West Jefferson Medical Center expert, Darlene Gondrella, reviews strategic initiatives for hospitals to integrate care coordination and revenue cycle teams for better outcomes across the organization.
•Engage care coordination in the revenue cycle process
•Integrate clinical and revenue cycle teams
•Bridge communication gaps across the organization
•Reduce readmissions through an integrated approach to patient discharge and follow-up
Figuring out telemedicine reimbursement can be tricky. The guidelines can vary based on your state, payer, and how you're using telemedicine. At eVisit, we're trying to demystify this process for physicians - so telemedicine makes it easier to increase your practice revenue!
Learn how telemedicine reimbursement works for Medicare, Medicaid, and Private payers - including specific CPT codes and tips for billing.
Transforming clinical phamacy into a seven day serviceNHS England
This webinar gives an example of how the role Pharmacy services are improving patient care and flow across seven days a week.
Richard Cattell from NHS Improvement gave a national overview and weekend benchmarking information and Steve Brown, the regional lead from NHS Improvement & England gave some background information on the Carter Report.
Iain Davidson from Royal Cornwall NHS Trust and David Heller from Surrey and Sussex Healthcare NHS Trust describe the development of their respective weekend Pharmacy services and how this has improved patient care and flow
Telemedicine is transforming the field of orthopedics. Telehealth solutions like eVisit offer orthopedic surgeons a way to revolutionize post-op care, making check-ins more efficient and convenient for patients. Plus, more time-effective post-op care means surgeons can spend more of their valuable time in the OR - getting paid.
As you probably already suspect, choosing the right telemedicine software for your practice is just one step on the road to building a successful telemedicine program. From there, you’ll need to train staff, get your equipment set-up, figure out your workflows, let patients know, and more.
The good news is, the path to building a successful telemedicine program in your practice is often simple once you know the steps.
At eVisit, our team has a lot of experience guiding providers from selecting a telemedicine solution all the way to “launch day,” and making sure the practice is set-up for success. In this presentation, we’ll guide you through the top tips and strategies that you’ll need to build a successful telemedicine program.
You'll Learn:
Common telemedicine workflow mistakes and questions you’ll need to answer
Telemedicine best practices you should implement
Suggestions on equipment set-up and technical tips to know
Strategies for marketing telemedicine to your patients
This presentation was included in an eVisit webinar. Request a recording here: http://try.evisit.com/implementing-telemedicine-your-medical-practice/
A total of 64 fertility clinics were included in the study. The average GCR fertility clinic quality score was 2.5, demonstrating the huge range of rising healthcare standards available in the country.
The GCR - Global Clinic Rating, the leading provider of healthcare clinic ratings worldwide, aggregated and analyzed fertility clinics throughout the New York during 2016 including fertility clinics in Rochester,Buffalo and Albany.
Figuring out telemedicine reimbursement can be tricky. The guidelines can vary based on your state, payer, and how you're using telemedicine. At eVisit, we're trying to demystify this process for physicians - so telemedicine makes it easier to increase your practice revenue!
Learn how telemedicine reimbursement works for Medicare, Medicaid, and Private payers - including specific CPT codes and tips for billing.
Transforming clinical phamacy into a seven day serviceNHS England
This webinar gives an example of how the role Pharmacy services are improving patient care and flow across seven days a week.
Richard Cattell from NHS Improvement gave a national overview and weekend benchmarking information and Steve Brown, the regional lead from NHS Improvement & England gave some background information on the Carter Report.
Iain Davidson from Royal Cornwall NHS Trust and David Heller from Surrey and Sussex Healthcare NHS Trust describe the development of their respective weekend Pharmacy services and how this has improved patient care and flow
Telemedicine is transforming the field of orthopedics. Telehealth solutions like eVisit offer orthopedic surgeons a way to revolutionize post-op care, making check-ins more efficient and convenient for patients. Plus, more time-effective post-op care means surgeons can spend more of their valuable time in the OR - getting paid.
As you probably already suspect, choosing the right telemedicine software for your practice is just one step on the road to building a successful telemedicine program. From there, you’ll need to train staff, get your equipment set-up, figure out your workflows, let patients know, and more.
The good news is, the path to building a successful telemedicine program in your practice is often simple once you know the steps.
At eVisit, our team has a lot of experience guiding providers from selecting a telemedicine solution all the way to “launch day,” and making sure the practice is set-up for success. In this presentation, we’ll guide you through the top tips and strategies that you’ll need to build a successful telemedicine program.
You'll Learn:
Common telemedicine workflow mistakes and questions you’ll need to answer
Telemedicine best practices you should implement
Suggestions on equipment set-up and technical tips to know
Strategies for marketing telemedicine to your patients
This presentation was included in an eVisit webinar. Request a recording here: http://try.evisit.com/implementing-telemedicine-your-medical-practice/
A total of 64 fertility clinics were included in the study. The average GCR fertility clinic quality score was 2.5, demonstrating the huge range of rising healthcare standards available in the country.
The GCR - Global Clinic Rating, the leading provider of healthcare clinic ratings worldwide, aggregated and analyzed fertility clinics throughout the New York during 2016 including fertility clinics in Rochester,Buffalo and Albany.
