MACRA is Coming: Tips to Prepare

Are you ready for MACRA? If not, you’re not alone. A recent Deloitte Center for Health Solutions 2016 Survey of U.S. Physicians states that 50 percent of physicians surveyed have never heard of the law, and 32 percent recognize it by name but are not familiar with its requirements.

Alarming? Yes. But it’s not too late to prepare.

For those who do not know about MACRA: it is the Centers for Medicare & Medicaid Services (CMS) Medicare Access and CHIP Reauthorization Act of 2015. MACRA is a Medicare payment law intended to drive healthcare payment and delivery system reform for clinicians, health systems, Medicare, and other government and commercial payers. MACRA is intended to create a path toward a new Medicare payment system that will more closely align payment with quality and outcomes. It offers financial incentives for healthcare professionals to participate in risk-bearing, coordinated care models and moves away from the traditional fee-for-service system. Providers participating under the Medicare fee schedule will generally choose between participating in Alternative Payment Models (APMs) or receiving payment based on individual performance under the Merit-Based Incentive Payment System (MIPS).

It’s not too late to get informed on all things MACRA, as there are tools and resources available. The American Medical Association recently introduced a series of online tools designed to help providers transition to Medicare’s new payment schemes under MACRA. In the AMA’s STEPS Forward platform there are 42 modules, including those on selecting and implementing an EHR, reporting to data registries, and complying with the law’s quality measures. The AMA also released a Payment Model Evaluator, which will help providers understand how MACRA will affect them and how best to succeed under the new law.

Bottom line: Staying apprised of all-things MACRA, taking advantage of tools, data and other information will help as you prepare your practice for this change.

Read more in Becker’s Hospital Review. 

Happy Holidaze: Be Sure Your ICD-10 Code Book is Close By

Season’s greetings to all! As we enter the busy holiday season, you are sure to begin seeing an uptick in patient visits.
You may want to be on the lookout for the following ailments:

Holiday_ICD_10_Blog_RemitDATA Comparative Analytics

As you close out the books to a successful, though likely challenging 2016 due to ICD-10, we’d like to offer a
happy holiday greeting to all, and best wishes for a prosperous 2017!

Healthcare Consumerism is Shaping Payer/Provider Relationships

Consumers today have it easier than ever before. In this digital age, information is as accessible as the air we breathe. There are apps that help us compare mortgage loans, the cost of a car, even groceries.

Consumers are savvy and are rightfully seeking pricing information from providers – before a service is performed. It’s only natural.

However, the healthcare industry has some obstacles to overcome to achieve this level of transparency, even with the mandates of the Affordable Care Act (ACA). Let’s sum it up with a few quick facts from Public Agenda’s 2015 Report. Did you know:

  • Most Americans are not aware that prices can fluctuate across healthcare providers. 57 percent of insured and 47 percent of uninsured Americans are not aware that physicians might charge different prices for the same services.*
  • 67 percent of those with deductibles between $500 and $3,000, and 74 percent with deductibles higher than $3,000 have sought out price information before getting care.

Despite the obstacles, there is hope.

  • 82 percent of those who have compared prices across multiple providers say they will do so again in the future.

The demand for medical cost transparency has led to many alternative payment models (like bundled payments), which are proving extremely beneficial.  This “82 percent” stat tells us comparative data analytics work and are increasing transparency and collaboration of medical costs like never before. 

These types of changes will ultimately help bottom lines across the industry – making it easier for the patient to make wise budget decisions. Over time, providers would see less payment defaults and payers could monitor and further reduce costs.

So, healthcare industry, what can we do to keep up?

Read the article published by AdvanceWeb to learn more.  

Fall is Football Madness: Make Sure You’ve Got the Right ICD-10 Code for That

ICD-10_Football_RemitDATA_Comparative Analytics

Go…Huskies! Bobcats! Tigers! Or…insert your favorite football team here.

Wherever your allegiance lies, just be sure that when patients begin to flood your lobby with suspicious injuries, conditions or illnesses you’ve got your ICD-10 code book handy to properly treat, code and bill accurately.

