AGS Health experts frequently help healthcare finance leaders and health information management (HIM) professionals adapt to changes to help optimize efficiency and ensure compliance throughout the revenue cycle. Check out a sampling of recent news articles where we have been making headlines lately.
SDOH and health equity were the topic of a conversation between AGS Health Chief Revenue Officer Cheryl Cruver and Chief Healthcare Executive during the ViVE Conference (AGS Health is working on health equity, and helping hospitals do more). Noting that “health equity is on what I call the whiteboard of priorities for most health systems,” Culver shared that AGS is working with coders to ensure they are including essential SDOH information. She also shared that AGS helps health systems lower costs and overcome declining reimbursements and increased denials while addressing economic challenges with HIM support, innovative automation tools, and other technology solutions. “Some of it is understanding the denials,” she says. “And we can do that through analytics. But then it's really having a plan to target the causes of those denials.”
In 5 Must-Have Features for AI Platforms in RCM, AGS Senior Vice President of Product Management Emily Bonham shared recommendations with HIT Consultant readers on five features to look for when evaluating AI-enabled solutions to streamline the RCM process. When implemented thoughtfully and with realistic expectations, systems and vendors that deliver workflow visibility, robust computer-assisted coding (CAC), “human-in-the-loop” services, agility for future growth, and expert support can successfully reduce denials, missed charges, and low-risk scores.
In The High-Risk Game of High-Risk Diagnosis Groups, Vice President of Coding Services Leigh Poland, RHIA, CSS, summarized the seven high-risk diagnoses targeted by OIG and coding tips to help providers and payers avoid OIG’s investigative net in For the Record.
In RAC Monitor, AGS Director of Product Manager Suhas Nair discussed the evolution of CAC and the influence of AI, machine learning (ML), natural language processing (NLP) and clinical language understanding (CLU) on coding technology. In Understanding how CAC Fills the Coding Void, he writes that today’s coding technologies “are evolving along with the healthcare industry’s need to accelerate the coding process, improve accuracy, boost productivity despite ongoing coder shortages, and enhance the revenue cycle by reducing denials and audit risk.”
As they evolve, he writes, “they will continue driving improvements to the financial stability of provider organizations and forming a solid foundation for success under current and future value-based models of care.”
Senior Vice President of Coding Eric McGuire shared advice with BC Advantage readers on Overcoming Code Denials in Healthcare, including understanding trends and incorporating “denial prevention strategies into the daily workflow to avoid denials and keep revenue flowing. Unfortunately,” he writes, “it is not uncommon to have claims denied, so know and understand the most common denial reason codes to prevent them.”
McGuire also shared Seven Critical Factors for a Successful Risk Adjustment Program with For the Record readers.
Also in BC Advantage, Nair provides readers with an autonomous coding reality check in Truly Autonomous Coding Requires a Multifaceted Solution, noting that “one of the biggest limitations is what autonomous coding cannot yet do, which is code 100% of a healthcare organization’s census.” However, there are numerous benefits to be realized from autonomous coding if limitations are understood, gaps are filled, and the right vendor selected. “Look for one that can provide a truly autonomous coding solution with both the technology tools and technology-enabled services integrated on one platform and under one roof,” he advises.
Bonham explored the growing popularity and rapid ROI of bespoke technologies like robotic process automation (RPA) in her Healthcare Business Today article, Transforming RCM with Bespoke Automation Tools. In it, she shared the experiences of Tidewater Physician Multispecialty Group (TPMG), for whom AGS created an RPA tool to automate to automate its penny adjustment transactions, achieving a 99% accuracy rate and generating anticipated savings of more than $200,000 over a five-year period.
“By enabling more rapid patient billing,” writes Bonham, “RPA has also helped accelerate the revenue cycle, improve overall cash flow, and provide TPMG with clearer insights into its financial outlook – not to mention alleviating a significant source of customer and staff frustration.”
In Health IT Answers (Halting Revenue Leakage with Integrated Financial Clearance), Matt Bridge, Senior Vice President, Patient Access and A/R Service Lines, discussed how 41% of claims denials are caused by front-end RCM issues, including registration, eligibility, authorization, and non-covered services that could be avoided with a robust integrated financial clearance (IFC) process. “When correctly designed and implemented, IFC creates a seamless and cohesive approach to all facets of the long journey from scheduling to authorization and eventually to payment,” he writes.
Bridge also shared insights into “Automating Financial Clearance Processes to Reduce Denials, Accelerate Patient Access” with readers of Healthcare Business Today.
Poland shared with ICD-10 Monitor readers insights into what to expect from 2024 ICD-10-CM updates in FY 2024 ICD-10-CM Code Updates: Key Changes and Highlights, noting that “it is essential for coding professionals and all applicable team members to keep up-to-date with these annual code changes, understand how to apply them and recognize any new documentation requirements.”
Findings of an AGS Health-HFMA survey on autonomous coding were the topic of Bridge’s Electronic Health Reporter article, Automating Financial Clearance Processes to Reduce Denials, Accelerate Patient Access. The survey, which found that 60% of healthcare organizations were using or were planning to use autonomous coding despite less than half knowing what it is, was also covered by RevCycle Intelligence in How Do Healthcare Organizations Feel About Autonomous Coding?.
More expert insights on a wide range of RCM topics can be found in the AGS Health newsroom.
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