In the latest episode of RCMchat by AGS Health, the focus was on clinical documentation improvement and utilization management. Scott Entinger, CEO of CDI Answers, and Eric McGuire, Senior Vice President for Medical Coding and CDI Service Lines at AGS Health, discussed CDI's role in emphasizing the criticality of accurate clinical documentation, the challenges faced by CDI programs, and the differences between inpatient and outpatient CDI.

Key conversation points:

• CDI's Role: Emphasized the criticality of accurate clinical documentation.
• CDI Challenges: Discussed issues like changing regulations and lack of support.
• Inpatient vs. Outpatient CDI: Highlighted the differences and the need for more education in outpatient CDI.

About Scott Entinger, CEO of CDI Answers

Entinger's expertise comes from CDI Answers, a firm dedicated to recruitment and consulting in the realm of clinical documentation and integrity. CDI Answers works nationwide with health systems to elevate their CDI programs, rejuvenate existing ones, and provide education via their CDI Academy.

About Eric McGuire, Senior Vice President for Medical Coding and CDI Service Lines at AGS Health

McGuire supplements the conversation with his 25 years of experience in medical coding and CDI at AGS Health, a company providing comprehensive revenue cycle services with technology enablement.

The world of healthcare coding is evolving with the new Evaluation and Management (E&M) 2023 code changes. After nearly 25 years, these E&M code changes promise to reduce the administrative burden for physicians and coders while refining patient care. The shift underlines the healthcare sector's commitment to streamlining processes, improving efficiency, and emphasizing medical decision-making over paperwork. These improvements come on the heels of exciting new healthcare technology advancements critical to enhancing ROI.

What does this overhaul mean for practitioners, coders, patients, and the healthcare ecosystem?

Michelle Dawn Mooney speaks with Leigh Poland, Vice President, Coding Service Line at AGS Health, and Lingaraja Prabhu, Executive Director, Coding, at AGS Health, about this significant transformation. In this episode, they discuss the recent E&M code changes and their impact on various stakeholders.

Key conversation points include:

• Significant changes in E&M 2023 guidelines compared to the previous ones from 1995 and 1997
• The transition journey from previous guidelines to the 2023 version and its effect on denial management and post-submission audits
• The benefits of the new guidelines for physicians, coders, and patients and the challenges they pose

Technology is continuously evolving, which leaves room for even more evolution and of course, new technology. Healthcare technology in particular has seen its fair share of advancements and up-to-date machinery and tools are the norm in the medical field. Considering current trends, experts forecast that due to significant growth and expansion, healthcare technology jobs, specifically, are expected to grow 15 percent by next year.

Why is understanding new technology an important factor in healthcare?

For a new episode of the RCM Chat, host Michelle Dawn Mooney chatted with two senior team members from AGS Health, Emily Bonham, Senior Vice President, Product Management, and Nicholas Frenette, Executive Director of Solutions Engineering. Mooney interviewed the duo about new types of technology making waves in healthcare, and how healthcare organizations can adopt and incorporate them.

The trio explored how Artificial Intelligence (AI) has been gaining ground in healthcare and …

• Where healthcare organizations lack or fail in adapting and utilizing new technology
• The use of AI, such as ChatGPT, in various areas of healthcare technology
• How new technology can benefit healthcare organizations and their ROIs

About Emily

Emily Bonham is the Senior Vice President of Product Management at AGS Health. She previously worked under the same title and department at Health Fidelity and directed product management at Healthicity. Bonham is an advocate for the environment and animals and has dedicated volunteering to both causes. She is also a graduate of the University of Minnesota-Twin Cities.

About Nicholas

Nicholas Frenette is the Executive Director of Solutions Engineering at AGS Health. He was previously the Director of Revenue Cycle at the Commonwealth Care Alliance and held the titles of product manager and consultant at Athenahealth, where he worked for more than a decade. He is a graduate of the University of Massachusetts Boston and Plymouth State University.

About AGS Health

AGS Health uses AI-enhanced technology, data-driven services, and specialized support to maximize the performance of their healthcare clients’ revenue cycle to allow them to focus on the most crucial part of their business: caring for patients.

Currently in the U.S., hospitals have been seeing abysmal profit margin numbers. A recent research report showed that since the start of the pandemic, many hospitals are operating at a loss. There are many systemic causes, ranging from labor shortages and costs, supply chain issues for equipment, and the general increased costs in every facet of the economy due to inflation.

Why are hospitals facing declining profit margins, and what are some solutions that could help turn this around?

On the latest episode of RCMchat, host Michelle Dawn Mooney chatted with two senior team members from AGS Health, Leigh Poland, Vice President of Coding Service Line, and Ashish Kumar Aggarwal, Senior Vice President of Operations and Process Excellence, about the subject. On the show the two discussed with Mooney the cause and effect that has led to hospitals seeing declining profit margins and several solutions that can help remedy the downward trend.

Mooney, Poland, and Aggarwal also talked about the pandemic’s role in declining margins and also …

• Reasons for why labor costs are also rising

• How older patients and patients with chronic conditions have increased healthcare demands
• Other contributing factors that are playing a role in the declining profit margins

About Leigh

Leigh has over 20 years of coding experience and has worked in the coding and education realm over the last 20 years. Her true passion is coding education making sure coders are equipped to do their job accurately and with excellence. Leigh is a frequent presenter at regional and national AHIMA, ACDIS, and AAPC meetings.

About Ashish

Ashish Kumar Aggarwal is the Senior Vice President of Operations and Process Excellence at AGS Health. He’s been with the company for over eight years now and has 27 years of global delivery experience and is certified in project management.

About AGS Health

AGS Health uses AI-enhanced technology, data-driven services, and specialized support to maximize the performance of their healthcare clients’ revenue cycle to allow them to focus on the most crucial part of their business: caring for patients.

In the healthcare sector, it is becoming increasingly challenging for patients to receive insurance coverage for their services; payor denials are increasing. Oftentimes, insurance companies are deciding that certain services are not “medically necessary,” making it more difficult for patients to receive access to the care they need. In fact, in 2021, almost 17 percent of in-network healthcare claims were denied—that’s almost one in every five! And combatting an insurance denial is an extreme headache, so healthcare workers and patients don’t always fight back for coverage.

Why is there such a high number of payor denials and how can healthcare companies and patients combat this?

On today’s episode of the RCMchat podcast by AGS Health, host Michelle Dawn Mooney speaks with Matthew Bridge, SVP, RCM Service Line and Erica Franko, SVP of Customer Success, both of AGS Health, to discuss payor denial management in healthcare.

Mooney, Bridge, and Franko also discussed…

• The recent trend in the uptick of insurance denials
• Reasons why denials are up in healthcare
• Suggestions for management within organizations struggling with the increase in denials

About Matt

Matthew Bridge is Senior VP at AGS Health and prior to working at AGS, held leadership roles as Director and Manager at KPGM, Manager, Associate, and Analyst at Huron Consulting Group, and Analyst at Partners Healthcare. Bridge attended Curry College, where he earned a B.A. in Business Administration and Management.

About Erica

Erica Franko is an experienced customer service professional who is currently SVP of Customer Success at AGS Health. Before working at AGS, Franko was Senior Manager Healthcare Provider Consumer Experience at Accenture, Beta User at The Fourth Floor, and Senior VP of Technology/Service Implementations and Advisory at nThrive, amongst other roles. Franko holds a B.A. in English Language and Literature/Letters from Penn State University and a Master of Public Health Administration, Health Policy and Management, from the University of Pittsburgh School of Public Health.

About AGS Health

AGS Health uses AI-enhanced technology, data-driven services, and specialized support to maximize the performance of their healthcare clients’ revenue cycle to allow them to focus on the most crucial part of their business: caring for patients.

The healthcare industry endured staffing shortages long before the pandemic. However, the situation has been more critical in the past three years. Many now consider staffing shortages in healthcare a public health crisis.

The USC School of Medicine looked at the staffing shortage crisis and found several factors combined to make the situation what it is today. From an aging population that will continue growing through 2030, requiring more care, to provider burnout brought on by the COVID-19 pandemic, to a lack of nursing faculty in colleges creating a nursing shortage; these are the reasons why healthcare is at a crucial impasse. Industry estimates indicate healthcare lost 20% of its workforce during the pandemic, including 30% of nurses. Couple that with the need to improve productivity in healthcare, and it’s a perfect storm in desperate need of solutions.

RCMchat podcast host Michelle Dawn Mooney spoke with Emily Bonham, Senior Vice President, Product Management for Healthcare Technology at AGS Health, and Eric McGuire, Senior Vice President for Medical Coding and CDI Service Lines at AGS Health, to get some in-depth advice on managing these staffing shortages while still improving productivity. McGuire believes technology can play a pivotal role in both.

“I have to give a plug for technology to help with those staffing shortages,” McGuire said. “For example, implementing something within coding, a computer-assisted coding product for your coding team, we’ve seen productivity improvements starting at about 20%, and then as the organization uses the software and becomes more comfortable with it, we can see those go up to about 40% productivity improvement.”

Mooney, Bonham, and McGuire discuss several things during their conversation, including the following:

• The size and scope of the issues related to staffing shortages and productivity

• Tips to elevate the staffing shortage crisis

• The link between staff retention and increased productivity

About Emily

Emily Bonham is a leading innovative healthcare technology product manager with over 20 years of experience building award-winning products from the ground up. She’s turned around underperforming products and helped organizations quickly scale. Bonham holds a B.A. in English from the University of Minnesota.

About Eric

Eric McGuire bridges the gap between healthcare IT and business operations by combining technology enablement with a focus on transformation and value creation. By driving transformation through strong strategy execution, McGuire’s teams can measure success by achieving detailed strategic goals and business KPIs. He enhances customer and patient experience, optimizing operations to grow revenue, mitigate risk, and contain costs. McGuire holds a B.S. in Macroeconomics from The Ohio State University.

About AGS Health

AGS Health uses AI-enhanced technology, data-driven services, and specialized support to maximize the performance of their healthcare clients’ revenue cycle to allow them to focus on the most crucial part of their business: caring for patients.