Whatever ailments you’re starting to see, many of the above are likely the cause of football – and we’re not talking the friendly game of flag football either.

Happy viewing!

For additional resources and information, visit our Knowledge Center.

An 8-item Checklist for Picking the Right RCM Partner

As hospitals and health systems transition to alternative payment models, many are seeking outsourced revenue cycle management services.

Numerous provider organizations believe making the change to value-based payments will require a need for tighter clinical and financial integration, which means adding resources dedicated to improving clnical-financial performance, according to a peer60 report.

The report also reveals the amount of potential RCM segments healthcare organizations are seriously considering for outsourcing has grown in the past year. Accounts receivable management and collections, claims and billing, denial management, contract management and eligibility and benefits, coding, audit, transcription and clinical documentation improvement also are now being included in potential RCM segments needing to be outsourced.

Overall, according to Black Book’s 2016 RCM survey, the U.S. market for physician and ambulatory revenue cycle management outsourcing and extended business office services is expected to increase by 42 percent from the fourth quarter of 2016 to the first quarter of 2019.

The demand for RCM outsourcing is due in part to an increased need for more reporting and transparency between all organizations. Instead of focusing on getting claims out and collecting money, changes in payment models dictate the need for hospitals and health systems to validate the costs of collecting while keeping their accounts receivable days low, said Chare Franks, senior director of client services at Plano, Texas-based healthcare technology company RemitDATA.

With the revenue cycle in this state of transition, it is imperative that healthcare organizations align themselves with the right RCM partner.

Representatives from RemitDATA recently spoke with Becker’s Hospital Review about areas to consider when choosing an RCM partner. Below are eight areas they recommended.

1. Access to comparative data. Hospitals and health systems should consider whether the RCM partner has access to external data in addition to the organization’s internal data. This allows the hospital or health system to compare itself to peers, and gain insight on whether an RCM issue is specific to that particular organization, or if their RCM issues are happening across the industry. “That’s really important. They need to know how the issue is impacting them and what’s going on in the marketplace,” says Stacie Bon, vice president of marketing at RemitDATA.

2. Access to real-time data transparency. Ms. Bon also recommends hospitals and health systems seek an RCM partner that can provide a real-time view into its data. “Looking at what’s happening now and being able to compare your year-over-year success is important,” she says “Is the issue seasonal, or is this an anomaly you haven’t had before? Being able to run real-time reports and understand why spikes are occurring and the pattern of these issues allows you to determine whether the issues you’re having are happening across the market, or whether it’s something specific to your organization. Real-time comparative data can help you overcome these issues more quickly.” It is also important to understand how the partner will share this information with the hospital or health system. It’s important for the data to be in an easily digestible format that can be shared throughout the organization.

3. Proactive denials management system. The right RCM partner should not only be able to identify RCM problems, but also be able to help resolve them. If the organization does not help resolve the root cause of the issues, manpower will continue to be used to fix every issue individually, according to Ms. Bon. Therefore, she said, hospitals and health systems need to get down to the core of the RCM issue to decrease denials and increase reimbursements by asking the following questions: Why is that issue happening? Should the hospital or health system be coding something else? What in the hospital or health system’s process is causing it to have this issue over and over? After the issues are identified, how will the RCM partner help the hospital or health system ensure the same issues do not continue to occur.

4. Ability to set key performance indicators. A good RCM partner should help hospitals and health systems track and monitor their RCM process through KPIs, according to Ms. Bon. With KPIs, organizations are able to identify their top business issues by return on investment. “If you know the top three issues with the greatest ROI, you’re not going to worry about the other 20 right now. Resolving those top three will be priority because they’re going to have the most immediate impact on your cash flow. And if you’re continuously resolving the top three you shouldn’t have the same issues over and over,” Ms. Bon says.

