GeBBS Healthcare Blog

By Nitin Thakor, GeBBS President & CEO

In a recent blog we asked that CMS go slowly with the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA), a landmark payment system for Medicare physician fees that replaces the sustainable growth rate formula.

By Nitin Thakor, GeBBS President & CEO

Some lawmakers are warning the CMS that its Medicare Access and CHIP Reauthorization Act (MACRA) draft rule on new physician payments could significantly harm small physician practices. When MACRA goes live in 2019, it is supposed to improve healthcare delivery by giving bonuses to top-performing doctors and clinicians and provide negative incentives for underperformers on a variety of measures, especially quality of care. However, many people in the healthcare industry believe that MACRA will have a net negative effect on care delivery and cause many small practices to close their doors or consolidate with other practices, which will undoubtedly lead to higher healthcare costs.

By Nitin Thakor, GeBBS President & CEO

I was struck by recent article in the New England Journal of Medicine Catalyst entitled: “How Multi-Specialty Hubs Fill a Major Gap in the Care Continuum.” The article brings out a fact that all of us in the healthcare industry need to take to heart, and that is: how can we “think outside of the box” and take advantage of the resources we presently have and use them to improve care and reduce costs.

By Nitin Thakor, GeBBS President & CEO

A relatively new phenomenon in healthcare has the potential to negatively impact hospitals’ revenue stream. This new phenomenon is called the freestanding emergency department (FSED). We know that market share in any hospital marketing area is critical to the facility’s success. If a competing FSED opens in a hospital’s market area it will surely impact the hospital’s revenue.

Black Book™, well-known for its accurate, impartial customer satisfaction surveys in the services and software industries, recently conducted its annual revenue cycle management outsourcing and software/technology user poll. They survey the clients of RCM vendors to provide insight into their customer experience in the functional areas of Billing, Charge Capture, Mid Process Coding, Claims Management, Reimbursement, Insurance and Payer Management, Payment Resolution and Collections, and collectively for end-to-end RCM software/technology and outsourced managed services.

The Centers for Medicare & Medicaid Services’ (CMS) grace period for denials of claims under ICD-10 will end on October 1, 2016. Healthcare providers and billing companies must be prepared for this deadline and its financial effects.

With cash flows declining, margins shrinking, and bad debt on the rise, it's more important than ever for healthcare providers to maintain a steady stream of income. If your organization has not implemented an end-to-end, comprehensive best practices revenue cycle management (RCM) solution, it is time to do it! You don’t have to add staff; just call on an experienced outsourcing firm with 10+ years of RCM experience with expertise in multi-specialty collections and billing. They will be able to deliver an all-inclusive RCM solution that follows industry-standard key performance metrics to measure success and integrate best practices, so that you get the value of their proven experience and expertise.

AHIMA has designated July as CDI Month.

As the demand for accurate and timely clinical documentation increases, health information management (HIM) professionals are using their skills and expertise to improve clinical documentation. Because clinical documentation is at the core of every patient encounter, in order to be meaningful it must be accurate, timely and reflect the scope of services provided. Successful CDI programs facilitate the accurate representation of a patient’s clinical status that translates into coded data. Coded data is then translated into quality report cards, physician report cards, reimbursement, public health data, and disease tracking and trending. HIM professionals provide two key roles within a CDI program as a clinical documentation improvement specialist and coding professional. By working together, HIM professionals can support their organizations efforts to collect and provide meaningful information throughout the continuum of care.

In their May 6, 2016 newsletter, the AMA stated that: “Patient care is the top priority and a source of passion for physicians, but making sure the business side of your practice is ‘healthy’ also can contribute to better outcomes and patient satisfaction.”

We couldn’t agree more!

A large Chicago-based health system recently posted an operating loss of about $186 million in 2015, nearly 15 times the amount reported in the previous year. In addition, the system will lay off 250 employees and leave 450 jobs unfilled. The health system has told its bondholders that it will write off $53 million of its accounts receivable for patient bills that went uncollected, according to a major Chicago newspaper. The CEO has attributed almost half of the system's financial losses to an inadequate collections system, which forced the hospital to write off some bills for being too old to collect.

This did not have to happen!