10. May 2014 · Comments Off on Do you have Hidden ROI? Discover it now – Session 41(Himss Conference, Orlando) · Categories: Uncategorized

The lecture mainly focuses on Management Strategy, unified communication and collaboration strategy and toolset, and how it can uncover hidden ROI in Healthcare organizations.

Salient Features:
1. Introduction of collaborative strategy that with the help of technology like Sharepoint enterprise system should bring multiple offices or hospitals on the same centralized servers.
2. Thus increasing communication and collaboration between service providers ensuring data and analytics synergy.
3. Improve associate communication, collaboration and productivity
4. Increase patient, physician and associate satisfaction
5. Improve patient safety
6. Realize cost savings and/or cost avoidance

This strategy would ensure that the same work is not done multiple times hence reducing costs and increasing revenue.

10. May 2014 · Comments Off on Big Data in Healthcare 101 – Bob Rogers and Vishnu Viyas · Categories: Uncategorized

What is Big Data?
Big Data is the unstructured data that we find in our lives. In the Healthcare space it is accounted for the unstructured text and scanned data available. It accounts for 63% of the data in healthcare. To be able to provide valuable business intelligence and clinical analytics in healthcare big data is the new frontier and frankly without Big Data efficient and accurate clinical analysis is not possible.

Develop and implement a comprehensive project that converts the unstructured data into structured data that can be used for analysis. This does not only have potential in the healthcare industry but in almost all industry that require accurate and efficient business intelligence and analysis.

10. May 2014 · Comments Off on The Financial Case for EHR/RCM Integration The Power of Clinically Driven Revenue Cycle Management · Categories: Uncategorized

What is an EHR system?

An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care. EHRs can:
Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results
Allow access to evidence-based tools that providers can use to make decisions about a patient’s care
Automate and streamline provider workflow
One of the key features of an EHR is that health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one health care organization. EHRs are built to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.

What is an RCM system?

The revenue cycle management (RCM) system in the traditional sense is revenue generation function for a healthcare provider. It includes collection of revenue for the practice from insurance, posting of charges and rebilling in case of denials. Healthcare providers either have in house RCM or outsource it to billing companies that charge a percentage for collecting money from insurance companies.

Majority of the providers do not have these two systems integrated, when there are clear benefits gained by the practice if these two systems are tightly linked. The benefits of a true integration are given as follows.

• A rules-based engine can identify opportunities to optimize revenue streams directly at the point of clinical decision-making
• Alerts can advise when a requested procedure or test won’t be reimbursed by the payer, as well as flagging duplicative care
• Alternative procedures or tests for which the payer honors claims can be recommended over an initial, non-reimbursable choice
• As the rules-based engine grows over time, the system can recommend proven means for improving clinical and financial outcomes
• Electronic flow of data captured in the EHR directly into the RCM increases overall efficiency, accuracy and accountability
• When claims are still occasionally denied, faster and more accurate processing with rich clinical documentation supporting claims can speed up denial resolution
• Issues can be identified and resolved in the earliest stages of the revenue cycle, preventing recurrent errors later
• Reduction of errors and omissions at the point of clinical decision-making increases overall revenue capture
• Clinical — More informed decision-making at the point of care can lead to improved clinical outcomes and health management
• Financial — Consumers are far less likely to face hefty and unexpected out-of-pocket costs for tests or procedures not covered by their insurance plans
• Satisfaction and consumer engagement — Having the combination of clinical and financial data at the time the caregiver is engaging with the patient leads to a better dialog regarding options, engaging the consumer more directly in care and achieving a higher level of satisfaction with the healthcare encounter and provider

True integration

What is meant by true integration? True integration is achieved when both systems share data at the database level i.e. they share the same database. They should be passing and saving information in the unique patient records efficiently and effectively.

ICD 9 to ICD 10 Conversion

The advent of ICD 10 has proven to be a challenge for healthcare providers with unintegrated EHR and RCM systems for the following reasons.
1) The conversion will increase cost in new software updates
2) Increase costs in physician and staff training
As a result it is expected that to advert these costs, 30% of healthcare providers will render the services of billing companies and thus outsource the RCM function of the practice. The question remains is that will the outsourcing give the same kind of data integrity and benefits enjoyed by an integrated RCM/EHR system?


I believe that integrated RCM/EHR solutions would be essential for all healthcare providers, as it reduces human intervention and thus human error. The Integrated RCM/EHR system is efficient. Let us analyze the workflow for a traditional practice. The doctor sees a patient makes a record of diagnosis, the back staff generates a super bill that is either taken to a biller in-house or to an outsourced billing service who bill the insurance companies. The integrated RCM/EHR system would eliminate all these steps and human intervention. The work flow of a truly integrated system would be the doctor filling in the diagnosis for the patient which the program will automatically save in the patient record and charge their insurance company. Hence it is essential for healthcare providers to have an integrated RCM/EHR system.

