The pMD Blog

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pMD Blog...

where we cover interesting and relevant news, insights, events, and more related to the health care industry and pMD. Most importantly, this blog is a fun, engaging way to learn about developments in an ever-changing field that is heavily influenced by technology.


Here's The Latest in Health Care:


According to a new survey, nearly three-quarters of hospitals and health systems in the US have been actively engaging with revenue cycle management optimization during the pandemic through RCM technology. RCM was one of the areas in health care that largely moved to remote work once the pandemic hit, which many hospitals and health systems are considering making more permanent.  Read More

CMS is proposing a series of changes to their Promoting Interoperability Program, the successor to meaningful use, designed to bolster the response to public health emergencies such as COVID-19. The agency plans to amend program stipulations for eligible hospitals and critical access hospitals, broadening requirements focused on public health and clinical data exchange.  Read More

New research shows that critical care nurses' overall health is linked to the number of medical errors they reported. 67 percent of nurses with higher stress scores reported making medical errors in the last five years, more than 10 percent more than the nurses with lower stress scores.  Read More

For the first time, the majority of physicians worked outside of physician-owned practices in 2020, as doctors continue to gravitate toward employment by hospitals and other organizations, according to the American Medical Association (AMA). A number of factors, including the growing complexity of health care, new Medicare regulations around value-based purchasing, and insurer prior authorizations have contributed to making these employment arrangements increasingly more desirable.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.


In part one of this series, we talked about the health care technology landscape that has contributed to a state where rarely does one system hold a patient’s entire, or current, health record. Rather, in many cases, pieces of information are scattered across a variety of different systems operated by the various providers involved in a patient’s care. Fortunately, health care providers are required by law to give patients access to their health data. We previously walked through the process one might follow to obtain copies of their health records, now it’s time to determine how and where to store that information.


Why go through the trouble of compiling all of your health care records? The short answer is so that you can have them easily accessible when you need them most. In today’s world, the vast majority of people own a smartphone, which they take with them wherever they go. Because of that, we’d argue that organizing and storing your health records in a secure app, on your phone, is by far the best way to manage your health care data.  As of Q4 of 2020, there were 51,476 iOS apps listed under the “medical” category in the Apple App Store, and 49,890 Android apps in the Google Play Store.


So what should you look for when choosing an app with which to entrust your sensitive information?  First and foremost - it should be HIPAA-compliant. But what does that mean from a technical perspective?  Look for references to encryption, emergency access, secure backup, and biometric, or “two-factor” authentication. It’s important that if you leave your smartphone sitting out, someone can’t just pick it up and look at your lab results, or a recent communication with your doctor without first scanning their face, or finger, or entering a password.


Similarly, if you were to lose the phone, you’d want to make sure anyone trying to pull data off of it would be prevented from accessing the health care app’s database due to the use of strong encryption. On the other hand, when you got a replacement phone, you wouldn’t want to rebuild your centralized health record database from scratch. Look for an app that makes reference to securely backing up your data and try to understand upfront what the process of recovering your information involves.


Finally, and arguably the most important item to consider is data transmission and control. A driving factor behind curating your own health records is the ability to grant access to relevant parts of it to providers involved in your health care. Consider choosing an app that has convenient tools for sending and receiving health information between you and your doctor easily and securely. The app should let you choose the means by which you transmit your data and should provide an avenue that’s encrypted end-to-end.


And finally, do some homework on who built the app. Pick a company that is oriented around improving patient health outcomes by providing better continuity in health care data, not one that’s out to make a quick buck by monetizing your health records. At pMD, we care deeply about empowering both patients and providers to have a higher quality, delightful health care experience.




 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.

Here's The Latest in Health Care:


After years of holdout, health care organizations are coming around to treating individuals less like patients and more like consumers. On the provider side, that’s meant expanding beyond traditional services and into new primary, specialty, and acute care delivery approaches enabled by new virtual care technologies.  Read More

The COVID-19 pandemic created a host of challenges for revenue cycle management leaders, from widespread service line shutdowns to shifting staff to work at home and increasing self-pay balances. Gaining a clear picture of A/R productivity is crucial to managing denials and increasing collections for revenue cycle management success.  Read More

Aligned with their physician counterparts, nurses graded EHR usability an “F,” and respondents also revealed a high level of burnout, according to a new study. In fact, almost half of the nurses experienced burnout, which health care professionals connect to low EHR usability. Improved EHR usability can lead to higher EHR adoption rates, fewer clinical errors, less clinician burnout, financial benefits, and improved patient safety.  Read More

The pandemic accelerated "hospital at home" programs, which use remote monitoring and telehealth technologies to provide patients with hospital-level care without the risks and costs associated with hospital stays. Health system innovation executives are particularly excited about the emergence of hospitals at home and how technology can shape the future of the care model.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.


