Here's what your organization should be doing to protect patient data.
When it comes to cybersecurity, healthcare is lagging behind other industries. The increasing frequency of cyberattacks has put numerous organization's on their guard and tightening up security is the best first step. Here are some tips to consider implementing.
A new survey's findings show that physician reimbursement has per patient decreased by 2.3% between 2005 and 2021.
The Medicare budget neutrality requirement is intended to balance the program’s expenditures against its budget as new services are added and volume increases. However, the findings of a new study by the Harvey L. Neiman Health Policy Institute show that hasn’t been the case.
Researchers examined the changes in payments for Part B services for 100% of traditional Medicare beneficiaries between 2005 and 2021.
Looking at the changes in payments for Part B services for all Medicare beneficiaries between 2005 and 2021, researchers found that physician reimbursement per patient decreased by 2.3% and patients saw a 45.5% increase in services.
Additional findings showed a 9.9% increase in payments per beneficiary across all medical providers and suppliers and a 206.5% increase in payments to non-physician practitioners. Payments to limited-license physicians increased by 16.3% and those to medical suppliers increased by 44.4%.
Low Medicare reimbursement rates continue to be a pain point for providers. In March, President Joe Biden signed a spending bill which cut the Physician Fee Schedule reimbursements rate down to 1.69%.
In a statement, Joshua Hirsch, MD, Neiman Institute affiliate senior research fellow, warned that the continued decline of Medicare reimbursement may negatively impact patients’ access to care.
“Continued decline of Medicare reimbursement relative to reimbursement by private insurance incentivizes providers to favor privately insured patients,” he said. “Our study pinpoints the extent to which real decreases in reimbursement are occurring despite greater consumption of care.”
Catherine “Mindy” Chua, DO, chief medical officer of Davis Health System, previously told HealthLeaders about how the cut will affect health systems and the physician practices they own.
“The physician fees are going to the hospitals to maintain the physicians they employ. We are not going to be decreasing what physicians are paid because Medicare is cutting our reimbursement,” she said. “You are not going to keep physicians if you do that.”
An overhaul of the facility's practice management system helped stabilize its finances.
Financial stability is a concern for many providers and it’s no different for central Alabama-based UAB Selma Family Medicine Center.
In 2022, staffing challenges and limited resources had the practice struggling to ensure quality of care and efficient operations, which began to negatively impact the financial state of the facility.
The medical center knew that their time should be spent focused on their patient population and not billing office tasks. To improve efficiency and streamline operations, the facility decided to implement new tech solutions into their processes, specifically for billing.
“I wasn’t really happy with how hard [staff] had to work to get the claims paid and money in the bank,” Jeff Denney, administrative director, told HealthLeaders. “It wasn’t always timely. I didn’t have good reports. It was hard to check in to see how [operations] were doing on the surface.”
Selma Family Medicine had always done its billing in-house but Denney saw the potential to improve efficiency with a new practice management system. While the implementation was successful, there was a learning curve to overcome as the facility’s previous system had been in place for about a decade.
“[At the time] everybody on the leadership side of the business office was very tenured and were reluctant to learn anything new, so that was a hurdle,” he said. For the most part, Denney added, staff weren’t apprehensive about bringing in a new system because they knew it would ultimately help them.
While demoing the new system, he was particularly impressed with having a team on the system’s side managing the reporting for coding, billing, and collections, and how much easier it made things for him and business office staff.
As part of the reporting support, the system has a feature that shows real-time updates, where staff can see where any holdups or missing items are and help move processes along.
“By outsourcing, you’ve got people who are working all day, every day, know the business in and out, and supporting you at a high level,” Denney said. “I feel like I know a lot more about the health of the practice, especially, as far as the claims, billing, and collections go.”
Not only did the new system solve an immediate problem, but it improved workflow efficiency. Staff now have time to complete other tasks in addition to their usual ones, and the practice’s billing, coding, collection, and reimbursement benchmarks have seen substantial improvement.
There has been a reduction in overall denials and day in accounts receivable, the latter by 78%. The gross collection rate has gone up 39%, as well as payments per encounter by 64%.
When it comes to revenue cycle management, AI must undergo more "evaluation and refinement" before it can be used for coding.
Artificial intelligence has become a popular solution in revenue cycle operations, but some tasks are best completed with a human touch.
A study from the Icahn School of Medicine at Mount Sinai has found that large language models, state of the art artificial intelligence systems, have limited accuracy when it comes to medical coding.
“Previous studies indicate that newer large language models struggle with numerical tasks,” Eyal Klang, MD, director of the D3M’s Generative AI Research Program, said in a statement. “However, the extent of their accuracy in assigning medical codes from clinical text had not been thoroughly investigated across different models.”
Researchers used over 27,000 unique diagnosis and procedure codes, excluding identifiable patient information, and asked LLMs from OpenAI, Google, and Meta to produce the most accurate medical codes. All three models showed limited accuracy in reproducing the initial medical codes.
“Our findings underscore the critical need for rigorous evaluation and refinement before deploying AI technologies in sensitive operational areas like medical coding,” Ali Soroush, MD, MS, assistant professor of data-driven and digital medicine at Icahn Mount Sinai, said in a statement.
The study’s findings will come as a disappointment to health systems struggling to hire medical coders and considering digital expansion to assist them.
After integrating AI into its bedside procedures in 2023 to assist with medical coding, Henry Ford Health was able to utilize staff in other areas that needed them.
“Regarding the big picture on the people side of Henry Ford Health, it reduces the daily workloads on physicians, medical coders, and billing administrators,” Joann Ferguson, vice president of revenue cycle at Henry Ford Health, previously told HealthLeaders. “Driving better financial and operational performance while improving our coders’ job satisfaction.”
Authors of the Icahn Mount Sinai study maintain that AI has potential but warn that there must be continuous development in order for it to be a reliable and efficient solution for the healthcare sector.
As RCM solutions grow in utilization, revenue cycle staff set the standard for efficient operations.
With the growing interest in revenue cycle management and automated solutions, there isn’t much focus on revenue cycle staff. This doesn’t mean that they’re less important to operations—in fact, staff play an important role in the successful implementation of RCM solutions.
Here are some HealthLeaders stories that reflect the importance of revenue cycle staff.
When an organization makes the decision to implement an RCM solution, a common misconception by staff is that they’re being replaced. In reality, the solution is intended to make their jobs easier by completing the simpler, repetitive tasks, enabling them work on more complex tasks.
“It’s [important] to show them the value [of the technology], get their buy in, and have them realize how it affects the whole practice,” Sherri Lewis, director of revenue cycle for Boulder Centre for Orthopedics, told HealthLeaders.
The rise of cyberattacks has made cybersecurity a priority in healthcare. Cyberattacks have the potential to disrupt operations, leaving providers unable to submit claims or even process payments. Situations like the Change Healthcare ransomware attack have demonstrated the importance of having individuals on staff that understand the changing digital landscape.
“There is a newer wave of IT leaders that grew up from the operational side of business and weren’t just tech people,” Bill Arneson, director of business operational transformation at Moffitt Cancer Center, told HealthLeaders.
Every employee begins their journey as a candidate, and it’s talent acquisition team’s job to know what to look for. From there, the best way to retain staff is to talk openly about what they want their future within the organization to look like—or show them. Succession planning is a good strategy to help employees actively work toward their goals and ideal titles.
The hiring process begins with the human resources department knowing what to look for in potential candidates.
At Moffitt Cancer Center, Lynn Ansley, vice president of revenue cycle management, has established a strong partnership with the organization’s talent acquisition team, calling them the “first line of review.”
“With seasoned professionals, we’re looking for very specific certifications from a specific set of governing bodies,” Ansley explained to HealthLeaders.
“It’s all well-defined within our job descriptions and we have a lot of checks and balances throughout the whole recruitment process to make sure we’re getting the right candidate with the right credentials for the right role.”
Moffitt does a good amount of outreach for niche roles requiring experience that can’t be cultivated in house. However, there are different methods in place to enable current team members to move up in the organization.
For example, within its coding team the organization has apprentice coders, where entry-level employees are able to start on the path to becoming a medical coder.
Previously, when most employees were in the office, Moffitt would offer classes where coders could come in to be trained on oncology and sign a contract committing to work with the organization for two years after graduation.
“We have not brought it back since the pandemic,” Ansley said. “But it’s something we’re actively talking about because we really just want to make sure that we’ve always got the pipeline of talent for those harder-to-fill roles.”
Moffitt’s talent acquisition team also creates partnerships with colleges and universities in the surrounding community, speaking with students, informing and getting them interested in different roles in healthcare and revenue cycle.
Succession planning in particular has been a successful strategy for developing a internal talent pipeline.
Entry-level roles can be hard to hire and retain, but showing employees a career path, as well as providing training opportunities, can make a difference.
“We’ll bring them in as Customer Service Representative I and after six months they’ll be able to apply for Level 2, and there’s a pay differential between them,” Ansley explained.
“There’s also opportunity for things like certifications that then build their resume and get them ready for other roles.”
Three areas revenue cycle leaders should pay attention to.
During last month's PFE NOW Summit, leaders noted three areas crucial to a seamless patient financial experience: communication, good customer service, and a simplified billing and payment process.
Communication
Systems should have multiple channels of communication to accommodate varying levels of technological knowledge and language barriers within their patient population, and ensure accessibility.
Customer Service
With patients covering more of their healthcare costs, price estimate and transparency tools can help them understand their financial responsibility before receiving care. Patient portals and their different functions can give them additional control over their care.
Billing and Payments
Billing statements should be formatted in a way that patients know what they’re paying for. If your system offers payment plans, there should be a team that oversees set-up and can be contacted to answer questions.
CMS found Stanislaus Surgical Hospital to be out of compliance with Medicare and Medicaid program requirements.
Since being found out of compliance with the requirements for Medicare and Medicaid in February, the fate of Stanislaus Surgical Hospital has gone from bad to worse.
On April 11, CMS issued a notice to the 23-bed short-stay Modesto, California hospital terminating its Medicare Provider Agreement, effective April 30. A complaint validation survey conducted found the hospital was out of compliance with a number of the Medicare Conditions of Participation, including nursing staff, pharmaceutical services, and surgical services.
With the termination of the agreement, the hospital won’t receive any payments from Medicare and Medicaid programs for care provided to patients admitted after April 30. Payment for care provided to patients admitted before the termination date would have been available for up to 30 days afterward.
According to a local news publication, the hospital has notified Stanislaus County officials that it will most likely close on April 30 for an “undetermined time,” with employees being laid off between April 29 and May 1. A statement from the hospital added that it is challenging the CMS’ decision to terminate its provider agreement.
Rather than closing the hospital, Mani Grewal, chairman of the Stanislaus County Board of Supervisors, told a local news publication that CMS should give the hospital some latitude to get in compliance with the Medicare standards.
“If there are some things they need to fix, there is an intermediary process where they can help them get through some of those violations,” he said. “We feel that is a better position than shutting them down, especially when we are low on healthcare services in the county.”