Health insurance payers and providers—both private for-profit companies and publicly funded government entities—are under pressure to control costs, improve medical expense ratios, and slow the growth of insurance premiums so consumers and employers can afford care. To transform how care is delivered, physicians, hospitals, and health systems are increasingly measured and rewarded for quality outcomes. They must have processes and technologies in place to put more attention on patients and be more efficient with resources. Healthcare companies must supply innovative, high-quality medicines, devices, and diagnostic capabilities that improve health at a reasonable cost.
HRSA requirements for a compliant sliding fee scaleCompliatric
The Health Center Compliance Manual outlines the requirements of both the program legislation and implementing regulations. The most recent updates to the Manual from HRSA provided some needed clarification in a number of areas, including the Sliding Fee Discount Program that is central to the Health Center Program. This webinar will outline the Sliding Fee requirements and provide examples and best practices for Community Health Centers to consider.
Inside a Private HIE: Clinical, Economic and Operational Successes at The Was...TriMed Media Group
The Washington Health Information Network (WHIN) is a private health information exchange (HIE) that connects The Washington Hospital and physician practices affiliated with the Washington Physician Hospital Organization (WPHO). MobileMD is the backbone of WHIN. Denise Abraham, the health information exchange coordinator for The Washington Hospital, and Charles R. Vargo, executive director of the WPHO, work closely to keep this vital piece of caregiver connectivity alive. WHIN is having a positive impact on patient care and clinical practice by increasing physician knowledge and boosting efficiency by allowing physicians, nursing and key clinical staff secure access to key information such as lab and radiology reports and EKGs. The private HIE has united 13 EMRs from different vendors via interfaces to provide one data repository for enterprise access. Learn why they chose a private HIE, how it has evolved from 2006 until now and what advice they offer to other healthcare systems ready to embark on a private HIE project.
For more information contact: Slideshare@marcusevans.com
Presentation delivered by Josh Luke, PhD, FACHE, Founder, National Readmission Prevention Collaborative, Interim Chief Executive Officer, Memorial Hospital of Gardena at the marcus evans ACO Payer Leadership Summit Spring 2015 held in Las Vegas, NV
5 Ways Your Pharmacy Can Boost Your Revenue CycleCompleteRx
With rising drug costs and decreasing reimbursements contributing to shrinking margins (in 2014, according to Modern Healthcare, 61.3 percent of healthcare providers reported decreased margins from the previous year), hospitals continue to scrutinize their revenue cycles to ensure they stay in the black, and there’s an oft-overlooked resource they would do well to consider: pharmacy. Historically, the hospital pharmacy has been labeled a cost generator, but there are actually many ways this strategic department can positively impact each stage of the revenue cycle – from point of service to claim submission and more. This webinar will explore innovative tactics, including optimized processes, improved data management, and creative patient programs, which hospital pharmacies across the country can leverage to boost overall hospital revenue.
Health insurance payers and providers—both private for-profit companies and publicly funded government entities—are under pressure to control costs, improve medical expense ratios, and slow the growth of insurance premiums so consumers and employers can afford care. To transform how care is delivered, physicians, hospitals, and health systems are increasingly measured and rewarded for quality outcomes. They must have processes and technologies in place to put more attention on patients and be more efficient with resources. Healthcare companies must supply innovative, high-quality medicines, devices, and diagnostic capabilities that improve health at a reasonable cost.
HRSA requirements for a compliant sliding fee scaleCompliatric
The Health Center Compliance Manual outlines the requirements of both the program legislation and implementing regulations. The most recent updates to the Manual from HRSA provided some needed clarification in a number of areas, including the Sliding Fee Discount Program that is central to the Health Center Program. This webinar will outline the Sliding Fee requirements and provide examples and best practices for Community Health Centers to consider.
Inside a Private HIE: Clinical, Economic and Operational Successes at The Was...TriMed Media Group
The Washington Health Information Network (WHIN) is a private health information exchange (HIE) that connects The Washington Hospital and physician practices affiliated with the Washington Physician Hospital Organization (WPHO). MobileMD is the backbone of WHIN. Denise Abraham, the health information exchange coordinator for The Washington Hospital, and Charles R. Vargo, executive director of the WPHO, work closely to keep this vital piece of caregiver connectivity alive. WHIN is having a positive impact on patient care and clinical practice by increasing physician knowledge and boosting efficiency by allowing physicians, nursing and key clinical staff secure access to key information such as lab and radiology reports and EKGs. The private HIE has united 13 EMRs from different vendors via interfaces to provide one data repository for enterprise access. Learn why they chose a private HIE, how it has evolved from 2006 until now and what advice they offer to other healthcare systems ready to embark on a private HIE project.
For more information contact: Slideshare@marcusevans.com
Presentation delivered by Josh Luke, PhD, FACHE, Founder, National Readmission Prevention Collaborative, Interim Chief Executive Officer, Memorial Hospital of Gardena at the marcus evans ACO Payer Leadership Summit Spring 2015 held in Las Vegas, NV
5 Ways Your Pharmacy Can Boost Your Revenue CycleCompleteRx
With rising drug costs and decreasing reimbursements contributing to shrinking margins (in 2014, according to Modern Healthcare, 61.3 percent of healthcare providers reported decreased margins from the previous year), hospitals continue to scrutinize their revenue cycles to ensure they stay in the black, and there’s an oft-overlooked resource they would do well to consider: pharmacy. Historically, the hospital pharmacy has been labeled a cost generator, but there are actually many ways this strategic department can positively impact each stage of the revenue cycle – from point of service to claim submission and more. This webinar will explore innovative tactics, including optimized processes, improved data management, and creative patient programs, which hospital pharmacies across the country can leverage to boost overall hospital revenue.
