👩💻 Certified Woman-Owned Business
Health information management (HIM) is a unique concept within Healthcare Administration and Finance that differentiates the industry from others. It encompasses health sciences, information technology, policy, law and business approaches. Changing government requirements, healthcare regulations and insurance and reimbursement models further complicate the task. The increased demand on administrative staff to keep up with these changes while managing the patient clinical and financial experience may lead to a decreased operational efficiency, revenue management or even gaps in compliance.
Having a good team of HIM professionals by your side will help your organization to manage and disseminate essential information to internal and external stakeholders for decision-making, improved quality and reporting, compliance and revenue management.
AJHC Financial Partners HIM professionals use their knowledge of the industry to form the link between clinicians, administrators, technology designers, and information technology professionals, by incorporating the disciplines of medicine, management, finance, information technology, compliance and law into the practice. Our team of HIM professionals will work in lockstep to update and educate your internal team about industry intricacies, ensure the most efficient RCM process possible while being in line with compliance. When possible, automating some of the processes can significantly reduce administrative and time burdens.
AJHC Team will work with your practice on the following areas under the HIM umbrella: REVENUE CYCLE MANAGEMENT (RCM), INFORMATICS and DATA ANALYTICS and INFORMATION GOVERNANCE and COMPLIANCE.
AJHC HIM team can help with the Business Intelligence, Policy and Advocacy, as well as the technology aspects of your organization, ensuring the integrity of data through mapping and quality improvement processes.
AJHC team will work with your practice to assess existing procedures within RCM, identify key improvement areas and provide recommendations, solutions, best practices, and train internal team in: front end, billing, quality reporting, credentialing and contracting.
AJHC team experts work with healthcare operations, documentation, coding, finance, managed care, life sciences, law, compliance, and data to manage risk, ensure quality and protect value. We develop creative solutions to help clients address their unique challenges.
INFORMATICS AND DATA ANALYTICS
Healthcare Informatics is defined as “the integration of healthcare sciences, computer science, information science, and cognitive science to assist in the management of healthcare information” (Saba & McCormick, 2015, p. 232).
Current demand in the field is being fueled by the healthcare industry’s focus on evidence-based medicine, quality improvement, and data security and accessibility for patients. President Obama signed the American Recovery and Reinvestment Act (ARRA) into law in 2009. This law includes the Health Information and Technology for Economic Clinical Health Act (HITECH). HITECH formulated the Meaningful Use (MU) program under the Centers for Medicare and Medicaid Services (CMS). Meaningful Use shifted into the Merit-Based Incentive Payment System, or MIPS, in part due to the introduction of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. These incentive programs are now a part of Medicare Promoting Interoperability Program. They all started by incentivizing providers to use their Electronic Health Records (EHR) and reporting patient care quality measures by financially rewarding them when demonstrating their use, but also posed a threat by penalizing them if not used in the future. Many similar changes constantly happen in the healthcare field, as we move towards the Value Based Healthcare (Value-Based Programs , or VBP, by CMS), while standards for data management, security and integrity get more stringent. Policy makers are now able to utilize electronic data submitted by healthcare providers to Managed Care Organizations or other stakeholders to inform their decision-making about public-health issues and needs.
The information modernization undoubtedly leads to positive results, such as enhanced delivery of care, prevention and disease management on a bigger scale, improved health outcomes and advanced patient education. However, with any innovation there are challenges, whether foreseeable or coming to light after unveiling of the new process or a product, in the form of clinical, administrative, or policy implications. The key to continually improving the process is rooted in setting attainable benchmarks and regularly measuring results.
AJHC Financial Partners supports healthcare systems and providers in changes required by the changes in policy and healthcare modernization (HITECH) to implement innovative systems, workflows and applications with smoother transition and better outcomes. We do so by training the key stakeholders, creating templates and automating the process, where possible.