5. Staff mix. According to Ms. Franks, hospitals and health systems should ensure the staff and team of their RCM partner gels with the organization’s case mix. “Make sure the partner has that expertise where they can really help you,” she says. For example, if the organization is focused on emergency medicine and surgery, but the RCM partner focuses on internal medicine and pediatrics, they are likely not the ideal RCM partner for the organization.

6. Treatment by the RCM partner. It is important that hospitals and health systems ensure the RCM company will fit in with their way of doing business, according to Helen Bardo-Levins, RemitDATA’s vice president of client services. “You have to make sure it’s not a cookie-cutter format, meaning everybody’s not treated the exact same way,” she says. “You have to make sure they’re monitoring your billing around what you’re looking for and what’s important to you.”

7. Technology integration. The right RCM partner will have technology that interfaces with the hospital or health system’s existing health IT system. Ensuring technology from the RCM partner integrates with the existing system at the hospital or health system will save time and effort during the onboarding process, according to RemitDATA. It will also help the RCM partner to get a more complete view into the organization’s data, allowing them to be more successful in helping the organization get the greatest ROI.

8. Agreement on contract terms. Hospitals and health systems should ensure they have agreed with the RCM partner on contract terms and performance goals, including goals for reporting. “From a reporting standpoint, how are we going to keep a successful relationship? It’s not just about the RCM company getting you up to speed and then moving on and focusing on other customers. It’s crucial to have this partner helping you continuously drive change. And I think that’s why setting up mutual goals to hold them accountable to is important for these organizations,” Ms. Bon says.

Click here to read the full article in Becker’s Healthcare.


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Questions and Answers to Seek as you Optimize your Revenue Cycle

There are so many questions to ask in the world of healthcare revenue cycle management. Ask the right questions, and you could find some powerful answers.

How is your business performing?  Do you have the data and insight you need to know if your business performance is specific to your organization or is it impacted by industry wide trends?

In a market where shifting payment models have a direct impact on your business, your patients and your clients, it is critical to know the root causes of your biggest business issues and how they are impacting your bottom line.

Did you know that you can leverage the power of healthcare analytics to identify these inefficiencies and overlay the power of comparative analytics to truly understand how your business compares to your peers in the market?

Once you identify your greatest challenges and how you compare to your peers, you can more quickly resolve these administrative and revenue cycle inefficiencies, and put into action a plan to improve.

The main question of course is where do you get the data to compare yourself against your peers? How accurate is the data and what do you do with the data when it is sitting in front of you?

It sounds overwhelming. The good news is, it is not. That is where we come in.

When you get to Medtrade 2016, come by the RemitDATA booth #1451 and we will show you just how simple it is to leverage your own data to quickly identify inefficiencies, and see how you compare against your peers at the state and national level.

View a short demo and walk away with a $10 iTunes gift card! And you will be entered for a chance to win a $100 American Express gift card.

Looking forward to seeing you in Atlanta!  

Follow the conversation on social media. 

ICD-10: The One-Year Mark, and Preparing for End of Grace Period

Happy anniversary! Or perhaps we should say congratulations for making it through the first year of ICD-10.RemtiDATA_Comparative_Analytics_ICD10_One Year

If your organization reflects what our data is revealing, the past 12 months have likely been relatively uneventful. Taking a look at our data, we are continuing to see a steady decrease in claims processing and payment velocity. Reviewing average processing time from October 2015 through September 2016, we are noting that processing time is down.

And yet, by the time you read this blog, we’ll be well into October, the grace period for getting the correct code will have ended. As you are likely aware, the Centers for Medicare and Medicaid Services (CMS) stated that it will not extend the ICD-10 grace period beyond October 1, announcement released in August.  When ICD-10 went live in 2015, CMS said it would not deny claims as long as healthcare providers used codes in the correct “family” related to the treatment. This is now changing.

Claim denials, already one of the largest areas of lost revenue for healthcare organizations, have even greater potential to impact the bottom line as the grace period ends.

In order to minimize the impact, be sure to benchmark your performance and implement a denials management process, to identify any coding discrepancies or process road blocks.

For additional resources and information, visit our Knowledge Center.