Reference: Greenway • WHITE PAPER: Clinically Driven RCM

08. May 2014 · Comments Off on Using Documentation Technology to achieve physician alignment with ICD-10 – Adele Towers, Tom Mercer.(HIMSS Conference, Orlando 2014) · Categories: Uncategorized

The lecture highlighted in detail the documentation hurdles that a service provider will face during the transition from ICD-9 to ICD-10. It also provides with an awareness and education based curriculum that would be used on service providers and coders to make the transition smooth and less costly. The lecture also highlights how technology can play a part to reduce the initial anxiety that will be faced by service providers due to the transition. EHR and EPR providers have also started to incorporate the diagnosis changes into their programs. Unfortunately the overwhelming change in the codes will still cause problems in actual documentation. For instance, a code for ankle sprain in ICD-9 had just 4 sub codes while in ICD-10 has 72 sub-codes for ankle sprain.

Develop a strategy to educate and help service providers in the implementation of the ICD-10 transition.
The strategy should not only educate the doctor but also provide with a tool to make the transition easy.

02. May 2014 · Comments Off on Understanding the Patient Education and Engagement Market: · Categories: Uncategorized

The following guidelines are important to consider during patient engagement and education products:

  1. Identify the learner (patient population demographics)
  2. Provide patients with simply, easy to read material
  3. Verbal, personal patient instruction videos might be an opportunity.

During research for patient engagement and patient education apps, the author discovered plenty of apps that educate patients to a very specific disease state. For example, iHearttouch is an app that can educate patients with regards to their heart conditions.3  Apps such as Modality Body provide MDs with precise anatomy of the human body that they can use to educate their patients about a disease.4 However, as per my general observations, many of these apps are too technical and may not be very useful in conveying the message to the patient.

An average American can read and write at an eighth grade level. Adding complicated medical lingo to discharge instructions has risk of confusing patients and defeats the purpose of patient education. Secondly, it is not clear how many individuals will actually use such healthcare apps for medical education. As per a paper by IMS, 5 the downloading and the usage of healthcare apps is low with “50% of healthcare apps receiving less than 500 downloads”.5 Thirdly, most of the current consumers of healthcare are elderly individuals (65+) who are not necessarily technology savvy.  Usage of apps among such patient population is very minimal5 as they tend to rely on face to face interaction for health information. Hence, an App that can integrate verbal communication by the physician and uses simple language to convey health information will most likely be successful.

Listed below are two companies that are trying to make a contribution to the patient engagement market space.

Axial Exchange:

As per its website, “Axial comprehensive patient engagement solution includes Mayo Clinic health content, software tools for tracking vitals, labs, and symptoms, and integration with wearable devices such as Fitbit”.1

With an axial app, a patient can get their hospital visit organized ( the app can provide the patient with the MD’s contact number as well as the date and the time of appointment), improve patient’s health literacy ( provide patient with educational material pertaining to their possible disease state),  arrange patient’s medication list ( provide patient with a list of their medication as well as instructions on how to take them and when to take them), scheduled post discharge appointment as well as manage patient’s progress.1

The app also provides health systems with web-based dashboard that provides insight into how patients are engaging utilizing their education or following their appointments. The app also provides personalize communication ( for example a patient with untreated HTN will get personalize message stating “Here are some tips to control your HTN”).



WeLVU is a cloud based patient engagement technology platform which aims to improve patient satisfaction and outcome. WeLVU mobile, provides ipad and iphone based platforms that combine medical illustration, a providers verbal conversation with the patient to create a patient specific engagement video.2 By providing patient specific videos and illustration, the chances of enhancing patient engagement is increased.





1: http://axialexchange.com/howto/

2: http://www.welvu.com/mobile/

3: https://itunes.apple.com/us/app/iheart-touch/id534675711?mt=8

4: https://itunes.apple.com/us/app/modalitybody-interactive-anatomy/id364370895?mt=8


08. April 2014 · Comments Off on Understanding PQRS and Negative Payment Adjustments: · Categories: Uncategorized

Physician Quality Reporting System (PQRS) is a reporting program that uses a combination of  incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs) and group practices1. The program provides an incentive payment to practices  with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]) who successfully report clinical quality data for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). 1

Voluntary reporting program with Negative Payment Adjustments:

PQRS allows Eligible Providers to “voluntarily report” quality reporting measures, it will start enforcing negative payment adjustments starting in 2015.  As per Section 1848(a)(8) of the Social Security Act, Centers for Medicare & Medicaid is required to subject eligible professionals (EPs) and group practices who do not report data on Physician Quality Reporting System (PQRS) quality measures for covered professional services during the 2013 program year for a payment adjustment beginning in 2015.2

1.5%  negative payment adjustment will occur in 2015 (EP or group practices participating in GPRO will receive 98.5% of his/her allowed Medicare Part B PFS amount for covered professional services that would otherwise apply to such services).2

In calendar year 2013, medical practice groups of 100 or more EPs (all of whom file Medicare PFS claims using a single tax identification number) must register and participate in PQRS as a group in order to avoid an additional negative 1.0% payment adjustment in 2015 under the Value-based Payment Modifier. 2

