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Moving Health IT Ahead with New HIMSS Medical Banking Project

John Casillas

As the convergence between banking and health IT accelerates, HIMSS and the Medical Banking Project have come together to form the HIMSS Medical Banking Project. HIMSS President & CEO H. Stephen Lieber and MBProject Founder John Casillas made a joint announcement on Oct. 29 in Chicago and at the Southern California Health Care Summit in Ontario, Calif.

The unification brings together two organizations with similar organizational mission statements with both focused on leveraging IT to achieve efficiencies, cost savings and overall improvement in healthcare delivery.

“The HIMSS Medical Banking Project provides a banking technology stakeholder perspective to the Society that positions HIMSS as a single industry resource with all major financial, administrative and clinical stakeholders,” said Lieber. “With quality education and thought leadership as hallmarks of HIMSS, we look forward to providing the industry's leading educational platform to advance the medical banking industry and to encouraging policies and practices that achieve more efficient financial transactions.”

That platform through the HIMSS MBProject aligns two expanding areas – health IT and banking – to create a new HIMSS membership community in medical banking. This new focus fosters much-needed education and cross-industry dialogue between the banking and health IT communities to expand and build current HIMSS MBProject programs that include industry forums, work groups and an annual institute.

The new HIMSS medical banking community is focused on banks, providers, payers and employers, audiences that can benefit from innovations in health IT and banking. Current membership of the MBProject is 163 organizational and 41 individual members. Casillas joins HIMSS as senior vice president managing the medical banking content area.

To provide ongoing programming for this membership constituency, HIMSS will incorporate medical banking issues into many of its initiatives. The HIMSS MBProject will also continue collaborating with leading and global trade groups to build and expand established programs targeted to the new banking technology stakeholder.  
           
“The HIMSS Medical Banking Project expands our outreach and ability to facilitate a strategic dialogue between banks and health IT communities,” said Casillas, HIMSS senior vice president. “I look forward to working with HIMSS and its members to position medical banking as one of the drivers for reduced healthcare costs and improved healthcare delivery.”

The MBProject Web site, www.mbproject.org, features additional information on activities and resources. HIMSS’ Financial Systems content Web site currently features resources exploring the role of banking in healthcare, including:

The Intersection of Healthcare and Financial Systems white paper examines how technologies being applied to payment processes are improving workflows and ensuring secure and private payment transactions among providers, payers and patients.

Medical Banking 101 presentation facilitates learning about Medical Banking, and how banking infrastructure and systems are being integrated with administrative operations to drive EDI-enabled workflow processes within healthcare delivery systems; this presentation is a collaboration with the 2008 - 2009 HIMSS Financial Systems Steering Committee and the MBProject.

Coming in January 2010: Financial Edge will begin featuring a monthly MBProject column.

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Automate for Cleaner Claims, Increase Revenue

By Karen Bowden, RHIA

In turbulent economic times like these, healthcare organizations cannot afford to leave hard-earned money on the table. Yet many hospitals continue to sacrifice up to eight percent of the revenue they have rightfully earned, by generating a high percentage of “unclean” claims that create resource-intensive rework, increase A/R days and ultimately reduce profitability. 

The average U.S. hospital drops a clean claim—one that is paid in full the first time it drops—only 75 – 85 percent of the time. Fortunately, between improved business processes and revenue cycle specific technology, a significantly higher clean claims rate is easily achievable and can potentially add an additional 5 – 8 percent of claims revenue to the bottom line.

Producing a clean claim is a time intensive and very challenging process, and often hospital billing staff alone are no match for the complex research, analysis and coding activities that go into generating clean claims. To hospitals, the most challenging hurdles to improving clean claims rates are:

• Constantly changing coding and billing rules
• Keeping up with unpublished payer edits
• Organizational focus on DNFB over first-pass pay rates

With so much room for error, many hospitals recognize the value of using pre-billing claim scrubbing technology to automate the process of flagging claims before they go out the door and routing them to appropriate staff to correct prior to claim submission. When applied in combination with sound analytics and billing best practices, the revenue gains can be significant, and near 100 percent collection from payers is an achievable goal.

A best practice strategy for improving clean claim percentages involves four key steps:

1. Discovering and implementing all payer edits
2. Understanding root causes of internal errors
3. Implementing efficient workflows to rework claims
4. Setting policies for continuous improvement

Evolving reimbursement trends and rising compliance and accreditation standards have made it no longer reasonable to assume that staff alone can keep pace with the volume and frequency of change in the healthcare reimbursement environment. Hospitals will find it is well worth the revenue to invest in partners, products and process improvements.

