PROMEDICAL News

By doug 22 Jul, 2020
In 2016, healthcare vendors need the most efficient claims processing systems out there. By now, flexible, web-focused methods for important claims tasks are clearly the industry's path forward, and will play a major role in bridging the gap between patients and providers. A fast, digital claims method makes a direct link from implementation to delivery for workers' compensation and motor vehicle billing alike. Now is the time to invest in better revenue cycle management, with a focus on detail-driven, well-facilitated collection that breaks down barriers. Despite the growing pains involved with adopting any new technology, there are a couple of areas where smarter systems have already improved claims processing online. Direct accessibility With each new convenience, the future of healthcare looks more integrated. Data analytics harvests insights from seemingly unrelated details for fuller results. To make this innovation worthwhile, however, there needs to be a distinct pipeline between entities. "Data analytics harvests insight from seemingly unrelated details." Online healthcare portals are already addressing this need, providing direct communication through smart devices like phones and tablets. By bringing necessary information together in a simple, accessible source, these solutions set the stage for clean claims assembly. Shorter cycles Proper collection from the outset can reduce the amount of work hospitals have to do later if the claim is resubmitted, according to Gary Marlow, Vice President of Finance at Beverly Hospital and Addison Gilbert Hospital. "From a revenue cycle perspective, getting the most accurate information up front starts with patient scheduling and patient registration," Marlow told RevCycleIntelligence in 2015. "That provides the groundwork by which claims can be billed and collected in the most efficient and effective manner possible." The way information enters the claims process can impact how it gets managed. If technology, like artificial intelligence, is present at the beginning and guides the claims throughout, there's a consistent system handling the information the process to meet best practices. PROMEDICAL's benefits With our secure, efficient and comprehensive system, PROMEDICAL is staying ahead of the game. We're doing that by developing the following features: Communication: Users can choose from multiple languages with our online offerings. This allows you to customize your system to better reach patient populations and keep claims moving faster. Customization: If our proprietary options aren't currently meeting your needs, we can change them to do so based on feedback. Adapt to state fee schedules or language demands on a case by case basis. Encryption: A must for secure file exchange, PROMEDICAL ensures a secure file transfer process. Our process protects backup data equally strong as primary data, for efficient security across the board. Planning: Organizations also benefit when a set deadline is involved, putting clear limits on when submissions are set for review. Processing records requests within a preordained period of days helps managers know what to expect, and regular reports set up clear overviews of important statistics. Contact PROMEDICAL today to learn more about our healthcare revenue cycle solutions.
By doug 02 Mar, 2020
According to Pew Research, 15 percent of U.S. adults have used ridesharing services . Where does insurance enter the picture? Uber, Lyft and other ridesharing apps throw a proverbial wrench in hospitals' revenue cycle management operations. Billing is already a major pain point in hospitals – Black Book Research noted most facilities are outsourcing their RCM because in-house teams lack the resources to efficiently handle motor vehicle reimbursement. Ridesharing will only exacerbate the issue. For example, if a rider gets injured and has to go to the hospital, from which institution does the hospital receive reimbursement : The driver's insurance? The passenger's? Uber's? As Uber and Lyft are the most popular ridesharing apps, we'll focus on how these companies handle driver insurance. How do Lyft and Uber insure drivers? Lyft has three types of coverage within its insurance policies: Contingent Liability activates when a driver logs into the app and requests to accept rides – a state Lyft designates as "Driver mode." This coverage provides up to $100,000 per accident for bodily injury. Contingent Comprehensive and Collision kicks in when a driver has picked up a passenger. This coverage applies when a non-collision event damages the driver's vehicle. Uninsured/Underinsured Motorist applies when an at-fault driver who is uninsured or underinsured causes bodily injury to himself, his passengers or any third parties. The coverage provides $1 million per incident, and includes no deductible. For example, if a driver is injured in an accident at a time when he is not working for Lyft, his personal insurance will cover him (assuming he lives in a no-fault state, but that's another issue). However, when the driver activates Driver mode, Lyft's Contingent Liability will protect him even if he hasn't accepted a ride from a passenger. What if the driver's at fault? According to Rideshare Dashboard, Lyft's commercial insurance will cover all damages to third parties and the passenger, but the driver will have to cover his own medical expenses. That's when state laws dictate payment. In Massachusetts, for example, which also happens to be a no-fault state and requires all motor vehicle owners to possess auto insurance, the rider's personal auto insurance will cover the medical bills. Uber's insurance system is somewhat similar to Lyft's but possesses a few minor differences. For example, when an Uber driver is transporting a passenger, and another motorist causes an accident that results in bodily injury to the driver, the passenger and anyone else involved, Uber's UM/UMI will cover bodily injury of anyone in the rideshare vehicle.
By doug 28 Jan, 2020
With new, transformative technological advancements on the rise, it's no surprise that nearly every industry is feeling the impact of the digital age. From a healthcare provider's perspective, new resources can be used to revamp the current revenue cycle management processes you have in place. To reap the benefits of an optimized approach, you must be willing to take advantage of such emerging technological tools and resources, as stated by Chad Sandefur, Director and Healthcare Analyst at AArete. "Generally speaking, in order to strengthen the revenue cycle management, embracing technology within the revenue cycle is key," Sandefur shared with RevCycleIntelligence.com. "Having the platforms to seamlessly facilitate provider-payer interactions are really integral. In many cases, it's mostly about bad debt avoidance. With that in mind, there are a few specific points." Let's take a closer look at the benefits of utilizing technology, plus some of the emerging resources your facility can use to revamp your current RCM processes: The benefits of an optimized approach By paying attention to the new digital advancements that can benefit your RCM, you can ultimately impact the workflow of your staff members while better streamlining services for consumers. Here are some of the advantages of an optimized approach: Reduced chance for human error – Human error is inevitable when handling large amounts of data. Management software can be used to keep track of patient data input and maintenance. Better opportunity for precise, automated data entry – Between appointment scheduling, data input and claims submission, employees have a lot of duties. Automated software can take care of some of these responsibilities, allowing staff members to better focus on a single task at a time. I ncreased cash flow – Claims management technology can expedite claims quickly and produce clean, accurate claims, ultimately increasing cash flow , as stated by Becker's Hospital Review. Optimizing your RCM approach can lead directly to a significant return on investment and improve the overall reputation of your billing department.
By doug 29 Dec, 2019
The danger of texting while driving is complicated by the increasing functionality of smartphones. When drivers depend upon their handheld phones for navigation and other features, they could raise the risk of distraction and possibly cause an accident while in transit. However, a new case brings an interesting wrinkle to this situation by asking: Could the phone manufacturer be liable? Last month, The New York Times looked at whether or not Apple could implement a "lockout" feature to prevent drivers from using certain aspects of their iPhones while behind the wheel. According to the source, Apple received a grant for this technology in 2014, though it is unclear whether or not the program is actually in development. Nonetheless, it shows that the company has at least been aware of possible steps it could take to address a cause of accidents. The discovery comes in the context of a 2013 car accident case involving a driver using a phone. "The New York Times looked at whether or not Apple could implement a 'lockout' feature." However, even though the court has brought up interesting questions, Axinn Veltrop & Harkrider LLP's technology litigation expert Gail Gottehrer argued that blaming the phone during an accident doesn't make logical sense. "If you think about it, then you would have manufacturers being responsible for all sorts of distractions," Gottehrer said. "For example, all too often you drive past somebody who's reading a book on the steering wheel. Does that mean that distraction is the source of an accident if it happens, so you would go back and sue the book publisher?" PROMEDICAL is a national healthcare revenue cycle management company. Since 1995, we have provided the healthcare community with a client- focused, technology driven, revenue cycle partner. Our third-party liability solutions include workers' compensation and car accident injury claim billing. A partnership with PROMEDICAL ensures proper reimbursement, timely resolutions and increased cash.
By doug 20 Dec, 2019
Decreasing overhead enables care providers to dedicate limited financial resources to where they are most useful: procuring new equipment, hiring personnel, training existing staff and other investments. Allaying financial scarcity entails identifying the largest costs and implementing processes to reduce them. The hospital revenue cycle is a major source of fiduciary waste in health care institutions. A study from McKinsey & Company found that revenue cycle inefficiencies cost 15 cents on every dollar health care institutions obtain. In a $2.7 trillion industry, $400 billion goes to claims processing, billing and revenue cycle management. How can providers reduce this financial burden while maintaining compliance and without compromising the patient experience? Here are three powerful strategies to consider. 1. Outsource workers' comp and MVA Complex Claims Given the financial and regulatory pressures under which hospitals operate, they rarely possess the administrative resources to optimize the revenue cycle, especially with respect to receiving payment from automotive insurers and workers' compensation programs. Consider the following situation: A New Hampshire hospital treats a patient from Massachusetts who was in a serious car accident. Delivering the care costs $12,000. In this case, the hospital will have to coordinate benefits between the patient's automotive insurer and his health insurer to determine proper reimbursement allowed on the claim, according to Massachusetts State Law. The patient finance department may not have the technology or expertise needed to efficiently orchestrate payment from both parties. Collecting payments from a Massachusetts-based auto insurer may not warrant the same system as obtaining settlement from an auto insurer in New Hampshire, given that the latter state possesses at-fault laws. In addition, if the hospital discovers minor injuries that require treatment, but may or may not be related to the accident, the auto insurer may push back over which charges it should cover. To reduce health care RCM costs, hospitals should consider outsourcing their workers' comp and automotive insurance payments management to parties that provide health billing services, manage attorney correspondence, negotiate claims and conduct other administrative responsibilities. According to Black BookMarket Research, 54 percent of health care financial executives believe outsourcing RCM enables them to increase efficiency and improve fiduciary well-being. 2. Find a RCM partner that optimizes IT consumption IT can either be burdensome or advantageous, depending on the manner in which administrators utilize existing systems. When outsourcing their RCM, hospitals must assess their partners' technical wherewithal and resources, asking the following questions: Is partner's application proprietary? If so, does it have a robust, responsive and dedicated development team? How does the application support claims management? Is the application compatible with in-house resources? Does it require any special integration? What differentiates the partner's application from third-party solutions? The latter question warrants further expansion. The value an RCM partner's technology brings to the table depends on how well the partner integrates its knowledge expertise into the application's function. For example, the solution must bring clarity to complex claims processes involving interstate communications while acknowledging the state laws and guidelines. 3. Keep patients informed on medical billing Hospitals must also educate patients as to who will pay their bills under specific circumstances. Chad Sandefur, director and healthcare analyst at AArete, explained that ensuring patients develop this knowledge is critical to avoiding bad debt, RevCycleIntelligence reported. "By training staff to collaborate with patients and to educate them early, it removes the surprises when the bills come and that facilitates the payment component," Sandefur told the publication. Providing such knowledge does involve detailed instruction, however. RCM partners can assist administration in educating nurses, physicians and other staff to mitigate the burden of transferring information to professionals interacting with patients.
By doug 30 Nov, 2019
The ability to assess analytics through predictive modeling is quickly becoming a key technology throughout the healthcare sector. In fact, a survey by Health Catalyst found that 80 percent of hospital leaders believe that predictive analytics can improve the future of healthcare. But how exactly can the healthcare community benefit from these tools? Here are a few ways hospitals can use analytics and the insights they produce: Assess data for clinical decision support The health of the patient should always be the top priority of the healthcare provider. By utilizing analytics for clinical decision support, medical experts can make more informed decisions, which can ultimately lead to cut costs as well as better outcomes, according to George Zachariah, a consultant at Dynamics Research Corporation in Massachusetts. "Medical experts can make better decisions about their patients by utilizing analytics." "If all the important information is on one electronic dashboard, clinicians can easily see what needs to get done for a patient, and what has already been done," Zachariah told Healthcare IT News. "They can then make clinical decisions right on the spot. In addition, clinicians will not be double-prescribing patients certain medications due to the lack of information they have on the patient." Analyze denials for future prevention Because the revenue cycle contains many touch points, there's plenty of room for claims to unravel and produce other errors, according to Healthcare Finance. To reduce denial prevention for the future, hospitals can encourage the revenue cycle management department to take an analytics-driven approach. Identify where your inefficiencies most often occur – perhaps through registration data entry, eligibility and benefits checking, coding, clinical documentation or elsewhere. Assessing denials by identifying processes and errors can put things into perspective and prevent a given problem from occurring again in the future. "While about two-thirds of denials are recoverable, almost all are preventable," Marcy Tatsch, senior vice president and general manager of reimbursement optimization solutions of a tech company told Becker's Hospital Review. "So identifying and resolving the root causes of denials has a larger financial benefit than appealing and overturning them. Managing denials begins with using available data to analyze where errors and slowdowns occur, prioritizing those causes, and then addressing them." Evaluate analytics to prevent fraud and abuse Zachariah also mentioned that a significant amount of money is spent on cleaning up the mess that is fraud and abuse in the healthcare community. Hospitals and facilities can use analytics to provide insight into patient information for determining whether such abuse is occurring. "Analytics can track fraudulent and incorrect payments, as well as the history of an individual patient," he said. "However, it's not just about the analytic tool itself but understanding the tool and how to use it to get the right answers." While health systems need to prioritize patient health, they also need to maintain financial viability. Preventing and managing claim denials, removing obstacles to payment and reducing debt in correlation with fraud and abuse is key. By utilizing advances in analytics technology, the healthcare community can assess data and learn from insights that would otherwise remain hidden, and which can lead to performance improvements across the board. Having a secure, analytics-driven management system in place can lead hospitals to success and foster consumer and patient satisfaction.
By doug 11 Nov, 2019
Looking ahead into 2020, it appears delivering health care will require more resources than last year. A report from PricewaterhouseCoopers found medical costs will increase 6.5 percent this year. Hospital inpatient and outpatient spending make up the bulk of these costs – 30 percent and 19 percent, respectively. Why is the cost of care rising? Administrative resources are stretched thin. PwC noted care utilization is rising among patients, but hospitals are struggling to find the human capital required to manage an increasing number of payments while complying with state regulations. How can administrators reduce hospital revenue cycle costs without violating compliance standards? "In 2012, business and insurance-related spending accounted for 15% of health care spending." The costs of revenue cycle management and compliance Let's start with a fiscal overview. A study conducted by Aliya Jiwani, a researcher at the University of California San Francisco's Philip R. Lee Institute for Health Policy Studies, determined the percentage of billing and insurance-related (BIR) activities as a part of overall care costs in hospitals, physicians practices and insurance companies. Jiwani and her colleagues discovered BIR expenses totaled approximately $471 billion in 2012. Overall, BIR accounted for 15 percent of health care spending. Recent research suggests this percentage may be even greater today. Given the complexity associated with hospital billing, it's not surprising BIR expenses are so high. What's happening in the background? What's behind RCM costs? There are several reasons as to why revenue cycle management (RCM) consumes so many resources, especially with respect to billing auto carriers, worker's compensation firms and other payers specializing in accident claims. Motor vehicle accident (MVA) claims, for example, are regulated by every state's property and casualty laws, which determine who is responsible for providing payment in certain situations. These laws leave administrators with the task of: Figuring out how to bill for a service. Determining how long the accounts receivable should be on the books. Authenticating the patient's place of residence and other demographic information that may affect the claims process. Further complications arise when a patient residing in a no-fault state, such as Florida, is injured while driving in a fault state such as Georgia and visits a hospital in Atlanta to receive treatment. According to the Insurance Information Institute, as per Florida law, the insurance company has to cover the patient's financial losses associated with the accident, but does that stipulation apply when the patient in question is injured in Georgia? This doesn't even touch on which party the Atlanta hospital should bill for services. The advantages of outsourcing RCM It's more financially viable for administrators to outsource their MVA revenue management responsibilities to businesses that possess the knowledge and resources required to process payments efficiently. When selecting an RCM partner, hospital administrators must ensure a prospect has the following capabilities: A fully-staffed legal team that can address litigious issues. A rules engine that spots underpayments when they occur. Revenue cycle service staff specializing in MVA, worker's compensation and other niche insurance facets. A database of all statewide laws regarding MVA. Overall, partnering with an RCM specialist enables administrative staff to focus on processes with which they're more familiar. In addition, hospitals can reduce the costs associated with managing MVA claims while ensuring they're complying with statewide regulations. If care costs continue to increase in the near future, it's likely outsourcing will become a more popular strategy among administrators.
By doug 24 Oct, 2019
HIPAA compliance is important both for hospitals and every organization they work with that handles personal data, including medical billing firms. The Department of Health and Human Services has published new guidance, however, addressing the rigors of HIPAA rules with the growth of cloud computing. With cloud technology posing possible advantages for healthcare, the advisory may be especially important. As the official HHS site said, the guidance applies specifically to "business associates," among others, to address possible questions surrounding cloud use. While a covered entity can store electronic protected health information in the cloud, it has to sign a "business associate contract or agreement" to assure HIPAA compliance. "The new guidance may prove especially important with cloud technology." Since HIPAA is multilayered, entities will have to remember the applications for the Breach Notification, Privacy and Security Rules. The source also noted that Cloud Services Providers are still business associates even if all of the protected data they store is encrypted. Though the guidance also avoids recommending any particular brands, it does allow providers to access relevant information in the cloud through mobile devices if they take the correct precautions. This follows other HIPAA guidance released earlier this year. In a press release from Feb. 25, Jocelyn Samuels, director of the HHS Office of Civil Rights, said that individuals are "empowered" when they have the right to send information to a third party. This may have been about a separate HIPAA issue (right of access), but it sill ties into the ways the HHS is preparing for greater concerns. PROMEDICAL is a national healthcare revenue cycle management company. Since 1995, we have provided the healthcare community with a client- focused, technology driven, revenue cycle partner. Our third party liability solutions include workers' compensation and motor vehicle accident billing. A partnership with PROMEDICAL ensures proper reimbursement, timely resolutions and increased cash.
By doug 03 Oct, 2019
We live in an increasingly automated society. From ordering coffee on an your phone to asking Alexa to write down your to-do list, you can now complete processes faster and more efficiently than ever before by leveraging cutting-edge technology to do the footwork for you. And healthcare revenue cycle management is no exception. Despite obstacles such as cost and security, RCM departments continue to push toward automated solutions to improve the patient experience and maximize reimbursements. Specific trends in 2017 have included enterprise resource planning systems, cloud applications, data analytics and outsourcing – strategies all intended to increase the efficiency and accuracy of the RCM process. Investment in enterprise resource planning systems In your RCM department, your staff need to budget their time and resources effectively to ensure that claims are completed correctly and on time. Often, that can mean learning through trial-and-error attempts at coordinating team members and tasks. Luckily, there's a better way. Many organizations are opting to invest in enterprise resource planning systems to ensure that they're maximizing their workflow to ensure the highest possible reimbursement rates. According to a report on 2017 RCM trends by Black Book, 93 percent of CFOs believe that ERP is necessary to adequately achieve supply chain efficiency, price transparency and true costing in value-based care. This type of automation in healthcare means that your staff have time to focus on the tasks that most require their attention, improving your department's ability to meet deadlines and increase reimbursements without the necessity of additional employees. Cloud applications as the primary storage platform In healthcare and beyond, the cloud is becoming an increasingly popular home for information storage. A McAfee white paper reported that 93 percent of organizations currently use cloud services and 74 percent store sensitive information in the public cloud. "In RCM storing information in the cloud is quickly becoming the norm." In RCM, storing information in the cloud is no longer novel – it's quickly becoming the norm. According to Black Book's 2017 Trend Report, more than 55 percent of CIOs are confident in their strategy for cloud applications. But looking forward, these professionals now need to think about disaster recovery. The survey found that 83 percent