CMS Likely To Deny Coverage For Pricey New Treatments

According to a new analysis on national coverage decisions between 1999 and 2012, getting medical devices, drugs and procedures covered by Medicare is becoming more difficult. In order to justify the cost, CMS requires more evidence that the new interventions are “reasonably necessary” and should be paid under the federal healthcare program. CMS is about 20 times more likely to say no in more recent years. Researchers analyzed 213 decisions made between 1999 and August 2012 and found that a total of 74 were denied coverage during that time period. The majority of the denials happened in more recent years with Medicare being less likely to pay if there were alternative interventions and no estimate of cost-effectiveness.

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Patients Want Apps To Manage Care

HMS Healthcare Management SolutionsAccording to an online Harris Interactive/HealthDay survey of more than 2,000 adults, patients want to handle personal health care issues using smartphones and tablets. While respondents expressed interest in being able to ask doctors questions, schedule appointments and receive test result, they were less interested in receiving reminders to exercise, take medication and quit smoking.  Currently, implementing new technologies seems to be stagnant but will eventually come with time under carefully constructed provisions.

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Determining Your Organization’s ICD-10 Denials Management Readiness

HMS Healthcare Management SolutionsICD-10 denials management is a top priority for healthcare leaders as they attempt to mitigate revenue loss and manage accounts receivable during the transition to the new coding system. Below is a denials management checklist for providers to stay on track.

  • Identify Existing Trends: Denials have a way of sneaking into an organization through many pathways Defining the denials, learning where they are coming from categorizing the reasons for denial will help identify trends before changing to a new system.
  • Evaluate New Technology: Identify the tools associated with a denials management and how the analytics will be delivered to revenue cycle team members.  Establish a system to keep denials moving, provide information to payers as well as assign and track accountability.
  • Track Progress: Be sure the intended selection, setup, and training period associated with implementing such technology aligns with the organizations broader ICD-10 readiness, revenue cycle, and health information management (HIM) goals.
  • Quantify The Effects: Tracking and trending progress against baseline measures and industry targets will help the organization better understand the impact of such technology on the organization’s denials management capabilities.
  • View Denials: The organization should be able to identify high-dollar or high-frequency clinical procedures and services most at risk for denial post ICD-10 and commit resources to work with physicians who perform these procedures or services.
  • Trace & Fix Issues: Assess communication to determine what’s happening in relation to current denials, the management process and how effectively documentation is amended. Any workflow inefficiencies between the business office and the Health Information Management (HIM) department will only be amplified with a surge in denials post ICD-10.
  • Evaluate Financial Reserves: Evaluate the health system’s financial reserve and develop strategies to address shifting needs associated with the transition to ICD-10.

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Tiptastic Tuesday: Understanding Medical Bills

Medical bills can be confusing for patients.  Below are five easy steps medical practices can apply to help patients understand their medical bills and be better prepared to handle them.

  • Educate Staff:  Make sure office staff knows what plans your providers are associated with and understands the differences and complexities between different insurance companies
  • Use Eligibility Technology:  Today’s technology completely automates the process of checking patient insurance. Having these details at your fingertips will help inform staff about the patient’s responsibility.
  • Share Insurance Eligibility With Patients: Require staff to share the specifics of a patient’s insurance with the patient. Explain the expectations your practice has for patients including what part of the payment is expected at the time of visit and what portion will be billed after the visit.
  • Provide A Sample Statement:  Give patients a sample bill so they can familiarize themselves with your statements. Describe each area of the statement and provide an accompanying to create handout that explains the information in detail.
  • Explain Insurance Basics:  Don’t assume a patient understands all of the basics of insurance. Train your staff to be able to clarify these things with patients.

FDA Seeks To Regulate Medical Apps

Medical apps offer the opportunity to monitor health and encourage patient wellness on a moment-to-moment basis. Some even replace devices used by docs both in their practice and hospitals.

With more than 40,000 medical applications currently available for download on smartphones and tablets, new regulatory efforts from the Food and Drug Administration (FDA) are being developed which would require mobile app developers making medical claims to apply for FDA approval for those applications.

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Five Mobile Health Solutions to Watch

HMS Healthcare Management SolutionsEach day seems to bring a fresh dozen debuts of new mobile health (mHealth) solutions. In recent weeks, there has been a flurry of announcements for new apps that monitor asthma patients’ breathing, predict pain after hernia surgery, provide automated pill reminders to patients, and help physicians better treat burn victims.  To be sure, it’s an exciting time to be in healthcare IT. But nowhere is this truer than in the fast-growing area of mHealth technology.

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Cellphone App Estimates ER Wait Times

HMS Healthcare Management SolutionsAs technology continues to change the way healthcare is delivered, a partnership between a Florida hospital and a mobile healthcare application provider is transforming the way patients manage their medical care.

A new smartphone application partnered by Physicians Regional Hospital and iTriage allows emergency room visitors to view wait times, search symptoms and estimate procedure costs. The free app provides users the ability to refill prescriptions, store and update insurance information and track appointments.  Those who travel will love the built in hospital locator in case of emergencies on the road.

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