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June 2022 Connect with us Facebook Twitter Sign up  |  Archive  |  Advertise
Editor's e-Note
With auditing activity on the rise, more stress is being placed on release of information teams that must supply payers with the necessary information.

Fortunately—as this month’s E-News Exclusive illustrates—technology can help health care organizations go from audit chaos to being comfortably in control of the situation.

Lee DeOrio, editor
e-News Exclusive
From Audit Chaos to Control
By Jeff Burbank

As audit volumes continue to explode, providers are seeking solutions to simplify workflows and automate data retrieval to maintain stronger payer relationships for improved patient care.

Managed care audits, particularly Medicare risk adjustment (MRA) audits, are a huge burden on care providers—one that has only grown heavier in recent years. Going back at most a decade, request volumes from third parties for managed care audits made up about 10% of a provider’s release of information (ROI) requests. Today, these audits comprise upward of 50% of the volume received. And as both payers and providers are aware, these requests do not present in a steady stream, but rather in massive waves due to their seasonal nature. Managing the onslaught can be overwhelming—or even untenable—for providers, particularly in the current staffing environment.

The use of application programming interfaces (APIs) is helping care providers—and HIM departments, specifically—to streamline efforts and simplify workflows surrounding ROI. The process for responding to these audit requests, while complex, is manageable when providers can leverage data control and automate workflows with complementary EHR tools. Efficient management of managed care audits improves relationships with payers and allows care providers to better meet patient needs.

Administrative Headaches
Not only is the volume of information requests growing but complexities stemming from requestor specifics also have expanded. A provider may deal with 20 different payers that require the information to be sent in 20 different ways. Accessing the right information from various locations in a timely manner to meet requests via portals, faxes, mailings, or direct EHR access all present management challenges to overworked HIM departments. Providers respond with piecemeal strategies resulting in numerous workflows and, frankly, total audit chaos. Once behind on audits, it becomes difficult for the department to catch up, let alone keep up.

Full story »
Other News
Study Explores Medical Record Linkage With Goal of Improving Match Accuracy
A new study from the Regenstrief Institute evaluated commercially available patient matching methodologies, reports Medical Xpress.

EHR Documentation of Medical Cannabis Use Lags Patient-Reported Measures
Research in Washington state found that most medical cannabis use is not documented in the EHR, according to EHRIntelligence.
Products & Services
Clinical Documentation Technology and Artificial Intelligence Improve Patient Outcomes
AHIMA and Iodine Software have released the “CDI: Compliant Technology Adoption and the Role of Clinical Documentation Specialists” white paper. The paper explores how artificial intelligence (AI) technology is transforming clinical documentation integrity (CDI) with improved accuracy and better patient outcomes. From its onset, CDI has sought to ensure the accuracy and integrity of health records. However, due to limitations in the systems, a heavy manual entry component was necessary and often led to frustrated providers and inaccurate reimbursement and quality scores. Advances in AI can enable a concurrent workflow, allowing for improved clinical decision support and provider efficiency. It also creates a complete patient narrative reflecting an accurate clinical picture, including level of care leading to improved patient outcomes. Technology based upon AI machine learning models compliantly support the accurate capture of documentation of high-quality, low-cost care. This leads to appropriate clinical decision making, adheres to best practices and protocols, and eliminates redundancies in care. Learn more »

First AI to Refine Medical Coding by Exploring Therapeutic Data
Medical artificial intelligence (AI) start-up Aesop Technology announced a new partnership that made its new product, DxPrime, available in the Olive Library. DxPrime provides physicians and clinical documentation improvement teams with information about missing and wrongly coded diagnoses and procedures to correct the patient's chart in just a few clicks. It makes completing discharge summaries, prioritizing work for clinical documentation improvement teams, and medical coding much easier, faster, and less error-prone. DxPrime provides high-quality suggestions to support physician data entry based on a machine learning model that has been run on top of data from 3.2 billion patient visits, including vast amounts of structured information. It allows DxPrime to use items from the patient’s record like lab test results and medications ordered when predicting a diagnosis. This comprehensive model utilizes AI to efficiently compensate for traditional clinical decision support system and natural language processing weaknesses to find correct or missed diagnoses. Learn more »
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Industry Insight
Mount Sinai Launches Tech Fund for BIPOC, Women Innovators

Mount Sinai Innovation Partners (MSIP), the commercialization arm of the Mount Sinai Health System in New York has launched i3 Prism, a technology commercialization fund focused on women and Black, Indigenous, and people of color (BIPOC) health care innovators.

This unique opportunity empowers diverse innovators, including Mount Sinai’s faculty, staff, and students, to help advance technologies and develop commercialization plans. Participating innovators can receive up to $33,000 in funding, based on their work’s milestone achievements, in an effort to bring innovations to life and improve health and well-being for all people.

MSIP and its collaborators aspire to increase access to funding for Mount Sinai inventors, regardless of field, and the fund is available to all teams across the entire Health System. i3 Prism is the newest addition to Mount Sinai’s i3 (innovation, inflection and impact) family of funds, supporting innovation and advancing Mount Sinai technologies.

“i3 Prism will enable women and BIPOC innovators to take the next step in advancing breakthrough health care technologies to benefit patients,” says Erik Lium, PhD, president of MSIP and chief commercial innovation officer of Mount Sinai. “This fund will directly support i3 Prism awardees in bringing their solutions to the next level.”

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