Product Spotlight: Patient Accounts Management
Documentation, auditing tools target RAC program, pay-for-performance goalsPatient accounts management is a critical business function for pay-for-performance and the Centers for Medicare and Medicaid Services’ Recovery Audit Contractor programs. Healthcare providers need to monitor patient financials from admission to discharge and accurately document care details to prepare for potential audits and denied claims or opportunities to receive P4P funds. “As the hospital’s capacity continues to grow, just as a normal business process, it’s important for them to understand how the patient is moving through their operations,” said Jim DeWeese, senior vice president of ACS Healthcare’s solutions group. “As soon as the patient is admitted to the hospital, you better be working to figure out when they are discharged and where they go when they are - whether or not the payer is coming back in and taking a look at reimbursement.” |
 Patient accounts management is a critical function for hospitals seeking to receive pay-for-performance incentives, among other projects. |
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3 TRENDS TO WATCH
Jim DeWeese of ACS Healthcare and Lois Thoman, product manager for ACS’ MIDAS+ Care Management believe patient-related financial issues are greatly affected by the following trends, which should shape accounts management solutions in the coming year:
1.RECOVERY AUDITS: "Certainly there’s a strong trend related to the government payer looking to come in and go after more of the reimbursement dollars they’ve already paid," said DeWeese. Strong clinical data is key in supporting accounts data. 2.DENIALS MANAGEMENT:Denials management is critical to patient financial services, said Thoman. “The patient financial services folks need to understand quality data and where that data is going,” she said. It’s important to know what information in claims can result in denied payment. 3.PAY-FOR-PERFORMANCE: Patient financials should be closely tied to care documentation - a procedure of great importance in light of pay-for-performance trends. "As (payers) move towards P4P, there’s more pressure on the hospitals to make sure they’re documenting the clinical aspects of the patient stay in sufficient detail," said DeWeese. "That's certainly driving the need for hospitals to document their medical necessity and take their clinical documentation tools to higher levels and more detailed levels." |
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VENDOR SHOWCASE |
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Affiliated Computer Services (ACS) |
Boston Software Systems |
Caremedic Systems |
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Connance |
Navicure |
NextGen Healthcare Information Systems |
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Siemens |
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User Reviews |
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 "Using MedicareRT, a multi-entity healthcare provider organization under my direction was able to reduce Medicare aged AR greater than 60 days from discharge to under 2 percent in aggregate for over 50 acute care hospitals in 13 states. Prior to installing the CareMedic product, we had been averaging 12 percent to 15 percent aging greater than 60. We maintained this impressive aging statistic consistently for over two years."Rudy Braccili, director of revenue cycle services, Boca Raton Community Hospital. |
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 "Siemens’ advanced product design enables proactive process management. It’ll give us the consolidated foundation we need to extend best practices across the organization.”Richard Silveria, corporate director of revenue finance, Partners HealthCare System. |
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| "The University of Maryland Medical System implemented MIDAS+ in March, 1998. The Division of Clinical Quality Systems has been able to integrate work processes within and among a variety of departments and has had a tremendous impact on our productivity." Barbara Davis, vice president, clinical quality systems, University of Maryland Medical System. |
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 “I continually review workflows in an effort to automate manual processes. In our patient billing and financial services department, we had a homegrown program that scripted notes from the legacy denial/underpayment management system back into the MEDITECH billing/accounts receivable patient account. Over time, we found that using the homegrown solution was tedious, time consuming and required manual steps. Ultimately, we lost the ability to support this solution. We turned to the Boston WorkStation scripting technology to automate the process. It only took a few weeks to develop the script which starts every morning by running a Crystal report and exporting it to Excel. Boston WorkStation then posts notes into MEDITECH, applies an Excel pivot table to the original report, and sends an email to specific users with details of successes or failures. In addition, the Boston WorkStation script is able to save the files, once complete, to a network location with the specific date associated to the notes. Now, our department can provide the data properly formatted because it goes into the system cleanly, and the appearance in the notes section is standardized.” Kim Scaccia, systems administrator, patient business financial services, Halifax Community Health System, Daytona Beach, Fla. |
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 “Our A/R days prior to Navicure were at 59 and within six months we were able to get our A/R days down to 29, and it’s stayed relatively the same ever since then.” Pamela Hildebrand, business office director, Shepherd Eye Center. |
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 “The NextGen system provides outstanding reports that help us manage our A/R. We run reports by payer and by ‘aging bucket,’ so we can take a strategic approach to collecting the oldest and largest accounts. We also use tasks within the system to double check that no claim falls through the cracks”Kimberle Kennedy, Ironwood Dermatology, Tucson, Ariz. |
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