GeBBS Healthcare RCM Blog

CMS and AHIP Move to Improve Healthcare Quality Measures

Posted on Thu, Apr 28, 2016 @ 04:00 AM

The Obama administration and health insurers took steps recently to standardize and improve the measures that are intended to gauge the quality of healthcare. The CMS and trade group America's Health Insurance Plans (AHIP) have announced an agreement to adopt a core set of quality measures for the nation's doctors. Officials say the measures are necessary as payers and consumers bear more responsibility for finding and purchasing high-quality care and providers are increasingly paid under contracts tied to their quality performance. This is a good move!

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Nobody benefits when doctors spend time collecting different data for multiple insurers instead of using those resources to improve the quality of patient care. This agreement to standardize quality measures can accelerate development of capturing data that patients care about most – how fast they recover from any illness or treatment.

The most important aspect of this new quality program will be how it deploys superb clinical documentation and expert medical coders to identify and codify these new quality measures.

Medical coding is the lifeblood of a revenue cycle, regardless of whether or not it is used in pay-for-performance contracts. Accurate and efficient coding is crucial to meet financial and compliance goals. Medical coding can be complex yet time sensitive, where being down even a single coder can impact revenue. Healthcare providers need reliable medical coders who are accurate, productive, and experts in all types of inpatient and outpatient coding.

An expert HIM company can provide immediate, experienced coding professionals to help healthcare providers capture these new quality measures. Whether the medical coders work on-site or remote, U.S. or global, their knowledge and training is top notch. They know the most current coding regulations and keep up to date with the latest in patient care in the clinical and hospital setting. Strict enforcement of coding compliance guidelines, ongoing reviews, and a commitment to continuing education promotes coding accuracy, data integrity, and proper claims submission.

These new quality measures are also making accurate clinical documentation more important than ever. RAC, Medical Necessity, ICD-10, pay-for-performance, and the growth in volumes resulting from the ACA are all impacting healthcare organizations. The ability to get reimbursed is directly dependent on the quality of clinical documentation. Missing, poor, or non-specific clinical documentation will result in lost revenue.

Outsourcing can help you comply with the new quality measures and get you paid faster by improving your clinical documentation. Outsourced CDI specialists are professionals of the highest caliber. They are credentialed, experienced, and they are passionate about getting even the smallest details right. Whether the CDI professionals are assessing your program or supplementing your staff, they can help you develop, improve, and maintain your clinical documentation to meet the new CMS and AHIP quality measures.

Tags: Business Process Outsourcing (BPO), HIPAA, Medical Coding, Offshore Medical Coding, Outsource Coding, Medical Coding BPO

The Climb to Conquer “Mount ICD-10” Is Going to Get Steeper

Posted on Mon, Mar 28, 2016 @ 05:00 AM

The climb to conquer Mount ICD-10 is going to get steeper and more difficult. Be sure you have an experienced guide to help you on this perilous journey. The ICD-10 transition difficulties were lessened by CMS by not dropping all of the thousands of new codes on the healthcare industry at one time. That is going to change.

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The Centers for Medicare & Medicaid Services (CMS) recently added for review about 1,900 diagnosis codes and 3,651 hospital inpatient procedure codes to the ICD-10 coding system for healthcare claims in fiscal year 2017. The large number of new codes is due to a partial freeze on updates to the ICD-10-CM and ICD-10 PCS codes prior to implementation of ICD-10 on Oct. 1, 2015. The new diagnosis codes are included in the hospital inpatient prospective payment system proposed rule for FY 2017.

There is time to get prepared for onslaught of these new codes. Begin your search for an outsourcing partner who has the expertise to lead your facility on this journey and ensure your revenue cycle is not impacted.

While patient volumes are on the rise with the newly insured, your ability for achieving patient satisfaction, profitability, and compliance goals are increasingly at risk. A robust Health Information Management (HIM) program has never been more critical to the success of healthcare organizations than it is now.

This is precisely the time to engage with a partner who brings a deep understanding of the revenue cycle. An experienced outsourcing partner can help you cut through the complexity of the new ICD-10 codes with expertise, operational excellence, and a sophisticated technology approach.