What is revenue cycle management? How does it impact your practice’s ability to maintain profitability? What are the critical steps to take when managing your revenue cycle? This Quirk Healthcare Solutions Insights webinar will lead you through the important healthcare provider business practice of revenue cycle management. We’ll discuss the stages of RCM, development of a fee schedule, establishing financial policies, billing and collection cycles, and the practical application of revenue cycle management.
6 revenue cycle metrics you must be tracking nowango mark
Learn how you can improve the financial performance year on year. Leverage your practice revenue cycle metrics by setting benchmarks & KPIs for your billing department - http://bit.ly/2hwlqpm
Eight strategies to get paid - Revenue Cycle ManagementJames Muir
Join revenue cycle management expert Elizabeth Woodcock & James Muir to dissect the eight strategies for surviving and thriving in today’s turbulent reimbursement environment. This webinar will empower you with solutions to make your practice a top performer. In addition, attendees of this live webinar can quality for CEU credits.*
After this session, you’ll be able to:
Evaluate payer contracting opportunities and pitfalls
Determine contract management procedures to ensure appropriate payment
Implement effective methods of setting patient’s expectations for payment – before the visit
Apply time-of-service collections techniques
Develop denial prevention and management procedures
Assess technologies to support efficient revenue cycle management
Identify staffing needs for successful revenue cycle management
Differentiate the elements of reporting key performance indicators for revenue cycle management
Five Ways For Improving Hospital Revenue Cycle ManagementHealth Catalyst
Besides improving your information systems and educating your staff on the ins and outs of managing revenue, there are many more opportunities for improvement. Here are five suggestions to help health systems improve their revenue cycle management: 1. trend and benchmark your healthcare data; 2. use an enterprise data warehouse to mine your healthcare data; 3. constantly ask frontline staff for suggestions; 4. monitor all payer contracts; and 5. maintain convenient and caring touch points with patients.
The benefits of revenue cycle and compliance collaborationBESLER
This presentation highlights the importance of the working relationship between hospital Revenue Cycle and Compliance teams. This complimentary partnership can become seamless by utilizing the data analytics obtained from 835 and 837 data sets, Return to Provider (RTP), CERTs, Readmissions, ZPICs, HACs, RACs and Transfer DRGs. The combination of this data can assist in quickly identifying and resolving issues prior to provider submission, reducing days in AR and improving cash in the door.
The Key to Transitioning from Fee-for-Service to Value-Based ReimbursementsHealth Catalyst
The shift from fee-for-service to value-based reimbursements has good and bad consequences for healthcare. While the shift will ultimately help health systems provide higher quality lower cost care, the transition may be financially disastrous for some. In addition, the shifting revenue mix from commercial payers to Medicare and Medicaid is creating its own set of challenges. There are, however, three keys to surviving the transition: 1) Effectively manage shared savings programs to maximize reimbursement. 2) Improve operating costs. 3) Increase patient volumes. With an analytics foundation, health systems will be able to meet and survive today’s healthcare challenges.
Trans-quest is a Healthcare Solutions provider..with a key focus on Revenue Cycle Management services for Physician Groups with a special emphasis on AR & Denial Management. Besides, Trans-quest has medical transcription capabilities and have been servicing various Group Physicians ranging from Multi Specialty, Cardiology, Endocrinology, Neurology, Ophthalmology, Oncology etc.
New Ways to Improve the Patient Experience: Because it Begins Before the Fron...TraceByTWSG
This presentation will review strategic initiatives for revenue cycle leaders to further engage patients in their care experience – beginning before they enter the hospital’s front door. The session will present key strategies and related outcomes in patient satisfaction, staff performance, reimbursement and upfront patient collections.
• Ensure meaningful upfront encounters with Patient Access – at each and every encounter.
• Hardwire measurable standards throughout Patient Access teams.
• Reduce process time and eliminate duplication for quicker patient turnaround.
• Ensure consistent practices across hospital entities and among associates.
• Avoid financial harm through automated documentation.
• Protect staff through documentation integrity.
• Increase visibility of – and access to – critical patient touch points across the organization.
Leading the development of Texas Health’s Patient Access infrastructure, Patti Consolver and Scott Phillips oversee the centralized patient access intake center and the patient access departments for the system’s 13 wholly-owned hospitals.
HRG Executive Vice- President, OutPartnering™, Jason Coffin , will discuss the delicate process of managing self-pay in times of economic crisis. He will share best practices and tools to effectively balance productivity with patient satisfaction through this unprecedented time.
Using Technology to Lower Costs & Delight CustomersBJ Hoffpauir
This presentation outlines the challenges facing manufacturers, distributors, retailers and ultimately Consumers of Health Care Products - particularly those in need of Durable Medical Equipment (DME) Supplies and Products like Breast Pumps.
With the passage of the Affordable Care Act, every participant in the Health Care Product, Service, and Delivery value chain is facing increased competition in the marketplace while simultaneously being pressured from both Consumers, Government and Insurance Providers to reduce costs, profits and waste.
