The Corridor Group To Acquire HMS Healthcare Management Solutions, Inc.

We are delighted to announce that The Corridor Group has acquired HMS Healthcare Management Solutions, Inc.

The Corridor Group (TCG) is a leading national provider of compliance, consulting, coding, and education solutions to the post-acute healthcare industry. TCG has been a longtime industry leader providing business advice and solutions to thousands of clients ranging from large health systems and national chains to smaller independently operated agencies.

We are very excited to become part of TCG, a national leader in the healthcare industry. Through this collaboration, we have created a focused strategic opportunity by combining TCG’s post-acute healthcare expertise with HMS’s unparalleled knowledge base of revenue cycle services. We will remain dedicated to our clients and build on our offerings to deliver even greater value.

Click here to see the official announcement.

President & CEO Of HMS Healthcare Management Solutions, Inc., Donna Galluzzo, Elected CBIA Board Chair

We are proud to announce that Donna Galluzzo, President and CEO of HMS Healthcare Management Solutions, Inc. has been elected chair of the Connecticut Business & Industry Association’s board of directors. Donna Galluzzo succeeds James P. Torgerson, President and CEO of UIL Holdings Corporation.

Referring to CBIA’s 200th anniversary in 2015, Galluzzo said, “I’m honored to serve as chair of the CBIA in its bicentennial year.”

“CBIA has forged its reputation based on trust, integrity, and working collaboratively toward thoughtful policy and business solutions to some of the state’s most pressing challenges.”

“It is my intent to build on this strong history and to help the association benefit from a smooth transition of executive leadership while elevating Connecticut to one of the top 20 states in the country for business by 2017.”

Congratulations, Donna!

Click here to read more from CBIA.

That’s A Wrap! The Affordable Care Act, One Year Later Series Comes To An End

Throughout the month of October, HMS has explored the ins and outs of the Affordable Care Act. Our The Affordable Care Act, One Year Later Series has investigated both the positive and negative aspects of the new health law. It’s been one year since the implementation. Overall, how has the ACA impacted healthcare in America? Our final post in the series will examine if the health law did, in fact, do what it was intended to do-which is reduce the number of Americans without health insurance, make health insurance more affordable, and make Americans healthier.

According to a recent New York Times article, the ACA has indeed reduced the number of Americans without health insurance.  Although a perfect measurement of the number of people affected by the law is still difficult, most private sector surveys and government reports, including a Gallup poll, The Commonwealth Fund, and a CDC survey, reach the same basic estimates. The number of uninsured Americans has been reduced by 25 percent this year-that’s eight to 11 million people. More than half of that appear to be the newly insured who have signed up for Medicaid. Others are enrolled in private health plans through the new state insurance marketplaces. Three to four million people, mostly young adults, also became newly insured through ACA provisions that kicked in. The Congressional Budget Office estimates that by 2017, approximately 26 million more Americans will become insured through the law (lower than previously estimated).

Another question we all have: Is the Affordable Care Act actually affordable? According to the Obama administration, eighty-five percent of those who signed up during enrollment period qualified for federal subsidies to help pay premiums. The subsidies are estimated to have lowered the cost by 76 percent on average. However, the law has also required insurers to provide more benefits to cover people with pre-existing conditions, subsequently causing premiums to rise for some of those who already had insurance. Others plans were canceled or were not eligible for subsidies. On a more positive note, it has also been reported that premiums may actually become lower in the next year due to spurred competition among insurers.

Lastly, has the ACA made us healthier? Most experts believe it’s still too early to know. How will the ACA fare in the long run? Only time will tell!

*You can start shopping for health insurance on Saturday, November 15. If you want coverage to start on January 1, you’ll have to buy it by December 15. If you  miss the December 15 deadline, you can buy coverage, but it will not take effect until February 1 at the earliest.

HMS Gives Back To The Community

connecticut-food-bank

Thousands of families struggle with hunger and rely on food banks-especially during the holiday season. This holiday season, HMS Healthcare Management Solutions, Inc. is collecting non-perishable food items to donate to the Connecticut Food Bank. The HMS Thanksgiving Food Drive will be held from Wednesday, October 29th through Friday, November 21st.  

Click here to see the food items most needed by the Connecticut Food Bank.

In addition to the HMS Thanksgiving Food Drive, HMS will be hosting a raffle this week. As part of our company team-building exercise, we decorated pumpkins for Halloween. Tickets are $1 for 3, and the drawing will be held this Friday, October 31st. All proceeds from the raffle will go towards the Fred Ulbrich, Jr. Family Center as part of the Wallingford Emergency Shelter.

If you would like to participate in either activity and/or donate, please feel free to stop by the HMS office at 8 Research Parkway in Wallingford, Connecticut between the hours of 7:30am and 5pm Monday-Friday.

HMS appreciates your support. Every bit helps!

Monday Morning Recap

The HMS Healthcare Management Solutions Monday Morning Recap reviews some of the top stories and healthcare highlights you may have missed last week.

