Healthcare Revenue Cycle Blitz

by Tom Caswell

Sometimes you just have to blitz. In football terms a blitz is when you throw extra players into the pass rush to disrupt the quarterback.  Synernet has launched a revenue cycle blitz with great success to uncover the root causes of cash flow delays including an evaluation of the processes surrounding provider enrollment, charge capture and coding.

The Healthcare Financial Management Association (HFMA) defines revenue cycle:

All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.”

So why a blitz of revenue cycle? Successful revenue cycle management starts with an understanding that healthcare billing is a coordinated process of disparate departments working together to generate an accurate claim for payment in the shortest time frame.

To get to the root cause of cash flow issues, a revenue cycle blitz forces departments to come together and evaluate processes against best practices. Our experience tells us that a disruptive event,”blitz”, is needed to gain agreement from stakeholders on process changes, benchmarks, acceptable time lines and strategies to achieve an agreed upon metric.

A quote after a recent Revenue Cycle Blitz.

“You have far exceeded my expectations.”

Process Improvement – from 3 days to 20 minutes

“It took 10 minutes to print the packets for the 8 physicians and another 5-10 to get them into the FedEx packet to send out for initial applicants for both enrollment and credentialing.” Synernet automated a manual process, reducing the time from 3 days to 20 minutes.

Good people can’t overcome bad processes put in place over time.  A Revenue Cycle Blitz forces change where it is needed most – processes, benchmarks and communication.

About the author: Tom Caswell explores the impact of emerging technologies on the end user and healthcare.  You can reach Tom Caswell at tcaswell@synernet.net

Healthcare Cyber Threats – Vendor Focus

by Tom Caswell

Cyber-attacks on healthcare organizations will continue to make the news as the proliferation of healthcare data accelerates and unauthorized access attempts increase.  Understanding the inherent “risks” associated with healthcare data were clearly outlined by the  Bitglass Healthcare Breach Report 2016 – 2015 was a record year for healthcare data incidents.

  • 1 and 3 Americans were impacted by healthcare data breaches in 2015
  • 111 million individuals’ data was lost due to hacking or IT incidents in the U.S. alone
  • 98 percent of record leaks were large-scale breaches targeting healthcare

Why is healthcare vulnerable to more system and data attacks?  Modern healthcare produces an enormous amount of data while indiscriminate data gathering produces a “big data healthcare paradox” – managing, presenting and securing data for use in the clinical setting. Gathering data from thousands of EHR access points, 24/7/365 data capture, multiple onshore and offshore vendors adds variables and vulnerability.  It is not surprising that healthcare IT departments will accelerate cyber security spend in 2016.

The risks of indiscriminate data collecting are enormous. As reported by PWC , hospitals face a staggering hit to their bottom line if a breach occurs.  “Nearly 40 percent of consumers would abandon or hesitate using a health organization if it is hacked. More than 50 percent of consumers would avoid, or be wary of using, a connected medical device if a data breach was reported.”

As the economic risks are raised, healthcare organizations need to task internal stakeholders and vendors to partner on data gathering objectives, verification of data transfers and limiting data capture/transfer to reduce risk.  Moving beyond contracted cyber risk management programs to regular reporting and limiting access to PHI identifiers will markedly mitigate risk.

Choosing vendors must also move toward a cost/risk assessment model to determine the true cost of a vendor’s services – 100% U.S. based employee firms may offer better value when factoring in cyber risks?

About the author: Tom Caswell explores the impact of emerging technologies on the end user and healthcare.  You can reach Tom Caswell at tcaswell@synernet.net

Welcome to ICD-10

ICD-10 Post Launch – Cautiously Optimistic

by Millis Blackburn Perry RHIA, CCS, CPC

The implementation of ICD-10 has at last happened after decades of development, the frustrations of enduring repeated last-minute delays, and the never-ending regulatory hurdles to move beyond.  It is estimated that nearly $30 billion in costs have been incurred to plan, train, and convert systems, test and prepare for ICD-10.  Those of us who are in the medical coding profession are truly a part of U.S. healthcare history as we have seen the sunset of ICD-9 and are now assigning ICD-10 codes to the patient encounters we work with each day.

The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is a revision of the ICD-9-CM system which physicians and other healthcare providers currently use to code all diagnoses, symptoms, and procedures recorded in hospitals and physician practices. The ICD-10-CM revision has more than 68,000 diagnostic codes, compared to the 13,000 found in ICD-9-CM. The revision also includes twice as many categories, and is more specific in identifying treatment. For example, ICD-10 provides codes to distinguish between a left or right leg; ICD-9 does not.

Our U.S. healthcare industry will now begin to appreciate and understand the enormous benefits that ICD-10 brings to us.  Some of these benefits include:  fewer claim rejections with more accurate payments, more precise assessment of the quality of care provided, better detection of fraudulent claims, fewer requests for additional patient information, more effective disease management, a better understanding of efficacy of new technologies, and a greater ability to detect new and emerging health threats.

