Every industry is adopting IT practices enabling them to manage their resources better and improve their business processes. Management software is found in every other organization, be it aviation or accountancy, hospitality or healthcare industry. Management software is especially essential in healthcare industry, as they cannot do more with paper-based method. They need to adopt latest technology so that they can have information at their fingertips and provide quality services to their patients.Various software for healthcare industryThere are many readily available healthcare software products or they can get their software designed from the scratch from various software developers.Some of the readily available software are:• Data storage and management software• Back up and retrieval software• Patient appointment and billing software• Patient management software• Document management softwareSo what are the key benefits of using software? All software have some or the other benefits, some help keep your data safe while some help users to manage various processes of management. Let’s take software for document management for example.Document management softwareDocument management systems are designed to keep all your electronic records safe and make them more manageable. They provide facility for these four processes:1) Capture: You can capture all your files such as scanned paper documents, patient records, bills and insurance papers into a single, centralized repository, so that you don’t have to go looking for a document in various locations.2) Manage: Features like document profiling and tags, document relations, versioning and comprehensive search make it possible for all the users in your healthcare firm to find and manage your documents easily.3) Monitor: Some document management software like Docsvault are designed as a safe vault for your sensitive documents and provide features like user-based security rights, export restriction, email alerts system and audit trail.4) Share: You can route documents, assign document tasks and do much more with document management system.How can this help in healthcare firms? One of the major challenges for healthcare industry is to provide better services to their patients or customers but without increasing the cost of clinical or administrative services.Let’s take an example: A patient walks in the hospital, he is asked to fill in his basic details in the form at the reception. Receptionist sends the form to nurse who carries it to the doctor. When examining the patient, doctor reviews the form and adds his points to it. This paper is filed in a new file allocated to the patient. Various other papers containing test reports, diagnosis details, prescriptions and insurance forms are added to this file. This file is moved to the admin office or another location after the treatment is over. If the patient comes again after a few months, you have to retrieve this record, which takes long time and extra efforts.Document management software can allow you to digitize and store all records in a centralized repository so everyone from your staff to the head office in a remote location can access documents. You can also improve communication and flow of data between the patient, doctor and the hospital management personnel. This translates in to improved efficiency, reduced cost in terms of labor and storage and better services for your patients.
BasicsThe Sherman Act is a key federal law which is comprised of two sections: Section 1, prohibits concerted action which unreasonably restrains competition; and Section 2, generally prohibits monopolies.For there to be a violation of Section 1, there must be an agreement and it must unreasonably restrain competition. For there to be an agreement, there must be more than one economic unit involved. That is, there can be no such agreement by one economic unit with itself. For example, generally speaking, shareholders in the same corporation are, for antitrust purposes, legally incapable of engaging in illegal concerted action together if they share substantial economic risk. They are generally considered to be part of a single economic unit. Conversely, members of two or more competing economic units, separate professional corporations, for example, may not agree to a whole host of things, because such agreements would violate one or more antitrust laws.Some agreements are considered to be so egregious that they need not even restrain competition. The mere fact that such an agreement has occurred is enough, and there is no defense. Some of these per se violations of the antitrust laws include: agreement among two or more independent physicians to charge a particular amount for a particular service (Aprice [email protected]); agreement among two or more independent physicians not to contract with a particular HMO ([email protected]; agreement among two or more independent physicians regarding their hours of operation, the services they will offer, or the geographic areas they will serve (market allocation). This is by no means a complete list or a complete description of the antitrust laws, but describes some types of activities that will violate antitrust laws.IllustrationsCase #1: A payer approaches you and several of your colleagues, who are competitors. The payer gives you a contract and fee schedule, which you review with your colleagues. Though the payer recognizes that you are not a physician group practice, it would like to deal with just one of you for contracting purposes. You choose one of you to represent the group of you, and seek changes in the contract, including the fee schedule.Impression: The Sherman Act has been violated. Since you and your colleagues are competitors and are not members of a single professional corporation through which you conduct all or substantially all of your professional practices, you may not discuss fees among yourselves, and you may not appoint someone to act as the voice of the group. In addition to the price fixing described above, if you decided together not to contract with the payer, you would have engaged in a group boycott.The violations can be avoided by properly structuring a formal group and adhering to certain rules in negotiating with payers. In scrutinizing activities of a physician organization, one of the key things antitrust enforcement authorities will examine is the degree of the organizations economic integration, the degree to which economic risk is shared among the shareholders. The level of integration is key in determining whether the organization is a single economic unit or whether it is comprised of two or more economic units.Determining whether a physician organization is sufficiently integrated is often, however, an extremely difficult task. The law changes and is very fact-specific. The FTC looks to such things as: 1) whether the organization is capitated; 2) the extent services are centralized in the organization; and 3) accountability of the shareholders to the organization through such things as utilization management, quality assurance and peer review.A Good TrendHealthcare reform is causing the Department of Justice and other regulators to do two nearly unprecedented things in the history of anti-trust law: innovate and cooperate. I’m exaggerating, but the truth is that healthcare reform has lit a huge fire under the…ummm…butt of government regulators to find ways to facilitate