In an interview for Morning Briefing POTUS, Guidehouse’s Jan Vrins, leader of Guidehouse’s global Energy, Sustainability, and Infrastructure segment, discusses how governments and corporations can adapt to the energy transformation.

As healthcare shifts to the outpatient setting, enhancing clinical documentation improvement (CDI) has become more of a focal point for providers. Outpatient CDI is designed to accurately capture the acuity and severity of a patient’s illness in order to maintain complete and accurate medical records, capture chronic medical conditions, and promote higher-quality patient care. In this podcast, Guidehouse Director Rajiv Sheth discusses the main reasons why providers should consider developing an outpatient CDI program, to include:

- Better patient outcomes

- Decreased risk of hospital readmissions

- Specificity of coding and documentation for care provided

Additional outpatient CDI program benefits Sheth mentions include producing fewer denials on the back-end, better continuum of care coordination, and improved financial and profile accuracy.

Our discussion concludes with Sheth’s opinion on a recent survey suggesting providers are planning to implement CDI technology that leverages artificial intelligence (AI). He agreed that CDI technology is crucial today and predicts that think AI and machine learning will continue to evolve. He also suggests that providers should implement programs that include AI machine learning, as it will only help them be more effective and ultimately provide better care for their patients.

As healthcare shifts to the outpatient setting, enhancing clinical documentation improvement (CDI) has become more of a focal point for providers. Outpatient CDI is designed to accurately capture the acuity and severity of a patient’s illness in order to maintain complete and accurate medical records, capture chronic medical conditions, and promote higher-quality patient care. In this podcast, Guidehouse Director Rajiv Sheth discusses the main reasons why providers should consider developing an outpatient CDI program, to include:

- Better patient outcomes

- Decreased risk of hospital readmissions

- Specificity of coding and documentation for care provided

Additional outpatient CDI program benefits Sheth mentions include producing fewer denials on the back-end, better continuum of care coordination, and improved financial and profile accuracy.

Our discussion concludes with Sheth’s opinion on a recent survey suggesting providers are planning to implement CDI technology that leverages artificial intelligence (AI). He agreed that CDI technology is crucial today and predicts that think AI and machine learning will continue to evolve. He also suggests that providers should implement programs that include AI machine learning, as it will only help them be more effective and ultimately provide better care for their patients.

The rise of robotic process automation, or RPA, has impacted industries worldwide. Compared to humans, bots work 24/7, never take sick days, are more accurate, and can often do the work of multiple full-time equivalents. Financial services firms have been at the forefront of RPA, with sector average cost savings ranging from 50% and 75%.

While examples of provider RPA success to date is limited, that’s likely to change. According to an HFMA/Navigant survey, 15% of health system executives are targeting RPA to drive future revenue cycle improvements, whereas it wasn’t on the radar of a single executive a year ago.

In this podcast episode, Navigant Director Len Mandel discusses how providers can improve efficiencies and reduce costs using RPA. Mandel provides a specific roadmap to success that includes four key segments: strategy, infrastructure, transition and support, and production monitoring and scaling. He also outlines the many areas in the healthcare revenue cycle that can benefit from RPA, including patient access services, such as appointment scheduling and registration notifications; auditing self-pay for existing coverage, insurance eligibility, and verification; patient self-pay administration; and submitting pre-authorizations. Mandel concludes with a summary of the opportunities across healthcare for those looking to integrate RPA.

The rise of robotic process automation, or RPA, has impacted industries worldwide. Compared to humans, bots work 24/7, never take sick days, are more accurate, and can often do the work of multiple full-time equivalents. Financial services firms have been at the forefront of RPA, with sector average cost savings ranging from 50% and 75%.

While examples of provider RPA success to date is limited, that’s likely to change. According to an HFMA/Navigant survey, 15% of health system executives are targeting RPA to drive future revenue cycle improvements, whereas it wasn’t on the radar of a single executive a year ago.