It's an incredibly difficult challenge for even the most Agile and nimble startups that are well funded from Venture Capital Investors or Private Equity Groups, but for the established participants in the the DME Marketplace, many of whom are over 100 years old, some of the oldest companies in America, adapting quickly to changing market environments is not a capability they have ever developed. Many of these markets are heavily regulated and the ACA was the first major change to some of those markets in 50+ years.
This presentation discusses how ACA Ventures, owner and operator of some of the most successful retail and wholesale distributors of Breast Pumps and Breast Feeding Accessories and Supplies in the USA went from it's first order to becoming a national innovator leading the market in customer service and technological innovation based on Open Source technology like Magento and a commitment to agile principles, customer service and delivering real value to every one of its partners and customers in the value chain of their market.
Do our patients consistently receive evidence-based, effective care every time he or she needs it? This presentation discusses the concepts associated with high reliability:
Today Clinic Continues to Innovate and Thrive with KareoKareo
When Scott Mayer, MD, took over as Director of Today Clinic he could see there were billing and operational issues that needed to be addressed. They had tried in-house and outsourced billing but hadn’t found the right fit. He realized they needed a new billing service and a more integrated package of technology. Attend this free webinar to hear about how using a fully integrated suite of technology and billing services has helped Today Clinic focus on patient experience, growth, and innovation.
Health IT Summit in Seattle 2014 - Case Study "Health IT Transformation: Insurance Exchange and Provider Perspective" with Curt Kwak, Chief Information Officer, Proliance Surgeons
Making the Right Technology Investments for Your PracticeWebley MD
In this presentation, two industry experts will discuss how automated appointment reminders and automated lab results can have an immediate, measurable impact in key areas of your practice. These affordable, subscriber based medical communication technologies improve the efficiency and profitability of all practices, whether large or small. You’ll learn how to avoid making the costly mistake of failing to invest in technology in order to “save money” in the short run, while harming the long term viability of your practice by continuing to rely on costly, time consuming methods of communication.
Similar to Integrating Care Coordination in the Revenue Cycle (20)
This Conversation May be Recorded for Quality PurposesTraceByTWSG
Three industry leaders will share strategies to improve patient experience by recording, monitoring and scoring patient encounters.
As consumers, we have come to expect customer service calls to be recorded for quality purposes. This presentation will share why leading healthcare organizations are now following suit and incorporating recording and quality scoring throughout the revenue cycle. A panel of Patient Access innovators will share methods for monitoring and scoring patient encounters to improve patient experience. Attendees will hear outcomes and walk away with practical steps to standardize communication best practices among their teams.
Bookends of the Patient Experience: Improvement Strategies from Admission to ...TraceByTWSG
In this webinar, Yvonne Chase of Mayo Clinic shares strategies to improve patient experience across the continuum of care - from pre-service to post-servcie activities. This presentation shares tools and processes used to streamline patient access, coordinate patient care and conduct patient follow-up post discharge - all while monitoring patient interactions to ensure clear and accurate communication from the first point of contact to the last.
How Orange Regional Medical Center Reduced Readmissions by 30 PercentTraceByTWSG
Industry thought leaders from Orange Regional Medical Center, Nexus Health Resources and The White Stone Group will discuss care coordination strategies that have resulted in a 30-percent reduction in hospital readmissions at Orange Regional Medical Center.
Bookends of the Patient Experience: Improvement Strategies from Admission to ...TraceByTWSG
Yvonne Chase has a strategy. She shows how hospitals can prepare for the paradigm shift of value-based purchasing. She has the exact revenue cycle tools and processes used to streamline patient access, coordinate patient care and conduct patient follow-up post discharge – all while monitoring patient interactions to ensure clear and accurate communication from the first point of contact to the last.
Communicating Effectively: Strategies to Ensure the Quality of Communication...TraceByTWSG
Ensuring that patients receive clear and accurate communication from the first point of contact is critical to setting the stage for a positive experience across the continuum of care. In this presentation, Health First will share strategies to better manage communication with patients across the revenue cycle. The presentation will include discussion of a QA tool used to measure and improve the quality of patient interactions through monitoring, scoring and focused training with staff members.
Communicating Effectively: Strategies to Ensure the Quality of Communication...TraceByTWSG
Blair Wright (The White Stone Group, Inc.) presenting to Massachusetts Association of Hospital Access Managers (MAHAM) on how the quality of communicating with patients is directly linked to the perceived quality of care.
Rate Controlled Drug Delivery Systems, Activation Modulated Drug Delivery Systems, Mechanically activated, pH activated, Enzyme activated, Osmotic activated Drug Delivery Systems, Feedback regulated Drug Delivery Systems systems are discussed here.
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...The Lifesciences Magazine
Cold Sores, medically known as herpes labialis, are caused by the herpes simplex virus (HSV). HSV-1 is primarily responsible for cold sores, although HSV-2 can also contribute in some cases.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
The global radiation oncology market size reached US$ 8.1 Billion in 2023. Looking forward, IMARC Group expects the market to reach US$ 14.5 Billion by 2032, exhibiting a growth rate (CAGR) of 6.5% during 2024-2032.
