Following House’s lead, Senate introduces bill to repeal ICD-10

ICD-10… what a conundrum, right? Early last year, many of my colleagues had pontificated about the possibly of the ICD-10 transition would be pushed back. I was one of those who thought that “healthcare” had delayed roll outs for other pending legislation and there was no way they would delay ICD-10. Well I may have been wrong. Could it happen? It sure could. I’m going to sit back and enjoy the ride as developments unfold…. Here’s another idea, should we just forget about the ICD-10 mess and wait until 2017 for ICD-11?

I am still working with my client’s, who are planning ahead and beefing up their coding resources in anticipation of the potential catastrophic reduction in productivity which is on the way. With all of the ICD-10 talk, it’s got me thinking. This time in history is like riding a healthcare roller coaster. When you get off the ride, you’ll either be sick or act like you just had the thrill of your life. - PCS

ICD-10

A bill seeking repeal of the ICD-10 code set is now in both chambers of Congress after its introduction to the U.S. Senate last month.

The Cutting Costly Codes Act of 2013External Link, which was first introduced into the U.S. House of Representatives in April, would prohibit the U.S. Department of Health and Human Services from implementing, administering or enforcing current regulations that require the new code set to take effect Oct. 1, 2014. The bill was introduced to the Senate May 16 by Senators Tom Coburn, MD, R-Okla., John Barrasso, MD, R-Wyo., Rand Paul MD, R-Ky., and John Boozman, R-Ark.

In addition to repealing implementation of the ICD-10 code set, the legislation also would require a federal study on ways to mitigate the disruption any replacement of the ICD-9 code set would cause for physicians and other health care providers.

The AMA has voiced strong support for the legislation, including a formal letterPDF FIle sent to Rep. Ted Poe, R-Texas, the day he submitted the bill to the House.

“The differences between ICD-9 and ICD-10 are substantial, and physicians are overwhelmed with the prospect of the tremendous administrative and financial burdens of transitioning to the ICD-10 diagnosis code set with its 68,000 codes—a five-fold increase from the approximately 13,000 diagnosis codes currently in ICD-10,” the letter states.

Experts say the new code set will affect not only claims submissions but also such processes as patient eligibility verification, pre-authorization for services, documentation of patient visits, research activities, and public health and quality reporting. The cost for individual physician practices to adopt ICD-10 is estimated to be around $83,000 for a small practice and as much as $2.7 million for a large group practice.

At the same time, physicians should make preparations for the new code set to avoid disastrous results if ICD-10 is rolled out as planned. Those who aren’t ready by next year’s deadline will not receive payment for their services. Resources to help physicians prepare are available on the AMA’s ICD-10 Web page and through the AMA StoreExternal Link.

The AMA will continue to work with members of Congress toward a solution to ensure physicians’ practices are not disrupted as the result of implementation of a new code set.

This post can be seen on the AMA website

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Phil C. Solomon is a healthcare finance, clinical documentation and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

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Fitch: Non-Profit Hospitals Face Negative Credit Potential from ICD-10 Conversion

ICD-10NEW YORK–()–While the financial impact of the conversion to ICD-10 is expected to be manageable for non-profit hospitals, the potential for revenue cycle disruption may have negative credit reverberations, according to a new Fitch Ratings report.

‘It is a challenging time as health care reform moves forward and other pressures, such as sequestration, inpatient volume declines, and reduced reimbursement, are being felt. ICD-10 conversion will bring additional costs at a time when hospital operations are already under pressure,’ said Gary Sokolow, Director in the U.S. Public Finance Group.

ICD-10 directly affects the central components of hospital reimbursement – coding, billing, and payment. Further complicating the change is the simultaneous transition of government and private payors to ICD-10.

While providers and payors have had ample time to prepare for transition to ICD-10 there is a heightened potential for payment delays and disruption. Fitch believes the solid liquidity position of investment-grade rated hospitals and health systems should help weather short-term pressure.

For more information, a special report titled ‘Hospital Hot Topic: ICD-10 Conversion’ is available on the Fitch Ratings web site at www.fitchratings.com.

Additional information is available at ‘www.fitchratings.com‘.

Applicable Criteria and Related Research: Hospital Hot Topic: ICD-10 Conversion

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The real reason doctors hate ICD-10 – They struggle with new quality mandates and IT meaningful use requirements, while having to comply with the new CMS mandate.

“Once initiated, ICD-10, will be like a turtle stuck upside down on his shell,  it will not be easy to flip over and catch up with the rabbit hare (Phil C. Solomon).