The next phase is to see what “aftershocks” occur and what challenges they may present.  We will watch closely to see the trends in reimbursement, front-end rejection rates and back-end denial rates.  With only a few weeks of data available, the initial reports are cautiously optimistic and some healthcare organizations are reporting a smoother transition than originally thought.  This is in great part attributed to the many months of dual coding and working with the clearinghouses and insurers on testing claims submission.

Hopefully the predictions of substantial increases in account receivable days, delayed payments and the 30 – 50% in coder productivity will prove to be overestimated.

You can reach Millis Blackburn Perry, RHIA, CCS, CPC at mperry@synernet.net

Medical Transcription Changes: A Conversation with Vicky Donaldson, Director of Medical Transcription

Tom Caswell
Director of Sales & Marketing

Portland, ME

Q – Do you see Medical Transcription at Synernet as a growing service line?

A – (Vicky) The Medical Transcription industry has seen a whirlwind of changes in the last few years.  As a Medical Transcription Service Organization (MTSO), we must keep up with these changes in this competitive arena.  Nuance has become a household name and has bought out many smaller companies but Synernet has a unique value proposition in healthcare – service excellence!  Business opportunities are still plentiful but the dynamic of obtaining that business has changed.

Q – What changes have you seen in Medical Transcription?

A – (Vicky) Over the last decade we’ve seen more physician practices being bought and physicians being employed by the hospitals in an effort to coordinate better care and provide a wider span of services.  Now that idea has expanded on the hospital level whereby hospitals are grouping together to create hospital systems.  The costs of interfacing and the man hours it takes by the hospitals to interface has deterred individual hospitals from making those decisions realizing that their platforms may change under these newly created hospital systems.  Therefore, our focus is to work with hospital systems.

Q – How important is a Medical Transcriptionist to the continuum of care?

A – (Vicky) For Medical Transcriptionists, the career field has been uncertain.  With the push for the complete electronic record, the industry has seen line reductions. Hospitals are provided financial incentives for the “meaningful use” of electronic health record (EHR) technology.  Most healthcare organizations are in stage 2 of the process and have difficulties with implementation. The realization is that accurate individualized medical documentation is vital for patient care and the medical transcription/editing professional is critical to the continuum of care.

Q – Does Synernet have a transcription technology partner?

A – (Vicky) Dolbey Co. is our transcription software vendor that has allowed us to bring on six new clients recently.  We are currently in negotiations with additional hospitals through our relationship with Dolbey.  Tom Caswell and attended the AHIMA conference in San Diego in late September where we showcased our services and attended events with Dolbey representatives, management and HIM Directors from across the US.

Q – What sets Synernet apart from the competition?

A – (Vicky) At Synernet, we’ve created the scale and expertise over the past 11 years to compete across the U.S.  Our relationship with our transcription software vendor, Dolbey has truly allowed us to become a solution provider by offering dictation, transcription, voice recognition and 24/7/365 coverage.  Beyond the technology, we truly believe our value starts with our team of transcriptionists, supervisors, managers, QA managers, project managers and IT staff.  We strive to be the more responsive to our customers’ needs for faster TATs and 99% QA which positively impacts the continuum of care.

Also, medical transcription along with our coding services, provider enrollment and credentials verification, provides the expertise hospital systems are looking for in a one vendor relationship.

You can reach Vicky at vdonaldson@synernet.net or visit www.synernet.net.

Vicky Donaldson
Director of Medical Transcription

A Conversation with Millis Blackburn Perry, Synernet’s Director of Coding Services

Tom Caswell
Director of Sales & Marketing

Portland, ME

Q – ICD-10 has been delayed before; will we see ICD-10 in 2015?

A – (Millis) The compliance date for implementation of ICD-10 CM/PCS is October 1, 2015, for all Health Insurance Portability and Accountability Act (HIPAA) covered entities. And while there remains concern that it will be delayed yet again, CMS has made the statement it will not and the conversion to ICD-10 will move forward as scheduled.

Q – Why is ICD-10 important for U.S. healthcare?

A – The healthcare industry can ill afford to remain with the ICD-9 classification system because of the limited structural design and lack of flexibility to accurately reflect advancements in current clinical technology and emerging treatment modalities. This in turn compromises the validity and reliability of our healthcare data and it will continue to decline until the implementation of ICD-10 allowing for greater specificity in code assignment. The ICD-10-CM diagnostic code set is nearly five times larger than ICD-9 and has more than 69,000 available codes.

Q – How will ICD-10 impact Synernet’s Coding Services?

A – In the next twelve months our clients will be very focused on preparing for the many facets of this transition while attempting to prevent coding backlogs and maintain timely reimbursement. This is where we, the coding team at Synernet, can help.

Q – How will ICD-10 impact Synernet’s Coding clients?

