How Your Healthcare Revenue Cycle Is Affected When You Add a Specialty Pharmacy

Posted on October 14, 2016

Working with so many healthcare organizations on facets of revenue cycle management like billing and practice management over the years, we know industry trends can have huge impacts on our clients. From regulatory changes to new technology advancements, changes in the industry affect how our clients do business.

Acquiring or launching a specialty pharmacy practice is one trend we’ve been keeping our eyes on recently. It has grown in popularity due to soaring drug prices. Has your practice thought about how acquiring or building a pharmacy practice might impact your revenue cycle in the short and long term?

Benefits of Acquiring or Launching a Specialty Pharmacy

The trend of pharmacy growth didn’t come about in a vacuum — like most healthcare trends, it grew to fill a gap.

In 2014, the United States spent $124.1 billion on specialty drugs, up from $98.1 billion in 2013. Despite an average growth for pharmaceuticals of 20 percent a year, hospitals fill their own prescriptions less than 20 percent of the time, and clinics and outpatient services are often comparable. This highlights a sizeable gap where practices who might need specialty drugs for patients or procedures are putting a significant portion of their revenue at the mercy of a third party that is not bound by payer contracts or rates.1


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CPT Code 99490: Increase Your Revenue by Billing for Chronic Care Management

Posted on July 15, 2016

Some professions are impossible to contain inside working hours. Teachers work more hours than the school day or school year would suggest, for instance. And we know well that physicians also work far more hours than is revealed by hours billed or patients seen. One of the common refrains we hear from clients who rely heavily on physician practices or physician procedures for their revenue is that physicians spend a great deal of time on patient care activities that can’t be billed because they aren’t direct interactions with patients. For example, if a physician spends an hour every few weeks calling a patient’s cardiologist to ensure they are coordinating care, many practices believe that’s an hour of time that can’t be billed.

Now, however, they could bill for it. And so can your organization. As part of an effort to encourage more emphasis on patient outcomes, the Centers for Medicare and Medicaid Services last year began allowing Medicare payments under the Medicare Physician Fee Schedule (PFS) for the American Medical Association’s Current Procedural Terminology (CPT) code 99490, which covers face-to-face care coordination services for Medicare beneficiaries with multiple chronic conditions.


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Four Ways to Measure an Electronic Health Record Transition’s Effect on Revenue Cycle

Posted on June 17, 2016

Gone are the days when the good ship Healthcare Practice floated on a sea of paper. Today, most of us work with electronic health record (EHR) systems to do everything from access patient information to streamline lab testing.

As of 2012, 72 percent of physician offices used EHR systems. That’s up from less than 50 percent in 2009, when the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed, providing incentives from Medicare and Medicaid to organizations that made a commitment to “meaningful use” of technology and adopting EHR systems.1 Since the 2012 data, we’ve certainly noticed even more healthcare entities adopting EHR systems and upgrading from older ones to new systems.

We worked with a Nevada clinic to help it transition from paper records to an EHR, and another practice as it went from one cloud-based EHR system to another that better suited its needs. Since these were already clients of ours, we were in a position to warn them that EHR migrations often result in unplanned revenue cycle disruptions. Outbound claims can stagnate as staff undergo training and learn the new system. Everyone’s emphasis on revenue optimization can falter as multiple departments prepare for migrating from paper to EHR, or from an existing EHR to a new one.


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Now What? The Biggest Challenges of the ICD-10 Transition Could Still Lie Ahead

Posted on May 18, 2016

We sometimes use a pie analogy when working with clients on all the different aspects of revenue cycle management. It helps our clients train their staff if they understand the different steps and how everything must work together and be timed correctly to get a good result. This holds true whether we’re talking about a delicious, made-from-scratch pie or a healthy revenue cycle. When it came to working with providers on October 2015’s ICD-10 implementation, we once again found ourselves breaking out the pie analogy.


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Mind the Gap: How the ICD-10 Transition May Have Exacerbated Your Revenue Cycle Difficulties

Posted on May 5, 2016

Over the past several months, we’ve come to some realizations we hadn’t previously about the recent ICD-10 transition: Many healthcare organizations who used the grace period leading up to ICD-10’s official arrival to prepare were blindsided by the little ways ICD-10 immediately impacted what they thought were small areas of their revenue cycle.1

By any measurement, and in any context, going from 13,000 of something to 68,000 of something is a big jump. When we’re talking about codes used to drive the payments and reimbursements of one of our country’s most crucial and complex industries — healthcare — it’s easy to see why the ICD-10 transition is considered one of the most important changes in the field in a generation. For the most part, it looks like the big-picture transition has gone very smoothly for almost all healthcare entities and payers — everyone is mostly using the right codes and not seeing a drastic rise in rejected claims or other issues.