An experienced outsourcing partner can offer a comprehensive range of HIM solutions that will help you comply with these new codes using a diverse portfolio of services, including:

Make sure your facility has an “experienced Sherpa” to help you master the climb to the pinnacle of “Mount ICD-10.”

Tags: Business Process Outsourcing (BPO), HIPAA, Outsource Coding, Medical Coding BPO

There Is NO Substitute for Training & Experience When It Comes to HIPAA Compliance

Posted on Tue, Mar 22, 2016 @ 10:20 AM

By Nitin Thakor, GeBBS President & CEO

The HHS Office for Civil Rights (OCR) recently imposed heavy monetary fines and acceptance of resolution agreements and corrective action plans on two provider organizations following substantial violations of the HIPAA privacy and security rules.

About 30 organizations to date have now agreed to such sanctions after OCR determined they were essentially ignoring HIPAA.

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This action reinforces the importance for healthcare providers to deal with experienced vendors and outsource organizations when it comes to HIPAA compliance. There is no substitute for intense training on how to handle protected health information (PHI). PHI touches almost every aspect of healthcare delivery from revenue cycle management to patient care, and healthcare providers must ensure they are dealing with a partner that completely understands all aspects of HIPAA compliance.

Whether it’s an HIM solution, end-to-end revenue cycle management, insurance billing, or a patient access solution, the company applying these applications to help healthcare providers must understand, and more importantly, apply ALL HIPAA compliance regulations as they use these solutions in the actual delivery of healthcare. Training and experience are the key factors in delivering on HIPAA compliance.

An experienced outsource company will have in place a business associate agreement (BAA) that addresses risk analysis and all potential vulnerabilities to a client’s electronic protected health information. They will examine where and how their solutions impact PHI and address its protection enterprise-wide throughout the client’s IT infrastructure.

When it comes to PHI and HIPAA compliance, training and experience do make a big difference.

Tags: Business Process Outsourcing (BPO), HIPAA, Medical Coding BPO

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

Healthcare Solutions in India | The Globalization of Healthcare Delivery

Posted on Sat, Dec 22, 2012 @ 12:51 PM

GeBBS technologyGeBBS service delivery model

Due to technology advances and process virtualization, the healthcare industry now has access to the highest-quality/lowest-cost services anywhere in the world, creating a unique opportunity to transform care delivery in the U.S. and around the world.



Healthcare providers can now leverage global supply chains and operating systems for high quality solutions and expert talent pools (e.g., offshore coding of medical charts and revenue enhancement services), thus eliminating major healthcare cost centers. This globalization has already begun and is often totally transparent to many end users of the services. One such global provider is GeBBS Healthcare Solutions

 

With an in-depth understanding of the industry, GeBBS is totally focused on providing end-to-end solutions to help healthcare providers meet today’s information technology challenges. The company employs a local service delivery model using global resources to rapidly deliver high quality, cost-effective BPO solutions. By basing their support and account management locally, they are able to provide clients with high quality customer service using global delivery centers worldwide. 

 

This onshore/offshore delivery model allows GeBBS to provide clients with the ultimate in services/products delivery capabilities. To maximize output at the lowest possible cost, the company moves work among their multiple state-of-the art global delivery centers. GeBBS measure the complexity of each process and the specific geographic needs in deciding where to process them. By basing their support center in the U.S., they are able to give a local feel to their client base and still be able to tap into a large pool of highly skilled, English speaking healthcare professionals.

 

In addition, they are able to accelerate delivery times by providing 24-hour per day, 7-day per week, work schedules made possible by the time difference between North America and India. All the company’s delivery centers are HIPAA compliant and certified by TUV NORD for ISO 27001: 2005. 

 

Their unique delivery model allows the company to tap into a large pool of highly skilled, professionals that help clients succeed by leveraging the company’s healthcare expertise and their innovative and cost-effective approach to outsourcing. GeBBS service and delivery are based on their highly skilled professionals, robust processes, proprietary workflow engines, world-class infrastructure, in-house expertise and a commitment to clients.