Just as 2015, Section 1848(a)(8) of the Social Security Act, requires the CMS to subject EPs and group practices to a payment adjustment in 2016. EPs and group practices receiving a PQRS payment adjustment in 2016 will be paid 2.0% less than the PFS amount for services rendered January 1- December 31, 2016 (or receive 98% of his/her allowed Medicare Part B PFS amount for covered professional services that would otherwise apply to such services). The reporting period for the 2016 PQRS payment adjustment is the 2014 program year. 3

Avoid 2016 Negative Payment Adjustment: 3

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03. April 2014 · Comments Off on New Data From eHealth Price Index Points to Off-Exchange Enrollment Trends as Open Enrollment Draws to a Close · Categories: Uncategorized

eHealth is the largest private online health insurance exchange and updated its eHealth Price Index. This Index includes data on key enrollment demographics, consumer plan selections, and average health insurance costs for the second half of Obamacare’s open enrollment period.

Over the last three months, the eHealth Price Index shows eHealth customers were younger and usually were previously uninsured. eHealth has been successful in approaching the 18-34 age group and signing up customers, noting that plans generally have lower average monthly premiums than the ones from the first half of the Affordable Care Act. The ultimate goal is to be able to enroll subsidy eligible people online on a large scale, not just through the phone. Enrollment in “catastrophic” plans has increased tremendously, while regular plans have subsided in popularity.

Feel free to learn more by clicking on the links below.




01. April 2014 · Comments Off on Understanding PQRS and how it relates to Meaningful Use Clinical Quality Measures · Categories: Uncategorized

PQRS (Physician Quality Reporting System) is a “reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs).” 1

The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer).

It is a program that was created in 2006 Tax Relief and Health Care Act (TRHCA). At first, it was known as Physician Quality Reporting Initiative (PQRI) and offered 1.5% bonus payment for successful reporting on quality measures. In 2008, Medicare Improvement for Patient and Provider Act made the program permanent, and in 2010 the Affordable Care Act ensured that individuals who would not adhere to PQRS would face negative adjustments starting in 2015.

CMS defines PQRS as a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs).  The program provides incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer).

The goal of PQRS program is to collect data that can help lead to improved patient care. By reporting PQRS quality measures, EP (Eligible Providers) can quantify how often they are meeting a particular metric. They can then use this data to compare their performance with their peers. PQRS measures consist of a numerator and a denominator. The numerator describes the clinical action required by the measure for reporting and performance, according to CMS. PQRS denominator describes the eligible cases for each measures such as the eligible patient population associate with a measure’s numerator. Currently there are 259 measures in PQRS.

PQRS should not be confused with EHR incentive program “Meaningful Use”. The EHR incentive program was created under the American Recover and Reinvestment Act of 2009, which provides incentive payments to EPs, Hospitals, and Critical Access Hospitals for the “meaningful use” of certified EHR technology. Since Meaningful Use is a separate program than PQRS, attesting to Meaningful Use does not mean successful participation in PQRS or vice versa.

As per CMS, CQMs (Clinical Quality Measures) are tools that help us measure and track the quality of healthcare services provided by EPs, eligible hospitals (EHs) and critical access hospitals (CAHs) within our health care system. These measures use a wide variety of data that are associated with a provider’s ability to deliver high-quality care or relate to long term goals for health care quality. In 2014, EP are required to report on 9 of 64 approved CQM’s, where else EHs and CAHs must report on 16 of 29 CQMs. CQMs must be selected from at least 3 of the 6 key healthcare policy domain such as Patient and Family engagement, Patient Safety, Care Coordination, Population and Public Health, Efficient use of healthcare resources, Clinical Processes/effectiveness. Furthermore, in 2014, all EP’s beyond their first year of Meaningful Use will be required to report their CQM data electronically from their 2014 certified EHR system.

Though both programs, PQRS and EHR incentive program “Meaningful Use”, are administered by CMS, reporting for both programs is slightly different.  In order to use the EHR to report PQRS data, the EHR has to be ” Qualified” by CMS i.e. tested, vetted and approved by CMS. Therefore, an EHR may be certified for Meaningful Use but may not be approved to participate in PQRS.




“Physician Quality Reporting System.” – Centers for Medicare & Medicaid Services. N.p., n.d. Web. 2 Mar. 2014. <http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/pqrs/index.html>.



04. August 2013 · Comments Off on What is Meaningful Use? From Healthcare IT.gov · Categories: Uncategorized

Meaningful use is the set of standards defined by the Centers for Medicare & Medicaid Services (CMS) Incentive Programs that governs the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria. 

The goal of meaningful use is to promote the spread of electronic health records to improve health care in the United States.

The benefits of the meaningful use of EHRs include:


.For details about the incentive programs, visit the CMS website.


04. August 2013 · Comments Off on Electronic Medical Records Go Largely Unused: Survey (WSJ article) · Categories: Uncategorized

Clint Boulton from the WSJ writes about a study that finds that only 24% of consumers are using electronic medical records systems.  The Centers for Medicare and Medicaid Services states that 80% of eligible hospitals have adopted EMRs. To read the full article, click on the link below: