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.

Vendors that are strategic partners

 

In 2010 the Centers for Medicare and Medicaid Services began to release Comparative Billing Reports (CBRs). A CBR compares provider to provider billing practices, both regionally and nationally, to determine if a provider is an “outlier”, or billing outside of the expected pattern. If a provider is found to be an outlier, they will receive a notification detailing the analysis and erroneous billing, while offering education on the topic. CBRs review many areas of billing, and even topics outside of billing. Some common topics include; evaluation and management, modifier utilization, and groups of specific codes, for example, radiation modality treatments for oncology providers or dialysis visits for nephrology providers. It's also important to note that CMS is not the only one reviewing billing practices in this manner. Other large commercial payers have similar programs, such as UnitedHealthcare’s Peer Comparison Reports, which functions much like the CBR.

What is a CBR used for?


CMS and other payers perform CBRs and similar reports with the goal of providing educational resources and outreach. This outreach ensures compliance with coding and billing standards and reduces potential fraud, waste, and abuse. CBR’s can also help patients. Most patients are unaware of the many coding and billing rules that exist and therefore have a difficult time identifying when they have been overcharged. This can lead to costly out-of-pocket expenses toward co-insurance and deductibles. Educating providers can offer a real impact on reducing a patient’s financial burden.

What should I do if I received a CBR?


While CMS says “receiving a CBR is not an indication of or precursor to an audit” the receipt of a CBR can still be a stressor, especially if a provider or practice does not have the right tools to internally investigate the CBR findings, or worse, does not know where to begin to address a CBR. The risk of removing focus from the patient care to address these billing practices is high. Additionally, ignoring the report altogether could place the provider and practice at risk for more CBR’s in the future and even potential audits. CBR’s should be promptly reviewed and addressed by taking the following steps:

* Examine the issue identified in the report closely,
* Evaluate the organizations or individuals billing patterns as they relate  to the CBR subject,
* Perform a root cause analysis and address or correct any errors with education,
* Continue to monitor the situation closely.

How do I avoid a CBR?


One of the best defenses for CBRs and other billing challenges is to practice proactive risk analysis, or regular and consistent monitoring to identify potential billing issues before they begin. Proactive risk analysis can easily be achieved by utilizing the data that already exists within your billing software. Reports that visually display information such as charge capture counts or evaluation and management level distribution can be particularly useful. The same reports can then be combined with CMS benchmarking data, allowing a provider or practice to easily identify any variance from expected billing patterns.

These reports should paint a clear and visible picture, providing valuable insight. In the event a CBR is received the reporting can be used as part of the examination and subsequent monitoring following education on the error. Reports can also be supplied to coding/auditing or Clinical Documentation Improvement Departments as a resource to begin analysis for targeted internal education.

Taking a proactive approach to billing patterns can effectively decrease billing errors, support operational excellence and allow providers to spend more time focusing on patient care, which is the heart of pMD’s mission.

If you are interested in learning more about pMD’s Billing & 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:


Advancements made in the use of digital tools like telehealth, remote patient monitoring, and predictive analytics have been touted throughout the pandemic for helping health care organizations address the access challenges caused by months of limited in-person patient contact at many facilities. But it's critical that stakeholders ensure these innovations make life easier, not harder, for clinical and administrative workers.  Read More

Patient experience consulting and surveying firm Press Ganey got a big leg up after the Centers for Medicare & Medicaid Services (CMS) approved it to administer the Primary Care First (PCF) Patient Experience of Care Surveys. CMS developed PCF as a means to improve clinical quality and patient experience, as well as cut down on healthcare costs, within the primary care setting.  Read More

Amid significant backlash from providers, UnitedHealthcare is delaying its new emergency department coverage policy, which would allow the insurer to retroactively deny ED claims it determines are non-emergent. The policy was set to take effect July 1 in fully insured commercial plans but will be pushed back until at least the end of the national public health emergency period for COVID-19.  Read More

A recent report found that 70% of acute care hospitals allowed inpatients to access their health data using a mobile phone or other software applications in 2019, which represents a more than 50% jump from 2018. Similarly, in 2019 75% of hospitals enabled inpatients to view their more detailed clinical notes in their patient portal, an increase of more than 30% from 2018, as federal regulations continue to incentivize data sharing.  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.
Vendors that are strategic partners

 

When I first joined pMD, a little over 5 years ago, I quickly became fascinated with nephrology and the intricacies of nephrology-specific workflows and billing, specifically when it comes to dialysis. Over the years we’ve worked with hundreds of nephrologists, honing in on and building several features designed specifically to account for their major pain points. We’re not afraid of feedback, in fact, we seek it out and create easy-to-use solutions to solve complicated problems. So how exactly does pMD support our nephrology practices in meeting their unique workflow needs?

