges and $558 billion in estimated allowed amounts, depending on the incidence rate of the infection in the US population. - The total average charge per COVID-19 patient requiring an inpatient stay is $73,300 and the total average estimated allowed amount per
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Wolters Kluwer, SAS Integrate to Power Real-World Evidence (RWE) Analytics
- SAS to leverage Wolters Kluwer’s Health Language portfolio of data quality solutions to power real-world evidence (RWE) analytics within SAS Health. - Through a disease-centric approach, Health Language will enable SAS Health’s clients to more effectively manage reference data, such as ICD-10, CPT® and SNOMED CT, establish relationships between clinical and claims data and extract value from unstructured text within the medical record–providing a comprehensive view of a patient’s clinical
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Amazon Comprehend Medical Adds Ontology Linking to Help Clinicians Detect Medication and Medical Conditions in Unstructured Clinical Text
- Amazon Comprehend Medical, Amazon’s HIPAA eligible natural language processing service that uses machine learning to find insights in unstructured texts, announced a new capability of linking information to medical ontologies. - The new ontology-linking feature will help clinicians to detect medication and medical conditions in unstructured clinical text. Amazon will now support ICD-10-CM and RxNorm ontologies through Comprehend Medical. Amazon Comprehend, a HIPAA eligible natural language
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10 Considerations for Success In A Post-MACRA Value-Based Healthcare Reality
The first two years of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program (QPP) are in the books and many organizations are wondering if their strong performances will ever be met with a significant upside adjustment.
Year 1 (2017) enjoyed very high participation levels, 95% of eligible clinicians, but very low upside adjustments. Between the Test Pace option, artificially low bar (3 points) for an upside adjustment, and numerous opportunities to score
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