Nalashaa Healthcare Blogs
The Quality Payment Program (QPP) was introduced in 2015 as part of the Medicare Access and CHIP Reauthorization Act (MACRA), which replaced the sustainable growth rate. Two ways of participation: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). MIPS highlights of 2022 for incentive claims on 2023 To avoid a payment penalty…
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Data security and transfer have always been major concerns for the healthcare industry since ages. The No Surprises Act was passed in 2020 and was effective in Jan 2022. The Consolidated Appropriations act of 2021 introduced several new changes to protect patients from surprise bills. This came as a boon for the millions of people…
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Healthcare RPA is not like the AI robot Sophia or the Curiosity Mars rover. RPA in healthcare is more delicate. Intelligent bots and programmed software agents which work on a specific task. RPA has been useful in several areas of the healthcare industry, including patient interaction systems, insurance, laboratory insurance, and inhabit accounting. Utilizing structured data of…
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The benefits/upsides/ of our Virtual Healthcare Solutions for Providers Reducing the need for in-person meetings: We provide administrators and clinicians with the opportunity to quickly record and disseminate brief video messages to a group of stakeholders via asynchronous video. Video conveys a message more personally than a basic email, allows for on-demand viewing, and eliminates…
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Healthcare is rapidly evolving into a new era, where almost everything is connected through digital technologies. This introduction of IoT, IoMT (Internet of Medical things), and medical devices have been the driving factor behind more informed care delivery and better access to value-based care. But such rapid digitalization comes at a cost. The healthcare industry…
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How DATA and AI can improve Technology? Streamlining administration: AI has the ability to speed up and automate certain tasks, which could lead to a more efficient workflow in a healthcare setting. Additionally, AI can help to identify potential issues and problems that may arise, which can help to prevent or mitigate them before they…
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A smooth patient journey requires efforts from a lot of players in the healthcare ecosystem. The point-to-point ecosystem of today has become stagnant and is not helping the increase of efficiency. An interconnected and automated back office can help both payers and providers. How disconnected are Healthcare Systems today? EHR portals: Most EHR portals are…
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A perioperative suite drives almost 40% revenue of every hospital. But for them to work effectively they require access to the right information. Just having an EHR doesn’t solve every problem. EHRs are intended for use by healthcare providers to manage patient care, not for data analytics. It just provides rich clinical Data. But data is not…
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As we can see from the above infographic providers are facing the wrath of information-blocking claims. 6th October 2022, HSS released a revised version of the Information blocking rule to reduce this provider burden. What is new in the Information Blocking act? Changes to EHI Data: The definition of EHI has now expanded. Earlier information…
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The healthcare industry has witnessed rapid digitalization in these recent years. But most of these changes have been targeted to solve a specific problem in the network. This has resulted in digitalization but has also created disconnected provider networks. Challenges that’s been crippling the industry Staffing shortages: There is a staff shortage in the US…
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ONC and other agencies have been trying hard to reduce reliance on paper. They revealed the gaps in the nation’s public health infrastructure. The overburdened hospitals caused a mass decrease in the electronic reporting of patient data. Over 70% of hospitals experienced at least one major challenge with electronic public health reporting. This will cause…
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2023 will bring about more complications and regulations for healthcare technology. With the PHE ending, Government bodies are now busy revising the rules and policies for 2023. The recently published 2023 Medicare Physician Fee Schedule and the reforms to the Information Blocking Rule released on October 6th, 2022 suggest a lot of changes in revenue generation,…
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Fraud, waste, and abuse (FWA) in healthcare is a widespread problem in the United States. The Office of Inspector General (OIG) at the Department of Health and Human Services (DHHS) estimates that FWA costs the healthcare system will reach upto 27% of the total Healthcare spending. In its report, “Fighting Fraud, Waste, and Abuse in…
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Open enrollment is typically opted for by employees of organizations, which means they come under Medicaid, corporate insurance, and Individual Market. This process opens up every year around the same time (Nov to Jan), but people still let their previous year’s benefits carry over without checking for new benefits and then try to opt into…
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What Does CMS Have to Say: 2023 Medicare Physician Fee Schedule In 2019, a terrible pandemic swept across the world. A pandemic that forced us to stay at home but also increased our dependency on doctors. Keeping this in mind, the US govt decided to add multiple new temporary CPT and HCPS codes to the…
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The opioid epidemic is a major concern for both the US healthcare ecosystem and the US Government. A whopping 10 million people misuse Opioids every year and over 48,000 people lost their lives due to overdose in 2020 (Link). PDMPs stand for Prescription drug monitoring programs (PDMPs). The state-wise PDMP databases were created with the…
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Claiming for health insurance is a lengthy process. Though patients are not subjected a tedious claim process, the provider and payers are . Prior Authorization is the very first step in the process of claim. This is a permission from the health plans for the payment of the treatment. Without prior authorization some medical treatments…
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“Substitutable Medical Applications, Reusable Technologies” aka SMART is a standard framework to facilitate the development of interchangeable healthcare applications. Since its initiation in 2010, the SMART Health IT Project has attracted the collaboration of many organizations (creating the SMART Advisory Committee). SMART, now is a standard that works on top of FHIR in the same ecosystem.…
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The Patient Protection and Affordable Care Act, also known as Obamacare, signed into law on March 23, 2010 has had a series of rules and regulations published under its wing. The CMS-9922-F in 2020, and the CMS-9906-F in 2021 are a few regulations under this act. In January of 2022, the HHS proposed amendments to…
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The benefits of EDI in healthcare is not an alien topic. The healthcare industry is one of the many industries that handle huge volumes of data like —patient medical records, health insurance reimbursements, and healthcare claims, among others. Using paper forms can be cumbersome. Since its inception, EDI systems have been pivotal in helping healthcare…
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Many key aspects of the healthcare revenue cycle have been driven by manual processes that are borderline monotonous. Let’s face it; healthcare providers are having to ‘do more with less’ due to changing healthcare regulations, and much-needed respite is long overdue. In short, the current need of the hour for healthcare providers is effective billing…
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A Snapshot of the Mobile Health Market The mobile health market is predicted to grow at a rate of 41% CAGR in the coming year. Monthly downloads are as high as 3.2 billion across all mobile healthcare apps. A recent statistic also predicts that the mobile healthcare apps market will reach over 11 billion dollars…
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Automation has been at the forefront of technological innovation for quite some time now. Every industry needs automation in one form or another, be it Robotic process automation, industrial automation, APIs, or Business Rules Engine (BREs), it is inevitable for organizations to accomplish day-to-day tasks without leveraging automation. Health Plans can leverage automation by automating…
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CMS has been releasing a plethora of regulations in the quest to enhance patient care quality. All the players in the healthcare ecosystem have been affected by these regulations; Health Plans are no different. There are certain regulations which takes priority for health plans, as non-compliance may prove too costly for them. Below are regulations…
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The concept of Telehealth solutions arrived in the late 20th century with the advent of the telephone & radio. Today advanced technologies, including video telephone, the latest telemedical devices, mobile cooperation technology, diagnostic methods, and distributed client or server applications have upgraded the quality of telemedicine and thereby US healthcare in general. It is said that Technology can only improve when…
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According to the Centers for Disease Control and Prevention (CDC), population health management (PHM) is “an interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally.” It helps improve the “Triple aim” moto of the US healthcare industry. Triple aim stands for improving population health, enhancing the patient…
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The last three years have accelerated digital evolution in a matter of months. The healthcare industry is facing a sudden need to provide virtual care and remote assistance especially when human contact is restricted. To keep up with these latest trends, legacy systems used across the healthcare industries need urgent modernization. Presently, more organizations in the healthcare…
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In the healthcare ecosystem, scalability and information storage are age-old problems. Cloud computing in healthcare provides faster innovation, increased efficiency, better data analytics, higher security, and lower costs. These offer businesses greater scalability and the opportunity to launch new products in real-time. Moreover, the recent pandemic has shown healthcare providers the importance of automation and…
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Quality assurance is one of the pivotal processes that software vendors or end businesses should consider implementing. Policies and care provided to their members aren’t the only concerns for health plans. The system their employees and members use must be quality tested before deployment to avoid irreversible damages. Claims management is one of the software…
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Member engagement solutions play a crucial role in the smooth functioning of a health plan. Keeping members happy, satisfied, and healthy works in the favor of both the health plan and the member. With great member engagement solutions comes reduced member dropouts and network leakage, improved care outcomes, and so much more. It also helps…
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The Trusted Exchange Framework and Common Agreement (TEFCA) was made effective in January 2022. The ONC also provided further clarity on the idea of seamless patient health information exchange in the form of the QHIN Technical Framework (QTF) and the SOP updates to the original TEFCA draft. In this blog, we’ll take a look at…
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“6 out of 10 Adults in the United States have chronic illnesses and 4 out of 10 have two or more. The Key Lifestyle risks for Chronic Diseases are poor nutrition, lack of adherence to medication, reduced physical activity and excessive alcohol and tobacco use.” – Centers for Disease Control and Prevention From the statistics above, it…
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Payers and members make up two-thirds of the healthcare ecosystem and bear the brunt of the care delivered. Undesired care outcomes mean growing inconvenience for the member who has to go back to the provider. For the payer, this means more prior authorization requests, more claims, and ultimately more time and cost spent on one…
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Make no mistake, Robotic Process Automation (RPA) isn’t anything like the robots you generally see in science documentaries or Sci-fi movies. RPA is all software and it’s remarkably practical and economical enough to be adopted into real-time business applications. However, it also isn’t as complex and ridiculously expensive like the ‘aware’ computer systems that can…
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In 1991, the Healthcare EDI systems came to existence. Since then, it has been embracing many changes, owing to various updates. Incorporating all the latest updates, healthcare EDI proved to be one of the cornerstone of the Health IT spectrum, especially in the aftermath of the Covid-19 Pandemic. A few recent studies show that the…
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A good provider network is essential for payers. Finding new providers and enrolling them into networks is relatively easier than maintaining one. Providers can choose to drop out from health plans for a number of reasons; the reasons are as follows. Delayed Reimbursements Providers often deal with health plans that delay the claim reimbursements even after the…
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Health Plans are one of the most crucial aspects of care for patients. Since health plans have to interact with various parties in the ecosystem, they require a robust software solution to aid them in their journey towards care, compliance and excellent customer service. A robust healthcare payer solution can help health plans make data-driven decisions that…
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EDI stands for electronic data interchange. It creates a bridge between computer systems and applications to provide seamless data transfer. This is used by companies to communicate business documents in a standard format. It replaces paper-based documents thus saving time and minimizing errors related to manual processing. Healthcare EDI In the US healthcare ecosystem, EDI…
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According to the first-ever survey conducted in 2020 by debt.com on medical debts, 46% of Americans are in medical debt. The number doesn’t seem to be going down, as the next survey conducted showed an increase in the number by 4%. Half of the American population is in debt or having trouble paying off their…
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Member management is crucial to healthcare payer organizations. Member engagement KPIs are what decide a payer’s Net Promoter Score. This means that payers must put in extra effort to ensure member attrition is kept to the minimum and ideally eliminated from their health plans. Members drop out of health plans for a number of…
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Before we step into how data analytics can transform a payer’s organization for the better, one must address the chains holding them back from the miracles of analytics. The lack of interoperability has been plaguing the healthcare ecosystem for quite some time now. The Interoperability and Patient Access rule along with the Proposals to Reduce Burden,…
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The Trusted Exchange Framework and Common Agreement (TEFCA), is the primary constituent in the ONC’s roadmap for nationwide HIT interoperability. Since its introduction in 2018, it has been under review and was only published in the dawning weeks of 2022. TEFCA’s publication brings with it notable changes for HIT developers seeking to transform into Qualified…
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FHIR has taken the healthcare industry by storm. Health plans are rushing to incorporate FHIR into their systems to not just evade penalties but also to attain the end goal of affordable, easily accessible healthcare and healthcare data. In the previous two blogs, we have discussed the origin of FHIR, the need for FHIR, as…
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With the latest Interoperability and Patient Access rule, the proposals to reduce provider and patient burden, FHIR-based APIs have become the talk of the town. The latest proposed rule works towards enhancing health information exchange and achieving appropriate and necessary access to complete health records for patients, providers, and payers. At the same time, CMS is also looking to…
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With the introduction of the Interoperability and Patient Access rule, FHIR APIs created quite the buzz within both the payer and the provider communities. As a follow-up to the rule, CMS released a couple of proposals urging payers to implement a few more FHIR-enabled APIs along with the implementation guides. In this blog, let’s take a look at why these FHIR-enabled APIs were introduced in the…
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Affordable healthcare is the need of the hour and interoperability is the means to that end. The healthcare ecosystem is looking into ways they can enable this affordability as soon as possible, and that is where FHIR comes in. FHR promises an on-demand exchange of secure healthcare information. It has become an increasingly popular protocol, thanks to its commitment to ensuring interoperability in the…
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The need for interoperability was first highlighted back in the 1980s when payer organizations had to expand to working with data from more than one system. They needed a foolproof method of exchanging data from one system to another, where both systems could understand and process the data as per requirement. Today, however, the number of systems within a…
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In the previous blogs, we’ve covered payment models and the processes involved in provider network management. However, in practical world scenarios, managing a provider network can be tedious and repetitive. In this blog, we shall look at a few of the common challenges that plague health plans when it comes to managing provider networks. We shall also look at a few parameters health plans must-visit while…
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The COVID-19 pandemic has disrupted healthcare delivery significantly. Care facilities across the United States sustained financial losses that threaten the viability of medical practices. The unexpected increase in demand for healthcare services has dramatically increased the requirement for specialized care and has exacerbated the clinician burden in the process. Broken interoperability, the lack of value…
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Do you comply well with the frequent updates of the Transparency in Coverage Rules and Consolidated Appropriations Acts? Having a hard time managing everything on your own? Don’t fret! First, learn what the new updates are. In our last blog Here’s How You Can Implement Transparency in Coverage, find out the three areas where you…
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Having provider networks is a necessity. This is true for health plans and providers or hospitals, and especially, for the enrolled members. Managing provider networks can be a lot of work. Identifying the providers and hospitals according to the parameters mentioned in the previous blog is just the tip of the iceberg. The rest of the work essentially needs effective management and maintenance of provider networks. A few of the processes involved in provider network management are as follows. Credentialing and Enrollment Credentialing is…
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The healthcare ecosystem consists of three participants: payer, provider, and members. Payers and providers are constantly rolling out effective, value-based, good quality care for members. There are several ways to achieve this goal, and here we shall delve into one of them – provider networks. A health plan’s provider network is essentially a roster of physicians, be it health providers, or hospitals who are in a contractual relationship with the health plan. These professionals are called in-network providers, and the…
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The word ‘wearables’ usually brings to the mind, images of fitness devices linked with the smartphone. The birth of these devices accompanied the evolution of mobile devices into significantly more powerful computing platforms. While wearables have established utility in the fitness, gaming, and entertainment industries, their role in healthcare remains less clear. In this blog,…
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The proposed rule is currently titled ‘Reducing provider and patient burden’. However, the proposed rules do not promise any reduction of burden for payers. Payers must make sure their systems are updated, along with their workflows to be compliant with the proposal once it does become a rule. As burdens go, here are a few…
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The COVID-19 pandemic is still at large, operating in waves and through transmutation. It appears that its effects are destined to linger for many years to come. While most of these effects have been devastating, the pandemic has had one profound positive effect on the healthcare industry. Federal agencies such as the ONC, FDA and…
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The healthcare industry is currently undergoing a radical change driven by patient centricity and the quest for the seamless access and exchange of electronic Patient Health Information (ePHI). Healthcare Information Technology (HIT) and the capabilities it offers for healthcare and payer organizations will determine the success of this vision. The interoperability of healthcare systems and…
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The new CMS mandate for Electronic Prior Authorization (ePA) requests focuses on the NCPDP SCRIPT version 2017071 standard for four electronic Prior Authorization (ePA) transactions. The PA initiation request/response, PA request/response, PA appeal request/response, and PA cancel request/response and prescribers will be required to use this standard when performing ePA transactions for Part D-covered drugs…
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In the previous blogs, we have defined the Transparency of Coverage rule’s compliance requirements and their corresponding solutions. Now that the expectations from the solution is set, here we are looking at the implementation. Let’s cut straight to it. The implementation approach will depend on various technological factors such as cloud platforms, identification of the right source system with respect to data elements, data quality, etc. Without further ado, let us take a close look at the various dimension required to implement a solution to comply…
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The outbreak of the COVID-19 pandemic presented a unique challenge for care providers. They were handed the daunting task of identifying patients who needed medical attention the most. The burdensome aspect of this challenge was the level of data accuracy needed. One wrong move and the consequences severely affected patient mortality rate. Care providers have always been strapped…
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The healthcare industry is currently undergoing a tectonic shift towards a patient-centric care model to pursue Value-Based Care (VBC). To unearth the ‘value’ in care delivery, care providers must tap into incoming patient data to induce ‘well-informed’ clinical decisions. With this, the fascination for data has grown significantly over the last decade in the US healthcare industry. However,…
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As the dates set for public disclosure requirements, Jan of 2022, draws close with every passing day, it is best for everyone involved if health plans got themselves aligned with these requirements. Compliance would ensure faster delivery of quality care, resulting in reduced visits to the hospital, thereby healthier members. Disclosure requirements for public files…
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The Department’s guidelines on ensuring transparency in coverage are quite elaborate on the context and objective of disclosing information. Our previous blogs outline the disclosure requirements for both the Participants, Beneficiaries, or Enrollees, and the public. However, when disclosure requirements are converted into solutions, complexities arise. Currently, health plans do not have the required information in one place. Even if they do, their Enterprise Data Warehouse (EDW) would…
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Since the past couple of years, the CMS began its journey to instill interoperability into the healthcare ecosystem and trying to bring about a culture of patient-centricity into the picture. The Interoperability and Patient Access final rule aimed to address the existing drawbacks hampering interoperability and thereby improve the quality of care. However, it missed…
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Back in May 1, 2020, The Centers for Medicare & Medicaid Services (CMS) introduced the Interoperability and Patient Access Final Rule. The rule aimed to improve healthcare quality provided by improving patients’ access to their healthcare information. By adopting the patient-first approach, CMS believed it would help patients make informed care decisions. While Interoperability and…
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Cost is one of the key elements that profoundly influences the efficiency of care delivery operations. Care providers don’t just incur costs when acquiring resources for care delivery. Expenditure is incurred for enabling it also. Healthcare technology is a foundational aspect of enabling care delivery and among the essentials. With the healthcare industry transitioning to…
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Provider expectation from HIT vendors has grown exponentially. These expectations encompass data security to application performance and the manageability of IT resources and systems. The good news is, HIT vendors have many avenues to explore to overcome the barriers that prevent care providers from realizing the potential of their technological choices. In this blog, we look at those areas…
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Patient engagement was initially only a methodology to ramp up the extent of patient satisfaction. With the improvement of healthcare technology, many benefits of patient engagement such as patient safety, transaction efficiency and better-quality care outcomes began to rise to the top. As the healthcare industry aligns itself to ‘patient-centric care’ patient engagement is set to play a leading…
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Access to healthcare is undoubtedly one of the most important factors in leading a well-rounded, healthy life. Although access alone is not enough, healthcare must also be easy to comprehend given that people from all walks of life need to access it. To ensure people are kept in the loop about their healthcare coverage options…
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Successful reimbursements supplement successful care outcomes. In simple words, when clinicians get paid for their services regularly, the frequency of the medical services amplifies. On the downside, there is no sure-fire way to ensure the quality of care with flawless reimbursements. This is mainly where reimbursement models are undergoing a radical change. Recent CMS regulations have introduced a plethora of changes…
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EHR systems rose to prominence at an exponential rate since the beginning of the ‘meaningful use’ days in 2009. However, the multitude of contextual changes, mainly driven by perennial regulatory updates, have impeded innovation in EHR development. EHR vendors must restart their innovation engines in the face of evolving reimbursement models, improvements in interoperability standards, rising consumerism and clinician…
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It has been reiterated time and again by the CMS that member engagement is crucial to both the health plans and members. To the health plans, engaging with members contributes to their shared savings, when their members choose a low-cost, high-value service post-consultation. To members, engagement with a payer results in proactive and well-informed healthcare decisions. Keep An Eye Out For These Roadblocks The…
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Health Plans are in pursuit of ensuring that members get to choose the best healthcare service which results in better care quality and outcomes. To do so, they are expected to come up with innovative and effective member engagement strategies. As the term suggests, Member engagement is about interacting with members the right way and at the right time. To gauge the right time and right way, or rather to get the context of the engagement right, Health Plans must keep an…
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The US healthcare industry is undergoing a tectonic shift towards Value-Based Care (VBC). Changing reimbursement models and HHS regulations are the two primary forces energizing the circumstances. Care providers are caught in this crosswind of a radical industry-wide change. Healthcare Information Technology (HIT) is the buoy that can help them stay afloat and advance towards…
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Member engagement is the new trend, taking the healthcare ecosystem by storm. Health Plans are now compelled to make themselves more approachable with enhanced member experience. By definition, member engagement is the interaction health plans have with their members. Traditionally, this interaction was limited to collecting premiums and reimbursing claims. With the onset of mobile applications, however, interactions between…
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The healthcare industry is witnessing a cultural shift, and aligning business goals along member-centricity. This shift is propelled by both member expectations as well as the plethora of rules and regulations. One such rule is Transparency in Coverage, requiring organizations to divulge cost-sharing details with those concerned, promoting better care decisions. Back in November 2020, ‘The Departments’ released a set of new requirements…
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The benefits of cloud computing in healthcare need no introduction. Many healthcare facilities in the United States have sampled the power of the cloud. Those who have exhibited excellence in personalized care have also managed to trim operational expenses in the process. As care providers explore healthcare cloud computing in further detail, patients have become acclimatized with quick…
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The healthcare revenue ecosystem is always on the move to achieve operational excellence, to offer personalized policies, proactive care programs, and preventive healthcare measures of the best quality. One way to achieve operational excellence is through continually improving the analytics culture, ensuring the data flowing in is utilized the right way to pull off business…
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With the onset of consumerism in healthcare, health plans must be prepared to make adjustments or modifications to IT systems and business processes to include the oncoming set of rules and regulations. Back in November 2020, ‘The Departments’ released a set of new requirements under the Transparency of Coverage rules. ‘The Departments’ consist of the…
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Data is the octane that powers the revenue-generating engines of all businesses on Earth. The CMS and ONC understand the possibilities of digitizing and storing high-quality data well, and this explains the ardent push towards a ‘patient-centric’ transformation of US healthcare. Establishing a partnership among patients and care providers is the goal, and it puts the onus on the providers…
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The healthcare industry is going through a makeover where organizations are pushed towards patient-centricity. With the rapidly surging volume of data and care information available online, regardless of the accuracy, patients are demanding access to optimized healthcare delivery. To keep patients satisfied and to stay ahead of the competition, it is high time health plans…
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Descriptive analytics ensures payer organizations are aware of trends in their workflows and key performance indicators (KPIs). Once a deviation within these trends is identified and addressed, stakeholders may need to be updated on the possibility of undesirable events in the future. This is where predictive analytics comes in. It gathers data to come up with event predictions and can notify payers whether their healthcare data management strategies would grant them desirable results. Predictive Analytics in Action The exponential increase in data…
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Payer organizations deal with data, day in and day out. It is not enough that payers fulfill their roles in the healthcare revenue ecosystem through claim management, credentialing, code entry, billing, and so on. They need to identify their shortcomings as an organization and address them to achieve higher efficiency, and this is done with the…
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Clinicians are currently playing the role of superheroes protecting humanity from a vicious enemy, the COVID-19 pandemic. There appears to be another silent adversary wearing our warriors down. Unfortunately, this enemy exists in the administrative systems that we created to support healthcare and well-being in the first place. Clinician burnout continues to affect healthcare professionals at a growing rate, and COVID-19…
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On December 13, 2016, the 114th United State Congress passed the 21st Century Cures Act with an intention to make it big in the face of U.S Healthcare. While it is designed to accelerate preventive care, health IT development and clinical research, it also intends to encourage data fluidity in the healthcare ecosystem. Recently, through the Cures Act Final Rule, released on May1, 2020, it brought…
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Telehealth services have been the guardian angel of both care providers and patients since the outbreak of the pandemic in 2019. They served as a lifeline for patient triaging and to deliver non-emergency care to chronically ill patients. Care providers’ and patients’ response to telehealth strategies and the extended support for care plans is a shining example of how global communities have adapted…
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From member enrollment, eligibility checks, and provider network management to billing and collection, healthcare payers are involved in handling and reporting sensitive healthcare data. The healthcare payer process is drawn out and cumbersome, with human errors resulting in penalties and loss of revenue, and must be automated at all costs. Besides the obvious benefits of report automation, it provides an excellent opportunity for all external stakeholders to view and analyze data efficiently in a customized manner. Payer Challenges in Absence…
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The COVID-19 pandemic has delivered punishing blows to chronic disease management. Patients enduring pulmonary diseases, hypertension, diabetes, and mental health conditions were among the most impacted. To hold the fort, care providers must utilize remote care platforms and contextually designed engagement to their fullest. But where exactly is the locus of control in Chronic Care Management during the…
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Today, data is everywhere and in many forms. The processing power to crunch huge amounts of data and get analytical insights is exponentially increasing. Cloud technologies are boosting the effective utilization of data at a rapid rate. Low-cost storage and on-demand scalability are taking data handling capabilities to new heights. But there is a flip side…
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When Deepmind’s AlphaGo defeated Lee Sedol, a top professional Go player, in the year 2016, deep learning (DL), a subset of machine learning (ML), became the buzz word instantly all over the world. After the demonstration of AlphaGo’s DL capabilities, businesses began to assess long term strategies to make serious commitment towards AI/ML implementations. Since then, the experimentations and use cases of implementation of AI/ML…
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Since the Meaningful Use initiatives of 2009, Healthcare Information Technology (HIT) development has been driven by continually evolving healthcare regulations. The Interoperability and Patient Access Final Rule & the 21st Century Cures Act Final Rule, released in 2020, continue this trend. HIT’s role in improving care outcomes and managing the pandemic is far too important to…
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The ONC issued a final rule on March 9th, 2020, to hold entities who interfere with, prevent, or materially discourage the access, exchange, or use of electronic health information (ePHI), accountable. It was the Information Blocking final rule, and it affected healthcare providers (Hospitals, SNFs, LTCH, Mental Health Centers, and more), ‘Certified Health IT’ developers, (Certified EHR developers), and HIEs. The…
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Although at the beginning of the 21st century, many businesses had started to focus on data, the COVID–19 pandemic has forced organizations to develop and adapt to a must–have data-driven culture at all levels. Data was once a business byproduct for many organizations. Now, data itself is a key driver for decision making in most businesses. Increasingly, many future business decisions will rely on data insights the company gets from its internal and external sources. When the pandemic hit, world economies and organizations went into panic mode because…
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The 2019 Physician Fee Schedule introduced three new CPT codes (#99453, #99454, and #99457) to enable hospitals and home health agencies to qualify for CMS reimbursements. The CMS’s proposed 2021 Physician Fee Schedule, released in August 2020, adds further clarity to how care providers can use the new CPT codes with the existing ones covering…
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ICD-10-CM has been used to document inpatient hospital procedure coding since October 1, 2014. It was introduced as an update to ICD-10. The year 2020 introduces two new changes to the coding system. In this blog, we cover the changes in detail. In July 2020, the CMS released the 2021 ICD-10-CM Official Guidelines for Coding and Reporting.…
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Millions of citizens in the United States rely on the accuracy of Electronic Health Records (EHR) to make crucial decisions about their well-being. EHR systems are the conduits that host, exchange and retrieve patient health records for clinicians, patients and other dependent institutions that are an integral part of the care continuum. When the integrity…
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Consumer satisfaction is paramount to the success of the product or service delivered by a business playing the field in the consumer segment. With increasing competition in the healthcare industry, this key performance variable is crucial to how your patients see you as a care provider. The CMS and the ONC continue to push for…
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We are witnessing a rise in the use of AI/ML concepts and technologies in healthcare. Today, algorithms are already outperforming radiologists at spotting malignant tumors and guiding researchers to construct cohorts for costly clinical trials. There is also an increasing number of investments being made around AI/ML use cases and proofs-of-concept across the healthcare industry. …
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The health of your organization is directly dependent on the health of the members enrolled with it. A holistic view of your members gives you a complete status of their health, enabling you to decipher future patterns in their healthcare. Such levels of visibility are vital to your profitability/prosperity/growth/organic growth. With excellent insights from the…
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Innovations in technology are constant in every industry, and healthcare is no exception to this trend. Healthcare IT (HIT) systems have taken center stage in improving the value of care through meaningful use and the seamless interoperability of patient health information initiatives by the CMS and ONC. HIT vendors must now constantly adapt to regulations without compromising on…
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The Centre for Medicare and Medicaid Services (CMS) has introduced a final rule to update the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS). The IRF PPS was introduced to cover all the capital costs that IRFs are expected to incur in furnishing intensive inpatient rehabilitation services. The final rule advances the CMS’s vision and…
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