Most of us see a variety of health care providers for everything from routine primary care, to specialty treatment for chronic conditions, to lab tests and x-rays, to procedures for injuries. In the United States, it’s likely that each individual practice and facility will have their own system(s) for storing the health records associated with the portion of your care that they rendered. However, those databases often don’t communicate or share information with the other providers’ systems. U.S. law requires that each health care provider store your electronic health records securely, but it does not mandate that it all be centralized in any one place.

As a result, as we move through the healthcare system we often leave a trail of comprehensive, but very siloed information behind us. A recent study estimated that a single hospital, on average, has 16 different electronic medical record vendors actively in use across all of its affiliated practices. This makes putting together a complete picture of one’s health history, or even current status, potentially a very daunting challenge. Your lab results, imaging tests, vaccination records, current medications, notes from that recent cardiologist visit, and even data from your fitness tracker device might all live in separate places.

Not only is this inconvenient and inefficient, but it can also be potentially dangerous.  Imagine being treated at an emergency room and not remembering, or not being capable of communicating your blood type or known drug allergies. What if your gastroenterologist unknowingly prescribes a medication that has an adverse interaction with your blood pressure drug? Because these disparate providers don’t necessarily share or have access to all of your health records, the burden is on the patient to build and maintain a centralized repository of their data and self-report this information to all of their various providers.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) gives individuals the right to request copies of their medical records from each of their providers. Health care entities are required to provide this information within a reasonable timeframe and for no or low cost. Unfortunately, most state laws don’t stipulate that patients actually own their data, and the process for requesting and obtaining it can be cumbersome - sometimes requiring a written request. But, the federal law is at least clear about the patient’s right to access the data.  

Furthermore, HIPAA mandates that individuals can request their health information be delivered to them in digital format, which is helpful when approaching building a centralized, patient-controlled repository of one’s healthcare records. Once you’ve got the data in hand, the question becomes how, and where to store it in a way that’s both secure, yet easily accessible for you and any family member or health care provider with whom you choose to share it.  

In part two of this series, we’ll look at why it makes sense to carry your health information with you on your smartphone and discuss what to look for in an app to help make it easy and safe.

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.

Here's The Latest in Health Care:


Telehealth investment hit an all-time high of $4.2 billion in the first quarter of 2021, almost doubling the $2.2 billion raised in the same quarter a year ago. That's the highest global funding for telehealth during one quarter on record, which also represents an increase of 18% from the $3.6 billion raised in the fourth quarter of 2020. Clearly, investors are betting on telehealth to continue to play a large role in care delivery moving forward.  Read More

Landmark data-sharing regulations from HHS' Office of the National Coordinator for Health Information Technology and CMS seek to tie healthcare providers and patients across the care continuum closer together—but historical disparities in technology adoption between health care sectors could pose challenges for providers in post-acute and long-term care settings.  Read More

Round two of the COVID-19 telehealth program, which is a $249.95 million federal initiative that builds on the $200 million program established as part of the CARES Act, will open the application portal on April 29th. This round contains a number of tweaks, including a system for rating applicants that prioritizes hard-hit and low-income areas, tribal communities, and those in provider shortage areas.  Read More

CMS has announced the suspension of the Medicare sequester cuts, which was set to expire April 1st, will now last through the end of the year, and that it will release all claims held since the start of April. In addition to the extension, the new law also contains other health care measures, including technical corrections related to rural health clinics and disproportionate share hospitals.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.

Here's The Latest in Health Care:


The goal of hospitals should be to always provide patients with a positive experience. New research by Press Ganey found that while common themes run through the experiences of happy patients, there is much more variation when it comes to the experiences of unhappy patients. The findings demonstrate that preventing negative experiences requires the same kind of vigilance needed to prevent the vast range of potential safety problems.  Read More

Over the last few years, there has been an estimated 20 percent increase in hospitals and health systems considering physicians as candidates in their CEO searches. It’s become apparent that physicians with the right training and experience could learn a lot about hospital operations and bring with them the much-needed clinical and front-line experience.  Read More

Before the COVID-19 pandemic, telehealth was more of a novelty than a necessity. The concept of touching base with a doctor remotely was promising, but there were hurdles. Now, almost 90 percent of Americans want to continue using telehealth for non-urgent consultations after COVID-19 has passed.  Read More

• The Mayo Clinic has launched a new initiative to collect and analyze patient data from remote monitoring devices and diagnostic tools to accelerate diagnoses and disease prediction using artificial intelligence (AI). The platform will deliver clinical decision support tools, diagnostic insights, and care recommendations to help clinicians make faster and more accurate diagnoses.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.