More Info:- https://www.imarcgroup.com/radiation-oncology-market
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
COVID-19 PCR tests remain a critical component of safe and responsible travel in 2024. They ensure compliance with international travel regulations, help detect and control the spread of new variants, protect vulnerable populations, and provide peace of mind. As we continue to navigate the complexities of global travel during the pandemic, PCR testing stands as a key measure to keep everyone safe and healthy. Whether you are planning a business trip, a family vacation, or an international adventure, incorporating PCR testing into your travel plans is a prudent and necessary step. Visit us at https://www.globaltravelclinics.com/
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
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Great Intro Blair.And Welcome to everyone listening today from all across the great USA! Now, let me tell you a little about myself. I have been at WJMC for the last 16 years. As the VP of Care Coordination, my areas of responsibility include IP Case Management (which includes Case Managers, Social Workers, Discharge Planners, Discharge Expeditor and clerical staff), OP Care Coordination (which we will spend a little bit of time on here today) and PAS. As Blair mentioned Current Healthcare Challenges span the entire spectrum from clinical to financial and Care Coordination is the bridge that connects the 2. So, hopefully today I will be able to share with you some ideas and processes that we have implemented here for Care Coordination enhancement to improve the revenue cycle process. I will do my best to leave time for Q&A at the end of our time, but if time runs out, I will be happy to take calls/emails from you and my contact information will be listed at the end of the presentation.
Of course, I must take a moment to highlight West Jefferson by telling you just a few of our proudest accomplishments. West Jefferson Medical Center is a 427-bed not-for-profit hospital and health system located in Marrero, Louisiana, just outside of New Orleans. We have provided more than four decades of service to the West Bank of Jefferson Parish and the surrounding area. We are one of only three area hospitals that kept its doors open in the onset and aftermath of Hurricane Katrina’s arrival on the shore of New Orleans in August 2005. And I was there through it all, but that’s a story for another day!We have over 400 physicians on our Medical Staff, over 1900 employees, 67 volunteers, 23 Nurse Practitioners and over 350 contracted employees.Just to name a few of our most recent awards:-Top 100 Hospitals with Great Heart Programs (Becker’s Hospital Review)-Get with the Guidelines Stroke Gold Plus Achievement (AHA, Am. Stroke Assoc)-Mission Lifeline STEMI Gold Recognition (AHA)
Case Managers – 12Social Workers – 14Expeditor – 1D/C Planners – 3Clerical – 3Managers – 2Weekend coverage on site by both a Case Manager and a Social WorkerStaggered hours to allow coverage on site until 7:30 M-F and until 5:30 Sat and SunOn call coverage for all remaining hoursOP – 6 but in process of hiring a 7th and expect to continue to expand in this arena.
Many CM depts fall under the Nursing Division, which is outside of the Revenue Cycle areas. Here at WJMC, we have always been under the same umbrella with the rest of the Revenue Cycle Team.So, as you can see, we report to the CAO, and I’ve listed all the depts that fall under the same division. PAS, HIM, CM, PBS, (which are the typical revenue cycle depts) along with a few others.
So, what are our goals for Revenue Cycle Integration with Care Coordination?Well, at this point we have 3 main areas of focus:Bridging Communication GapsDecrease unnecessary denialsReduce readmission penaltiesAnd I’ll go into a little more detail for each of these as we continue through the presentation.
I’m sure many of you have this already in place, so like you, we have a Monthly Revenue Cycle Team Meeting. This is not a meeting with just the Directors and Managers of the dept, but it also includes the Respective Vice Presidents of the area, and the CAO. In order to really be productive and identify and strategize on our opportunities, we feel it is important to have Top Leadership in the meetings as well as some of the front line supervisors, managers in each area.
Some of the issues/topics we discuss, include coding, denials, trends, RAC audits, training needs (whether it be for staff, physicians, physician office staff, etc), And of course new rules and regs from CMS (as we all know that these change quite often and keeping up to date with them can sometimes be a challenge).
As I mentioned, the goals of Integration of Care Coordination in the Revenue Cycle, include Bridging Communication Gaps, Decreasing denials and reducing readmissions, So, how do we do this?For Bridging Communication Gaps:As I previously stated, we have monthly team meetings. And then depending on an issue that might come up, we may need to have additional subcommittee meetings.This also includes meetings to discuss new service lines being implemented like Palliative Care or Heart Failure Resource Center. Too many times, a dept begins implementation of a project only to find out at the last minute that Go Live has to be delayed because they forgot to get the input from PBS on how they were going to bill or what codes were to be used and what the charges were going to be. Or, they forgot to include registration to see what accomodation code is to be used and how the pt will be registered and if a registrar would be needed in that area vs. presenting to central registration. Involving all the players is essential to the success of a roll out of a new service. For example, the ortho service wanted to implement a new product that was to replace our standard SCD pumps in house, which included a portion of pump use at home. No-one included CM and we were the ones who knew if the payors would authorize such a new product.