CAPTURE DIALYSIS CHARGES IN JUST 2 SECONDS!


We know time is of the essence. Providers at dialysis clinics may see dozens of patients per day for either limited or comprehensive visits. Entering the same few charges for so many patients can be repetitive and time-consuming. With our Instant Capture feature, those visits can be captured in as little as two seconds, giving providers back precious time every day. Less time spent entering charges means more time available to care for patients.  

REAL-TIME MPC VISIBILITY & REPORTING


With high patient volume, tracking monthly dialysis visits can be a huge undertaking. We’ve taken the guesswork out of it to ensure providers and staff are always on the same page regarding patients’ MCP (Monthly Capitation Payment) progress. The total number of monthly limited and comprehensive visits are automatically calculated and visible at-a-glance on the provider's mobile device. Access to enhanced reporting and analytics dashboards makes it easy to quickly identify missing visits to ensure revenue is not being left on the table. In addition, the census can be customized to show additional important information such as shifts and if patients are enrolled in certain quality programs. It’s all right there at your fingertips.

DIALYSIS DOCUMENTATION MADE EASY


When rounding at multiple dialysis clinics, many of which may be using different documentation systems, getting that information back into the EMR can be tricky, especially at some of the smaller or more remote locations. We’ve made it easy! Instead of spending time contacting facilities to send supporting billing documentation, providers can document those dialysis visits directly in pMD with real-time chart access. The documentation is then generated in a format that’s easy to read, share, and upload and can be automatically routed to the right person upon completion. Plus, we can improve your ability to also track quality metrics for incentive programs such as MIPS or CKCC, making reporting a breeze.

STREAMLINE END-OF-MONTH ESRD BILLING


For nephrology billing teams, end-of-month ESRD billing can be hectic and stressful. No worries, we can do some of the heavy lifting! Save time and stay organized by auto-batching of MCP dialysis visits. We automatically move limited and comprehensive visits into a queued batch for your billing team to increase the efficiency of end-of-month billing. pMD also has “MCP Magic,” which will automatically calculate the correct code to bill at the end of the month based on the number of charges submitted for a dialysis patient. 

ADVANCED INPATIENT ROUNDING


We’ve talked a lot about dialysis, but we of course also cover inpatient rounding as well. With shared patient lists, secure HIPAA compliant messaging, and telehealth built into our charge capture solution, pMD covers the entire patient journey from inpatient to discharge and beyond.  

If you are interested in learning more about pMD’s Nephrology solutions, 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:


Even before COVID-19, 250-bed hospitals lost $4.7–$11 million per year from mid–revenue cycle leakage. Now, pandemic-fueled volume losses and razor-thin margins mean hospitals can no longer afford to lose out on that earned revenue. Educated guesses and imprecise, stopgap efforts aren't enough. Revenue cycles need precise strategies to identify exactly where leakage occurs and implement solid processes to stop leakage before it starts.  Read More

Health care organizations have a responsibility to create an environment where patients feel like it's safe to raise their hand if something has gone wrong. But, why aren't they speaking up? According to a recent study, the reasons vary from wanting to simply put the event behind them to not believing it will do any good. Hospitals and health systems have placed an emphasis recently on getting patients and families to speak up when they've experienced medical harm such as a misdiagnosis.  Read More

• According to some health care leaders, the pandemic has reinforced the reality of racial disparities in the U.S. health system, but that story remains difficult to see in the data, which is still inconsistently collected and reported across the country. This week, a coalition of researchers and advocates launched a tool they hope will fill some of those gaps. The Health Equity Tracker is a portal that collects, analyzes, and makes visible data on some of the inequities entrenched in U.S. medicine.  Read More

In the past few years, big tech companies and retail pharmacy chains have scaled up their consumer-minded healthcare offerings. These efforts, from companies such as Amazon, Walmart, and CVS, promise to improve affordability and convenience for patients. However, it's unclear whether these consumer-minded healthcare pushes have made it easier for Americans to access the care they need and stay healthy.  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:


To recover from COVID-19’s financial downturn and to improve patient outcomes, health care organizations are prioritizing health IT and EHR optimization. According to a recent survey, EHR optimization is a big-ticket item for most CIOs in 2021, with nearly 60 percent saying that getting the most out of existing IT purchases, like EHR systems, is their health care organization’s biggest financial goal post-COVID-19.  Read More

The root causes of nursing burnout are varied, as are potential solutions for it, but given that nurses are frequently responsible for clinical documentation, it's perhaps not surprising that reducing documentation burden is frequently cited as a key strategy for fighting burnout. Whether it's through automating pieces of documentation or by taking an outside-the-box look at workflows, fighting burnout associated with EHR should be a high priority for health care organizations this year.  Read More

CMS announced it will be reweighting the cost performance category under the Merit-Based Incentive Payment System (MIPS) from 15 percent to zero percent for the 2020 performance period to provide additional COVID-19 relief and account for the lack of reliable data. Those points will be redistributed to other categories and will impact reimbursements paid out to eligible clinicians in 2022.  Read More

Consumers might assume their health care providers are securely maintained, HIPAA-guarded fortresses. They might also expect to be made aware if and when those protections were breached, especially by criminals, but that is not necessarily the case. Without more security and transparency, health care organizations run the risk of damaging one of health care’s most valuable assets — patient trust.  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.
Vendors that are strategic partners

 

In any given year, the changing healthcare landscape presents an ever-moving target. To keep up, busy practices may add a new vendor to address each problem they encounter. Further, on average teams with a clear goal may end up managing 3-8 vendors to execute that initiative fully. The result?  Teams became numb to the slow shift from managing priority problems to managing a growing list of vendors. 

Then 2020 happened. The disruption to clinic operation opened the eyes of many clinic operators and provided a unique moment of clarity. Looking at a laundry list of vendors to pay, teams were asking themselves difficult questions — how many of these relationships are essential? Which of these vendors are actually looking out for my business?


Teams turned the year poised to take more control in 2021. Seeking to reduce the risk that was exposed, clinic leadership has been actively consolidating the number of vendors they now manage. A recent technology industry survey reported more teams, nearly 10% greater than two years earlier, claim to now use up to 20 vendors. Further, fewer teams believe that it is easy to manage multi-vendor environments, down from 26% to 17%, while the number of those who see managing such an environment as “very challenging” has gone up by 8%. 

The benefits are clear and so the decision to reduce the number of vendors may be an easy one on paper. But the act of consolidating, and thus removing some vendors who may be performing a small task well, forces teams to look critically at the vendors they use today and to identify true strategic partners with which they will align for the future. 


Identifying Real Partners & Opportunities to Consolidate Vendors


A good first step to this process is to create and keep a vendor “score," routinely reviewing a vendor’s performance, grading them on key aspects of your relationship. Another good option is to review all your contract terms and establish a calendar reminder set for before that contract renews. Use those established timelines to investigate options to consolidate a current contract into a vendor who’s already performing well in another area and who may now offer a similar feature/service. As vendors expand their features and services to provide overlapping solutions, the opportunity to strategically consolidate vendors may be easier than you think.

But be mindful of the vendor’s ability to influence this trend. Some smaller clinical teams have shared that they may be facing fees upwards of tens of thousands of dollars to end an existing contract. Larger teams may face multi-million-dollar fees to end a relationship. These high fees can lead to inaction on the part of the clinical team and a lack of engagement with that vendor that has the compounded impact of complacency on the part of the vendor where the “chosen” vendor begins to lose their competitive edge. 

The Partner with Integrated Revenue Cycle Software & Services


When considering reducing the number of vendors you are managing, remember that the right partner should feel like an extension of your team. And any teammate needs to have time invested to fully realize all the benefits from that relationship. An integrated revenue cycle software and services partner like pMD pairs our team of national RCM experts and industry-leading software engineers to deliver control and ownership over revenue cycle metrics to prepare you for whatever the future may bring.

If you are interested in learning more about pMD’s Billing & 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.