Kevin MD blog by IRA NASH, MD - MARCH 10, 2014

ICD-10It has been freezing cold in much of the country for the last two months, but things have been heating up in the controversy over the implementation of ICD-10. First, a quick primer for those of you who have not been following this.The “ICD” in ICD-10 stands for International Classification of Diseases. The “10” refers to the version of the taxonomy, which is maintained and revised periodically by the World Health Organization (WHO) and “is the standard diagnostic tool for epidemiology, health management and clinical purposes.”Although conversion from the ICD-9 standard, which is still in use in the US, to ICD-10 is causing a major kerfuffle, it is important to note that ICD-10 has been around since 1990, and the WHO is poised to release ICD-11 in 2017. The 9th and 10th editions differ primarily in their specificity of coding, with the 10th differentiating between acute and chronic states of the same condition, left and right sided findings, initial and ongoing treatment, etc.The net result, of course, is that there are a lot more ICD-10 than ICD-9 codes to describe the full array of human disease and unfortunate mishaps, even though humans and the things that befall them have not gotten much more complicated since 1990. The current controversy arises from the fact that the Centers for Medicare & Medicaid Services (CMS) has mandated that hospitals and physicians submit their bills using the new codes as of October 1, 2014, effectively creating a new national standard for reimbursement determinations.The timing of the changeover means that doctors and hospitals must implement this as they simultaneously struggle with new quality mandates and IT meaningful use requirements. No wonder, then that the AMA has renewed its call for a delay in implementation, citing, among other things, a study (that it funded) that estimates that it will be financially “disastrous” for physicians to implement ICD-10. Although these are legitimate concerns, I think the objections that many physicians have to ICD-10 goes deeper than having to change some old habits of how we write our notes and drop our bills. I think it has to do with a fundamental disconnect about the role of documentation.As students and trainees, we were taught that the medical record is a tool for patient care. That it is intended to share information with other providers; or create a narrative over time, so that a patient’s progress (or lack thereof) can be observed; or provide a repository of reference information that may serve a future, as yet unidentified, clinical need. Yes, including enough information in our records for others to summarize into ICD-10 codes based on hospital documentation, or selecting the codes ourselves for office-based encounters, serves those ends.But the problem is that most clinicians believe that they can achieve the fundamental goals of clinical documentation without the constraints and complexity of ICD-10 coding. Here is the real problem. Just as I pointed out with EMRs, we have accepted a system that pays doctors and hospitals for “doing stuff.” Naturally, those paying the bills want to make sure that the stuff they are paying for is both appropriate and actually getting done, and have demanded that we document both. The language chosen for that exchange (we tell you what we did, and you pay for it) is an epidemiologic classification scheme that was not designed for that purpose. Is it any wonder that doctors hate it? Ira Nash is a cardiologist who blogs at Auscultation.

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Phil C. Solomon is a healthcare finance and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

 

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New business models, more corporate VC & 8 other healthcare industry trends for 2014

December 16, 2013 by Deanna Pogorelc

In the first quarter of 2014, has PwC’s predictions come true? 

 

healthcareBased on healthcare industry predictions made last year by leaders and analysts, this year should have brought a re-evaluation of meaningful use (yep), a quantified self movement that would move mainstream(ehhh),  more M&A activity in the industry (definitely) and the emergence of interoperability as a competitive benchmark for providers (not quite yet?).

For 2014, analysts at PricewaterhouseCoopers are predicting that healthcare companies, especially drug makers, will have to make adjustments to their innovation and business processes to account for changes in ecosystem. We’ll also see more corporate venture capital, more employers exploring private health insurance exchanges and more price transparency.

Here are 10 predictions from PwC’s annual “Top Health Industry Issues” report:

  1. Industry changes will cause healthcare companies to reconsider their roles and business models. Many companies will look to expand their footprint and expand revenue streams (ex: insurers are acquiring providers and providers are entering the insurance business).
  2. Social, mobile, analytics and cloud tools have changed how health organizations interact with patients and with each other, which will drive new business models for healthcare companies.
  3. Companies will think more like startups — forcing experimentation and failing faster, cheaper and better.
  4. Demand for price transparency continues to grow and will be fueled by new health insurance exchanges. Cost-conscious companies will make transparency a priority in negotiations with health plans and providers.
  5. New technology has created rising demand for a digital-savvy healthcare workforce that can leverage technology to engage with patients.
  6. More employers will explore the potential of private exchanges. Sixty-five percent of surveyed consumers preferred that their employers offered three to five plan choices.
  7. In the face of precision medicine and a focus on specialty products, drug makers will need to embrace alternative clinical trial designs.
  8. Drug makers will prepare for new requirements to prevent counterfeit medications in the drug supply mandated by the recently enacted Drug Quality and Security Act. In 2015, drug makers will be required to begin tracking prescribed drugs in large bundles.
  9. Corporate venture capital will make up a bigger share of healthcare deals, filling in gaps left by retreating traditional venture capital firms. Partnerships between those two kinds of VCs will help corporations broaden their reach into start-up communities.
  10. States will continue to turn to managed long-term care solutions to help contain Medicaid costs. PwC estimates that 26 states will have Medicaid managed long-term care programs by 2014.

