Author Archives: Vignesh Eswaramoorthy

Patient Centricity as the Future of Digital Health Management

Digital health is an all-encompassing term that refers to the care provided through eHealth and mHealth through advances in computing sciences.

Challenges or Gaps in Traditional Care

Major technological challenges faced by the healthcare industry have got to do with data processing, cybersecurity, and providing a user-friendly experience. However, advancements in each of these fields have proven to be gainful, and will continue to do so. Our focus here has more to do with the user experience aspect of digital health management.

There are quite a number of digital health care providers, rather, platforms that avail services outside the traditional settings. Consider a regular appointment with the doctor; the patient is examined, tests are probably taken, the prognosis is given, medicines are prescribed, and the doctor sends them on their way after scheduling their next visit. What happens from then to the time of the next visit? Do patients remember to follow their diet plans? Or do they just revert back to their unhealthy lifestyle? The motive behind having health care is to have a better quality of life, and this means strictly following doctors’ instructions!

Where US Healthcare is headed

The most common complaint from American patients is that they have scheduling difficulties. Being in the digital era, and not utilizing resources to make life easier can be frustrating. Say that an appointment is scheduled, but the patient ends up spending less time than they expected. Not only are they dissatisfied, but so are doctors for not getting adequate time with their patients. Then comes the hassle of insurance and billing. Enough said! And this is just the patients’ side of things, there’s still a host of things that need to be managed in the providers’ front.

This is the decade where digital and technological advancements will make providing healthcare efficient, and digital health management is what care organizations need to be looking into. Thankfully, there are now provisions that don’t require patients to walk into a clinic, as this sometimes ends up in no-shows. The reason could be a lack of resources, or an inconvenience to commute, or even that the patient just doesn’t feel like it. It’s no surprise that even a no-show rate of 20% can cause significant revenue loss for healthcare systems.

Need for a Smart Comprehensive Platform

Since the essence of the matter at hand is primarily on the patient experience, here’s what they want. A one stop shop where everything is kept track of – vitals are monitored, real time stats are provided, diet plans are charted out. 97% of American adults now have smartphones, maybe even the wearables that go along with it. Many companies provide such services, few excel at it.

To go the extra mile, a smart, comprehensive platform is exactly what they need. Excellent customer service comes from customization, and personalized should digital health management be!

What can be achieved with a Digital Integrated Platform

Let’s say these amazing, user friendly features are all assembled and ready to go. There needs to be an objective behind each of these features, because, let’s face it, it needs to truly give results to last longer in a challenging market. More than 60% of the patient population require personalized care plans, and a significant portion wants to be able to consult with their provider digitally before going in-person. Pain points such as this need to be addressed.

With a digital integrated platform, providers can now enable that and more. Patients wouldn’t have to worry about not being able to contact their doctor, because with such a platform, there would be more access for all. They wouldn’t have to deal with managing their bills, because the platform would store such information, and all they have to do is view them when required. This platform would also be a digital blessing to providers, for they can manage their organization too. There would be data readily available for patient history, they wouldn’t have to wait until the physical records are brought to them.

On the administrative front, there would be a reduction in the time spent scheduling patients, searching for availability, and even they would be able to take breaks in between. Nurses spend 70% of their time in direct patient care, and with 12-hour shifts, it could be hard.

By transitioning into the digital health space, care organizations can expect better outcomes, higher satisfaction, and find that care management goals can be better regulated. From a monetary perspective, better care equals better profitability. It’s as simple as that, a win-win situation for all parties involved.

HealthViewX Digital Health Management

All said and done, this is where HealthViewX DHM platform comes in. What makes us a candidate worth collaborating with is we’re constantly engaged in providing the best digital experience. Enhancing your practice is just the beginning, so get started and schedule a demo!

Earn from Medicare’s Chronic Care Management Program! CCM made simple!

Chronic Care Management Services are delivered to Medicare beneficiaries with two or more chronic conditions with a goal of improving health and quality of care for high-need patients. As population ages, FQHCs, RHCs, ACOs, Hospitals, individual practitioners, etc. face the daunting challenge of improving quality of care for chronically ill patients while containing costs.