Another way to bridge the Communication Gap is Education! We all know that consistency and accuracy in our workflow prevent errors which could lead to unnecessary denials. In addition, staff turnover can also lead to increase in errors due to learning curves of new staff. So, the #1 thing we can do is to constantly Educate. We educate each other between the various depts (for ex: contract changes, coding changes, denial reasons, trends, etc). We do quarterly Physician Lunch and Learn sessions, attend monthly Hospitalist meetings and submit articles for inclusion in the Physician newsletters. -In addition, we will go as a team to physicians offices to educate them on processes relating to prior auth requirements from payors, etc. We recently met with a Neurological group regarding differences in levels of care for elective surgeries and what this means to us and to the payors and why the communication between the physician offices, the payors and Case Management is essential to ensure accurate and appropriate billing.We also have Interdisciplinary meeting for service line development: For example…-CTC development (Care Transition Clinic)-Heart Failure Resource Center development-Cancer Center-Palliative Care-urgent care clinicWe make sure all depts affected in any way, sit around the table together to discuss before the roll out of any new service. As a nurse myself, we know that clinicians think about what they can do clinically to help our patients, but someone has to think about the charging, coding and billing process in order to ensure payment for the great services we decide to implement.
We thought this slide would be a good way to show all the phases where CM and Revenue Cycle integration is crucial to cash flow.Admission PhaseProviding clinical reviews to payors for urgent/emergent admissions. Admission review of elective admissions.Early identification of discharge needs. Concurrent PhaseApplication of utilization management criteria such as Interqual or Milliman Care Guidelines to all inpatientsProvide timely concurrent continued stay reviews for payers and take appropriate action when criteria are not met.Discharge PhaseFinal review of authorized daysExecute the discharge planPost-discharge PhaseActive denials management and timely response to post-billing denials and outstanding reviewsClearly identify how denials management responsibilities and accountabilities are divided between finance and case management (medical necessity, appeals process)Follow-up with patients with discharge plans including home care and durable medical equipment
Let me reflect back on some of our challenges in CM before reviewing our 3rd way to Bridge Communication Gaps……-Some of our challenges included:1- Medical necessity denials (2000 - medical necessity denials were more than $700,000)He-said, she-said challenges Discrepancies over number of days approved, appropriate level of careDisputes over payment when case manager gave clinical but payer had no record of call2-Documentation FailuresInability to document routine communication, other than manuallyDifficult to remember to document in the financial system post discharge, which still sometimes happens today (however we ask the business office to check TRACKER before calling CM to research)Inaccurate or incomplete documentationPatient account numbers transposed, putting the information on the wrong account, preventing retrieval later on. (HL7 interface in TRACKER so it is much less likely to have errors like this)3-Time Constraints: Inefficiencies, Delays, UnderpaymentConstant rework in collections (back and forth between business office, case management and payer)Payment delayed an additional 30 to 60 daysIncreased medical necessity denialsUnderpayment for services rendered-So, as you can see…..from eligibility and benefits, to precert to authorized days to physician communication and discharge placement, COMMUNICATION is complex!-and our communication activities are: -numerous -daily -across multiple venues -many times seem insignificant – and often overlooked -and they have VALUE!-so, we implemented a tool that allowed access to transparent, timely, patient information and data which is another way that we bridge the communicate gap and integrate CM into the Revenue Cycle.Next Slide please
So, Technology Implementation…..-we implemented TRACE Tracker. This gives everyone access to the same information and it is time stamped. This tool allows depts like PAS and CM to record calls (both incoming and outgoing) or to keep track of authorization logs, denial letters, etc from the payors so that if there are any discrepancies on the payment on the back end, the Business office can just look in TRACKER and pull up the information. Once retreived, they can share that information with the payors claims dept to resolve any issues we have with underpayment of claims or false denials. -Again, as I said, all depts can access information entered into the system by the other depts. It allows for more efficient use of time and proof of the authorization which leads to a decrease in denials. It saves paper and toner and eliminates filing cabinets.Another way that this tool helps is on the Discharge Planning piece in the hospital which allows for blast faxing to multiple post acute care providers and it helps in the OP setting which I will go into a little later.
So, looking back at this slide that I showed you a little earlier, lets walk through each step in the process to show CM’s role in the Revenue Cycle process and why this is so important to your bottom line.
Pre-Admit Phase:-CM reviews cases for appropriate level of care based on Medical Necessity criteria (or the 2MN ruling) and informs patients of their level of care and what it means to them.-We also review all elective surgeries for appropriate level of care as well as for IP only procedures to ensure orders are correct at time of admission to ensure accurate auth is obtained if needed by the payor and to ensure appropriate billing/payment.-and we all know the payment could be vastly different for OBV for IP so it is essential to ensure we get the level of care correct to ensure we get the right payment for the services we provide.
Admission Phase:-Admission notification is required by the payors or they are quick to issue an administrative denial. So, we record all admission notifications to prevent any denials, as we will be able to prove to the payor that the notification was indeed done.-Eligibility and Precert calls are also recorded so that not only do we have proof of authorization but prook of what level of care the auth was called in for. We then can listen to these calls for quality assurance, which helps us to identify opportunities, which if found, we can then re-educate the appropriate staff. For ex: Perhaps the registrar called it in for an admission but it wasn’t clear if it was for OBV or IP and later there is a dispute about it. Listening to the calls allows you to identify your opportunities and correct the issue.-Documentation of clinical reviews. We do this through calls and/or faxes depending on the payor. Both methods are done using the tool so that we have documented proof that it was done. Again, listening to these calls allows you to hear the details of the clinical review, hear the approval decisions and if opportunities were identified, we can correct the issue. For example, we had identified that when the CM’s were recording the calls, they may forget to initiate the recording at the beginning of the call when the patients name was mentioned, and they hit the record button just for the approval part. The problem was that on the back end, even though we had a recording, there was no proof of what patient it belonged to therefore it did nothing for us. Re-educating the staff and letting them hear the call and how it was not going to help us make a case on the back end, made them realize the opportunity and change their process.
Concurrent Phase:-Pretty much the same process as admission with utilizing faxes and recorded calls to ensure proof of clinicals being sent to the payors was captured.-this is a huge time saver and we have eliminated fax machines as these faxes are able to be sent through the computer workstation without ever having to stand at a fax machine.
Discharge Phase:-At our facility, social workers are responsible for securing placement for patients in need of additional care upon discharge. Prior to TRACE, social workers used the following process for discharge planning:-Compiled hard copies of documents such as patient’s medical record, history and physical, x-rays, medication list and progress notes-Manually faxed the 30-page document to nursing homes and long-term care facilities-Continued sending faxes until placement was secured, often having to update the information or feed the fax one page at a time-Spent minimum of 5 hours per week on discharge planning as a department-This process took time away from the patient at the bedside as they were busy standing by a faxNow that we’ve changed our process, clerical staff can assist in discharge planning. -Clerical staff use FaxCert to send discharge placement forms to multiple facilities at one time. Allowing my Social Workers to spend more time at the bedside with the pt instead of doing clerical type tasks.-they can PixCert orders out of system and fax directly to LTAC’s and NH’s, and sometimes home health agencies without having to print a single piece of paper from the EMR.-Blast faxing function allows staff to fax the forms to pre-determined distribution lists through DCR Tracker. And we can later expand the search for difficult placements by just selecting the original transaction in Tracker and resending to a new group of facilities.-If placement is not secured after the first distribution, the fax can be resent to a new distribution list with an expanded search area (no need to redo paperwork)-If the patient’s status changes, staff can add an addendum to the fax with new progress notes instead of re-doing the paperwork.Of course, the EMR that we use is Cerner and we have been very successful with capturing this information using the tool without ever having to print 1 single piece of paper. This tool quickly became the staff’s best friend, but there was lots of resistant to the process initially (as we all know how resistant people can be to change).Next Slide please
Post Discharge Phase:-As I’m sure many of you face the same challenges with claims payment as we do, and often times a claim gets rejected/denied the first time out the door.-this is why bridging that communication gap and having a tool that can be used by the Business office to help get these claims paid timely is so important.-CM used to be very involved on the back end when claims were denied and many hours had to be spent researching cases and even calling back the payor review nurse back weeks after discharge to fight a claim dispute. Now, we are rarely involved as the Business Office does the research in TRACE themselves to get the proof they need to send to the payor to get the claim paid. The only time we really need to get involved is when TRACE was not used, which then leads to staff re-education!-Another part of the Post Discharge Phase is patient follow up which we’ll talk in further detail in just a few minutes.
So, I know we’ve talked about a lot, so I just want to remind you of our 3 goals of CM integration into the revenue cycle: Bridging the communication gaps, Decrease denials and reduce readmissions. We’ve talked a lot about the 1st one and have touched some on the 2nd one with decreased denials but here I’m going to touch a little but more on Goal #2 of why integration of Care Coordination into the Revenue Cycle is important….which is denials-so, we know that Proof of authorization lead to decreased denials-Our process now allows for more efficient use of time – PBS can search TRACKER for authorizations, proof of notification, proof of clinicals being sent in, etc and provide that to the payor either through email or they can even play the recording back over the phone to the payor to expedite claims reprocessing.I want to give you a recent example, we had a payor in the last 6 months who sent letters to PBS regarding payment recoupments on several patients resulting in upwards of 50K dollars. Lucky for us, the Business office keeps CM “in the know” when things like this happen. We have a financial system where CM puts notes to indicate authorization and these were clearly documented as approved by the payor. But of course, with just that, it was my word against theirs. So, we looked up all those accounts in TRACKER and sure enough we had logs from the payor with the actual approval from them on their template form. We called a meeting with the CAO, VP of Revenue Cycle, myself (VP, Care Coordination) and the payor which included their Executive Director, their UM Manager and their Medical Director. We laid out on the table all the approval logs from them on these patients they were trying to recoup on. Needless to say, we won on all cases AND in the process, the payor realized they had holes in their process that they needed to correct, which took them several months to do. It was agree that no further recoupments would take place after a secondary review on their claims unless and until they had a clear process in place.
Our initial outcomes:-Avoided initial denials from payors by showing documented proof of calls.-improved turn around time on claims payments by 30-60 days.-Increased percentage of medical necessity denials overtuned by providing proof of clinicals or insurance logs with days certed and level of care-reduced number of medical necessity denials-allowed case manager previously handling appeals to take on a full case load and handed off the appeals process to PBS.
