Reid Kiser

#ICYMI: Last month, #FEHRM Data Integration Solutions Director Crystal Baum talked about #FederalEHR Advancements in Population Health at #DHITS. She detailed the federal EHR's implementation of population health applications like HealtheRegistries to identify gaps in patient care, HealtheAnalytics to provide aggregation of data to offer different levels of reporting, and HealthRecord to offer a complete view of the longitudinal record. Learn more at https://lnkd.in/eqGY-9qC. 

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Attending the 2024 Tri-State Health Information Summit? Don’t miss AGS Health's VP of Coding, Leigh Poland, presenting on "Coding and Documentation Accuracy in Mortality Cases." The session will analyze common coding errors and documentation gaps from mortality audits, explore case studies, and discuss how coding and CDI impact APR-DRG and SOI/ROM. Gain valuable insights into coding and query issues and understand top procedure coding errors. Don’t miss this essential session! https://hubs.la/Q02P7vgV0

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The OIG highlighted in its 2024 Semiannual report it expects to recover nearly $3 billion, has taken 712 enforcement actions, and has excluded 1,795 individuals and entities from the federal health care program. The OIG's oversight work conducted during the reporting period, focusing on the most significant challenges facing the HHS, has highlighted a key area: Third-party liability (TPL). State Medicaid agencies continue to struggle to meet TPL requirements, which are crucial for ensuring that Medicaid is the last resort payer. The OIG has pinpointed various obstacles, such as difficulty obtaining timely and dependable coverage information from third parties. Outsourcing these workflows and allowing an expert team to assist you in overcoming these challenges can ensure that your State Medicaid agency meets TPL requirements. 🚫 Don't Let TPL Challenges Hold You Back Contact me anytime to learn more about our solution and how we can help your State Medicaid agency thrive. Schedule some time with me here: https://lnkd.in/g76sD7dC By partnering, you: 📝 Minimize administrative burdens and costs related to managing third-party liabilities. Most vendor agreement conditions only charge if revenue is found and collected.  💰 Improve the accuracy and timeliness of payments or, in some cases, collect on accounts receivable subject to write off. ✍ Reduce recoupment payment adjustments and interrupt revenue forecast and budget planning. 📊 Tap into advanced data analytics to detect and prevent errors and discrepancies. 👨‍⚖️ Receive expert guidance and support to comply with OIG recommendations and CMS regulations. 🏫 Access custom training and education to empower your staff to confidently manage third-party liabilities. #TPL #ThirdPartyLiabilityManagement #MedicaidLiabilityRequirements #HealthcareFinance #PayerOfLastResort #MedicaidCompliance #HealthcareRegulations #ThirdPartyPayments #MedicaidAdministration #HealthcarePolicy #GovernmentPrograms #OIG #Healthcarenews Read the full article here: https://lnkd.in/gPBiMMeE

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📣 CMMI Update on Value-Based Care Initiative ICYMI: This week, CMMI released an update on its value-based care initiative, which focuses on value-based payment and service delivery models to reduce costs, improve care quality, and ensure equitable outcomes through high-quality, affordable, person-centered care. Models like ACO REACH, Transforming Maternal Health (TMaH), and Making Care Primary (MCP) mandate sociodemographic data collection, health equity plans, and HRSNs screening and referrals. They feature innovative payment policies and support for underserved populations. 📊 Significant strides have been made in 2023. CMMI highlighted progress in safety-net provider participation, data collection, and payment innovations aimed at reducing disparities. These new models ensure diverse provider participation and offer much-needed support for Medicaid beneficiaries, including Federally Qualified Health Centers (FQHCs) and community-based behavioral health providers. We are excited to hear the progress they are making in their efforts to enhance whole-person care, address HRSNs, and advance health equity. 📖 Read the blog https://lnkd.in/eXrpC5Je #HealthEquity #ValueBasedCare #CMMI #CMS #HealthcareInnovation

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Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