The Centers for Medicare and Medicaid Services (CMS) says about 93% of total Medicare spending is on beneficiaries with multiple chronic conditions. Research has shown that highly fragmented care for Medicare beneficiaries with multiple chronic conditions are more likely to present in emergency rooms, and be admitted than others.

In spite of the need for proactive care for Chronic Care Management Patients, a lot of the providers are still underutilizing this benefit. There are several reasons why providers like FQHCs, RHCs, ACOs, Hospitals, individual practitioners, etc. have chosen to leave it on the table.

Complicated Process:

There are several rules physicians and practices have to follow in order to qualify for CCM reimbursement. CMS has set rules right from enrolling Medicare patients up to the necessary documents that have to be furnished for CCM reimbursement. Other mandatory requirements include providers offering CCM service, should have access to patient’s health records, provide 24/7 access to care, provide care plans, and patients be able to reach providers to meet urgent care needs.

Time Consuming and involves additional costs:

Many providers feel offering CCM service is a time-consuming effort, and requires additional staffing. They find it difficult to document each of these and also provide quality care for their patients. Providers feel there is an increased administrative burden to managing and tracking CCM services, and it also involves additional cost.

Patients Consent:

Providers must identify Medicare eligible patients, explain CCM services and get consent to enroll the patient and start the service. Providers must explain the required information in detail where the patient can either accept or decline the service. 

Wait and See Approach:

Providers  want to first see if the approach is effective before deciding to opt for it. Many providers and physicians wait to see if other providers who opted to provide the service have success with reimbursement before committing to participation in the program.

HealthViewX makes Chronic Care Management process easier with the below features and makes reimbursement simple:

Automated Documentation for CMS Auditing

HealthViewX automates and streamlines the end-to-end CCM process. Integrates with softphones to accurately record the time spent on each call. It easily helps generate reports as per CMS requirements. 

Comprehensive Care Plan

Structured care plans are essential to help organize coordination of actions for proper patient progression and self-management. The solution helps create condition-specific, personalized and comprehensive care plans for each patient including tasks and goals for both the patient and care coordinator track for better care coordination. Simplifies and streamlines workflow to guide tele-nurses in creating care plans. 

HIPAA Compliant

HealthViewX CCM follows HIPAA compliance requirements and guidelines. The solution lets you define the access, have user-specific access conditions, and provides secure access to patient records.

Analytics and Dashboard

Gives detailed actionable insights for better care coordination. Data can be visually represented and users can gather detailed information by clicking the desired data. The dashboard also displays the follow-up reminders that can be set-up by the user against each patient.

Take this simple step to improve health outcomes and reduce costs for patients with multiple chronic care conditions.

Schedule a demo and talk to HealthViewX Solution experts today to discuss the CCM solution. Or simply outsource your CCM services. HealthViewX also provides end-to-end CCM services through our network of seasoned RNs and CMAs that enable you to increase your monthly reimbursements without incurring any additional cost of hiring additional staff or investing in technology solutions.

Understanding the scope of Chronic Care Management and what is required to make it profitable

Approximately 71% of the total healthcare spend in the United States is associated with care for Americans with more than one chronic condition. Among Medicare fee-for-service beneficiaries, people with multiple chronic conditions account for 93% of total Medicare spending.

It is said that a large percentage of these expenses are associated with acute care and emergency visits that could be prevented by earlier intervention. Patients who have multiple chronic conditions require ongoing medical attention. Putting further emphasis on health programs with an eye towards preventing and controlling chronic disease is one of the ways to address such costs.

The Centers for Medicare & Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as a critical component of primary care that contributes to better health and care for individuals.

What Physicians need to understand?

Medicare’s Chronic Care Management program has a primary clinical goal which is improving the health of Medicare patients with two or more chronic conditions expected to last at least 12 months or until the death of the patient, and who are at significant risk of death, acute exacerbation/decompensation, or functional decline. In addition to understanding the service-level parameters, pay levels, CCM codes.

