Divyang Dave is deeply associated with BAPS and currently he is involved with them promoting a big and interesting project in IT services. (WWW.BAPS.ORG).
It is to build a huge multi-functionality portal with content management, work flow, media, Ecommerce, etc. with 1300 sub-sites serving worldwide users. The solution is going to be based on Share Point and MS .NET technologies.
Showing posts with label Divan Dave. Show all posts
Showing posts with label Divan Dave. Show all posts
By Divan Da’ve
Revenue cycle management (RCM) is an integral part of any organization. When we discuss RCM in the healthcare industry, billing comes to mind. However, it is a much wider and more intricate concept than billing. Effective RCM has major impact on operating profit, cash flows and patients’ receivable balances. Unfortunately, while most organizations perceive RCM as a cost center, it is actually a profit center.
What is RCM?
RCM not only focuses on patient billing and collections, but also incorporates checking eligibility, collecting complete patient demographics, benefits verification, capturing charges, coding, claim submission, collecting and posting payments from patients, denial management, reporting and data analysis (see Table 1). The main objective is maximizing revenue.
Table 1: RCM Processes in Healthcare
Why RCM is Complex in the Healthcare Industry
Providers are facing countless regulatory requirements, which incorporate classification of codes, reimbursement policies and common terminologies. From the provider point of view, up-to-date information is required to ensure payers are billed appropriately, of which coding plays a significant role and serves as a basis for disease and illness classification. At the same time, coding is the common language between providers and payers during the reimbursement process. Each payer has a different set of ambiguous rules for processing and paying medical claims; studies have shown as much as $210 billion in redundant costs annually.1
It is believed that on average, 32 percent of all claims are rejected, while 5 – 15 percent are lost in the process, never to be collected. The average time it takes to collect is 60 to 90 days. In addition, aside from the time, this process involves tremendous cost in managing the entire claims filing process. The New England Journal of Medicine states that a typical provider's overhead and billing expenses account for 43.7 percent of his/her gross income.2 The Medical Group Management Association (MGMA) states that it costs $25 - $30 to process the average denial.3
Common Problem Areas of RCM
- Incorrect demographics entries at the front end lead to a high volume of claim denials.
- Incorrect coding of ICD -9 and CPT- 4.
- Lack of domain knowledge results in incorrect coding of CPT and ICD poses major challenges in compliance and leads to regulatory audits.
- Standard units of medication not billed correctly result in direct revenue loss.
- Claims submitted are exact duplicates of previously submitted claims.
- The time limit for filing a claim has expired.
- Inappropriate information system to track documentation and billing.
- Lack of diligent follow-up.
- Lack of appeal experience.
- Integrating processes between the front end and back end
- Implementing adequate tools and technologies such as EHRs
- Providing employee enrichment programs, continual training
- Analyzing and reviewing organization processes to improve efficiency and remove repeated errors
- Creating benchmarks and standards for achieving desired revenue
- Soliciting an external audit by consultants
Conclusion
Efficient RCM is very important and requires much involvement and coordination by physicians, billing staff and consultants. Spending money on new technology, training and consultants can provide a very high rate of return. However, on average, providers are losing 7 – 10 percent of their revenue due to RCM inefficiencies. Providers learn medicine in medical school but some lack the business knowledge to manage a practice. In order to sustain a successful practice in today’s competitive market and increase revenue, providers either need to learn the basics of RCM or outsource the RCM processes to trusted professionals.
References
1. California
2. “Costs of Health Administration in the U.S. and Canada ,” Woolhandler, S. & Himmelstein, D., New England Journal of Medicine, 2003;349:768-75. Available at
http://content.nejm.org/cgi/reprint/349/8/768.pdf. Accessed on Oct. 14, 2009.
3. Lowes, R. “Practice Pointers: How to cut A/R.” Medical Informatics Sept. 3, 2004. Available at
http://medicaleconomics.modernmedicine.com/memag/article/
articleDetail.jsp?id=120970. Accessed on Oct. 14, 2009.
Mr. Divan Da’ve is a CEO and founder of Integrated Systems Management Inc., and its product and services OmniMD,™a developer of a HIPAA compliant and SureScripts certified EMR/EHR, a practice management system and other healthcare IT products and services.