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"Are You Prepared for Your Electronic Health Record Upgrade?" Upgrading to a new version of an EHR (Electronic Health Record) software application is a significant task that requires careful planning and execution. Here are some best practices that Fivebase employs to ensure a smooth transition: ✔️ Understand Benefits: The organization must complete all due diligence on the upgrade and its benefits for clinical, revenue cycle, frontline, quality, and administrative leadership. This will give all team members an elevator pitch of the system's top “X” improvements. ✔️ Define and Prioritize Goals: Clear leadership and governance are crucial to aligning the upgrade with your organization's strategic goals. Defining the exact future state will keep the team focused on the end goal, ensuring a successful upgrade aligned with the organization's strategic direction. ✔️ Understand Current System: Document your current EHR workflows and core reports. You want to make sure you can discuss and review any updates that will be happening and let the team know the benefits of moving forward. This understanding will prepare you for the changes and make you feel more comfortable and knowledgeable about the process. ✔️ Review Project Plans: Your EHR vendor will provide a project plan for every implementation. Your team must thoroughly understand all timelines and their interconnections, especially if other projects are running in parallel. This understanding will ensure smooth coordination and successful implementation. ✔️ Review Upgrade Team: Software vendors constantly add and train new staff. This is core for any company. The main thing to focus on is coordination and training. You must have senior staff on the team to help and direct any upgrade. It’s okay to ask what type of experience people have regarding your upgrade. By following these best practices, you can minimize disruptions and maximize the benefits of your electronic health record system. The goal is to reduce electronic health record frustration and maximize quality time with clients. Fivebase is your partner for clinical process optimization. With a strong focus on integration and database reporting solutions, Fivebase aims to connect customers to their clients and data through innovative technology solutions. Let's connect today! #BehavioralHealthEHR #MentalHealthTech #DigitalHealthRecords #BehavioralHealthIT #EHRIntegration #CuresAct #EHRinteroperability

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"Manual data abstraction is usually a last-minute realization requiring a rushed effort to assemble an expert abstraction team." https://lnkd.in/gECR_W3m But it doesn't have to be. Discover how HCRS can provide you with superior data accuracy, management, and efficiency! https://lnkd.in/g3JFYS8R

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Traditional EHR systems often fall short in supporting the essential functions of Enhanced Care Management (ECM) under #CalAIM. ECM requires seamless coordination across physical, behavioral, and social determinants of health, proactive member engagement, and real-time data exchange—capabilities that extend beyond the scope of many EHRs. Our Incedo #CareManagement platform is fully aligned with ECM and fills the gap of traditional EHR systems. Incedo offers an integrated whole-person approach to care management and facilitates collaboration across providers and managed care plans to improve outcomes for California’s most vulnerable populations. If you’re looking for a complete #ECM solution, let’s talk about how Incedo can help. https://hubs.ly/Q02RnVwW0 #HealthcareInnovation

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📄✨ New Guide for Implementing Prior Authorization Requirements This paper explores key aspects of implementing the Centers for Medicare & Medicaid Services (CMS) 0057 Final Rule to help stakeholders meet regulatory requirements and enhance healthcare interoperability. It provides guidance based on CAQH’s extensive experience with industry standards, collaboration with key stakeholders, and the development of operating rules through CORE and Insights initiatives. Key focus areas include: 🌐 Establishing common connectivity and exchange protocols ⚙️ Adding optional steps to make prior authorizations smoother 💰 Assessing the return on investment for these changes Whether you're a healthcare provider or plan, this guide is your ticket to regulatory compliance and operational excellence. Ready to streamline PA? 👉 https://hubs.li/Q02D9Ld50 #Healthcare #Interoperability #PriorAuthorization

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WebMD Health Services' Center for Research has recently completed some exciting new research surrounding #EmployeeExperience and #WellBeing. Next Wednesday, June 26th @ 10AM PT and 1PM ET they are hosting a webinar to share valuable insights uncovered when navigating workplace dynamics and enhancing employee engagement. A few key takeaways from the session will include: - Understanding current factors influencing the employee experience - Exploring employee perceptions on well-being and burnout - Learning practical insights to enhance your workforce strategies Don't miss this opportunity to gain fresh perspectives on fostering a positive work environment and improving overall employee satisfaction. Register now to benefit from scientific evidence-based research and real-world case studies. https://lnkd.in/gnQbBGJh #EmployeeExperience #Wellbeing #Webinar

