Centers for Medicare and Medicaid Services,CMS,Health Insurance Claim Numbers,HICN,MACRA,MBI,Medicare Access and CHIP Reauthorization Act of 2015,Medicare Beneficiary Identification

Decoding the transition to Medicare Beneficiary Identification

Crystal Ewing, Product Manager, ZirMed

In the next 18 months, 150 million Medicare beneficiaries (active, archived, or deceased) will be transitioned to new ID numbers, called Medicare Beneficiary Identification (MBI) codes. The goal – to protect a vulnerable population from identity fraud – is admirable and urgent.

But the sheer magnitude of the process, combined with significant uncertainties about its rollout, should be of great concern to health IT leaders at hospitals and healthcare systems. Hiccups in the transition could potentially disrupt continuity of care and delay payments to providers. Health IT leaders would be well-served to develop a strategy now to minimize negative impacts down the road.

Why the change is needed

Up until now, Medicare beneficiaries have been using 11-character codes called Health Insurance Claim Numbers (HICN). The problem is that they all begin with the member’s social security number, with two characters added to the end. These ID numbers are easy to crack and – since Social Security numbers provide access to all sorts of private information – leave beneficiaries open to identity theft, both medical and financial. A Medicare card that is lost, copied, or even left in view in a public area or in the home could jeopardize a member’s personal health information or life savings.

So as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Centers for Medicare and Medicaid Services (CMS) will be replacing the old Health Insurance Claim Number (HICN) on Medicare cards with new, randomly generated Medicare Beneficiary Identification (MBI) codes. Officially, the change is known as the Social Security Number Removal Initiative. The new MBI codes will use a randomly generated combination of letters and numbers, similar to the recommended best practices for passwords.

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Data analytics,Navicure,revenue cycle

Making revenue cycle data actionable


Jim Denny, Founder and Chief Executive Officer, Navicure

When describing the amount of revenue cycle data available to healthcare organizations, many providers use words like “massive” and “daunting.” The reality is that providers have access to more data than ever before, yet they often don’t know what to do with it. There are literally hundreds of revenue cycle metrics that healthcare organizations can collect, resulting in a volume of information that if not managed well can be overwhelming.

The key to getting the most out of revenue cycle data is making it actionable, and that is where data analytics come in.

A relatively new idea for healthcare

Data analytics, sometimes known as business intelligence, involves examining raw data to identify patterns, discover risk points, uncover opportunities and draw conclusions. Although other industries have been using data analytics for years, healthcare is somewhat new to this world, especially when applying the concept to the revenue cycle.

Recent results of a national survey of healthcare organizations, conducted by Porter Research and Navicure, found only 45 percent of survey participants used a data analytics and reporting solution to analyze their revenue cycle. Of those that didn’t have a solution or were not looking for one, 36 percent didn’t think they needed it, and nearly 50 percent didn’t have the necessary time, budget or resources to employ such a solution. Those organizations using a data analytics solution place value on revenue cycle analytics. According to the survey, 73 percent of respondents viewed revenue cycle data analytics to be a top priority.

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Patient Relationship Management,patient retention,patient satisfaction,PRM system,Solutionreach

How patient relationship management software cultivates sustained practice success


Ryan Browne, Vice President of Client Success, Solutionreach

As with any business dependent on recurring revenue, healthcare practices are encouraged to engage with their patients and build relationships with them. As patients are becoming more responsible for the cost of their care, providing a high-quality patient experience is more important than ever.

With so many methods to connect and engage with patients — social media, newsletters, online reviews, etc. — developing strong patient relationships requires a large time investment. Fortunately for providers, technology is expanding to offer new, effective and efficient ways to manage the patient relationship.

Here are three reasons why implementing a PRM system is the right move for your healthcare practice.

Enhances marketing to new patients

According to a Johns Hopkins[1] study, 23 percent of patients saw three or more primary care doctors in two years, which means patients are exploring their options when it comes to healthcare. So how can practices best market to new patients? Meet them where they are — online.

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care coordination,CareSync,CCM,chronic care management,MACRA,Medicare Access and CHIP Reauthorization Act of 2015,Merit-based Incentive payment system,MIPS

MACRA and CCM: How IT leaders can deliver value

Bond head shot

Travis Bond, Chief Executive Officer, CareSync

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which aims to replace the volume-based era of healthcare with value-based medicine, may not take full effect for another three years in terms of financial impacts, but the performance measurement period is quickly approaching, beginning this coming New Year’s Day.

As organizations prepare for MACRA, it’s essential to take into account how requirements can be met through chronic care management (CCM) programs – a CMS initiative to help providers bridge the gap between fee-for-service and value-based care by emphasizing care coordination between providers. While technically separate initiatives, CCM programs are an underlying component of MACRA, practically driving what the regulation is aiming to achieve: a push toward truly value-based, patient-centric care. It is, after all, nearly impossible to meet the requirements of MACRA without also performing the tasks of CCM.

IT leaders, especially in mid-sized or larger group physician practices, play a key role in preparing their organizations by ensuring all tools and infrastructure are in place now to meet basic CMS requirements for care coordination and value-based care. In doing this, IT leaders have the opportunity to lay the foundation for a truly effective CCM program – that benefits the financial health of the organization and, more importantly, the physical and mental well-being of its patients.

Regardless, time is of the essence: For every day that physician practices fail to meet care coordination requirements under the MACRA performance period, currently scheduled to begin in 2017, they risk a reduction in Medicare reimbursements beginning January 2019.

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cybersecurity,FinTech,Georgia Cryptologic Center,Georgia Department of Economic Development,Georgia Quick Start,University System of Georgia

How a strong HIT value chain ensures success for Georgia businesses


E. Jane Caraway, Director of Life Sciences and Corporate Solutions, Georgia Department of Economic Development

What was once seen as ‘new’ industries, such as information technology, financial technology and cyber security, are now not only leading economic generators but are experiencing exponential growth with no signs of slowing down. There is little doubt that different states attract specific industries, and Georgia is quickly becoming recognized as the state that supports and enables the dynamic growth of leading, high-profile companies in these fields.

While the world is moving toward globalization, I still believe that the geographical proximity of individuals and organizations helps to lead to diversification and development of new technologies. In this way, there is solid evidence that the location of these high-profile companies in Georgia is resulting in the growth and development of organizations that supply electronic health records and healthcare management. The locations of these businesses, the convergence of their technologies and the development of the new health information technology in Georgia, is not a coincidence. Georgia offers one of the most robust value chains in the country: in Georgia an idea can be born, researched, developed, tried, manufactured, distributed and maintained.

To this point, an information technology business ecosystem has become established and is thriving in Georgia, and for good reason.

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patient education,patient relationship management technology,personalization,Solutionreach,value-based care

In the transition to value-based care, patient relationship management technology bridges the information gap

Jim Higgins, Chief Executive Officer and Founder, Solutionreach

Written by: Jim Higgins

With the doctor shortage amid a rise in healthcare costs, patients and physicians are feeling nervous about future changes in health care.

Nevertheless, the shift toward value-based health care continues, even in an era of regulatory uncertainty.

By 2018, the Centers for Medicare & Medicaid Services (CMS) will require 50 percent of payments to be value-based, while an increasing number of studies indicate a growing number of reimbursement plans are linked to outcomes.

For physicians who are uncertain about what the shift towards value-based care means to them specifically, as well as their patients, there are two options: Wait to learn more about the unknown, while staying silent, or reframe this uncertainty as a unique opportunity to educate patients and shape their outlooks (and outcomes) while providing high-quality care. Physicians should focus on the second option as value-based care takes off, especially considering that physicians are already experiencing challenges when it comes to patient engagement.

In moving forward, physicians will benefit from taking this time to familiarize themselves with technology solutions that can help practices improve their patient communication and engagement, while arming patients with the tools and resources they need to make their best decisions.