Finances and the revenue cycle can be a high source of stress for providers, who let’s be honest, would much rather focus on patient care. However, effectively managing a practice's revenue is crucial to actually being able to continue to provide that care. One of the most unpredictable phases of the revenue cycle is collecting patient responsibility, which often results from the high variance in payment methods as well as hesitation to pay due to a lack of understanding of insurance systems. Simply put, many patients don’t know what they owe and why.

WHY IS COLLECTING PATIENT PAYMENTS SO HARD?

According to the American Association of Family Physicians, only 14% of adults understand key components of their insurance plans. This confusion and uncertainty can often make it difficult to determine a patient’s financial responsibility at the time of a visit, leading to even more frustration when they get a bill in the mail months later that they don’t understand. Estimation tools and insurance cards can help ease this uncertainty or to point a practice in the right direction, but ultimately most patients end up in the dark when it comes to what they will owe in the end. 

Traditionally, many practices end up providing services for free, collecting a small insurance co-pay, or sometimes not even that, and then opting to bill the patient later, after collecting from insurance first. The problem is the process of settling with and collecting from insurance companies can take days, weeks, or even months and by that time patients are far less likely to pay for bills they receive long after services rendered. In fact, more than 60% of patients surveyed by InstaMed reported they would “consider switching providers for a better healthcare payment experience,” which includes upfront patient responsibility, eligibility, and the ability to pay with their preferred payment methods. 

With this in mind, it’s hard to believe less than 25% of physician practices have an eligibility and estimation tool in place to assist their practices in maximizing revenue, according to Healthcare Finance News.  By providing real-time patient responsibility estimates, providers can increase patient confidence and are more likely to collect the full amount they are owed for their services. Without an eligibility solution in place, practices could potentially be missing out on between 30-50% of their patient revenue. 

ADAPTING TO THE NEXT GENERATION OF PATIENTS

Speed and transparency make a huge difference when it comes to collecting patient payments. Giving your patients the tools to make the process as simple as possible is key to not only collecting but collecting quickly with high patient satisfaction. Many practices still rely on mailed statements and/or in-person payments, such as cash, check, or credit card, which can be a major hindrance, especially when it comes to younger generations. 

Gen Z, which are those born between 1995 and 2012, is expected to account for an estimated 61 million new employees in the global workforce in the next decade. Why is this important? Well, the majority of Gen Z have never lived without the internet, smartphones, and immediate access to information and products. With an influx of Gen Z patients, the expectation is that practices make it easy to receive and pay for care. If it’s not, they may seek care elsewhere. 

It’s much easier to collect payments when the patient is standing in front of you, but even if they’re not, the quicker a practice requests payment, the more likely patients are to pay it. Recent trends in expected payment options have shown nearly 50% of patients would prefer to pay their medical bills using contactless or paperless payment options. Practices using paper statements introduce significant lag into their collection systems by relying on mail carriers and printing/packing services. Recent improvements in payment processors and the technology they offer have made it possible to send statements and payment requests in real-time to speed up collections and boost patient satisfaction and confidence. 

EVERYTHING SHOULD BE IN ONE PLACE

The last part of the equation is making sure everyone in the practice is on the same page regarding patients’ financial status. The fewer systems involved, the less room for error and inefficiency. From patient intake to collecting payments, it’s important to be able to do everything in one place without having to log into multiple systems to piece together information.

 

If you are interested in learning more about pMD’s billing and revenue cycle management services, please contact us here or give us a call at 800-587-4989 x2. We’d love to hear from you!

 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.


Here's The Latest in Health Care:


• As telehealth continues to play an important role in meeting the demands of patients and a strained health care workforce, it’s critical that providers get patients on board with using the technology for the long term. Its future adoption, however, heavily depends on the ability to support a trusting relationship between patients and physicians.  Read More

According to a new survey, slow prior authorization protocols directly contributed to care delivery delays and poor treatment outcomes for some patients during the surge in COVID-19 cases last winter. Nearly all physicians surveyed said they spent 16 hours on average seeking prior authorization for patient care, which delayed treatment.  Read More

CMS has begun recouping the accelerated and advance Medicare payments from providers who borrowed the emergency funds to battle COVID-19. During the recoupment period, CMS will hold back a portion of new Medicare claims from providers until the payments advanced last year are recouped. Providers are required to have paid back the advanced payments in full 20 months after they received the first payment. If they fail to do so, CMS will charge an interest of four percent on the remaining balance.  Read More

The pandemic has accelerated a growing desire among providers and even some medical technology manufacturers to acquire or get into the surgery center business, experts say. One of the biggest drivers of this shift has been eroding patient volumes at hospitals due to fears of contracting COVID-19.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.