competing healthcare providers to “come together” for the sake of reducing cost and improving quality.Several years ago, the Department of Justice has lightened its almost unworkable antitrust restrictions by: (1) expanding the rule of [email protected] analysis for determining whether the antitrust laws have been breached, (2) expanding the notion of shared financial risk beyond mere capitation; and (3) expanding the role of the messenger. Though the role of so called Messenger Model organizations (e.g. IPAs) provide to be a failure, the fact that the DOJ would consider other ways of creating “substantial economic risk” was shocking. And now, what is even more shocking is that the DOJ recently: (1) promised to view all ACO proposals essentially more leniently, and (2) agreed in a joint statement with the HHS Office of Inspector General (which has primary enforcement authority on such things as Stark and Anti Kickback violations) to cooperate with eachother to facilitate the development and roll out of ACOs.Rule of ReasonFor those who appreciate a little more depth, possible antitrust violations are analyzed by governmental authorities using either per se or rule of reason analysis. Violations considered to be per se violations are indefensible, regardless of possible good intent or even positive market effects. Examples include: (1) two or more physicians agreeing to charge specific fees for certain procedures in their respective, independent practices, and (2) two or more physicians agreeing not to do business with a particular HMO.In contrast, rule of reason analysis requires enforcement authorities to probe deeper into the investigated arrangement to see if the arrangement furthers or conflicts with the principles underlying the antitrust laws. This type of analysis gives the investigated parties an opportunity to justify their arrangement; per se analysis does not.The revised Statements of Antitrust Enforcement Policy in Health Care, issued several years ago by the DOJ, expanded application of the rule of reason analysis to situations previously viewed as per se violations. For instance, a provider network has traditionally had to be financially integrated through capitation or withholds to receive rule of reason analysis, and discounted fee for service arrangements with the network sent many physicians to antitrust defense attorneys during enforcement actions based on the network=s negotiations of other payment arrangements. And now, with healthcare reform, they want to go further.Shared Financial RiskThe Statements also expanded the notion of shared financial risk, traditionally the cornerstone of compliance. The original guidelines identified only two examples that met the requirement: (1) capitation and (2) significant withholds. The revised guidelines expand the shared financial risk concept by looking at other things to satisfy the requirement. Now, risk sharing may include (1) the use of substantial financial penalties or rewards based on overall costs or utilization, and (2) the use of global or per case fees. Even more impressive is the fact that, instead of substantial financial risk, a network may pass muster if it demonstrates substantial clinical integration.Substantial clinical integration can be established by demonstrating that the network is likely to produce significant [email protected] via an active, ongoing program to evaluate and modify practice patterns by the physicians and create a high degree of [physician] interdependence and cooperation. Examples provided include utilization review, physician credentialling, investing significant financial and human capital, and clinical integration.Additionally, if the network has risk and non-risk contracts, the new guidelines will permit joint pricing if the efficiencies from the risk business spill over into the non-risk business. This is a boon to most networks, since they often have both risk and non-risk contracting opportunities. Though the changes are not an antitrust home free pass, they do free physicians from strict capitation only arrangements, which have been elusive in many practice areas.ConclusionOver the years, anti-trust law has been on a mudslide slow rate of change. The recent healthcare reform debate and innovations have accelerated at least the outspoken willingness of officials to ease up restrictions. But the proof is in the pudding, since officials continue to challenge proposed combinations which purport to reduce costs and improve quality. In their defense, officials said they would be more open-minded. They didn’t say they’d be stupid.
Three of the top revenue cycle management challenges are Medicare and Medicaid payments, claims denial and value-based payments.Medicare and Medicaid Payments: Complicated payment reforms, shrinking reimbursements and government mandates contribute to the delay and denial of payments for services covered by Medicare and Medicaid. Medicare and Medicaid represent an ever-increasing segment of the population and timely and adequate payment from these organizations rank as a top issue for healthcare practitioners. The Centers for Medicare & Medicaid Services (CMS) have significantly increased provider education tools including on demand webinars and other resources.Claim Denials: Some healthcare organizations say 25% of their claims are denied. Some for a technicality such as a missing signature on a medical chart, an incorrect spelling or inconsistent data entry. Sixty percent of healthcare organizations did not see a revenue impact, from the recent implementation of ICD-10 but 34% reported they did in a recent post ICD-10 survey. Continue to monitor your denial trends so patterns can be triaged and treated early on from the cause vs. the symptom. Also note while you are able to submit a valid diagnosis code from the right family and receive potential payment, you may not see the same after October 1, 2016, because coding to the correct level of specificity will be required.Value-Based Payments: ACA brought in the transition from fee-for-service to value-based payment model. The intent is to improve the quality of healthcare services being provided to patients so healthcare providers are paid based on the value of care they deliver instead of being paid for the number of patients’ visits or tests ordered. This means healthcare practices need to reconcile the new payment model with the traditional fee-for-service environment changing analytics and metrics to ensure payments cover costs.In addition, the U.S. Department of Health and Human Services (HHS) announced that by the end of 2016, 30% of Medicare reimbursements will be linked to the “quality or value” of services and 50% by the end of 2018. Penalties for not improving data quality include a docking of 2% of Medicare reimbursements.The 90-Day Grace PeriodAnother factor impacting revenue cycle management is the eighty-five percent of patients that received an advance premium tax credit via the ACA rules. They are eligible for a 90-day grace period to pay their outstanding premiums before insurers can drop their coverage. This rule applies to all consumers that purchased subsidized coverage through the Affordable Care Act’s (ACA) health insurance marketplace. It has the potential to be a problem not only to track patients in this situation but in the delay of payments. Identify if your patient is up to date on their premium payment as part of your registration process.