 

This combination makes the company an ideal partner for the following outsource healthcare services and technologies:

 

Eligibility and Benefit Verification 

These remotely hosted centralized eligibility services provide hospitals and physician practices with high-quality, cost-effective patient insurance eligibility and related services that improve A/R cycles and increase cash collections by reducing write-offs and denials.

 

Medical Coding

GeBBS provides high quality coding services to healthcare providers with experienced Certified Professional Coders (CPCs) accredited by the American Academy of Professional Coders (AAPC). The company’s coders have proficiency in CPT-4, HCPCS, ICD-9-CM, LCD/NCD and CCI EDITS.

 

Revenue Cycle Management Services

GeBBS provides a wide range of healthcare revenue cycle management (RCM) services by leveraging their experienced people, proven processes and information technology to provide operational and financial solutions to their clients that help them maximize reimbursement and reduce expenses.

 

Credit Balance Resolution

GeBBS credit balance services ensure that outstanding credit balances are accurately resolved in an expeditious manner, using a highly client-centric model. 

 

Pharmacy Transcription and Billing Services

GeBBS provides transcription and billing services to hospital and retail pharmacies, delivered by highly skilled and qualified pharmacy school graduates located in their global delivery centers.

 

Technology Solutions

GeBBS also provides global proprietary workflow technologies and automation tools that increase productivity, improve the quality of work, and provide the data, information, and the business intelligence clients need to make more informed decisions.

 

iCode -- combines expert workflow technologies, rules based automation and certified coders to guarantee an accuracy rates of over 97% for all coding with a 24 hour turnaround time

 

iP2P -- is a full-service outsourced payment posting solution for paper EOBs that provides for the automated receipt, processing and posting of all paper payments, including insurance payments, patient payments and correspondence. 

 

iERA -- is an optional module within iP2P that  imports 837 claim data and converts paper EOB's into a postable ANSI 835/ ERA. This GeBBS solution allows clients to treat every remittance as an ERA. 

 

iAR -- is a sophisticated tool that streamlines A/R follow-up by allowing GeBBS to perform skill-based routing, manage inventory, and generate intelligent and customized reports..

 

All of these technology platforms increase clients' visibility into their data, automate their processes, streamline workflow and provide business intelligence to enhance the decision making process. They improve efficiency and scalability and allow clients to maintain their competitive advantage.

 

Contact GeBBS Now

 

 


Tags: Revenue Cycle Management (RCM), HIPAA, GeBBS Healthcare Solutions, Medical Coding

Effective Tips on ICD-10 Implementation for Healthcare Providers

Posted on Sun, Nov 11, 2012 @ 07:45 AM

The old adage: an ounce of prevention is worth a pound of cure holds true for the potential increased denials that the new ICD-10 code set will bring when it is finally implemented in October 2014.

The conversion to ICD-10 is a HIPAA code set requirement. Providers, including physicians, are HIPAA “covered entities”, which means that you must comply with the HIPAA requirements.

Who else has to upgrade to ICD-10?
Health care clearinghouses and payers are also HIPAA covered entities, so they are required to convert to ICD-10 as well.

HIPAA code set requirements apply only to the HIPAA electronic transactions. But if you don’t use the HIPAA electronic transactions, you are still expected to require ICD-10 codes be used in other transactions, such as on paper, through a dedicated fax machine, or via the phone.

The Department of Health and Human Services announced a one year delay of ICD-10 implementation which is now scheduled for October 1, 2014. When CMS delayed the implementation ICD-10 date, this additional window of time presented an opportunity for U.S. healthcare providers to apply an ounce of prevention to the anticipated adverse effects from the new code set, including increased denial rates.

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Source: American Medical Association http://www.ama-assn.org/ama/home.page?

Hospitals, physician practices, and medical billing organizations should use this opportunity to do three critical things:

  1. Assess the knowledge gaps in their clinical, administrative and billing staffs

  2. Begin to use the ICD-10 code set to run side-by-side comparisons to determine if there will be a loss of productivity in their organization

  3. Create a plan of action to address these issues


The specific impact of ICD-10 on healthcare providers is not well-defined. However, it is anticipated that due to multiple technical and clinical system interdependencies the impact will be significant.

