3 Important Things to Know Before Attending HIMSS17

February 15, 2017

We are pleased to introduce Kerry Stark, Vice President of Business Development at VitalWare. Kerry brings more than seventeen years of Revenue Cycle experience creating, defining and building strategic partnerships with healthcare corporations. At VitalWare he oversees partnership growth and strategy nationwide.

What tech areas are critical to evaluate in 2017?

Last year, prior to HIMSS, I reflected on the major impact ICD-10 had on the complexity and specificity of medical necessity, and the enhanced work effort required for hospitals to get this process correct helping in their fight against claim denials. At the beginning of 2016, HIMSS Analytics predicted Medical Necessity Checking Content as the number two technology planned for deployment in the hospital market.

As I prepare to attend HIMSS17, I recently read a white paper released by RelayHealth entitled, GETTING IN FRONT OF THE PROBLEM: HOW CAN HOSPITALS EMPOWER DENIAL PREVENTION AND MANAGEMENT?.

In this report, RelayHealth suggests that still today, within healthcare systems across the country, up to 1 in 5 claims is delayed or denied.  And, according to The Advisory Board Company, these denials can cost healthcare organizations up to three percent of their net revenue stream. They point out that there is not one single problem responsible for denied claims but several areas throughout the revenue cycle that contribute.

In a direct study with one of their health system clients, RelayHealth determined Medical Necessity validation was number three on the list of contributing factors accounting for several million dollars in denied revenue. In fact, the director of patient financial services at one of their hospital clients stated that Medical Necessity is THE most common cause for denials.

ICD-10 has had a major impact on Medical Necessity and the CMS grace period on edit rules has now expired.

As we now know, ICD-10 has had a major impact on Medical Necessity as the complexity, specificity and number of codes has grown exponentially. The Medical Necessity landscape has changed dramatically from ICD-9 and as CMS begins to delete Unspecified, and Not Otherwise Specified codes from the available selections, hospitals and physicians may begin to see their denials increase and revenues decrease significantly. With ICD-10 now in full effect, and CMS beginning to pull back on the grace period, healthcare organizations need to be asking “should we re-evaluate our current process and technology specific Medical Necessity validation?”

The VitalWare team has taken Medical Necessity Validation to the next level.

These facts reaffirm the work VitalWare has been performing to help our clients tackle Medical Necessity Validation and decrease denials.  Our team has spent the last six years developing a Medical Necessity Edit application to help hospitals, physicians, and healthcare technology companies effectively deal with the new requirements to ensure a correct process and outcome. Our Coding and Data Integrity team created a Medical Necessity Editing tool, along with a stringent validation process, to consider all of the coding groups, logic pathways and policy complexities associated with the new world we now live in. This allows us to provide immediate feedback to our clients so they can feel confident in their Medical Necessity Validation activities and enjoy an impactful decrease in their rate of denied claims.

At VitalWare each of us is dedicated to making the business of healthcare easier for our clients and partners. Please stop by and introduce yourself at HIMSS so I have the opportunity to learn more about your current business challenges and how we can support you in overcoming these obstacles.

VitalWare will be attending HIMSS17 and exhibiting at booth #637. Stop by and learn what makes our cloud-based technologies and intelligence different and for your chance to walk away with a 2nd Generation Amazon Echo-Dot for a hands-free, voice-controlled smart home experience.

Click here to schedule time to speak more with Kerry at HIMSS17.


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