PCP’s and other health organizations who provide CCM services need to understand how to effectively bill for CCM in order to profitably achieve that goal.

Some of the basic preconditions that providers must satisfy are:

  • the provider is required to complete an initial face-to-face visit
  • obtain verbal or written consent from the patient, and  develop a comprehensive care plan in the electronic health record
  • provide 24/7 access to care
  • use a certified EHR to aggregate all patient health information
  • establish continuity through a designated care team member who works with the patient to implement a dynamic plan that spells out the patient’s key prevention and treatment goals and strategies

Who all can provide CCM services?

Additionally to physician offices, Chronic Care Management Services can be provided by

  • Federally Qualified Health Centers
  • Rural Health Clinics
  • Critical Access Hospitals

And the following healthcare professionals can bill for CCM services

  • Physicians
  • Physician Assistants
  • Nurse Practitioners
  • Certified Nurse-Midwives
  • Clinical Nurse Specialists

Non-physicians must legally be authorized and qualified to provide CCM in the state in which the services are furnished.

Why provide Chronic Care Management Services?

It benefits both providers and patients. Patients will receive better-coordinated care thereby preventing hospitalization and re-admissions. Providers will not only receive payments for providing care but also improve practice efficiency, compliance, patient satisfaction, and health outcomes. Practices, large providers, and health systems can add net new recurring monthly revenue. 

How do physicians and other providers document the CCM services that are provided?

Some practices do the tracking manually, while some of the practices have CCM documentation built into their EHR’s. Other practices implement specialized CCM software to track time and ensure all the CCM requirements are met. Some of the CCM software has the ability to track not only the documentation but also send reminders or notifications to the patient, provider and other healthcare professionals involved in patient care. 

How to make CCM profitable?

Chronic care management requires 24/7 access to care. Practices take different approaches to meet this requirement to provide better care coordination. Some practices hire additional staff and some opt for a solution to automate the end-to-end process to cut down on additional staff expenses. Considering healthcare IT will not only cut down on additional expenses but will also make CCM more effective and efficient.

Talk to HealthViewX solution experts to understand more about HealthViewX CCM solution and make your CCM profitable. 

Learn how the COVID-19 pandemic is transforming healthcare with technology

The COVID-19 pandemic and its global sweep is scaling exponentially across the globe. We are witnessing that health systems across some of the COVID-19 affected countries are stretching beyond their ability to handle this pandemic. The affected countries have geared up and are urgently scaling-up aggressive measures to tackle the disease and combat COVID-19.

Unfortunately, even some large health systems in developed countries are designed to handle regular patient loads and not pandemics. The international community has asked for US$675 million to help protect states with weaker health systems as part of its Strategic Preparedness and Response Plan. Right from mid-March till the first week of April, the number of cases of COVID-19 outside China has increased 13-fold, and the number of affected countries has tripled.  Patients with an extreme disease from COVID-19 need average respiratory support of approximately 13 days and the number of new patients that can be accommodated during this prolonged outbreak is really low.

The rapid growth of cases can alter a public health emergency into an operational crisis if containment flops. Proper planning and response will require multidisciplinary effort from physicians, healthcare professionals, nurses, respiratory specialists, supply chain, pharmacists, etc. 

Here’s how technology is helping through its virtual care potential and other advancements

Healthcare workers on the front lines are overwhelmed due to the COVID-19 outbreak. The number of calls they receive from patients who want to talk to their respective physicians about COVID 19 symptoms is unimaginably high. As a result, health systems are suggesting their patients to use self-triaging tools to check for the COVID-19 symptoms before putting them through to their doctors. Chatbot’s have also been reconfigured with FAQ’s and assessment related to Coronavirus symptoms. 

The current COVID 19 outbreak scenario is terrifying and the major concern for many of us throughout the world.  Due to the sudden spike, patients triaged for COVID-19 should wait long in a virtual queue. During this long wait patients get frustrated and impatient, and also puts many patients in a state of panic and anxiety.  In one of the articles it is stated that the number of virtual visits have gone 10-15 times more after the COVID-19 outbreak. 