of healthcare organizations don't have cloud storage that would allow them to recover information in the event of a disaster. Cost-estimation through data analytics When consumers walk into stores, the prices of each product or service are typically clearly labeled and customers know how much they'll pay before they step up to the register. So when it comes to medical billing, patients can become quickly frustrated over the lack of price transparency. Creating estimates involves coordination between billing departments, insurers and more. To improve this process, some organizations are turning to cost-estimation solutions which use data analytics to not only give patients the cost information they want, but also aid healthcare groups in obtaining the data they need for the successful claims resolution that leads to increased reimbursement rates. Strategic use of RCM outsourcing Throughout 2017, healthcare organizations have strategically used RCM outsourcing options to increase the success of their claims resolutions. In fact, a report by Black Book predicted that the market for ambulatory and physician RCM outsourcing, as well as extended business office services, in the U.S. is expected to grow by 42 percent between Q4 2016 and Q1 2019. "Rising healthcare expenditures and the complex technology or staffing requirements to succeed under value-based care is creating the urgent demand for cost-effective, technically advanced business office outsourcing solutions in physician practices across the country," said Doug Brown, managing partner of Black Book. "High-impact drivers of the physicians practice outsourcing market include the increasing emphasis on compliance and risk management, and the need for more efficient and cost effective processes," To learn more about how outsourcing your specialized claims, such as workers' compensation and motor vehicle accident, can help streamline your healthcare revenue cycle management department, contact PROMEDICAL today.
By doug 14 Sep, 2019
Hospitals have faced issues with managing patient balances after insurance usage for years. However, a recent study by TransUnion Healthcare found the challenge continues to grow. Not only is this issue impacting hospitals across the country, but it’s also making it more difficult for patients, posing a serious financial burden on those who can’t afford care costs. PBAI increasing by the numbers According to the analysis, total bill responsibility of patient balance after insurance (PBAI) rose from 8 percent in 2012 to 12.2 percent in 2017. Commercially insured patients saw bills rise from an average of $467 to $781, a substantial increase of 67 percent. “The continued trend in costs is correlating to an increase in uncompensated care.” Unfortunately, this continued trend in costs is correlating to an increase in uncompensated care, something that impacts both the patient and the provider, according to Jonathan Wiik, author of “Healthcare Revolution: The Patient is the New Payer” and principal for healthcare strategy at TransUnion Healthcare. “It is becoming clear that patient balances after insurance is a major factor in increases in uncompensated care at the macro level,” said Wiik. “Higher out-of-pocket-costs from cost sharing has made patients responsible for an increasing percentage of the bill. Most patients simply cannot afford that, and hospitals need to make sure they’re actively engaging their patients to ensure they have funding mechanisms for the care needed. Tools like propensity to pay, charity scoring and others can help differentiate a patient’s willingness or ability to pay.” Medicare patients see costs jump Medicare patients are also struggling to pay deductibles and coinsurance. Hospitals and facilities are struggling to find a balance between reimbursement and patient responsibility due to this issue, according to John Yount, vice president of TransUnion Healthcare. “Unpaid medical debt continues to pose challenges and the rise in uncompensated care further reflects the importance of implementing new solutions to prevent revenue leakage, which ultimately provides a better patient financial experience,” said Yount. “A solution to address Medicare Bad Debt reimbursement is another critical component in a hospital’s toolkit to ensure they’re managing to the increased PBAI.” With the right plan in place, facilities can make better and smarter decisions toward decreasing the financial burden on patients.
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