Truly Epic! R&D Spending sensation 


In a story published on September 13th , 2016 by Healthcare IT News (HIT News), Epic Systems’ founder Judy Faulkner  ( just ‘ Judy’ to many in the Healthcare IT world) revealed that Epic invested something like 50% of its operating expenses on research and development, outstripping all organization in and out of the Healthcare IT ecosystem. 

HIT News verified through federal filings that Cerner spent 19%, Allscripts spent 34% and athrnahealth was at 10%. Google spent 45% of its operating expenses on R&D  (or $12 billion) and seemed to be the closest when it came to a percentage of operating budget. 

The thought that ran through my mind was ” Has this translated to better and more efficient and streamlined patient care at Epic’s customers versus provider organizations that have implemented a competing product? I’m all for R&D and believe that it’s really what makes America great  (I don’t think we’ve lost the ‘greatness’ since 1776 when the Founding Fathers declared independence, but that’s another story for another day). The technology of the 21st century has indeed been spurred by American innovation and ingenuity  (Facebook,  Twitter and the entire world of Social Media). R&D brings us medicines that have been life changing to many and previously were inconceivable even in the latter part of the 20th century, but with the cost of patient care rising and many Americans wondering how to get them within reasonable limits anymore, does this only add to our costs in the patient community or will it be the savior of millions and have a lasting impact for the country and the world. Makes you think. …

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Claim Denial! Definitely not a river in Egypt!

Revenue Cycle ManagementHaving worked with Revenue Cycle professionals over the last few years, gives me a finer appreciation of the work that provider organizations have to do to get paid. We’ve all received those bills we thought that the insurance company would have taken care of and wondered why are we receiving this? Why can’t I get through to the company that has sent me this? Did I really get disconnected after holding on this phone for 15 minutes? Frustration can certainly mount. I know it does for my family when trying to figure out next steps. According to an article from Healthcare Finance that I recently read, the top 5 medical claim denials that are the most common are:

1) Duplicate claims – When hospital administration resubmit claims when they have not heard back from the payer and end up restarting the clock for that claim and end up mostly with a denial due to re-submission

2) Lack of information on the claim – When a claim is processed but due to human errors, information such as a date of birth or the spelling of a name is incorrect, the claim gets denied.:

3) Expiration of Eligibility – When both the patient and the provider organization are unaware that the insurance eligibility of a patient has expired with that organization. This is a common mistake that can be avoided if the provider does an eligibility verification before and during when the patient comes in for their appointment.

4) Claim not covered by the payer – Providers can easily avoid this by leveraging the ability to use real time verification capabilities.

5) Time limit expiration –  Basically, the provider did not send the claim in on time as apparently many times, smaller providers don’t focus on smaller claims, but want to make sure larger claims are paid leaving a lot of smaller claim dollars on the table that eventually add up.

All in all, payer organizations also leverage the system to their benefit as any organization would. It is up to the patient to understand their eligibility options and the provider to recoup the money that they are owed. There are many opportunities for revenue cycle improvements that are more often than not, simple to deduce, but more difficult to achieve.

 

One Month to go! CSO HIMSS Spring Conference

There’s only one month to go for the Central & Southern Ohio Spring Conference – The Hacker’s Guide to Hacking Healthcare. THE Conference on Privacy and Cyber-Security you just can’t miss!

We’re looking forward to seeing many of you at the OCLC Conference Center in Dublin, OH on May 20th, 2016. AHIMA members get 4 AHIMA CEUs for attending so make sure to be there in force and get education and have a great time networking and interacting with the best of our community.

Please go to http://csohio.himsschapter.org to register!

See you there!