Millenium Medic

Revenue integrity is a critical aspect of financial health in the healthcare industry. Hospitals and healthcare organizations must ensure they receive appropriate reimbursement for the services they provide to their patients.

Post-pandemic healthcare has experienced more than 10 percent of healthcare workers calling it quits. Some walked away and retired. Others decided that healthcare was not the industry they wanted to be in anymore and took their skills to other types of work. The people left behind have had to shoulder an even larger load of work than ever before. This environment is now the “new normal” for healthcare.

Forms can be built in many ways, making the process of form-building and configuring charges overly complex. Certain charge build components need to be applied and accounted for in addition to the clinical build of the form for the action(s) within the form (i.e., Alpha Response) or the form itself to drop a charge consistently.

The migration from in-person office work to hybrid or entirely virtual work models has impacted nearly every industry, healthcare being no exception. In-person care models will always be the staple for healthcare providers, but for the supporting staff including IT, billers, coders and business office, remote work is here to stay. The question for healthcare organization leadership has accordingly transitioned from “How do I get staff back into the office setting?” to “how can I optimize this transition to the new normal of remote work?”.

When it comes to charging, pharmacy can be one of the most complex. With most charges within a hospital organization, you have an order for a service. Upon completion of that service, there is a charge that is created. There are some nuances such as which location the patient is registered to, what status the order is in, or what type of patient the encounter is for, but those charges are often relatively easy to build and support for an organization. These charges can be described as "true or false" for the charge to occur. However, pharmacy is not so simple.

Has your organization received denials of claims due to the National Drug Code (NDC) on the claim being deemed as an obsolete National Drug Code by the insurance company? When a claim is sent to the payor with a drug on it that has an obsolete NDC associated with it, typically the payor will deny the entire claim due to an obsolete NDC. This causes more rework for your organization’s billing office and/or PFS team. Dispensing of drugs that have an obsolete NDC can negatively impact billing and your organization’s denial rates.

More accuracy in predicting eventual re-admissions will allow the majority of the interventions to take place over the course of the patient visit, as opposed to post-discharge. If clinicians have access to decision support tools that can aid in directing the care they provide with a specific focus dedicated to reducing chance of re-admission, both quality of patient care and re-admissions outcomes metrics should measurably improve. Ongoing care coordination pathways can be established from the moment a patient is admitted and further emphasis can be directed towards patient education and identifying support outside the care of the hospital.

The purpose of healthcare organizations is to provide excellent patient care to the communities they serve. Yet, a lot of money goes toward human workers performing tasks like medical coding, insurance prior-auth, claims processing, charge reconciliation, and scheduling and managing appointments. I support automating these tasks through technology – which you see being implemented today by HIT companies around the nation. Of course, not all these problems are easy to solve, but it is important to consider the ATM case study when envisioning a world with automated healthcare processes. There will always be a need for clinicians, doctors, and essential staff. Automation may create more competitive pay for clinicians while allowing organizations to open more hospitals and clinics.

If we don’t take the time to learn what the software is capable of, we spend day after day, week after week, year after year, wasting time and energy. Softek Panther was created to do the heavy lifting for you, make your job easier, and give you insight into your data.

The adage “Work smarter, not harder!” has never been truer than any other time in healthcare support. Therefore, organizations must find and use tools that shorten the learning curve or does all the heavy research work for support workers so they can take action to solve the clinician problems in a timely manner.