Karen Bowden in the president of consulting services for ClaimTrust, Inc. During her 25 years of hospital administrative experience, Bowden managed fiscal and clinical operations in large academic teaching facilities in Pittsburgh and Boston. She has developed and implemented denial management systems to track, report, prevent and appeal denied claims.

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The Benefits of Lockbox Solutions in Healthcare Settings

By Richard Mobley

Richard Mobley

Advances in clinical technology receive the most news coverage, often because automation and technological innovation on the business side tend to arrive on the slow train. Despite HIPAA requirements to ‘electronify’ many transactions between payers and providers, there still exists a flood of manually managed incoming mail and documents, even in large, sophisticated, integrated delivery networks. Delays, lost information and breakdowns in the revenue cycle chain are inherent in this last bastion of paper-intensive labor—the healthcare business office. As such, a huge opportunity for improvement exists for organizations willing to invest in solutions that automate data extraction, push it into the appropriate business workflow, and speed the processing that follows. 

The integration of technology and labor arbitrage can significantly impact mailroom (sometimes called lockbox) operation and cost. High-speed document scanning and form recognition technologies first extract the appropriate data from documents. This data can then be formatted such that it is usable by business, accounts payable and patient accounting systems. When this technology is combined with outside services that specialize in handling such processes in extremely high volumes, the processing cost for each incoming document can fall precipitously. A side benefit to implementing such a solution is that some employees can be shifted to other, higher value projects.

Our experience tells us that lockbox/mailroom services, which have typically been provided by banks, are underutilized in healthcare. Even organizations in ‘underserved’ areas, or others previously deemed not big enough to warrant such a solution, can now employ a standardized, repeatable service. As a result, we believe they will then be able to shorten the payment cycle, make it more accurate, and get cash into the hands of providers and their vendors in a more organized and efficient manner. At that point, they will make the switch to the fast train.

Richard Mobley is vice president of the healthcare services division of BancTec, a global provider of advanced, high volume, document and payment processing solutions and services. Mr. Mobley previously served as vice president of electronic data interchange (EDI) services with Cerner Corporation. Mr. Mobley has served in various leadership positions with the Workgroup for Electronic Data Interchange (WEDI), as well as other HIPAA transaction industry organizations.

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Call for Public Comments on HIPAA Interim Final Rule

HHS has issued an interim final rule which amends HIPAA's enforcement regulations to incorporate effective statutory revisions that were passed under the HITECH Act which was enacted as a part of the American Recovery and Reinvestment Act (ARRA). These revisions relate mostly to the imposition of civil money penalties for HIPAA violations. More specifically, they incorporate the HITECH Act's categories of violations, tiered ranges of civil money penalty amounts, and revised limitations on the Secretary's authority to impose civil money penalties for established HIPAA violations occurring after Feb. 18, 2009.

This interim final rule does not make amendments with respect to those enforcement provisions of the HITECH Act that are not yet effective. Such amendments will be subject to forthcoming rulemaking.

Included in the interim final rule is an opportunity to provide public comments. We are asking that interested members send comments to HIMSS Informatics Coordinator Mike Kroll by 5 pm ET on Thursday, Dec. 3. 

Questions related to this request should be addressed to Lisa Gallagher, HIMSS senior director, privacy and security or Mike Kroll, HIMSS informatics coordinator.

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Save the Date: HIMSS10 Financial Systems Symposium

Follow the Money in 2010 - Understanding the Pressures and Impacts on Financial Systems

Sunday, February 28, 2010
8:00 am – 1:00 pm

Healthcare reform is one of the administration's top priorities and the landscape is constantly changing. The Financial Systems Symposium, to be held in conjunction with the 2010 Annual HIMSS Conference and Exhibition in Atlanta, will explore the rapidly moving field of electronic commerce in healthcare. Sessions will discuss and demonstrate how we are going to prepare to move forward efficiently and effectively with healthcare.