Current demand in the field is being fueled by the healthcare industry’s focus on evidence-based medicine, quality improvement, and data security and accessibility for patients. President Obama signed the American Recovery and Reinvestment Act (ARRA) into law in 2009. This law includes the Health Information and Technology for Economic Clinical Health Act (HITECH). HITECH formulated the Meaningful Use (MU) program under the Centers for Medicare and Medicaid Services (CMS). Meaningful Use shifted into the Merit-Based Incentive Payment System, or MIPS, in part due to the introduction of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. These incentive programs are now a part of Medicare Promoting Interoperability Program. They all started by incentivizing providers to use their Electronic Health Records (EHR) and reporting patient care quality measures by financially rewarding them when demonstrating their use, but also posed a threat by penalizing them if not used in the future. Many similar changes constantly happen in the healthcare field, as we move towards the Value Based Healthcare (Value-Based Programs , or VBP, by CMS), while standards for data management, security and integrity get more stringent. Policy makers are now able to utilize electronic data submitted by healthcare providers to Managed Care Organizations or other stakeholders to inform their decision-making about public-health issues and needs.
The information modernization undoubtedly leads to positive results, such as enhanced delivery of care, prevention and disease management on a bigger scale, improved health outcomes and advanced patient education. However, with any innovation there are challenges, whether foreseeable or coming to light after unveiling of the new process or a product, in the form of clinical, administrative, or policy implications. The key to continually improving the process is rooted in setting attainable benchmarks and regularly measuring results.
AJHC Financial Partners supports healthcare systems and providers in changes required by the changes in policy and healthcare modernization (HITECH) to implement innovative systems, workflows and applications with smoother transition and better outcomes. We do so by training the key stakeholders, creating templates and automating the process, where possible.
POLICY & ADVOCACY
- Value Based Healthcare Programs (VBP)
- Risk Adjustment (RA)
- Policy changes affecting industry
- Re-assessment of existing workflows, creating new
- Key stakeholder training involved in the process
- Change Management
BUSINESS INTELLIGENCE
- Data analytics and dashboards for key stakeholders: the board and leadership, community, government
- Benchmark, measure and monitor processes for quality assurance
- Data-driven insights for informed decision making
SYSTEMS & APPLICATIONS
- Data processing, reporting possibilities
- Electronic Health Records (EHR)
- Electronic Data Interchange (EDI) setup for claim submission, payments and Electronic Remittance Advice (ERA), eligibility, claim status
SYSTEMS INTEGRITY
- Clinical, Revenue Cycle and Accounting Systems and Data Integrity
- Efficiency and effectiveness of the processes in Health Information Management at every level, new opportunities for gaps
REVENUE CYCLE MANAGEMENT
In addition to providing the highest quality of care, medical groups must establish an effective revenue cycle management (RCM) process. The revenue in the healthcare facility or practice is mostly comprised of the reimbursement for the services rendered to the patients from the insurance carriers, followed by other resources, such as patient payments or governmental funds, if applicable.
Revenue Cycle Management encompasses the entire revenue cycle from the time of an appointment all the way through the time the patient’s visit is paid in full.
Provider groups and health systems need to be acutely aware of how it works, constantly find the ways to improve it and tackle common provisional and administrative challenges in a rapidly evolving environment marked by increasing demands in technology and healthcare policy. A healthy and successful healthcare RCM process is an integral component of the organization’s fiscal health to ensure timely revenue, steady collections, and financial viability for the organization, enabling the providers to focus on their core competence- delivering quality care to patients.
Conversely, poor management and billing practices can result in financial losses for the organization and even impact its ability to remain in business. As Centers for Medicare and Medicaid Services (CMS) leads the nation to shift from fee-for-service world to a value-based healthcare, streamlining operational procedures is the assurance for any organization to remain financially viable and focused on providing a superior patient experience.
AJHC Financial Partners will work with your organization to assess the current needs, identify key improvement areas and provide recommendations, solutions, best practices and train internal team to become efficient and effective in the process. When needed, our team will take hands-on approach on closing the hard tasks for your project success. In addition, AJHC HIM team is a qualified provider for performance medical audits, ensuring not only compliance, but identifying areas for revenue optimization through coding and clinical documentation improvement and new opportunities in services offered to the patients.