Medical errors are problems that can happen at any stages in today’s healthcare environment. In fact, according to an institute of medicine report in1999.up to 98000 people die each year because of errors that could have easily been prevented Medical errors do not only happen in hospitals, it can also occur in the clinics, in outpatient department of hospitals and even at the pharmacy. Most of these errors are caused by illegible handwriting, incorrect dosage selections, drug-drug or drug allergy interactions. Electronic prescribing could substantially reduce these errors, however ironically the healthcare sector lags behind retails and financial sector in adopting the benefits of technology. Electronic Prescribing reveals how clinical automation can assure quality while improving workflow and reducing medication errors E-Prescribing simplifies the entire prescription writing process increasing the scope for accuracy and eliminating physical coordination. It allows providers to write their patients prescriptions directly from their PDA (pocket Pc or palm) or Desktop PC, selecting the appropriate medication and correct dosage, confirming the medication is included on the patient’s health plan formulary and send the prescription via fax or electronically to the pharmacy of the patient’s choice, so the medication is ready when patient arrives at pharmacy. At the same time, these healthcare professionals receive the critical Drug Utilization Review (DUR) information including drug-drug and drug-allergy interactions providing optimum decision making tools at a moment’s notice.Most EMR systems are supported with e-Prescribing features, which form a backbone in simplifying medical processes and reducing medication errors. Some of the prime benefits to this are outlined below.
Create Quick Legible Prescriptions
With an easy to create prescription systems one can now do away with illegible prescriptions, which are prone to medication errors. The electronic prescribing is a step towards minimal coordination and eliminating time-consuming pharmacy coordination. Within seconds one can document and create prescriptions that are accurate and legible.
Right From “where You Are”
Prescriptions can be created right from the PDA, which stores a comprehensive drug database, patient list for the day and list of favorite prescriptions. With the avenue of creating prescriptions at the point of care the possibility of inaccuracy is eliminated, simultaneously making the process simpler.
Cutting Response Time
Each day the average physician writes 20 to 30 pharmacists to make phone calls to doctors’ offices for clarification such as formulary coverage, potential drug interactions, illegible handwriting, incorrect dosage etc. Providers can simply fax saved prescriptions to the pharmacy or print it at their office using Bluetooth or infrared printers. Everyone’s frustration is eliminated when pharmacists no longer need to call for clarification about a prescription or refills as they instantly get accurate and legible prescriptions.
Automatic DUR Checks
The system has an inbuilt workflow and alert system for intelligent drug utilization review (DUR) that alerts physicians of potential problems before filling specific prescriptions. It automatically checks allergies and drug interactions against the patient’s list of preciously prescribed drugs and known medication allergies that allow the physicians to dispense safe medication. It can eliminate up to 95%of adverse drug events.
Easy Refills management
Prescription refills become simpler, since with a simple click one can issue refills and automatically fax them to the pharmacy. This eliminates the need to re-enter redundant information, therefore reducing the instances of human error.
HSS is launching KBRE - The Ramayan Contest. The objective in launching KBRE Contest is to create awareness amoung Hindu children about one of their greatest and oldest literature of the world-Ramayana. Hindu values are widely acknowledged for their positive contributions towards peace, prosperity, family values and spiritual growth for the entire humanity. HSS' vision is to preserve, protect and promote Hindu culture by molding children - the future of our world.
Ramayan contest will provide a forum for all Hindu children in the USA to participate in the contest and win attractive prizes. Balagokulam will award a Ramayan memento to all the children who appear for in-person exam. There are attractive cash and in-kind awards worth over 10 thousand dollars.
When and for who?
The competition will begin on the auspicious day of "Makar Sankranti", the 14th of Jan. 2006.
Special highlights of the KBRE competition are:
1.There are 4 age groups: 5-6, 7-9, 10-12 and 13-15.
2.There will be 2 rounds, with the first round conducted online on the internet.
3.The 2nd round will be held in-person at the Balagokulam centers across the
country in the month of April.
4.More than 10,000 participants all over the United States.
The KBRE kit consists of
- Computer Game
- Card Game and a
- Coloring Book
Registration & Campaign Resources
The Ekal Vidyalay Foundation, www.ekalvidya.com, is a charitable organization that helps build schools in rural India. India’s illiterate population continues to grow and this organization hopes to eradicate illiteracy in the years to come. By creating non-formal education institutions, India can rise above the minimal level of learning for students and come together as a nation by fighting the education barrier its students and people face. People have the ability to sponsor schools by donating just $365, dollar-a-day, to the cause. ISM/OmniMD took an active role by sponsoring many schools, which is one step forward in fighting illiteracy in rural India. Divan Dave CEO of ISM/OmniMD believes, “Illiteracy is a sin. In the world of words, an illiterate is completely blind. We’re all connected. We are one large family. A Single person left behind impacts all of us.” While certain segments of India progresses tremendously, many in remote villages are left behind. The foundation hopes to acquire enough funds to operate 100,000 non-formals schools in the rural parts of India by 2011. It would be a great achievement to be able to eliminate illiteracy in India as a much as possible. ISM/OmniMD supports Ekal Vidyalay – “one teacher school to eradicate Illiteracy from India.”
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