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billing,collections,eStatements,Navicure,payment solution,Porter Research’s Healthcare Organizations + Patient Payments survey

Three steps to optimizing collections and avoiding patient payment pitfalls

Jeff Wood 2011

Jeff Wood, Vice President of Product Management, Navicure

Patient payment responsibility is increasing at a rapid pace: the average out-of-pocket cost per patient rose almost 255 percent during the last 10 years according to the Kaiser Family Foundation [i]. As a result, many healthcare organizations are starting to re-engineer or even re-imagine all of their processes from scheduling, to check out and billing follow-up, in order to keep pace with what patients need to pay for their care. At a minimum, patients have more questions about their higher financial responsibilities and generally want conveniences such as easy-to-use online payment options.

Whether you are just starting to update processes or are looking to fine-tune, here are three ways to respond to changing patient needs while optimizing payment collections.  

1. Educate staff and build consensus for a new patient collections model

Healthcare leaders understand their organizations can no longer remain financially healthy if they write off uncollected patient payments, but creating the necessary change can be difficult. As you develop new processes and implement new technology, it’s important to educate your staff and build consensus for these changes. First, your team needs education regarding why you’re making the changes and how critical patient payments are to your organization’s viability. Next, the team needs targeted training regarding how their processes will change and how to handle the new scenarios they’ll encounter.

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Advanced Alternative Payment Models,APMs,MACRA,Medicare Access and CHIP Reauthorization Act,Merit-based Incentive payment system,MIPS,Stoltenberg Consulting

MACRA considerations for physicians in 2017

Joncé Smith, Vice President of Revenue Cycle Management, Stoltenberg Consulting

Written by: Joncé Smith

Entering 2017 brings a huge degree of uncertainty amid major healthcare industry changes. In particular, the Medicare Access and CHIP Reauthorization Act (MACRA) holds several options for Medicare physician payment paths as healthcare providers interpret implications and exemption possibilities.

MACRA replaces the old sustainable growth-rate (SGR) formula for physician payment, shifting focus from the fee-for-service model to value-based care. Physicians must now pick from one of two reimbursement tracks: the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).

To help you better understand MACRA, we’ve outlined the program’s tracks below.

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claims,ERISA requirements,PBM,Pharmacy Benefit Manager,prescription benefit plan,TRICAST

Why prescription benefit plan sponsors should audit


Roy Wilkinson, Senior Consultant, TRICAST

Many sponsors of prescription drug benefit programs have operated on blind faith for too long. They have depended on their pharmacy benefit manager (PBM) to deliver safe and effective prescription drug coverage to their plan members while helping to reduce costs. The problem occurs when the plan sponsor relies on their PBM to tell them how they are doing! This is something akin to the fox guarding the hen house.

To make matters worse, prescription benefit programs and PBM business practices remain some of the most opaque operations in health care. It is almost impossible for a plan sponsor to fulfill their fiduciary obligations without some type of independent, third-party oversight. This is where outside auditing and monitoring comes into play.

Let’s take a look at the reasons why:

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clinical documentation,Data analytics,healthcare reimbursement,Navicure,Revenue Cycle Management

Optimizing healthcare revenue cycle management in 2017

Ken Bradley, Vice President of Strategic Planning and Compliance, Navicure

If there is one thing the healthcare industry has learned in 2016, it’s that change is constant. With regards to the revenue cycle, for example, increasing patient financial responsibility coupled with pressure to improve overall revenue cycle efficiency has prompted many healthcare organizations to revisit and rethink their current operations.

As 2017 dawns, healthcare organizations are once again facing uncertainty. Although it might be tempting to wait and see how the year unfolds and then take action, this approach can lead to missed opportunities to enhance quality, reduce costs and streamline operations. In particular, the following four revenue cycle strategies warrant attention in the coming year.

1. Improve clinical documentation

Complete and precise documentation goes a long way toward preserving revenue integrity. Not only does it ensure an organization receives all the payment it deserves, it can also limit denials, smooth cash flow and lower the cost to collect. There are a variety of best practices related to clinical documentation improvement, including working one-on-one with clinical departments to boost accuracy and thoroughness. In addition, organizations can implement technology that prompts clinicians to add detail and address all required components.

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