In this podcast episode, Navigant Director Len Mandel discusses how providers can improve efficiencies and reduce costs using RPA. Mandel provides a specific roadmap to success that includes four key segments: strategy, infrastructure, transition and support, and production monitoring and scaling. He also outlines the many areas in the healthcare revenue cycle that can benefit from RPA, including patient access services, such as appointment scheduling and registration notifications; auditing self-pay for existing coverage, insurance eligibility, and verification; patient self-pay administration; and submitting pre-authorizations. Mandel concludes with a summary of the opportunities across healthcare for those looking to integrate RPA.

In this Navigant On Healthcare podcast episode, Navigant Life Sciences Managing Director Ross Meisner and Director Mike Fix address the incredibly complex challenges that medtech companies face when bringing new technologies to market.

In this Navigant On Healthcare podcast episode, Navigant Life Sciences Managing Director Ross Meisner and Director Mike Fix address the incredibly complex challenges that medtech companies face when bringing new technologies to market.

Clinical denials due to errors in medical necessity documentation, length of stay, and level of care may be a fact of life for healthcare providers, but there are procedures that can be put in place to reduce the denial of payments by payers. To achieve payment, resolution of clinical denials requires an appeal on the part of the healthcare organization. In this Navigant On Healthcare episode, Navigant Senior Vice President Shela Schemel discusses the benefits of using an integrated and holistic solution for inpatient and outpatient units. Schemel highlights the effectiveness of the appeal process in collaboration with a healthcare provider’s utilization management department, patient access services, revenue integrity, patient financial services, and health information management. She emphasizes that the professional denials team should include nurses who provide clinical education with a focus on case management, utilization management, medical review, coding, and claims processes. Additionally, team members should have payer experience. When everyone on the team understands the payer side of it, healthcare providers can rely on this experienced team to have a superior knowledge of evidence-based clinical guidelines, applicable state and federal agency regulatory mandates, coding guidelines, and of changing policies. Denial management can be accomplished with critical evaluation and decision-making about whether an appeal is warranted.

Clinical denials due to errors in medical necessity documentation, length of stay, and level of care may be a fact of life for healthcare providers, but there are procedures that can be put in place to reduce the denial of payments by payers. To achieve payment, resolution of clinical denials requires an appeal on the part of the healthcare organization. In this Navigant On Healthcare episode, Navigant Senior Vice President Shela Schemel discusses the benefits of using an integrated and holistic solution for inpatient and outpatient units. Schemel highlights the effectiveness of the appeal process in collaboration with a healthcare provider’s utilization management department, patient access services, revenue integrity, patient financial services, and health information management. She emphasizes that the professional denials team should include nurses who provide clinical education with a focus on case management, utilization management, medical review, coding, and claims processes. Additionally, team members should have payer experience. When everyone on the team understands the payer side of it, healthcare providers can rely on this experienced team to have a superior knowledge of evidence-based clinical guidelines, applicable state and federal agency regulatory mandates, coding guidelines, and of changing policies. Denial management can be accomplished with critical evaluation and decision-making about whether an appeal is warranted.

As revenue degradation continues to challenge profit margins, understanding and optimizing reimbursement rates is a key component to a healthcare provider’s success. In this Navigant On Healthcare podcast episode, Navigant Director Robert Roig discusses the pressure that is on managed care leaders today to succeed by negotiating with strategic intent, clear goals, and precise data to support their requests from payers. These leaders also need to provide analytics for contract modeling and accountability to ensure payers are maintaining proper reimbursement that aligns with the negotiated contracts. Roig encourages providers to ask themselves:

• Are we able to ensure proper reimbursement is paid?

• Are we able to effectively model future payer rate changes?

In addition to contract modeling, Roig recommends that each organization reviews zero balance accounts that may have been have overlooked. Examples include when insurance payers apply money to accounts, but the total account value isn’t where it should be. Roig states that when you have a team and the technology that can investigate what’s happening with specific accounts: why they were denied, the opportunities for appeal, the contract language, and how it was applied to the account, you can see if there are payments that still should be made to the hospital provider.