When prospective healthcare staffing businesses compare factoring fees to bank lending rates, factoring almost always seems more expensive. Oftentimes, factoring prospects annualize the percentage charged by factors, extrapolating three percent per month to an interest rate of 36 percent per year. In the world of healthcare staffing financing, this scenario is like comparing apples to oranges.When comparing a bank loan with invoice factoring, it’s important to keep a few things in mind:
A factor does not loan money like a bank does. Rather, a healthcare staffing accounts receivable factor purchases invoices at a discounted rate. Factoring is a form of short-term funding, so a discount rate should not be converted to an interest rate. For example, some firms offer a two percent discount (2% for net 10) for quick payment. In a year, there are roughly 36 10-day periods. Using the annualized percentage parallel, that comes out to 72% “interest.” Are these companies really paying 72% for quick payment? No, and healthcare staffing factoring companies don’t earn 36% interest either.
Moreover, a factor is continuously advancing and collecting funds, compared to a bank that provides the money only one time, the day that the loan is received. An accounts receivable factor has the ability to grow as its clients grow. Once a company uses the funds from a bank loan or exceeds its credit limit, there’s little room for it to grow.
Banks approve business loans or lines of credit based on a company’s historical operating and financial performance, a factor’s main criteria is the creditworthiness of a prospect’s customers. Banks tend to shy away from business owners who are just starting up, going through seasonal growth, have bad personal credit or have too much concentration of their sales with one or two customers. Many factors are able to look past the above criteria because their decisions are based off of a prospect’s customers’ ability to pay. So it’s very possible for a business that has creditworthy customers to work with a healthcare staffing factoring company even though they have been previously turned down for a traditional bank loan.
The loan process with a bank is time-consuming and cumbersome, and it could take weeks or even months to receive the loan proceeds. Whereas a factoring firm’s application and approval process can take less than a week, and factors have an ongoing ability to approve additional lines of credit quickly.
Oftentimes, a bank loan requires collateral in addition to a company’s accounts receivable. The only collateral that a factor requires is the company’s accounts receivable. A bank will most likely require business owners to personally guarantee the loan as well, and factoring companies won’t always require a personal guarantee to advance money.
Taking out a business loan creates debt on a company’s balance sheet, and credit ratings go down because of loan limitations. On the other hand, healthcare staffing funding through a factor increases credit ratings by creating better cash flow and helping the company pay their bills promptly.
Whereas banks only loan money, there are a multitude of services that factoring companies provide their clients in addition to ongoing funding. Some of these supplementary services include: posting payments, dispersing reports, handling collections and reviewing credit for their customers’ clients.
When looking at the big picture, entrepreneurs have to weigh the costs of factoring against not having immediate cash. More often than not, the decision comes down to either selling the accounts receivable or putting up with crippling cash flow problems and missed sales opportunities.
Would you settle for second best when insuring your vehicle? Would you waste your hard earned money getting it fixed by an unqualified mechanic? Most likely, the answer to these questions is probably no. We want the absolute best option available for all of the important things in our lives. So if you are unwilling to trust your vehicle in the hands of an inexperienced worker, why should you do the same with your health professionals? So why not search for the best facility when it comes to your health? You want to find the absolute best in south Chicago Illinois healthcare. Well, there are plenty of medical centers where you can find the best doctors, nurses and staff. Locating one that will work best for you is easy!Finding a southern Chicago hospital with outstanding medical professionals is a very simple task. With such a large city, there are health centers located throughout the city and its suburbs. Do you need to find a center for family care? Or do you need a medical center that specializes in internal medicine? Are you searching for a podiatrist? Well, with the many different locations around the city and in the suburbs, solving these problems is simple. All that you need to do is grab a map or do a quick search on the internet and you will find endless possibilities for the medical needs of you and your family and friends. There are medical professionals with numerous specialties that will assure that you receive the best southern Chicago healthcare possible.The healthcare centers are all staffed with the best workers in the medical field available in the area. So whether you are being seen by a doctor or nurse, the quality of your care is assured. The rest of the healthcare center workers are all ready to help you and your family with any questions you may have or provide you with information that you may need to gather for paperwork and/or insurance. The medical professionals and staff in the many different centers located around the city are fully devoted to helping you and your family receive the best care. The staff is trained and equipped to provide the best healthcare in Chicago.