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Phil C. Solomon is a healthcare finance and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

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EHRAre EHRs at a ‘tipping point’?

 

Malcolm Gladwell, acclaimed author defines a tipping point as “the moment of critical mass, the threshold, the boiling point.” Gladwell states ” it’s that critical time that creates that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire.

With implementations past critical mass, AHIMA takes stock

CHICAGO | March 6, 2014 - Mike Miliard, Managing Editor at Healthcare IT News.

With more than 50 percent of practices and 80 percent of hospitals having adopted electronic health records and attested for meaningful use by now, it’s time to talk about next steps. The March edition of the Journal of AHIMA does just that, with a story that looks at the changes and challenges ahead for health information management professionals as EHRs become a fact of life.

“We have reached a tipping point in adoption of electronic health records,” said Health and Human Services Secretary Sebelius in May 2013. “More than half of eligible professional’s

and 80 percent of eligible hospitals have adopted these systems, which are critical to modernizing our health care system.” Now that the plumbing has been installed, the next step is making the water flow.Or, as the article’s author Mary Butler finds, perhaps telecommunications offers a better analogy. “If you buy a telephone, it’s only as good as the other people who have telephones and can call,” Judy Murphy, RN, deputy national coordinator for programs and policy at the Office of the National Coordinator for Health IT tells AHIMA. “One of the things we’re doing with getting EHRs installed is that we’re setting up the capabilities and electronically exchanging the information so we can create a patient-centric record.”But that’s easier said that done, Butler argues. “Even with telecommunications, where cell phone adoption is broad, problems linger,” she writes. “Dropped calls plague even the most robust cellular network providers, and coverage in vast swaths of rural areas can be spotty. When users outgrow or want to upgrade their phone before their contract ends, the costs are high.”

Those issues – interoperability challenges, implementation failures, geographic discrepancies in IT adoption, provider frustration with under performing systems – are all explored by AHIMA as it puts EHR adoption numbers in perspective and looks ahead toward the challenges of data exchange and patient-centered care.

As Butler puts it, “Although use of EHRs has reached critical mass, they’ll be in tweaking mode for a long time.” Key to making sure those tweaks are the right ones – and achieve the desired effects of better care for more people at lower costs – are health information management pros, who can and should have a place at the table helping clinicians optimize the use of clinical data, according to AHIMA.

“The heavy adoption of EHRs by providers is a significant milestone, one that can contribute to improved patient outcomes at reduced costs,” said AHIMA CEO Lynne Thomas Gordon in a press statement. “HIM professionals will play an important role in realizing the efficiencies offered by interoperable EHRs, and a key component will be establishing information governance principles to ensure the information is accurate, appropriately accessible and actionable.”

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Phil C. Solomon is a healthcare finance and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

 

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See on Scoop.itPOSITIVE NEWS NETWORK

Concerns are high among physician practices working to implement all the changes required to comply with ICD-10 come October 1, according to MGMA.
See on ehrintelligence.com

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ICD-10 – Action Items – March 1st MilestonesICD-10 Readiness
Written by: Lyman Sornberger, the President and CEO of LGS Health Care Inc.

1. Completed coder and CDS training and evaluated productivity
• Finalize coder and CDI training to begin dual coding and assist with communicating with clinical staff
• Evaluate outsourcing options (consider safety net strategy) and begin to contract now
• Secure additional hires and provide training-bring coders in house for 30-60 days Sept 15th to November 15th and create a code at home program
• Prepare for an increase in denials, follow-up & other tasks expected due to the transition. Consider assistance from internal staff and/or outsourcing for all related front end and back-end processes

2. End to end testing
• When and how will you “dual code”? When will you begin?
• When will all your vendors be ready for integrated testing?
• Co-ordinate the measurements of workflow changes of ICD-10 with clinical, financial and quality and what will the reporting look like in these areas? What will be the impact to each area?