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The IHS Health IT Modernization Program hosted a tribal consultation and urban confer on August 8 via Zoom, focusing on multi-tenant domain considerations and how they affect the building of the enterprise electronic health record (EHR) solution, PATH EHR. Check out this month’s blog post for a recap of the event and to learn more about how PATH EHR will support multi-tenant domain considerations: https://bit.ly/4dTuD3N #ModernizeHealth #HealthITModernization #NativeHealth #IndianCountry

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My Friday good news celebrates the heroes of value-based care: primary care physicians and teams. The most successful #Medicare ACOs, those delivering value for Medicare and Medicare beneficiaries and sharing in that value, are primary care-centric #ACOs. We know how they do it; the playbook often includes support from enablers like Aledade, Inc.. Dr. Menard and his colleagues didn't give up when success wasn't immediate. How do we grow more primary care-centric ACOs and generate more value for Medicare and more access and quality care for beneficiaries? There are some health system ACOs investing in primary care and integrated teams. But it might take more forceful nudges from Medicare to get big health systems participating in total cost-of-care risk models. Or, we might need payment policies to give primary care more independence to practice comprehensive care. Congress could also consider restructuring the APM bonus to reward primary care "centricity". #primarycare #valuebasedcare Primary Care Collaborative David Raths David Muhlestein AAFP Foundation Thomas Culhane, MD, MMM, MS Darrin Menard, M.D. Stacey Richter https://lnkd.in/dThMvJrQ

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What equity frameworks does your organization use? Have you seen the Agency for Healthcare Research and Quality's "Practical Guide for Implementing the Digital Healthcare Equity Framework"? AHRQ takes an intentional approach to considering equity throughout the digital healthcare lifecycle aims to promote improvement in: • Clinical outcomes such as mortality, morbidity, and health/quality of life • Process outcomes such as care continuity, care coordination, and care quality • Healthcare experiences such as patient satisfaction/engagement and provider satisfaction/engagement #HealthcareEquity #ClinicalOutcomes #PatientExperience https://lnkd.in/eTA9d9Gn

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Good read on policy opportunities for AI in utilization management and claims processing, including prior auth. While FHIR APIs and the recent CMS final rule on interoperability and prior auth address transparency between providers and payers, ensuring appropriate and safe use of AI within payers and providers remains. With continued testing and learning, we can find reliable application of AI to improve the overall process and monitor for errors for prompt remedies. https://lnkd.in/exJ6v-3H

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How CMS Updates are Shaping Healthcare Compliance in 2024 In 2024, CMS has rolled out several significant updates that healthcare providers, payers, and patients need to be aware of—changes that are not only shaping compliance requirements but also redefining the standards for patient care. One of the major updates includes stricter guidelines for billing and coding, particularly related to telehealth services. With the explosion of virtual care during the pandemic, there were concerns about overbilling and fraud. The new CMS updates aim to tighten those regulations, requiring more detailed documentation and justification for telehealth visits. While this increases transparency, it also adds a layer of complexity for providers, who now face a greater administrative burden. Is this a necessary step to maintain the integrity of the system, or will it deter providers from offering telehealth services altogether? Another key change focuses on quality metrics for Medicare and Medicaid services. The updated policies emphasize outcomes-based care, which holds providers accountable for the quality—not just the quantity—of services delivered. This shift towards value-based care is critical for improving patient outcomes, but it also presents challenges for providers who must balance quality with financial sustainability. Will the focus on quality metrics lead to better healthcare, or will it create additional barriers for smaller practices that lack the resources to meet these new standards? Finally, CMS is expanding its efforts in promoting health equity. Recent updates include measures aimed at reducing disparities in healthcare access for minority and low-income populations. This is a commendable move, but the road to health equity is long and filled with obstacles. What more can be done to ensure these efforts translate into real-world change? The conversation around healthcare reform must continue if we are to achieve a system that truly works for everyone.

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Access to healthcare is one part of ensuring high-quality care. Tracking and reporting quality measures to ensure programs like Medicaid work as intended matters, too. Find out how we are helping CMS develop, monitor and report on quality measures that matter for #Medicaid: https://lnkd.in/e_HT8m-B

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