GeBBS Healthcare RCM Blog

Security Breaches Must Not Undermine Healthcare’s Movement toward Electronic Record Keeping

Posted on Fri, Feb 27, 2015 @ 10:19 AM

For years, healthcare officials have worried out loud that privacy and security breaches could undermine public support for a federal program to accelerate the shift from paper to electronic health record (EHR) systems. But for just as long, healthcare spending on security has lagged behind security spending in other databreachindustries.

Recent survey reports from HIMSS peg average healthcare organizations’ spending on security at about 3% of their IT budgets. “That's too low to get the job done,” said an executive from a healthcare IT company, quoted recently in a Modern Healthcare article. “People in healthcare just have to wake up,” he said. “Healthcare data is a lucrative target for these guys.”

I couldn’t agree more! My position is that the movement towards EHRs is essential for higher quality patient care and increased efficiencies in the healthcare delivery systems. These types of data breaches should not delay this movement. Insurance companies, providers and their services and technology vendors must step up their data security and encryption efforts.

I sincerely believe that with all of the technological expertise we have at our hands in the healthcare industry, we can stop 99 percent of these breaches. According to what I have read in the newspapers and magazines, the recent breach at Anthem was not instigated by sophisticated data intrusions, but by multiple, simple “phishing” expeditions for passwords, conducted over several weeks, within with the breached company’s employee base.

These kinds of data breaches should be able to be identified and contained. They are not that sophisticated and should not provide access to any company’s vital records. We must not allow these hackers to de-rail our critical movement toward the EHR. We have the ability to devise security and encryption technologies that will foil these hackers. Let’s budget the resources and get it done!

Tags: Data Analytics, HIPAA, Healthcare IT Solutions / EHR

ERAs Are a Win-Win over Paper EOBs

Posted on Thu, Feb 12, 2015 @ 08:52 AM

The introduction several years ago of the ERA (Electronic Remittance Advice) created a quantum leap in the healthcare billing arena by providing an improvement to the traditional, paper-based EOBs. Astonishingly, many providers have not taken advantage of this revolutionary change. It has been estimated that even today only 46 percent of the claims are processed electronically, while the remaining 54% claims are processed in the traditional paper-based method. However, the Affordable Care Act (ACA) mandated that all healthcare plans adopt and support ERA operating rules before January 1, 2014. 

Here are just a few reasons why you should adopt ERAs:

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Significantly Reduce Processing Time: The major benefit of implementing ERAs is that they significantly bring down the medical claims billing processing time. When payment postings are done electronically, cash flow is accelerated. Also, since everything is electronic, the length of time a paper check or EOB spends in the traditional ‘snail mail’ system is avoided.

Reduce Manual Workflows: By adopting ERAs, providers and healthcare billing companies can reduce manual workflows significantly. Also, the number of employees can be reduced who have been assigned to post payments, or these employees can be reassigned to other medical claims billing functions.

Electronic Posting Efficiency: ERAs allow the use of electronic auto posting features, which enable posting of payments on to the system automatically. The error rate of the automated posting method is much less than that of manual postings, and the time spent correcting manual errors is also lessened.

Cost-Effective: Healthcare providers and medical billing companies can save significant dollars by implementing ERAs. The cost involved in recruiting new employees and training current employees is saved. Huge savings in terms of paper costs, printing costs and mailing costs can be realized. Electronic payment posting is not only time efficient, but also cost-effective.

It’s “Green”: The adoption of ERAs has encouraged several healthcare billing companies and providers to “Go Green.” Approximately, 2.5 billion pieces of paper can be saved by using eco-friendly electronic payment processing.

If you want to immediately achieve these benefits, your practice, hospital or billing company can implement a full-service outsourced payment posting solution that will allow you to instantly convert your paper EOBs to ERAs. Your outsourcing partner will use a technology solution that will import 837 claim data and convert your paper EOB's into ANSI 835/ERAs. The data will easily integrate with your document management system. By outsourcing this work, you can immediately treat every remittance as an ERA.

if you would like more information about the blog topic or how GeBBS can help you:

 

Contact GeBBS Now

 

Tags: Data Analytics, Revenue Cycle Management (RCM), Electronic Remittance Advices (ERAs), Explanations Of Benefits (EOBs), Accounts Receivable (A/R), Insurance Billing Solutions

Why Switch to ERAs?

Posted on Tue, Jan 27, 2015 @ 02:38 PM

Why Switch to ERAs?
In addition to inefficient processing and high administrative costs, paper EOBs contribute to a provider’s

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struggle with physical storage and document inaccessibility. Rummaging through paper archives as a means to investigate and manage secondary claims does not promote efficiency.
Even worse, your medical practice or hospital may miss out on the opportunity to harness the power of big data. In the absence of a readily accessible and centralized data warehouse, providers forfeit the opportunity to effectively analyze their payments and denials in hopes of making smarter business decisions.


How ERA Will Benefit Your Practice?
ERAs were created to handle increasing transaction volumes, complex compliance issues and high administrative costs. ERAs alleviate the tedious process of manually entering, checking and posting payments by automating processes and accelerating the revenue cycle.

The American Medical Association (AMA) estimates that the average provider can save almost $9,500 annually by switching to ERAs. Just imagine your office staff not having to collect mail, file paper documents, manually post payments and speak with payers. Transitioning to ERAs means less administrative waste and more effective patient care.

Adopting a system with the capacity to accept ERAs, post denials and run real-time analytics will allow your practice to track, analyze and manage the revenue cycle seamlessly.

If you cannot accept ERAs today, your practice, hospital or provider group can implement a full-service outsourced payment posting solution that will allow you to immediately convert your paper EOBs to ERAs. Your outsourcing partner will use a technology solution that will import 837 claim data and convert your paper EOB's into ANSI 835/ERAs. The data will easily integrate with your lockbox or document management system. By outsourcing this work, you can immediately treat every remittance as an ERA.

if you would like more information about the blog topic or how GeBBS can help you:Contact GeBBS Now

 

Tags: Data Analytics, Revenue Cycle Management (RCM), Electronic Remittance Advices (ERAs), Explanations Of Benefits (EOBs)

The Role of Predictive Analytics in Revenue Cycle Management

Posted on Wed, Apr 30, 2014 @ 09:01 AM

Advantages of Using Qualitative Data Analytics in Market ResearchHealthcare billing service companies provide vital services to the medical industry; both hospitals and physician groups need their critical services. However, these billing service companies often experience their own operational pains in the form of ever-changing governmental regulations that make medical billing confusing and complicated. Other reimbursement mandates and collection regulations exacerbate the problems medical billing companies face.

The mission of these billing companies is, of course, to handle the revenue cycle management, increase their clients’ efficiencies, and take onerous billing activities off the plates of their clients’, while continuing to improve their bottom lines. How are they able to provide these vital services while still tending to their own pains?

The answer is: predictive analytics.

By integrating predictive analytics and business intelligence software technologies, medical billing companies can treat their own symptoms, while providing end-to-end information management and billing strategies. These strategies combine performance management, with data analytics, to help healthcare providers make smarter revenue cycle management decisions that ensure they get every dollar earned. Advanced predictive analytics technologies help the billing service’s clients progress from reactive to proactive revenue cycle management decision-making.

Healthcare providers are in a continual struggle to balance the conflicting goals of how to enhance the  quality of their care, while maintaining profitability. They must deliver superior care to ensure the best possible patient results while minimizing administrative and clinical expenses. However, their often complex information technology architectures – which include not only administrative applications, billing and accounting packages, clinical management systems, but also unstructured data, make it difficult to gain insights into the factors that can help define strategy and improve decision-making.

Predictive analytics combine powerful, fully automated discovery and analysis technologies that give healthcare organizations an unhindered view of their patient care and revenue activities, so they can use their enterprise data to improve all facets of their operations, such as ordering supplies, setting schedules, defining patient treatment plans, and managing budgets and billing procedures. Analytical data can also be used to identify overdue monies from patients, opportunities for collecting missed income, including claims that have been wrongfully rejected by payers.

Billing services companies using advanced predictive analytics technologies have the ability to discover patterns and trends within own operations to help them cope with their internal pains while they provide their external clients with models that help them better understand the drivers behind revenue cycle management, treatment outcomes, readmissions and patient satisfaction. These models can then be deployed to predict future revenue generation trends, patient admissions, bed utilization, length of stay, and other metrics that can be used to predict future behaviors.

Not only do predictive analytics allow healthcare providers to take a more proactive approach to revenue cycle management, they can improve patient care by more precisely predicting which patients will develop chronic conditions, or which patients will respond best to certain types of medications or therapies. Predictive analytics can improve the outcome of patient treatments by closely analyzing which treatment regimens work best, allowing providers to make more intelligent decisions about treatment plans that minimize complications and patient readmissions.

When predictive analytics are applied to healthcare challenges, they can help providers make more informed financial, administrative, and clinical decisions based on their specific experiences and data. These decisions can result in higher profitability, reduced costs, improved quality of care, and a maximized ROI on the provider’s efforts.

Tags: Data Analytics, Revenue Cycle Management (RCM)

Big Data Is A Really Big Deal For Healthcare Revenue Cycle Management

Posted on Wed, Jan 29, 2014 @ 07:11 AM

big dataIn our initial blog on big data, we posed the question: “Is big data a big boondoggle or a big solution?” Based upon our experience of helping literally thousands of healthcare providers use vast amounts of financial and clinical data to improve their revenue cycles and care delivery – we believe that big data can provide big answers. What exactly is big data? A report delivered to the U.S. Congress in August 2012 by the TechAmerica Foundation defines big data as: large volumes of high velocity, complex, and variable data that require advanced techniques and technologies to enable the capture, storage, distribution, management, and analysis of the information.

Who is using big data today? Industry, healthcare and retailers -- Wal-Mart’s data warehouses now include some 2.5 petabytes (a petabyte of storage is about one million gigabytes) of information, the equivalent of roughly half of all the letters delivered by the U.S. Postal Service in 2010. That volume of data is 160 times larger than all the holdings of the U.S. Library of Congress.