3. Review the impact of ICD-10 by Specialty
• Select a sample set of completed charts – highest Case Mix Index
• Natively code these charts using ICD-10 (Without using a mapping tool) and outline the gaps in the documentation and create a public report to the clinical staff

4. Technical Testing Strategy
• Validate where the payers, clearinghouse, and other associated vendors are with their planning and quality assurance

5. ICD-10 Interface Testing
• Created a deadline of when you will test interfaces and how you will test them.

6. Map Out Your 2014 Clinical Training Plan
• Have a Physician Advisor Role
• He or she should be attending department meetings and ICD-10 – a meeting agenda item in all sessions
• Finalize a plan for physician training to include any tools
• Schedule on-site physician specialty training securing dates and rooms
• Clinical documentation tutorials or advisory sessions should be mapped out with a mandate to hours of completion
• Schedule Physician advisor and CDS staff to attend physician departmental meetings and provide ICD-10 documentation specificity essentials and guidelines

7. Additional Points for Consideration

• Have you incorporated CAC or CDI into your ICD-10 strategy?

• Important: CMS testing is not end to end testing. There will be no adjudication of claims to provide payment information

• Verify if your claims clearinghouses offers similar testing where the provider sends test claim files and the clearinghouse will apply basic ICD-10 edits to the test file

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Lyman Sornberger has previously held positions as the Executive Director of Patient Financial Services for the Cleveland Clinic Health System for six years and the University of Pittsburgh Medical Center for twenty-two years as a leader in revenue cycle management operations. In his current role, Lyman serves as President and CEO LGS Health Care Inc, a healthcare consulting organization. Throughout his career, Lyman has acted as a consultant and advisor to various health systems and physician practices. He has authored numerous articles for HFMA, AAHAM, and other associations in the Revenue Cycle arena. Mr. Sornberger earned his BS and Masters at the University of Pittsburgh, a Masters in Non Profit Management, and a Masters in Health Administration.

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Phil C. Solomon is a healthcare finance, clinical and revenue cycle BPO strategist with experience spanning over two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

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6 Reasons Medical Debt is SoaringAmericans Struggling to Pay Medical Debt – PPACA is Projected to Exacerbate the Problem

In order to mitigate the increase in medical debt, consider focusing your attention on the four strategies listed below:

  • Admissions – Extra training with point-of-service employees. Your staff needs the proper tools to help collect for past due balances and future services at POS.
  • Discharge – Make sure the bill is accurate. Many patients don’t pay their bill when they are actually able to, however they don’t believe their bill is correct.
  • Billing – Utilize reporting to identify broken process, identify trends and determine which area should be re-engineered.
  • Increase Collections – Collaborate with colleagues to make sure patients receive exceptional customer care. In addition, build a relationship with a collection partner who can demonstrate an ability to segment collection accounts by utilizing intelligence based collection workflows. This will result in better collections results.

Read the article and report below. The Kaiser Family Foundation published to help healthcare professionals understand why Americans are challenged to pay their medical bills.   Phil C. Solomon ~

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Medical Debt

With one in three Americans reporting that they have difficulty paying their medical bills, this report looks at some of the reasons Americans encounter medical debt, even when they have insurance, by drawing insights from the experiences of nearly two dozen people who recently experienced such problems.

This report identifies common causes and consequences of medical debt, and discusses the triggers of medical debt that will and will not be affected by the Affordable Care Act. It finds that health plan cost-sharing is a primary contributor to medical debt. Even relatively modest cost sharing can prove unaffordable because expenses often are unexpected and most Americans have less than $3,000 on hand to cover such costs.

For many, unaffordable cost-sharing may be compounded by other factors:

  1. Out-of-network expenses may also arise, often inadvertently for people who are hospitalized when hospital-based providers aren’t in the plan network
  2. Health care providers tend to promptly refer patients who can’t pay to collections
  3. Patients may use credit cards to pay unaffordable medical bills, which increases debt
  4. Illness often triggers income loss, further aggravating affordability problems
  5. People facing health issues may have trouble tracking medical expenses and resolving billing problems on their own.
  6. Medical debt is also linked to housing instability, reduced retirement savings, damaged credit, bankruptcy and barriers to accessing care.

Full report written by Karen Pollitz, Cynthia Cox, Kevin Lucia and Katie Keith.