Related Articles:

When to Consider Breaking Up with Your Medical Billing Company
Investing in Partnerships Pays Dividends
Interfacing Health Care IT Systems - Accuracy and Efficiency Should Not Cost Extra

Here's The Latest in Health Care:


The American Medical Association (AMA), in partnership with the professional services firm Manatt Health, published a framework this week aimed at examining the benefits generated by virtual care. Understanding the value of virtual care is vital to inform decision making that facilitates the shift to digitally enabled care models that blend the best features of in-person care with those of virtual care.  Read More

Three years after the AMA and other health organizations released a consensus statement urging reform, prior authorization still remains a major obstacle to achieving optimal patient care. Nearly 90 percent of surveyed physicians reported that prior authorization interferes with the continuity of care and that roadblocks can lead to delays in critical procedures and can extend the time patients have to wait to receive necessary prescriptions.  Read More

Patients are increasingly bringing consumer expectations to their health care interactions, looking for transparency and payment flexibility. Providers, meanwhile, are looking for ways to make these types of experiences a reality. Among other strategies, it’s important to integrate payment and cost discussions throughout the patient journey.  Read More

The Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC) this week launched a new initiative to plot out interoperability goals to drive the industry forward. Through its Health Interoperability Outcomes 2030 project, ONC plans to publish a prioritized set of "aspirational and achievable" interoperability goals that align with the federal health IT strategic plan.  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.


Doctors spend so much of their time on the go, moving from place to place caring for patients. They see twenty patients per day on average, spending most of their extra time doing paperwork. We’ve talked a lot about efficiency as it relates to using technology to reduce administrative burden and complexity, to make time for what really matters most — your patients. But how can you make sure that the time spent with patients is being used to its full advantage? This is where effective communication is essential.



The Very Different Impressions of Doctor-Patient Communication


Studies have shown that medical professionals often overestimate their abilities to convey information clearly. The Journal of Bone and Joint Surgery surveyed orthopedic surgeons after they met with patients, and while 75% of them believed they had communicated satisfactorily, when their patients were asked how they’d done, only 21% reported that their doctors had communicated well with them. That’s quite a significant delta and shows that two people can very often leave a conversation with completely different impressions of how it went.


There are a few reasons this can happen. Aside from potentially being in a hurry, dealing with as many patients as they do, physician burnout can lead to an increased detachment, which may cause doctors to misinterpret cues. It can be easy to stop treating patients as individuals with different needs and styles of communication.



Views on the Importance of Honest Communication Have Changed


While for much of the 20th century it was a common belief that giving patients hope and keeping them happy was more important than honesty, the modern schools of thought disagree completely. Patients who trust their doctors are more likely to follow their instructions, as well as provide them with the information they need to make an accurate diagnosis or treatment plan. Likewise, it is now understood that having a sense of understanding and control of your circumstances is much more beneficial to a patient than simply being comforted. 


Patients are more educated than ever before, and due to the ease and convenience of the Internet, they have resources at their disposal to form opinions and questions about their own health care. To get the most out of the time spent with patients, it’s imperative to treat the interaction as a mutually beneficial relationship.



Solutions for Improving Communication with Patients


Some proposed solutions include AIDET® Five Fundamentals of Patient Communication and The RESPECT Model. While slightly different approaches, they both have the same goal: ensuring that physicians are using the best communication skills they have at their disposal and fostering a sense of trust with their patients. It’s important to remember that each patient is an individual with their own set of needs that must be acknowledged and addressed.


If you are interested in learning more about pMD’s HIPAA-compliant secure communication and telehealth tools, 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.

Related Articles:

Patient Communication Tools for Better Patient Care
Healthcare Communication Solutions - pMD Much More Than Secure Messaging
Physician Burnout & How pMD Can Help

Here's The Latest in Health Care:


• As healthcare organizations recover from the significant strain of COVID-19, the Medical Group Management Association (MGMA) released a special report outlining health care leaders' insights on how practices can rebuild to pre-pandemic patient volumes and revenues through staffing stability, patient engagement, and telehealth.  Read More

There's broad industry support for revamping the U.S.' decades-old health privacy law to encourage patient access and care coordination, but provider groups are deeply worried about the unintended consequences. IT groups have warned that HIPAA alone isn't enough to protect medical data in today's information economy, joining providers in calls to harmonize the regulations with other federal privacy regulations. Read More

Telehealth has become a widespread option for patient care. But with clinician burden, primarily due to excessive EHR use, quickly swelling, health IT experts are looking for ways to streamline EHR documentation. EHR telehealth integration is critical for enhanced EHR documentation, but other options could streamline the process as well.  Read More

More than a third of the U.S. population has now been fully vaccinated, with 46% having received at least one dose of a COVID-19 vaccine. New cases of COVID-19 in the United States fell for a fourth week in a row, dropping 17% last week to just under 290,000, the lowest weekly total since September.   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:


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.