Healthcare is producing huge amounts of big data? U.S. healthcare big data alone is truly mind-boggling; it reached 150 exabytes in 2011 (1 exabyte of data = 1,000 petabytes or 1 billion gigabytes. Five exabytes of data would contain all the words ever spoken by human beings on earth. At this rate, big data for U.S. healthcare will soon reach zettabyte status (1 zettabyte = 1,000 exabytes, and not long after that, yottabyte status will be achieved (1 yottabyte = 1,000 zettabytes).

I said mind-boggling, didn’t I?

Here’s a specific example: Kaiser Permanente, the California-based health network, which has more than 9 million members, is estimated to have between 26.5 petabytes and 44 petabytes of patient data under management just from electronic health record (EHR) data, including images and annotations. This is the same amount of information that would be contained in 4,400 Libraries of Congress.

What does healthcare big data entail?? Healthcare big data can be comprised of the following categories or streams of information:

1. Web and social media data; it can also include health plan websites, smartphone apps, etc.

2. Machine-to-machine data, collected from sensors, meters, and other devices.

3. Transaction data from healthcare claims and other billing records, available in semi-structured and unstructured formats.

4. Biometric data, including x-rays and other medical images, blood pressures, pulse readings, fingerprints, genetic information, handwriting, retinal scans, etc.

5. Human-generated data -- unstructured and semi-structured data such as EHRs, physicians’ notes, email, and paper documents.

In recent years, it has become increasingly apparent that multiple streams of data like these can be leveraged with powerful new collection, aggregation, and analytics technologies and techniques to improve the delivery of healthcare at the individual patient level, as well as at the levels of disease and condition-specific populations. Big data promises to ease the transition to real data-driven healthcare, allowing healthcare professionals to improve the standard of care based on millions of cases, to define needs for subpopulations, to make more personalized decisions for individual patients, and to identify and intervene for population groups at risk for poor outcomes. Stay tuned for more, and …

Please join our conversation; we would like your opinions on the big data phenomenon.

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Tags: Data Analytics, Revenue Cycle Management (RCM)

Big Data: Solution or Mistake for Healthcare Revenue Cycle Management?

Posted on Wed, Jan 22, 2014 @ 07:55 AM

big data resized 600Big data is the hot buzz word right now in healthcare IT. The constant news barrage about the value of big data and business analytics/intelligence (BI) is forcing healthcare IT departments to take notice and determine what value big data really has for their facility. As this terminology has evolved in healthcare, big data has become the popular term to describe the exponential growth and availability of all kinds of data -- both structured and unstructured. What is the potential importance of big data to healthcare providers?

We would like you to join our conversation and give us your point of view on the role big data can play in the improvement of healthcare Revenue Cycle Management.

One answer might be that by examining more data, healthcare providers can make more accurate analyses, and more accurate analyses can lead to more confident and better decision making. Better decisions, of course, can lead to greater financial and clinical operational efficiencies, cost reductions and reduced risks.

Big data vendors are proliferating in the healthcare marketplace. Will their solutions provide more and better answers -- or just more statistics to dig through?

Apparently, big data isn't all talk and buzzwords. Based on research from Gartner, big data is expected to account for $34 billion in IT spending by the end of 2013, and this spending may triple by 2018. Also, in a recent article, CIO magazine discussed how big data and analytics are being used in the healthcare industry to improve care delivery. The article reported on several real-life cases where healthcare organizations have used big data analytics to improve outcomes and reduce costs. These cases all have one thing in common -- they push the analytics out to the point of care decisions.

Boston-based Partners HealthCare system--which includes Brigham and Women's Hospital, Massachusetts General Hospital and Harvard Medical School--uses big data to connect its financial, operational and clinical analytics systems. The system described as an "intelligence system for the EHR," allows for real time queries, analytics and reports at the point of care. It had about 5,000 users at the time the article was written.

Intermountain Healthcare, a Utah-based system of 22 hospitals and 185 health groups, has partnered with Deloitte to mine its more than 90 million patient EHRs for outcomes analysis with two programs--OutcomesMiner and PopulationMiner.

Researchers from Ohio State University's Wexner Medical Center and the analytics firm Farsite made progress in reducing readmissions -- they found heart patients skip rehabilitation appointments for reasons ranging from co-morbidities to transportation problems and lack of motivation. Based on those results, a trial program had patients’ families and influential friends send positive texts encouraging the patients to continue going to rehab.

The big data phenomenon is global. Healthcare organizations and businesses around the world, of all sizes, are taking a closer look at how to use big data solutions. Data analysis projects that begin with specific informational goals will more often than not produce the most valuable outcomes, because there is structure in place from the beginning.

The challenge for any organization wanting to use big data to improve its operation -- is to know the "right" questions to ask of the big data to make the value of its analytics worth the trouble.

Please join our conversation and stay tuned!

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Tags: Data Analytics, Revenue Cycle Management (RCM)