This insists on the need for health systems to standardize and streamline processes eventually to handle intake volumes and have the technology in place to manage such pandemics efficiently. It is said since the COVID-19 outbreak Telehealth visits/usage has increased by approximately 500% in the last few weeks. While some of the health systems have already successfully adapted to new healthcare technologies there are still plenty out there who have not thought about it yet.

It is time for health systems to realize, the power and potential of Telehealth, bring it into the mainstream and take it at one stroke to transform care delivery. Likewise, remote patient monitoring is also equally important to monitor chronic conditions patients and patients who are at high risk or suspected of contracting the virus during such pandemics.

The COVID-19 pandemic may be a turning point as we look at the future of healthcare across time horizons, how we live and work, and perhaps the planet’s future. During such situations, a certain degree of reprioritization is needed to speed-up the digital transformation of healthcare delivery.

Mainstreaming of Telehealth

Telehealth is on the rise during the COVID-19 pandemic. The HealthViewX platform supports patient-to-provider, provider-to-provider and multi-party collaboration from the onset of a condition. The platform supports both audio and video calling, and live-chats along with document transfer. Allows patients to join from any device like mobile, laptop, tabs, etc. It enables healthcare organizations to customize Telehealth experience for providers and patients, thereby enhancing the quality of patient care, raising patient engagement and improving patient experience and health outcomes.

For further customization, the platform engine helps build digital tools and platforms on-the-fly with no-code or low-code to orchestrate care journeys and facilitates transitioning to value-based care. The current system definitely needs to adapt to modern healthcare technology.  

Talk to us to understand more about healthcare technology advancements.

What’s New with CCM? Medicare Reimbursement 2020 Code Changes Explained!

First, let’s have a quick look at what were the codes in 2019.

Beginning January 1, 2019, the CCM codes were as below

CPT 99490 (Non-complex)

Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month.

CPT 99491

Chronic care management services, provided personally by a physician or nurse practitioner for at least 30 minutes, per calendar month to high-risk patients. Codes 99490 and 99491 cannot be billed in the same month for the same patient so practices will need to decide if this new code is a good use of their doctors’ time and which patients would benefit from it.

CPT 99487 (Complex)

 Complex chronic care management services, with at least 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month

CPT 99489 (Add-on for CPT 99487)

Each additional 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month (List separately in addition to code for primary procedure).

Complex CCM services of less than 60 minutes in duration, in a calendar month, are not reported separately. Report 99489 in conjunction with 99487. Do not report 99489 for care management services of less than 30 minutes in addition to the first 60 minutes of complex CCM services during a calendar month.

The billing practitioner cannot report both complex and regular (non-complex) CCM for a given patient for a given calendar month. In other words, a given patient receives either complex or non-complex CCM during a given service period, not both. Do not report 99491 in the same calendar month as 99487, 99489, 99490.

What’s New?

On Nov 15, 2019, Centers for Medicare and Medicaid Services (CMS) finalized the CY 2020 Medicare Fee Schedule (MFS). It has revised the current chronic care management reimbursement program and has created a new care management reimbursement program.

Here’s a quick look at 2020 Medicare Reimbursement Codes for Chronic Care Management:

99487, 99489*, 99490, G2058*, 99491

CMS has created an add-on code, HCPCS Code G2058 for non-complex CCM effective Jan 01, 2020.

G2058 Specifications:

A medical practitioner can bill CPT 99490 for the first 20 minutes of clinical staff time spent performing CCM activities (educating the patient or caregiver about the patient’s condition, care plan, and prognosis, etc.) in a given calendar month and can charge HCPCS code G2058 for the second and third 20-minute additions (additional staff time respectively). Use G2058 in conjunction with 99490. Do not report 99490, G2058 in the same calendar month as 99487, 99489, 99491. These CPT codes are tailored toward primary care physicians but can be billed by any physician or by any skilled healthcare professional and get the reimbursement by fulfilling the code requirements.

