by Stephen Reed | Accounting News, Healthcare, Industry - Healthcare, News, Newsletter
Electronic Health Records (EHR) deliver enhanced efficiency, improved patient care, and streamlined workflows. However, the implementation of EHR systems is complex and challenging. In this article, we explore common challenges faced during EHR implementation and provide insights into overcoming these challenges to achieve a seamless transition.
Choosing the Right EHR System
The market is flooded with various options for EHR systems, so organizations need to carefully evaluate and select a system that aligns with their specific needs. This typically necessitates thorough research of vendors and systems, as well as having a grasp of the timeline needed for implementation. Additionally, you’ll want to establish a generous and flexible budget that allows for additional or emergency resources. Implementing a system that caters to the unique requirements of the practice with an expert vendor that is transparent and knowledgeable ensures a smoother transition.
Communication and Training
When implementing EHRs, effective communication and patience during the rollout are paramount. Here are some valuable tips for fostering smoother communication and ensuring successful training:
- Enable and Support the Launch Team: Healthcare providers should grant launch staff the authority to proactively manage unexpected challenges. A clearly defined escalation strategy helps to swiftly address emergencies and mitigate potential frustrations among both staff and patients.
- Develop resolution strategies: Go-live support teams should establish detailed protocols for identifying and resolving technical issues, including issues with both hardware and software. Designate individuals responsible for each type of problem and be share they share solutions for issues. Keeping everyone involved in all stages of identifying and solving issues will go a long way in making the transition as smooth as possible.
- Support from Leadership: Implementing EHRs can be disruptive to a working environment. Leaders who communicate effectively to staff and patients on successes at setbacks, who can acknowledge the benefits and the challenges of an EHR rollout, and who can make sure users are aware of available support staff if issues arise can ensure a smoother implementation experience.
Workflows
Emphasizing the significance of workflows is crucial for healthcare professionals as they strategize, document, and communicate information regarding EHR implementation. Recognize that healthcare workflows vary, with certain processes being more integral to the well-being of patients.
Consider these workflows that warrant special attention in your EHR implementation:
- Blood banks: Blood banks play a vital role where lives depend on efficient processes. Therefore, it is imperative to ensure that your EHR implementation thoroughly addresses the intricacies of this workflow.
- Medication Reconciliation: Before the EHR system goes live, organizations need to confirm that the system effectively tracks patients’ medications both pre- and post-admittance.
- Patient Movement: Tracking patients’ movements throughout their hospital stay is paramount for ensuring proper care. This aspect of the workflow is critical to maintaining a holistic view of patient care and facilitating effective communication among healthcare teams.
- Level of Care: Accurately documenting a patient’s stages, whether they are in the ER or ICU, significantly influences accurate medical billing and ensures appropriate levels of care.
- Careful Transport: The careful monitoring of how patients are physically transported within the facility deserves special consideration during EHR implementation so that patients are moved smoothly and securely.
by Stephen Reed | Healthcare, Industry - Healthcare, News
Healthcare practices rely on prompt payment for provided services to maintain financial health of their business. Point of service collections refer to the process of collecting credit card or cash payments at the time of service, rather than going through a billing cycle, which can take months. Below we’ll go over some of the ways that healthcare practices can use point of service collections efficiently in order to cut the billing cycle, improve cash flow, and get paid more quickly while providing a positive experience for patients.
Train Staff to Discuss Payment Options in a Way That is Polite and Professional
Staff members who interact with patients should be trained to discuss payment options and expectations in a polite and professional manner. They should be prepared to explain services as they relate to a patient’s bill and answer any questions the patient may have about the billing process. This helps the patient feel comfortable paying their bills without confusion, surprise, or frustration regarding the cost of care. Transparency and approachability also help to build positive relationships with patients.
Offer Multiple Payment Options
Accepting multiple forms of payment increases your chances of receiving payment more promptly. Offering flexibility with methods of payment, including credit cards, checks, debit cards, cash, and virtual payments like Apple and Google Pay makes payment more convenient for patients. You can also consider offering payment plans or financing options for patients who cannot afford to pay in full at the time of service. Offering payment options that fit a patient’s financial situation can help ensure timely payment and build trust with patients.