SHS OASIS Audits

It has come to our attention that several home health agencies have received a letter from Strategic Health Solutions (SHS) notifying them of a follow up audit to review Medicare A claims from 2010. SHS is a Supplemental Program Review Contractor for CMS. This is a follow up to the 2010 OIG audit that reviewed selected records focusing on timeliness and certification of OASIS file submissions.

If you need assistance with your SHS OASIS audits, please contact HMS Director of Home Care & Hospice Services, Cheryl Leslie at (860) 881-8498 or HMS Director of Consulting & Regulatory Affairs, Pamela Meliso at (203) 294-6615.

ICD-10 is Coming: Will Your Practice Be Ready?

Being unprepared for ICD-10 could result in increased denials for your practice, impacting cash flow. HMS’ team of expert coders can get you on the right track to ICD-10 readiness/compliance so you can maintain your revenue stream.

Assessment package includes review of 10 records for $250:

  • A comprehensive review of each record submitted.
  • An analysis outlining findings on a clear and concise report.
  • A detailed summary report providing an in-depth explanation of each record reviewed.
  • Documentation, recommendations, and cross references to coding guidelines when applicable.

For more information, please contact Sherrie Fairchild at (203) 294-6659 or SFairchild@hmsabc.com

Physician Practices: It’s Deductible Season! Keep Your Practice Afloat with these Tips!

Co-pay and deductible amounts vary from policy to policy so it’s important to know your patients’ co-pay and deductible responsibilities. As part of patients’ contracts with their insurance companies, it is their responsibility to pay their portion.  However, physician practices are also obligated by their contracts to collect co-pays and deductibles and failure to do so is a violation of contract terms.

Here are some helpful tips to help you maximize your collections:

  1. If possible, it is best to understand your individual contracts with third party payers
  2. Delegate a staff member to be responsible for maintaining current patient insurance information
  3. Verifying insurance is extremely important. Enter all available information (i.e. insurance numbers, DOB) into your software system. You should also check the eligibility status prior to each patient’s visit to make sure the insurance information you have on file is current. If it is not, contact your patient before the visit to get the current insurance and enter it into the system so you can do a real-time eligibility check.
  4. It is best to review the eligibility checks to confirm if the deductible is met or not. Some plans will not provide detailed information, making this task difficult at times. Keep in mind that patients could be seeing multiple providers for the first few months of the year.
  5. Always advise your patients to bring current insurance cards and any applicable copay the day of their visit. Keep in mind that some services, such as preventative services and surgical global periods, may not be subject to co-pays, co-insurance or deductibles. Also, it is important to remember you cannot collect a deductible from Medicare patients (you can only collect applicable co-pays).
  6. It is important to have a financial policy in place that is reviewed every year (at least). Display your policy to ensure patients understand their obligation upfront. Your policy should outline the expectation that: 1. Co-pays are expected at the time of service. 2. Patients with deductible plans are expected to pay a set amount (to be determined by practice, for example: $50) at the time of service. Also, note that once the claim is submitted and reconciled, the practice will refund any amounts overpaid (if applicable) within a specific time frame (this will help to ensure you get some upfront payments for the visit until the claims are reconciled).
  7. Staff should understand the importance of your financial policy and be consistent about enforcing it. Develop talking points on what should be disclosed to patients. Most importantly, staff needs to know how to respond to objection easily and respectfully when attempting to collect money.
  8. Make sure patients are aware there are multiple ways to pay, including cash, check, credit card, or debit card.

If you need help putting together a financial policy, please contact Sherrie Fairchild at (203) 294-6659.

CMS Accepting More Proposals for its Bundling Initiative

CMS has reopened the opportunity for proposals in its Bundled Payments for Care Improvement (BPCI) for Models 2, 3, and 4. To date, BPCI is the largest voluntary innovation program offered by CMS. In reopening this opportunity, CMS hopes to increase the number of bundling demonstrations, as well as expand participation in various models. NAHC is encouraging home health agencies to consider developing a proposal for the initiative as there is a serious push in health policy to advance post-acute care bundling as a future model of payment. Home health care is very likely to be the beneficiary of that push because it can provide comparable care in the community at a much less expensive cost than institutional care.

If you have any interest in the Bundled Payments for Care Improvement (BPCI), please contact Robbin Boyatt at (203) 294-6619 or Joanne Erickson at (203) 294-6682.

Click here for more info

Tipastic Tuesday: Improving the Patient Experience

According to a new report, healthcare providers must encourage employee engagement if they want to improve patient care.  Staff engagement includes good management and teamwork which improve a number of aspects of clinical quality, patient experience, productivity and costs.

Among those surveyed, only 55 percent said they receive clear feedback from their managers on their performance, and 65 percent reported that they were satisfied with the support they get.  The report concluded that staff experiences shape patients’ experiences of care.

To increase staff engagement, the report recommends the following tips:

  • Give staff well-structured feedback, and ongoing training and support for personal and career development
  • Train managers and supervisors in people-management skills
  • Have well-defined teams that regularly meet to review how well they are doing
  • Create a space for staff to reflect on patient care challenges
  • Set goals for quality and safety
  • Articulate values and show how they translate into behavior
  • Act on staff feedback and allow staff to make the improvements they have suggested

Click here to read more