A – Our coding staff will be prepared to provide much needed services and support during this challenging time and beyond. We will help maintain the coding process to minimize any anticipated negative impact to the facility. This is definitely an exciting and rewarding time to be a part of the coding profession as our expertise and skills will be in great demand!

Q – Why do you employee only 100% U.S. based experienced credentialed coders?

A – Synernet is proud to employ the best and brightest U.S. based coders.  We feel strongly that only credentialed experienced coders can bring the required duality of 95% coding accuracy and turnaround times necessary for a successful coding support partnership.

You can reach Millis at mperry@synernet.net or visit www.synernet.net.

Millis Blackburn Perry, RHIA, CCS, CPC
Director of Coding Services

A Conversation with Deb Carter, Synernet’s Manager of Provider Enrollment Services

Tom Caswell
Director of Sales & Marketing

Portland, ME 

Q – Provider Enrollment Services (PES) had a “break out” year in 2014, so to speak.

 A – (Deb) Provider Enrollment Services at Synernet began in 2011 as a division of the Synernet CVO. In 2014 PES began operating as a separate service line and the early results are fantastic.  Synernet PES initially worked exclusively with Mercy Hospital to enroll their employed providers while Terry Knight joined Synernet as Supervisor of Provider Enrollment Services.

PES developed as a service line in response to a customer request and is growing as a result of customer needs across the U.S.  We now have customers in Maine, New Hampshire, Texas and California with frequent inquiries from around the country. Thanks to the recently updated web-site and our work with existing clients – the word is spreading fast.  We have also developed an additional enrollment product that allows customers to “rent” the Apogee platform from us while maintaining their own staff and work process.

Q – What changes have you seen in Provider Enrollment?

A – Customers are beginning to understand the role that provider enrollment plays in the revenue cycle of the facility. Enrollment is more than filling out a form. It is a blending of knowledge and experience in billing, claims management, coding, practice management, credentialing, contracting and healthcare organizational culture. Understanding how provider enrollment is connected to the revenue stream of an organization is crucial for accurate reimbursement. With reimbursements from third party payors being reduced, particularly Medicare, all healthcare organizations are focused on the revenue stream.

Q – How important is Provider Enrollment to the revenue cycle of healthcare organizations?

A – Simply put: enrollment done incorrectly can “sink the ship”.

Q – Does Synernet have an enrollment technology partner?

A – Yes. Our entire data base is housed in a module called Apogee which is part of MSOW, a Morrisey product. We work very closely with Morrisey and are presently working to enhance the software product.

Q – What sets Synernet apart from the competition?

A – Our talent and process. I have no doubts that our competition is utilizing automation to assist in the enrollment process but our automation combines process improvement and experienced professionals with an understanding of and experience in the revenue cycle.  Our practice management experience further enhances understanding of the relationship between enrollment and the patient experience.  Synernet’s foundation is customer service – our customers are our business and our business is accurate reimbursement, critical to each customer’s revenue cycle.

And finally, Synernet is 100% U.S. based, located in Portland, Maine.

You can reach Deb at dcarter@synernet.net or visit http://www.synernet.net.

Deb Carter, MS, CPMSM, CPCS
Manager of Provider Enrollment

Ask Five Questions to Determine if Provider Enrollment is Impacting Your Cash Flow

Debra K. Carter, MS, CPMSM, CPCS
Manager of Provider Enrollment Services
Synernet, Inc.

Portland, ME

Asking five simple questions within your healthcare organization can improve your bottom line while streamlining processes.  Provider Enrollment is a fundamental aspect of any healthcare providers reimbursement and revenue cycle. At Synernet we have a process of client engagement that includes a 360 degree look at the facilities billing process to align provider enrollment.

Question 1: What is your monthly claims on hold dollar amount due to enrollment?

Develop and require a monthly tracking and reporting of claims on hold.

  • Communicate on hold reports across department lines
  • Work toward a goal of $0
  • Track trends

Question 2: What claims are being denied due to provider enrollment?

  • Identify “root causes” of enrollment denials
  • $0 should be the goal

Question 3: How much ‘written off” claims due to incomplete enrollment?

  • Set a goal of $0
  • Automate the form submission and tracking process
  • Import provider data to improve accuracy

Question 4: What is the dollar amount of claims unable to submit due to non-par enrollment?

  • Review results monthly to identify trends
  • Aggressively reduce provider Non-Par denials
  • Eliminate Non-Par write-offs

Question 5: What is the average number of days unable to bill due to non-enrollment for newly employed practitioners already providing services to patients?

  • Enrollment starts with HR and recruitment
  • Communication is vital between HR, Billing, Medical Staff Office and practice locations.
  • What time factors are in place for the enrollment process?
    • Allowing time for the provider to be enrolled
    • Aggressively reduce the average days unable to bill

To learn more about the Provider Enrollment process, best practices and Synernet’s role in helping healthcare organizations achieve their goals, visit www.synernet.net or contact Deb Carter, MS, CPMSM, CPCS at dcarter@synernet.net