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Streamline Your Revenue LifeCycle Through HIPAA’s Administrative Simplification Regulations

Posted on April 21, 2016

When we meet with clients, we often discuss several different audit streams that help us evaluate their revenue cycle and ways to improve it. One area that we’ve found to be of particular frustration for many practices is HIPAA’s Administrative Simplification requirements. Compliance with these requirements is key to an organization’s revenue cycle, and important for its ability to better deliver patient services. Still, many practices feel the process for phasing in these requirements is too costly, and they have a hard time getting past that. This reluctance to see past the expense of compliance reminds us of an important reason why we work with our clients to see the big picture of the revenue cycle as well as the details.

Sometimes it’s very difficult to see the connection between all the rules and regulations that govern our healthcare ecosystem and the bottom line at your organization. Often, it feels like we’re dealing with compliance issues on a different plane than financial or revenue matters, when really they should be in the same conversation. HIPAA’s Administrative Simplification regulations have been phased in over the past five years and will continue under the Affordable Care Act. They live up to their billing — the changes you’ve already implemented at your organization to comply with these rules actually do simplify your life and help your revenue cycle.


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Prevent a Healthcare Data Breach: Improving Your Patient Health Information Security

Posted on April 14, 2016

If you’re an executive in the healthcare industry in 2016, you know one of your primary concerns is how to prevent a healthcare data breach. We discuss patient health information security, healthcare IT, new types of hacker attacks, and the latest breaches with our clients on a daily basis. It’s on all of our minds all the time.

Last year alone, the Office of Civil Rights recorded 253 data breaches that put 112 million private health records at risk.1 This is no longer “the IT person’s problem.” Bolstering an organization’s defenses against a data breach should be a cross-departmental initiative driven by leadership.


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Healthcare Data Breaches in 2016: How Your Practice Could Be at Risk

Posted on April 12, 2016

We’ve been hearing a lot of “did you hear?” from our clients lately.

“Did you hear about that Southern California hospital that paid $17,000 to hackers to unfreeze their systems?”1

“Did you hear about ——”

Data breaches and the security of protected health information are on everyone’s mind these days and for good reason. As attacks and breaches rise and intensify, healthcare executives are confronting the need for increased attention and expenditure on healthcare IT.


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Codes And Conduct: Maintaining Effective Relationships With Your Payers After The ICD-10 Transition

Posted on January 27, 2016

Just the other week, we spoke to a Western regional provider of diagnostic and outpatient services who told us that the most surprising thing about the healthcare industry’s ICD-10 transition wasn’t the coding changes themselves, but the unexpected ways in which their payers responded to the changes.

“We felt like we did everything right,” the chief financial officer told us. “We trained our staff and physicians; we prepared all our systems and technology. We just never thought to ask the payers, ‘so what are you going to change when ICD-10 hits, and how can we make sure we’re working together?’ We ended up doing some scrambling after Oct. 1.”

Had this provider been working with us on revenue cycle preparations for ICD-10, we would have definitely advised them to add “remember that ICD-10 impacts your payment partners, as well” to their preparation list.

Focusing internally probably helped ensure that everyone and every system within your organization was prepared for the ICD-10 transition. In fact, early reports after the Oct. 1 implementation indicated that most organizations were adequately prepared. But you might be operating completely in the dark about how your payers have been impacted by ICD-10, or what they may be planning to change.1


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Let It Begin With You: ICD-10 Training for Physicians and Coders Reduces Rejected Claims

Posted on January 25, 2016

Now that October 1 has come and gone, many of us in the healthcare world are breathing a sigh of relief that the move to the International Classification of Diseases and Related Health Problems 10th Revision (ICD-10) and its more complex codes appears now like our equivalent of the Y2K scare — much ado about nothing. For the most part, healthcare organizations used the grace year when implementation was pushed back from Oct. 1, 2014, to Oct. 1, 2015, to prepare for ICD-10’s massive code expansion. Recent reports cite successful implementation at 80 percent of surveyed healthcare organizations, with few reported technological snags and mostly uninterrupted claims processing across the board. 1

So is there a problem? Underneath the rosy trend reports celebrating a smooth transition, healthcare organizations who are struggling may be wondering what went wrong in their situation, and even those who navigated the transition without a ripple might find some issues lurking under the surface. For one thing, professional claims rejections have risen, and coder productivity has dropped almost 40 percent. Regardless of your size and the current success (or not) of your organization’s ICD-10 transition, it’s a good idea to make sure you and your professionals and partners understand all the changes, and why education can help bridge some of the remaining gaps.2


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