This post was originally published at Barton Associates.
Oregon’s state legislators recently passed a law designed to streamline the credentialing process for all healthcare organizations in the state. The bill, SB 604, requires the Oregon Health Authority establish an electronic database by 2016 that will contain all the information needed to credential a healthcare practitioner. All credentialing organizations, including hospitals and healthcare organizations, will have access to the database. The bill creates a system that is similar to neighboring Washington’s electronic credentialing system, except for one major difference. Oregon’s system is compulsory.
“When you don’t require something, and it doesn’t get used, you’re not really making a difference,” Jean Steinberg, CPCS, CPMSM, director of medical staff services for St. Charles Health System in Bend, OR, told HealthLeaders Media.
The news of a state-wide credentialing system may not be good news for locum tenens practitioners. Oregon is actually the second state in the country to require all healthcare providers use the state-managed credentialing body. Arkansas has its Centralized Credentials Verification Service (CCVS), which all organizations credentialing physicians for Arkansas and all physicians licensed in Arkansas must use. The CCVS system has done little to speed up the credentialing process in Arkansas. If anything it has made it worse. Whitney Jordan, credentialing manager at Barton Associates, says the turnaround time for Arkansas is one of the longest in the country, mainly due to the lack of staffing available at the state medical board and the lengthy CCVS process.
Time will tell if Oregon’s process will be quicker. Oregon’s lawmakers have two years to iron out the details of their new system, including how closely the system will scrutinize the information entered by each physician. Steinberg predicts that many organizations, including her own, will continue to independently verify physician information when credentialing a new physician, which means physicians may need to go through two credentialing processes, one for the state and one for the facility, before they can practice.
This post was originally published at Triple-Tree.
The passage of the Affordable Care Act empowered CMS to encourage the healthcare market to refine or in some cases develop new delivery models through changing reimbursement structures as the market evolves from pay for volume to a pay for quality.
These two reimbursement models are at odds as volume keeps the lights on for providers, but new incentives and penalties related to quality are challenging their profitability. This is an important point as the new initiatives encouraged by CMS can carry both a carrot and a stick but often just a stick.
- Hospital Acquired Conditions (HAC) and Readmission Reduction Programs are mandatory programs that penalize lower performing hospitals.
- HAC’s focus on patient safety and infection measures will force hospitals to evaluate their operating room workflow and their ability to ensure proper sterilization. Surgical instrument tracking solutions will play a critical role in supporting these efforts (see my colleague Elliot Amundson’s recent blog on that topic); and readmissions in the context of the current pay-for-volume reimbursement model can be challenging as hospitals have received additional reimbursement for readmissions.
- With the Readmission Reduction Program, hospitals may weigh the loss of revenue through readmission reduction efforts against the potential penalty for those with higher readmission rates than the national average. At what point does the penalty outweigh the investment to reduce readmissions plus the incremental revenue that it provides?
- In the case of bundled payments, a participating provider selects a specific condition or procedure and accepts a capitated payment. This arrangement with CMS gives the provider an opportunity to bear the risk and reward for the cost of delivering care for a particular condition or procedure. Providers can capture the financial rewards by finding and correcting current inefficiencies in the delivery of care and redesigning the care coordination efforts across multiple parties for that particular condition or procedure.
- Value-Based Purchasing also creates an opportunity for providers to participate in both risk and reward based on three key areas: clinical process, patient experience and mortality. Depending on a hospital’s score against the industry average and its individual performance over time, a hospital will receive either an increase or decrease in reimbursement. Value-Based Purchasing attempts to ensure that hospital efforts to decrease the cost of care do not sacrifice efforts to provide quality care.
The graphic below adds some additional context for these four programs:
Hospitals continue to invest time and money to meet ever-changing regulatory focus and requirements, and many are consumed with the ambitious goals of the Meaningful Use provisions in the HITECH Act. With the functionality and investment now taking shape, hospitals will be able to address CMS’s ultimate goals of increased patient safety, improved care coordination and better overall outcomes. Companies positioned to support hospitals in these new endeavors will find increased interest and engagement from the provider community.
Let us know what you think.
This post was originally published at medical practice insider .
Running a practice requires not just successfully caring for our patients, but managing efficient operations to ultimately make a profit. Not only are we trying to tackle healthcare reform changes and requirements, we’re seeing an influx of patients — many of whom are newly eligible to receive care under the Affordable Care Act (ACA), which brings added work.
As I’m sure you can relate, the four doctors at my practice have a passion for healing, not poring through mounds of paperwork and fine-print legal language. I didn’t want that either as I pursued my career as a practice administrator.
The solution? We strive keep the doctor’s focus on the patient and his or her care, and my office staff and I concentrate on running a successful business.
For a smaller practice like ours, that sometimes means outsourcing work. While I was skeptical of doing so at first, there are many benefits to outsourcing when it’s done with the right people and practices.
Consider these key points when outsourcing office work:
- Is there a hybrid workflow model offered? Does the company have both automated technology solutions and staffing solutions? Doubling up will keep your operations streamlined and keep you from vendor overload. For example, does the vendor have the ability to monitor productivity on your staff’s computer with plug-and-play technology, as well as people dedicated to appointment confirmation phone calls?
- Does the company have proven results? While anyone can claim they have saved practices any given percentage, don’t be afraid to ask for case studies and client references to validate such claims.
- Can the company handle claims, authorizations and eligibility? Having a full end-to-end portfolio of solutions will show that the vendor understands the workflow.
- Can you keep your staff numbers as they are? You outsource work to save time and staff hours. If the outsourcing company requires so much input that you need to dedicate a staff member to it, it’s counterintuitive.
- Will you be able to see reports? The right reports will help identify trends in denials. Will you also receive revenue reports? Will you be able to pinpoint down to the doctor and procedure what is making your business successful or costing you money?
- Is the company accountable and accessible? When I chose our vendor, ClinicSpectrum, I knew I would receive a response to my inquiry within one hour from a dedicated point of contact.
Learn as much as you can about the options and benefits of outsourcing back-office work from accounts receivable to appointment reminders. Remember that healthcare continues to grow more complex and the patients keep coming in the door. Help your physicians sustain their efforts on patient interfacing and care. Find a reliable, nimble and effective back-office solutions company to do the heavy lifting for you.
Company’s unique portfolio of solutions enable physician offices to maximize profitability and productivity
“Our goal is to support physicians and their practices by enabling them to focus on medicine and maximize profitability while ClinicSpectrum’s solutions automate their billing and collection processes,” explained Vishal Gandhi, chief executive officer, ClinicSpectrum. “With AutoCollectSpectrum, we can readily help practices benefit from the changes brought on from healthcare reform.”
AutoCollectSpectrum is an automated program to expedite the collection of deductibles and other balances owed. The patent-pending and proprietary collection method uses automated secure text, patient portals and other messaging channels in place of traditional phone calls, and hard copy, mailed letters. By eliminating the representative involvement and automating the process, physicians reduce the cost and time involved with retrieving payments.
Other products in the ClinicSpectrum portfolio that also help enhance efficiency and maximize revenue include EligibilitySpectrum, as well as the patent-pending ProductivitySpectrum, InvoiceSpectrum and CredentiallySpectrum.
EligibilitySpectrum – With the enormous influx of patient deductibles in the health insurance market place, EligibilitySpectrum enables practices to readily manage the complete eligibility of all patients by combining software and back-office operations resources. The options include using a real-time connection with a clearing house, insurance companies’ websites, or live calls conducted by ClinicSpectrum’s eligibility team. This product interfaces via an API with any EHR / scheduling system.
ProductivitySpectrum – Focused on benchmarking on various tasks and instilling self-accountability through daily reporting, this product calculates employee desk time and reduces ideal time or non-productive time. It provides comparative analysis with respect to industry and / or office benchmarks, and expected weekly or monthly productivity.
InvoiceSpectrum – By using a unique payment and invoice processing rule setup for auto-fax, auto-email, auto-credit card processing and auto-paper statement processing, practices will benefit from saving time on template creation, follow-up and more. Additionally the product provides monthly forecast management, receivable management and sales force productivity examination for better cost/profit analysis.
CredentialingSpectrum – CredentialingSpectrum is an automated tool for the credentialing of providers’ profiles and insurance participation, as well as for contract management. It allows users to import CAQH summaries for faster data entry of a provider’s profile, and also auto populates participation application forms from most insurances. It also has a built in document management, task management, milestone management, and reminder functionality for expiration of various documents and credentials, as well as communication templates and messaging solutions for automated calls, secure email, secure text and fax. For more information about ClinicSpectrum or any of their physician practice products, please visitwww.ClinicSpectrum.com.
ClinicSpectrum is a healthcare services company providing outsourcing/back-office and technology solutions for 17+ medical billing companies, 600+ medical groups/healthcare facilities including hospitals, and hospital medical records departments.
The company is promoted by technical experts from diversified industries. In a span of 12 years, ClinicSpectrum has been able to transform several billing companies and healthcare facilities nationwide with unprecedented efficiency. The company’s strategy is to build productivity through the use of technology, highly trained personnel who deliver results in a timely fashion, and customized consulting services. ClinicSpectrum has created a solution for all the problems in running a medical billing company and medical practice resulting in better clinical records, revenue cycle, and administrative task management. For more information, e-mail Vishal@Clinicspectrum.com or visit www.ClinicSpectrum.com.
The Follow-Up process is divided into 3 methods:
Online Claims Follow-Up – Using various Insurance company websites and internet payer portals we check on the status of outstanding claims.
Automated Claims Follow-Up (IVR) – By calling Insurance companies directly an Interactive Voice response system will give the status of unpaid claims.
Insurance Company Representative – If necessary calling a “live” Insurance company representative will give us a more detailed reason for claim denials when such information is not available from either websites or Automated phone systems.