Be Proactive and Transparent About Payment Expectations
By providing pricing transparency and establishing financial responsibilities, you help to create a more successful patient/provider relationship. This information can be provided over the phone, during the appointment scheduling process, or through the practice’s website. Staff should be prepared to provide a price estimate upfront, discuss the various payment options available to patients, and emphasize that point-of-service payment is preferred.
Use Technology to Streamline Payments
Medical billing software with an integrated payment processing platform that allows for point of service payments is essential in collecting up-front payments from patients. Look for one that offers point of service collections as a default. You could also implement a patient portal where patients can view and pay their bills online. This will help streamline point of service collections, reduce administrative burdens, and improve collection rates.
by Stephen Reed | Accounting News, Healthcare, Industry - Healthcare, News
The Consolidated Appropriations Act (CAA) was signed into law in late December, 2020 under former President Trump. It tackles multiple long-debated healthcare policies. The law stipulates new regulations that will require providers, insurers, and employers to provide consumers with data pertaining to coverage and costs before consumers receive care. This means that Americans will now have access to information that could change the way they shop for healthcare.
No Surprise Billing
Included in the CAA is the No Surprise Act (NSA). The NSA includes requirements for health insurers and group health plans to provide information and tools for consumers to better navigate their healthcare. Surprise billing — also known as balance billing — has long been debated for patients in covered out-of-network situations, such as when receiving emergency services. However, due to the NSA, beginning January 1, 2022, health plans must treat these out-of-network services as if they were in-network when calculating patient cost-sharing. Patients won’t be held accountable to the “surprise” bill, with insurers and providers handling any payment disputes.
A range of consumer protections are also included, such as a mandatory advance cost estimate. Health plans are obligated to implement a price transparency tool and provide accurate, up-to-date directories on public websites. Furthermore, providers will be prohibited from billing patients more than the applicable in-network cost sharing amount, and a penalty of up to $10,000 for each violation can apply.
A New Final-Offer Arbitration Process
The NSA also creates a new final-offer arbitration process to decide how much insurers must pay out-of-pocket network providers. If an out-of-network provider is dissatisfied with a health plan’s payment, it can initiate arbitration. The arbitrator must choose between the final offers submitted by each party after analyzing various factors, including the health plan’s historical median in-network rate for comparable services.
Health Insurer-Related Policies
The Act includes many health insurer-related policies such as forbidding “gag clauses” in contracts between plans and healthcare providers that limit access to cost and quality data. The law calls for reporting on drug costs and similar issues, and contains provisions related to “non-qualitative treatment limitations” for mental health or substance use disorders.
The Future for Healthcare Consumers
The price and quality transparency requirements set forth in the CAA can empower healthcare consumers to make informed decisions, and they’ll now have the ability to shop for high-quality healthcare at a fair price. The overall healthcare system and insurance markets will likely evolve quickly to reflect the demands of a more educated consumer with actionable data at their disposal.
by Stephen Reed | Healthcare, Industry - Healthcare, News
Escalating healthcare costs have been problematic in the U.S. for a long time. A range of proposals have been presented in an effort to undertake the issue, including single-payer healthcare and more free market solutions with a goal of boosting competition. RAND Corporation recently analyzed hospital costs and what could be done to limit them. They found that regulating hospital prices by setting (or capping) what private health plans pay could cut hospital spending by $61.9 billion to $236.6 billion per year. However, researchers found that this method has the most political resistance.
The Study
Using nationwide data from the federal Hospital Cost Report Information System, RAND’s study compared three policy options to determine which one would have the most influence on cutting costs:
- Regulating hospital prices
- Improving price transparency
- Increasing competition among hospitals
The study found that although improving price transparency and increasing competition among hospitals could reduce costs, neither option would have as dramatic an outcome as price regulation. They estimate that price transparency could reduce costs by $8.7 billion and increasing competition—depending on the size of the change and market price sensitivity—could reduce spending by $6.2 billion annually.