The new code set is designed to provide benefits to patients, payers and providers, such as enhanced tracking and trending of diseases, innovations in payment design and contracting, improved care coordination, more effective case management and improved utilization management. These benefits come at the price of an increase in the number and specificity of diagnosis codes.

The added complexity is evident in the increased specificity in coding injuries, additional codes for laterality and emphasis on affected body systems. Coders who are light on anatomy and physiology knowledge will have an increased learning curve adapting to ICD-10.

Organizations that have not done so, should perform a knowledge gap assessment as soon as possible and consider establishing a training timeline to address how their staff members will handle the impact of the 65,000 diagnosis codes in ICD-10-CM, an astounding increase from ICD-9’s 4,000 codes.

An effective “hands-on” staff training program should be started six to nine months prior to ICD-10 implementation. However, coding managers, leads and super-trainers should begin their training three to four months prior to the start of the staff’s training.

Using the October 1, 2014 implementation date as a benchmark, you can establish an effective training schedule using the suggested time frames. A professional medical coding outsourcing company can provide assistance with all of these training requirements.

There are three main issues that if addressed properly, can help providers cope with the challenges of ICD-10:

  1. Knowing their practice service patterns, assessing their staff’s knowledge, and determining training needs: Assessing staff knowledge - coders, billing editors, and denial resolution teams – will allow providers to benchmark the training needs for these critical positions. You may want to consider engaging an outsourcing medical billing company to assist with these critical issues.

  2. Being aware of their practice’s operation, will allow providers to determine the top 80 percent of the ICD-9 codes they presently use: Providers should analyze their most frequently denied ICD-9 codes. Understanding these frequently denied ICD-9 codes, will create a reference point from which to monitor similar codes in the new code-set.

  3. From this information, they can devise cross-walks which will significantly reduce the ICD-10 conversion hassle

The delay in ICD-10 code set implementation has provided the industry with a little more preparation time to apply an ounce of prevention. Use it wisely!


Tags: ICD-10, Business Process Outsourcing (BPO), HIPAA, Medical Coding

How to Deal with Today’s Shortage of Certified Medical Coders

Posted on Mon, Nov 05, 2012 @ 09:26 PM

In the face of today’s uncertain healthcare financial environment brought on by the effects of the American Recovery Reinvestment Act (ARRA Public Law 111-5) and Health Information Technology for Economic and Clinical Health Act (HITECH) and the House and Senate’s versions of the Affordable Healthcare Act for America, how can your healthcare organization deal with the shortage of certified medical coders needed for billing and audit functions?


Now more than ever, it is critical that your facility remain current with its billing and audit operations. However, this is becoming increasingly more difficult with the shortage of certified medical coders. Many organizations are seeing their charting volumes dramatically increase and their Evaluation and Management (E&M) auditing requirements also growing significantly. Simultaneously, when healthcare facilities try to hire additional coders to handle the increased workloads, they are finding that only about one-third of the medical coders interviewed were qualified for hiring. The second challenge was that the coders who were qualified were commanding salaries that were well outside the cost containment parameters most facilities have in place.


How can your facility overcome these challenges – finding qualified and certified medical coders, while still containing costs?

solution shortage medical codersqualified medical coders business process outsourcing
SOLUTION:

Many organizations are turning to business process outsourcing (BPO) or knowledge process outsourcing companies, as they are sometimes known, to solve these challenges. These companies help healthcare organizations meet the certified medical coder shortage challenges in multiple ways:

 

  • They are experts at hiring certified medical coders because they maintain a large pool of these professionals to deploy at their clients’ sites.
  • They are experts at training medical coders and getting them certified by the professional certifying organizations.

The solutions provided by a business outsourcing company can solve your coder shortage problems immediately. Not only can they provide a pool of expert HIPAA-trained outsource coders, but they can also provide the supervisory personnel to ensure your coding and auditing meet all compliance regulations, while helping you contain your coding costs.

Solve Your Coder Shortage Problem Now

Tags: Business Process Outsourcing (BPO), Evaluation and Management (E&M) Requirements, HIPAA, Medical Coding, Affordable Care Act