READ THE FULL KAISER FAMILY FOUNDATION REPORT

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Phil C. Solomon is a healthcare finance, clinical and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

 

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Helpful Suggestions for Managing the Medical Bad Debt Collection Process

Medical Bad DXebtThere are three major leverages, which “motivate” patients to pay a delinquent bill. The first is the involvement of an independent third-party. Collection agencies create a situation where the debtor may or may not know what the collection agency is going to do to collect the debt. I call this the threat of the unknown. This creates an environment, which motivates some account holders to resolve their debt quickly and amicably.

The second leverage is the threat of affecting a person’s credit. For those who care about their credit, a collection agency derogatory on their credit file is something they don’t want to see. The potential affects of a derogatory on a person’s credit report is a huge motivator to resolve their outstanding account.

The last leverage to collect a debt is the threat of litigation. A successfully litigated past-due account would include the initial amount of the debt in the settlement, and it possibly could include interest, court fees and potentially, the cost of collection fees, if it is annotated in the agreement the patient acknowledged when the service was rendered (such as a consent form).

Once the court has ruled in favor of the provider, wage garnishment and property liens are strategies to collect a judgment. I am a believer that providing quality medical services are paramount to a community’s well-being. In some areas, hospitals limit some leverages, such as not allowing accounts to be reported to the credit bureaus.

Limiting the leverages a collection agency may use to collect outstanding accounts will hurt the provider’s cash collections and can become an impediment for the financial health of the providers organization.

Providers, in most markets have experienced an increase of self-pay accounts. In some instances, I’ve witnessed increases as much as two or three-fold over the past three to five years. Minimizing the leverages a collection agency can use to collect outstanding A/R takes away from the financial well-being of the medical provider, thus reducing the amount of service they offer the community. Quality medical care does not come without a cost. I recommend providers use credit reporting judiciously, and only after the patient has an ample opportunity to resolve the debt.

In addition, the advent of the new Patient Protection and Affordable Care Act (PPACA) and the IRSs 501 (c) (3), facilities must be sure the accounts going to a collection agency do not meet a provider’s charity policy. If collection activity is performed by a third party, and it is determined the account could have qualified for charity, new legislation’s requirements could put a provider at financial risk.

I recommend to providers that they scan all accounts that are ready for write off with an automated charity-scoring tool. If providers follow a consistent process for identifying and pursuing patients who truly deserve to be written off as charity, they minimize the risk of collecting cash from charity qualified accounts.

Following a written charity policy and designating the correct accounts as charity, helps to lower the risk of running afoul of the brand new legislation and the IRSs 501(c)(3). These new requirements create a win-win situation for the provider and the collection agency. The provider wins because they can control their bad debt reserves, give more community benefits and eliminate the possibility of a legislative infraction. The collection agency wins because they are collecting on accounts, which truly are “collection accounts” thereby reducing the time and effort attempting to collect accounts, which should be deemed as charity.

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Phil C. Solomon is a healthcare finance and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

 

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We Must Think Differently, Unconventionally, or From a New Perspective

Writing and curating my blog is a hobby of mine. I have an intellectual curiosity that drives me to search for the latest news, thought leadership ideas, and financial performance improvement strategies to help healthcare providers work in a more patient friendly and financially sound way.

The United States has the best healthcare system in the world and I feel compelled share ideas to help keep our hospitals, physicians and medical billing companies as fiscally fit as possible.

Providing quality healthcare is the cornerstone of our health system, yet without a systemically sound financial strategy in place to continue to give quality services, many hospitals, medical groups and healthcare providers will feel the squeeze as reimbursements decline and uncompensated care increases. The healthcare revenue cycle has been feeling the effects of consumerism as employers focus on containing or eliminating healthcare costs so they can compete and stay solvent during today’s economic downturn.

How will healthcare providers address the new challenges? Today’s escalating financial pressures on healthcare organizations will skyrocket as consumers take on increased financial responsibility for their healthcare services (we can partially thank the exchanges for that).

Providers now must become the “lead dog” of the sled as if they were racing in the Iditarod Great Sled Race and boost their capabilities and creativity as they leverage their hospital information systems and other technology and services solutions to improve revenue cycle performance.

Healthcare leaders must respond to the new environment by crafting strategies to combat the challenges of healthcare consumerism, increasing self-pay patients, the need for improving clinical documentation, meeting required compliance standards and insuring payers are held to their contractual obligations. This is a daunting task for all healthcare executives.

One must always remember, if you are not stepping outside the box and looking ahead of the pack for creative solutions, you will end up like the rest of the dogs in the sled. Consider this, unless you are the lead dog, the scenery never changes. Get out in front and stay there!

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Phil C. Solomon is a healthcare finance and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, healthcare technology integration, clinical documentation and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

 

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