Goal #3 of Integrating Care Coordination and Revenue Cycle…Reducing Readmissions. We all know that the penalties for readmissions keep increasing in percentage and the DRG’s that are looked at keep increasing so minimizing readmissions is essential to the bottom line and CM plays an integral part in that.This is one of my favorite topics….OPCC and the CTC (which is our Care Transition Clinic or “Discharge Clinic”) was created and implemented mid 2012.For OPCC:-We created a home grown registry to capture discharges from our BOOST units, as well as anyone assigned to a Hospitalist-Later, we further expanded the program to include all patients who had a cardiologists on their case while they were IP-These patients get called at 48-72 hrs post discharge to review meds (if not already done by the NP during the CTC visit), follow up appointments, disease process education, signs and symptoms to look for , telephonic assessment of pt (wt gain, diet, BP, Bld sugar readings, leg swelling, etc). These calls are then done weekly or more often depending on the pts needs up until 31 days post discharge.Calls are recorded for quality purposes to ensure quality of calls, ensure teachback is done, review for complaints rec’d and to go back and review on a readmission to see if we missed picking up something in the phone call that could have prevented the readmit. -When opportunities are identified, the employees are called in to listen to their calls to see where the opportunity lies and it has proved to be a good learning tool for the staff. -When the program was first rolled out, we weren’t recording the calls and I suspected that teachback was not being utilized. So, we started recording and sure enough, we had gaps where teachback was NOT being done. Once the staff were re-educated on the importance of the teachback method, and they knew we were listening to calls, their practice of using teachback improved. -We have made it one of our PI projects for the dept and track by individual and have reached our benchmark of 90% for the 1st quarter this year.Another thing they do is follow up with the HH agencies/DME companies to ensure everything is in place. Often times the HH may say that they haven’t received the discharge information. Although this is sent by the discharge planners at the time arrangements are made, it gets overlooked or not into the right hands. -The OPCC have the ability to go into the system we use and just hit resend instead of pulling up the medical record, printing it all out and faxing it to the number. No paper is required. If they need additional information, they can capture the information in the EMR through TRACE and fax it over through the system without ever having to print anything out. -This reduces time, saves paper and toner for fax machines and printers.
Of course Hospital Compare data is always a few years behind, I just wanted to show you where we were initially.For MI, we went from 20.1% to 18.4% and continue to see downward trends concurrently.For CHF, we’ve gone from 27.7% to 22.5% and this is before implementation of our Heart Failure Resource Center which we believe to be attributing to further reductions concurrently. For the data we capture internally more concurrently, our CHF has dropped again in 2013 to 20.67% and ytd for 2014 is 16.25%. -We are so excited about our Care Transitions Program with our OP Care Coordinators telephonic follow up, the CTC and the HRFC and we are confident that we will continue to expand upon our programs and see continued reductions in readmissions
Goal #3 of Integrating Care Coordination and Revenue CycleFor CTC:We have a NP that runs a discharge clinic and sees patients discharged from the hospital within 24-48hrs. The purpose of this visit is to review their medications and ensure accuracy of med rec, review signs and symptoms of their disease process and to ensure all appropriate follow up has been scheduled. The NP basically does the transition of care and hands everything in a nicely tied package with a bow to the PCP prior to their follow up visit with the PCP (which is usually 5-7 days post discharge). This is a FREE visit. Appointments for the CTC are made prior to the patient leaving the hospital. The clinic is located on the main hospital campus with a separate ground level parking lot for easy access. We have now created within that same building a Heart Failure Resource Center to assist with management of our chronic CHF pts to help further reduce readmissions. This was a soft go live in last qtr 2013 and continues to grow.In addition CM works closely with HIM on AMA’s and planned readmits alerting them up front to ensure the disposition codes are accurate, not only for billing purposes but to help identify opportunities with readmissions if indeed it is an exclusion criteria for the readmit. For ex; AMI pt who returns for a CABG is an exclusion for a readmit. Although CMS is not looking at these in relation to the Readmission Reduction program at this time, it allows us to track and pull reports when looking for opportunities to prevent readmits. AMA’s however are always excluded and was already an existing code so we want to make sure those are coded correctly to prevent unnecessary penalties.Another project we are working on and hope to implement by June 1st is for our EMS dept. to check in on chronic patients as needed. This would be a referral from the NP at the CTC or an OP Care Coordinator who has concerns about the pt. We are hoping that early intervention in these cases will further reduce readmissions.
Here is another slide that shows all DRG’s and is more current data than Hospital Compare.-We track Hospitalists vs. Non Hospitalists because only our Hospitalists patients go to the CTC clinic visit (and this is at the request of the Non Hospitalist physicians). We of course are continuing to track this data and have discussions with the Non-Hospitalists to show the impact in hopes that we can get their approval for their patients to come to the CTC.-Our own Primary Care Physcians were initially hesitant to the CTC and the OP Care Coordination follow up as they felt burdened by some of the calls that took place after discharge to the PCP to clarify certain things like meds, diet, HH orders, etc, HOWEVER they soon realized the benefits to them and now get upset if one of their patients doesn’t go to the CTC post discharge (as the transition to the PCP for their first follow up visit with the patient is not as smooth and often time consuming).As you can see the hospital overrall went from 12.93% in 2012 to 10.44% ytd in 2014 which is a decrease of 19%.
28% reduction in readmits since implementation.
Integration of Care Coordination and Revenue Cycle are integral to the success of hospitals today. With the ever changing rules and regulations from CMS as well as continued Medicare cuts to both Hospitals and Physicians, it is essential you have a Revenue Cycle team in place that includes Care Coordination. This will lead to better outcomes, decreased denials and penalties and improved transitions of care through improved communications. Involving the patient and caregiver in the Plan of Care is key to success in maintaining our patients quality of life and keeping them healthy and active outside of the hospital setting.