Payment or reimbursement for the CPT code 99490 is $42.23 while the add-on code G2058 (up to two) pays $37.89. Therefore, total reimbursement for an hour or more of non-complex CCM services is $118.01.  

** Add-on codes are bundled and cannot be billed separately from their base code.

CCM Patient Eligibility

Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, are eligible for CCM services.

How does the scope for CCM look like in 2020?

Qualified healthcare professionals have been billing Medicare for providing CCM services like maintaining care plans, handling care transitions between providers to Medicare patients with two or more chronic conditions. Even today CCM continues to be underused.

The epidemic of chronic disease continues to grow and has reached global epidemic proportions. This condition is exerting considerable demand for health systems to adopt an IT solution to provide better care for their chronic patients. This increased demand has become a major concern today. Adapting new technology or operating models is vital for the health systems to provide care differently, more efficiently, and with better patient outcomes.

HealthViewX CCM platform helps individual physicians, practices, billing companies, etc. to provide CCM services seamlessly to their enrolled Medicare patients. The simplified and automated process makes it easy to meet the criteria for CMS billing and reimbursement.

Power your entire system – simplify your workflow, create patient-specific care plans, automate documentation, generate detailed reports, and improve overall efficiency. Hosted in cloud servers, HealthViewX CCM solution is extremely scalable to meet requirements of any operative size and our pricing model keeps overhead cost minimal and manageable.

Schedule a demo and talk to our solution experts today!

 

Ref: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf

https://hcpcs.codes/g-codes/G2058/

 

It’s time to stop faxing referrals – Why are we still faxing patient referrals?

One out of every three patients is referred to a specialist each year. These referrals are sent to specialists, imaging centers, etc., through multiple channels like phone calls, fax, emails, website forms, etc., and fax is the most commonly used channel. Despite the array of digital patient referral management software available in the market, health systems are still following the old school model of referring patients through fax machines and paper-based letters.  Ironically, there could be multiple barriers like the reasons listed below for not using the electronic referral communication software

  • Traditional workplace culture
  • Not having the right technology in place
  • Not understanding the software usage
  • Peers not using eReferrals 

Healthcare professionals need to understand the usability, security, and interoperability of the solutions available in the health IT market. Health systems need to adapt to more secure means to send and receive referrals. With that being said, Referral Management Solution is progressively vital for better patient experience and care coordination. Today, in most health systems referral workflows are poorly documented, insecurely sent and are not effective in providing quality care for patients.

Knowing the security consequences of maintaining paper-based systems and physical paper letters is critical – as they could be easily misplaced and accessed by unauthorized people. Some health systems still depend on their EMR to manage their referral process but they need to understand that EMR’s are not equipped enough to handle the end-to-end referral process. Health systems should understand the need of having a good patient referral solution.

Why do health systems need a good patient referral solution?

The healthcare industry is constantly scrutinized for inefficiencies in processes, systems, operations, etc. As a result, health systems are under more pressure to do more with fewer amenities. Inefficient referral processes lead to long lead times and are inconvenient to both patients and providers. A referral solution can streamline communication between the referring provider, receiving provider, patient and other healthcare providers, save time, enhance care quality and a lot more for both patients and providers.

Other Key Benefits of referral solution include

  • Reduced wait times for patients
  • Better referral tracking
  • Improved referral quality
  • Cost reduction
  • Enhanced operational efficiency
  • Secure transfer of patient information
  • Reduced referral leakage

Referral management solution is important for better patient experience, care coordination and to arrest patient leakage. Health systems lose millions of dollars due to referral leakage as every patient seeking care outside the network is lost revenue. Minimizing leakage is an increasingly key focus for many health systems. Health systems need to make substantial improvements in processing referrals efficiently, improve processes and invest in technologies. It is high time for health systems to stop receiving and sending unsafe fax referral and have a streamlined end-to-end referral solution in place.

A streamlined referral management solution has the potential to standardize the referral process, maximize efficiency in the referral process, and improve workflow through technology. Talk to our experts today and schedule a demo to understand more about our Patient Referral Management Solution.