Sessions include:

• Follow the Money – Healthcare Reform and Financial Systems Implications explores how the automated flow of health IT records, to claims, through payments, can result in cost savings and support financial incentive payments.
  Speaker: Henry Chao, chief technology officer, CMS
• The Emerging Partnership between Providers and their Banks describes how providers continue to experience problems with obtaining ERAs (835s) and EFT from payers, so banks are expanding upon traditional lockbox and financial EDI services to serve the provider community.
  Speakers: Jim Moynihan, senior vice president, FHFMA, CTP, CHBME, U.S. Bank Healthcare Payments, US Bank; Debbie Pung, U.S. Bank; Anita Whitcome, director, billing services, Luther Midelfort Mayo Health System; and Michelle Lee, CCS-P, supervisor, payment processing, Luther Midelfort Mayo Health System
• ICD-10: What's it Going to Cost & Are you Doing Enough to Prepare? explains how the implementation of the ICD-10 Coding requirement will touch all stakeholders in healthcare: provider organizations, health plans, regulatory agencies, system vendors and clearinghouses. Thorough planning and coordination between all these groups will be key to a successful rollout and the mitigation of risk.
  Speakers: Tony Trenkle, director, Office of e-Health Standards and Services, CMS; and Sid Hebet, enterprise program manager of the ICD-10 initiative as well as the HIPAA 5010 project, Humana
• Flipping the Switch: From Retrospective Systems to Real-time Forecasting examines how other industries have been implementing forecasting tools for years.  Airlines know how many seats they will sell on a flight in two weeks, retailers know how many boxes of detergent they will sell 20 days from now.  However, the same forecasting tools are not as widespread in the healthcare industry.  Forward-looking measures of a provider's patient flow would be an indispensable tool for financial managers and will be examined in this session.
  Speaker: Leslie Richard, director, revenue management, Centura Health

Save $100 on Registration
Save $100 when you register for the full conference and any symposium. This special discount applies to full paid conference registration (Sunday-Thursday) only and is not available for students. The discount will be applied automatically during the registration process. 

Registration, Travel and Housing
Early bird registration rates for HIMSS10 are available now through Dec. 15. HIMSS10 registration includes entrance to all education sessions and the exhibit hall, the Sunday Night Welcome/Opening Reception on Sunday, Feb. 28, and registration tote bag (while supplies last). The HIMSS10 Web site features details on all registration categories, registration for optional events such as the symposia, and discounted rates for a One-Day Pass and Wednesday Exhibit Hall Only Pass.

Air travel and hotel information are also available online. Hotels are expected to fill up quickly, so attendees are encouraged to make hotel reservations early through Ambassadors, HIMSS’ official housing and travel bureau. In addition to making reservations online, attendees can contact Ambassadors at 877-517-3038.

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Get Strategies for Achieving Meaningful Use On Demand

This month’s HIMSS Virtual Conference & Expo answered healthcare professionals’ most pressing American Recovery and Reinvestment Act and meaningful use questions. Although the live segment of HIMSS Virtual Conference on Nov. 3-4 is over, the event’s educational sessions and expo remain available to registrants through Dec. 4. HIMSS Virtual Conference is free to qualified registrants. Non-qualified individuals may attend for a nominal fee ($99 for HIMSS Members/$119 for non-members). Learn more and register online.

The call for proposals for the next HIMSS Virtual Conference & Expo on June 9-10, 2010 opens Jan. 18; the deadline for proposal submissions is Feb. 22. Details on proposal submissions will be available in the coming months.

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Advocacy/Public Policy Update: Public Option within Healthcare Reform a Main Topic for Senate

After passage of healthcare reform legislation in the House of Representatives, the Senate prepares to consider their healthcare reform legislation this week. Late Saturday, Nov. 7, the House passed H.R. 3962 , the Affordable Health Care for America Act, on a slim margin of 220-215. Among many things, the legislation would establish a public health insurance option, require individuals to have health insurance, expand Medicaid, and leverage health IT in such activities as care coordination and home-based care. A full listing of the legislation’s health IT related provisions can be accessed on the HIMSS Web site.

Eyes are now set on action within the Senate. With determination to pass legislation before the end of the year, Senate Majority Leader Harry Reid (D-NV) is working hard to obtain the 60 votes needed for passage in the Senate. Once Senator Reid receives a cost estimate from the Congressional Budget Office (CBO), the Senate can begin consideration of legislation as early as this week. Still to be known is what form a public health insurance option will take in the Senate legislation. Although the Senate Finance Committee’s proposal included an alternative to a public option, the establishment of regional cooperatives, Senator Reid has said that a public option will be included in Senate legislation. Yet to be determined is whether the legislation will include one of the favored “opt-in” or “trigger” options proposed in the Senate.

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