Policy Challenges
All three policy options present challenges and are heavily reliant on several factors:
- Price transparency: Success would vary in patient-driven scenarios (patients utilizing the information to research lower process) and employer-driven scenarios (employers establishing health plans that guide patients toward lower-cost hospitals).
- Price regulation: Researchers tested this by switching average commercial plan costs to an amount similar to Medicare costs for a given hospital. Despite evidence of significant cost-saving potentials, researchers found major barriers to price regulations, including hospital closures, erosion of quality, and discouraging political hurdles.
- Competition: Because current hospital markets are so concentrated, policymakers would need to thoroughly restructure hospital markets over and above what the study modeled for prices to reach competitive levels.
Political Pushback and Moving Forward
As reported by the Centers for Medicare and Medical Services, U.S. healthcare costs amounted to $3.8 trillion in 2019. Hospital spending accounted for the majority of that at 31% and increased to $1.2 trillion later that year. Although the study shows price regulation would have the most direct effect on reducing hospital spending, researchers pointed out that this approach routinely encounters the most political pushback, and the hospital community has decisively lobbied against price regulation, especially at prices comparable to Medicare. Moving forward, policymakers will need to consider the possible impact of various policies on hospital earnings and the quality of care as they examine alternatives for slashing hospital prices. They will also need to consider the political and administrative workability of all options.
by Pete McAllister | Accounting News, CARES Act, COVID-19, Healthcare, Industry - Healthcare, News, Tax Consulting
The Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund was initially established to provide funding to healthcare service providers impacted by the COVID-19 pandemic. While the financial support has provided much-needed relief, the programs introduced some additional rules and reporting requirements for healthcare providers. On October 22, 2020, the Department of Health and Human Services (HHS) updated its guidance on how providers should report their Provider Relief Fund (PRF) payments that have been allocated for expenses and lost revenues as a result of the pandemic. Below is an overview of what you need to know.
Key Clarifications to Instructions
Addressing some of the ambiguity present in the previous September 19 update, two key clarifications were set forth.
- Method of accounting: The HHS has clarified that PRF payments should be reported using the provider’s normal method of accounting (cash or accrual basis).
- Lost revenue definition: In a twist from prior instructions, which defined lost revenue as a negative change in year-over-year net patient care operating income, recipients may now apply PRF payments up to the amount of the differences between their 2019 and 2020 actual patient care revenue.
If recipients do not use PRF funds in full by the end of the 2020 calendar year, they will have a further six-month period in which to utilize leftover amounts for expenses attributable to the pandemic but not repaid by other sources, or to apply toward lost revenues in an amount not greater than the difference between 2019 and 2021 actual revenue.
PRF Reporting Requirements
The deadlines from here on out are as follows:
- January 21, 2021: HHS portal opens for PRF reporting
- February 15, 2021: Reporting deadline for all providers on use of funds, assuming all proceeds were accounted for in 2020
- July 31, 2021: Final reporting deadline for providers who did not fully spend PRF funds before December 31, 2020
- September 30, 2021: Due date for the single audit or program-specific audit reports for a December 31 year-end or the earlier of 60 days from the date of the issuance of the audit report
PRF recipients can start submitting PRF reports documenting how funds were spent or attributed beginning January 15, 2021. The level of reporting requirements differs by the amount received as follows:
- Entities that received less than $10,000 in total from the PRF do not have to file a report
- Entities that received more than $10,000 but less than $500,000 must submit a simplified report with only these broad expense categories: general administrative expenses and other healthcare-related expenses.
- Entities that received more than $500,000 in PRF must submit a detailed report described below.
- Entities that received over $750,000 in PRF may also be subject to an audit per federal regulations.
Audit Requirements
If an entity received more than $750,000 in PRF, they may be subject to an audit per federal regulations. Audits are required for entities (non-profit and commercial as it relates to PRF per HHS guidelines) that spent over $750,000 from federal grant funds in a reporting period. Note the difference between receiving $750,000 and spending $750,000. Some funds could have been received in cash but not yet spent.
Let MKR CPAs & Advisors help
Our trusted advisors are equipped with the expertise to help you unravel the complexities of these reporting requirements. If you need assistance, contact an MKR advisor today to get the conversation started.