Long-term benefits to improve your Revenue Cycle Management with AJHC HIM team:
Provider groups and health systems need to be acutely aware of how it works, constantly find the ways to improve it and tackle common provisional and administrative challenges in a rapidly evolving environment marked by increasing demands in technology and healthcare policy. A healthy and successful healthcare RCM process is an integral component of the organization’s fiscal health to ensure timely revenue, steady collections, and financial viability for the organization, enabling the providers to focus on their core competence- delivering quality care to patients.
Conversely, poor management and billing practices can result in financial losses for the organization and even impact its ability to remain in business. As Centers for Medicare and Medicaid Services (CMS) leads the nation to shift from fee-for-service world to a value-based healthcare, streamlining operational procedures is the assurance for any organization to remain financially viable and focused on providing a superior patient experience.
AJHC Financial Partners will work with your organization to assess the current needs, identify key improvement areas and provide recommendations, solutions, best practices and train internal team to become efficient and effective in the process. When needed, our team will take hands-on approach on closing the hard tasks for your project success. In addition, AJHC HIM team is a qualified provider for performance medical audits, ensuring not only compliance, but identifying areas for revenue optimization through coding and clinical documentation improvement and new opportunities in services offered to the patients.
Long-term benefits to improve your Revenue Cycle Management with AJHC HIM team:
- Reduced administrative costs
- Reduced bad debt and bad debts recovery costs
- Reduced denials and appeals and related costs
- Improved cash flow by streamlining the revenue cycle process and faster reimbursement
- Increased revenue by ensuring that all claims are processed accurately and paid
- Increased revenue by identifying and fixing errors in the billing/reporting systems.
FRONT END
- Registration and data capture
- Authorization and eligibility process
- Coding and charge capture
- Patient education
- Patient communication, satisfaction score and HCAHPS
BILLING
- Electronic transfer of data
- Claims status and follow up
- Remittance advice and payments posting
- Rejections and Denial management
- Utilization management
- Finance and quality reporting
CREDENTIALING
- Assessment of current credentialing needs and advisory
- Outline Credentialing strategy
- Department/ staff training on best practices
- Hands-on support
- Accreditation support
CONTRACTING
- Assessment of current contracting needs and advisory
- Department/ staff training on best practices
- Contract review & organization
- Contract (re)negotiation
- Individual vs Group, ACOs
INFORMATION GOVERNANCE AND COMPLIANCE
Overregulated in every direction, Healthcare infrastructure brings dozens of variables into play. Rapidly adapting to progression in artificial intelligence, data security standards, data management and integration with other systems, organizations grapple with existing rules and regulations. With every change in policy, there is a new set of specific security and compliance provisions to be fit into the current workflow. The stakes are high, so are the risks and penalties. Providers who do not adapt at the initial learning curve stage, find themselves in a trapped chaotic state until they find a team of professionals to step in and stabilize their businesses (reactive approach clients), while others look for ways to improve the processes and drive efficiency and automation (proactive approach clients). Over and over AJHC Team has been recognized for making the terrifying compliance process a breeze, sometimes a fun learning process, becoming true partners for healthcare providers and finance teams.
GOVERNANCE & COMPLIANCE
- Data security: HIPAA
- Coverage Compliance (National and Local Coverage Determinations (NCD & LCD)
- Accurate reporting to MCOs or government
- Coding compliance
- Adherence to policies, rules and regulations: federal, state, local
PEOPLE
ENFORCEMENT
- Compliance Committee or Chief Compliance Officer
- Education & Training
- Leadership and Stakeholder engagement
- External team involvement to identify risk areas and industry solutions
POLICIES & PROCEDURES
- Written policies and procedures (P&P)
- Demonstrating adherence to P&P
- Code of Business Ethics and Conduct
- Incident reporting rules
TECHNICAL ENFORCEMENT
- Periodic Auditing
- Feedback, immediate corrective action plan for findings
- System and technology monitoring