Claim denied. Ugh! These are two words that make all those involved in the health care revenue cycle cringe. Unfortunately, claim denials are very common, costly, and time-consuming to correct. However, there are strategies to avoid them, with the potential to significantly increase your bottom line and decrease your revenue-related headaches. We’re going to talk about one of those strategies here — real-time eligibility. 

WHY ARE MY CLAIMS BEING DENIED?

Eligibility verification is one of the first phases in the revenue cycle and by far the most significant. Did you know eligibility issues are one of the top five reasons claims deny? In fact,  nearly 24% of claims submitted are denied for eligibility and registration issues, such as the patient not being eligible for medical benefits on the date of service, or having incorrect demographic information, like date of birth or a misspelled name. 

The eligibility verification process is directly linked to claim denials which can have a variety of unwanted consequences. This includes a hike in the number of days in A/R, an escalation in write-off rates, a standstill of cash flow, inflated costs to collect, and most importantly, delays in a patients' access to treatment. The process of verifying eligibility needs to be both efficient and accurate in order to determine the responsibilities of both the payer and the patient.

HOW DO I MAKE SURE MY CLAIMS AREN’T DENIED?

Most claim denials are avoidable, in fact, 90% of them could be avoided. Research also shows that of those denied claims, approximately 60% of claims are recoverable, meaning they can be corrected and resubmitted for reimbursement. 

This sounds pretty good, right? Well, the reality is that a whopping 65% of denied claims are never reworked, which translates to a huge loss in revenue. The remaining claims that are reworked can be a drain on resources when factoring in both time and overhead costs. The average cost to correct and resubmit a denied claim can range anywhere from $30 - $125 per claim.

By implementing the right tools and processes, such as checking real-time eligibility, the likelihood of having your claims denied decreases significantly. By simply using real-time eligibility tools, you’ll be able to increase the number of  “clean” or error-free claims submitted,  tackling a number of the top reasons claims are denied, such as eligibility, no authorization, or being covered by another insurance plan.

WHAT IS REAL-TIME ELIGIBILITY?

But what exactly is real-time eligibility, and how do I use it to my advantage?

Real-time eligibility is a software tool that allows medical staff to electronically confirm a patient’s insurance coverage by interfacing directly with the insurance carriers. This instant eligibility check provides an up-to-date overview of the patient’s coverage and plan benefits. Real-time eligibility can answer important questions such as if the insurance policy is active, the start and end dates of a policy, deductible amounts, copay coverage, and if prior authorization is required. Verification checks can be done at the time of the patient’s appointment, or even prior, which not only saves both the staff and patient time during check-in but also provides a clear understanding of both the provider and patients’ responsibilities.

Real-time eligibility benefits all those involved in the revenue cycle management process. For example, the amount of time staff spends checking and verifying a patient’s coverage is reduced significantly, as it eliminates back and forth phone calls, and the need to check multiple systems in order to verify coverage. Additionally, verifications are saved to the patient’s record, which provides an audit trail and proof of insurance coverage. Plus, it makes it much easier to submit clean, error-free claims, which facilitates faster payment and improves cash flow, which leads to increased provider satisfaction. Let’s not forget about the most important part of the revenue cycle, the patient. Being able to communicate to the patient their financial responsibility prior to, or at the time of service, makes for a much-improved patient experience.

Claim denials are preventable when identified and addressed early in the revenue cycle process. By implementing real-time eligibility, you can decrease the burden of claim denials, and in turn, enhance revenue, improve the overall patient experience, and let the provider focus on what matters most — patient care.

 

If you are interested in learning more about pMD’s billing and revenue cycle management services, please contact us here or give us a call at 800-587-4989 x2. We’d love to hear from you!

 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.


Here's The Latest in Health Care:


Telehealth proved its mettle this past year. Now more hospitals and health systems are looking to expand their efforts beyond video visit-based virtual care, and push for expanded remote patient monitoring programs such as acute care at home. But some big questions still need ironing out, as regulations and reimbursement mechanisms are in major flux.  Read More

The industry-wide conversation around prior authorizations is both complicated and contentious. They are considered useful for preventing adverse health events but a headache for providers. In order to soothe the controversies around prior authorizations, payers and providers may turn to electronic prior authorizations for faster care delivery, lowered provider burden, and an overall better patient experience.  Read More

Telehealth use among surgeons for patient visits soared in the early months of the coronavirus pandemic in 2020. While rates of telehealth use have declined as in-person care has resumed, telehealth use remains substantially higher across all surgical specialties than it was prior to the pandemic according to a new study.  Read More

2020 offered a perfect storm for cybercriminals, with the number of ransomware attempts against the health care industry rising by 123%. Ransomware attacks cost the healthcare industry $20.8 billion in downtime last year, which is double the number from 2019. In addition, more than 18 million patient records were impacted by these ransomware attacks, a 470% increase from 2019.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.