Traci Quillen

💡💡Great insights from our #MDaudit #2023Benchmarkingreport Case accuracy in professional and hospital billing present significant revenue opportunities.... With national staffing shortages impacting the field of healthcare; technology, automation, and analytics have become important catalysts for billing compliance departments as leaders look to increase productivity despite fewer staff members. Operational efficiency and coding accuracy become key drivers for financial effectiveness. Billing compliance teams are doubling down on auditing coders and tracking case accuracy rates for E&M and procedure services across professional and hospital billing. As you will see in subsequent pages, a single percentage increase in accuracy rates will mean cleaner claims during initial submission and in turn millions of dollars in reimbursement in a timely manner. 1. Case accuracy describes the accuracy of the total claims being audited 2. Code accuracy describes the accuracy of codes (E&M, CPT/HCPCS or DRG) in the claims being audited

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This brief video highlights one of the challenges facing ACO leaders today as they consider quality reporting decisions for PY 2024 and 2025. Knowing your network provider's EMR strategy and constraints is critical to making the right decision and meeting your quality goals. #populationhealth #Medicare #MSSP

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One common misconception about eCQM reporting, and the necessary QRDA I files produced by certified EMR systems, is that these QRDA I files are aggregated for the population. This is not the case. QRDA 1 files are per patient, per measure, and the quantity of these files can add up quickly with large populations. See the below to watch the full video about how Nebraska Health Network is tackling this challenge.

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Billing Tip Tuesday: Keep claim denials below 2% by optimizing your denial feedback loop! UnisLink's billing expert, James Muir (30+ years of experience), recommends: - Regularly analyzing denial trends. - Sharing actionable insights with your team. - Implementing process improvements to stop recurring issues. Need help mastering denial management? UnisLink has you covered! #BillingTipTuesday #DenialManagement #RevenueCycleOptimization #HealthcareEfficiency

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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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To improve efficiency, save costs and elevate staff productivity and satisfaction, hospitals and health systems are automating parts of their revenue cycle using artificial intelligence (AI). #revenuecyclemanagement

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Join UnisLink tomorrow for an #AskMeAnything webinar and get all your billing questions answered! #Webinar #LiveEvent #Healthcare #AMA #RevenueCycle

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I can easily spot another Southern Californian by our bright smiles at the MGMA conference, especially when strangers walk by and we realize we’re all from the same spot in Orange County! 🌴🍊 Today, stop by UnisLink’s Booth 358 to chat with us about how we can highlight the importance of metrics in your billing data through a complimentary revenue cycle analysis. 💸🩺 #MGMA #BillingMetrics #Networking #KeyPerformanceIndicators #Billing

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Learn why nurses need a simplified #EHR system to do their best work and improve nursing care as frontline clinicians. Read this Wolters Kluwer Expert Insight and watch the replay of the Scottsdale Institute webinar, Insights on Institutional Fatigue: Combating Health Worker Burnout and Improving Patient Care in Complex Environments. https://gag.gl/aogitl

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Throw out the old approach of using siloed systems, incomplete data, and manual processes to manage your Enterprise Technology workflows. These traditional, labor-intensive methods just don't scale to today's IT challenges. They make it extremely difficult to orchestrate cross functional workflows like On and Offboarding while monitoring compliance and delivering world class employee experiences. Watch the video to learn how CHG Healthcare has transformed their Enterprise Technology Management (ETM) with Oomnitza’s solutions. https://lnkd.in/ehNU-pzR

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What direction are your revenue cycle KPIs headed? Compare your performance with Kodiak Solutions' latest national performance data on the 10 most-revealing revenue cycle KPIs. Download our April scorecard today: https://bit.ly/3SPjfNl #KodiakHC #KodiakTech #revenuecycle #revenuecyclemanagement #hospitalmanagement

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We know that when it comes to healthcare organizations, you're busy. That's why we built Certification Cloud with performance and ease of use in mind—so that you can stay on top of your workforce's certifications and other credentials, ensuring compliance without wasting time or money. Certification Cloud is a robust platform that allows you to monitor every aspect of certifications and corporate trainings. Easily search for employees by name or job title, or filter results by department and/or date range. You can even export the data for further analysis! Get started today by signing up for a free trial! https://bit.ly/4dbLE8q #VAIRKKO, #CertificationCloud, #EmployeeCertifications, #EmployeeTraining

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As our CRO, Patti Peets, often says to business executives, "If you can't measure it, you can't improve it." Let’s explore what's happening across your billing stream by taking advantage of UnisLink’s complimentary revenue cycle assessment for your healthcare business. #analytics #revenue #complimentaryassessment #processimprovement

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Empower your team with the latest technology releases as standard across your fleet, reducing staff pressure and driving better outcomes. https://lnkd.in/gj_wPWcN #Sustainability #Workflow #Efficiency #burnout #patientsatisfaction #staffsatisfaction

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The 2024 HealthLeaders Exchange RevTech Exchange in Nashville highlighted eight essential tips for effective revenue cycle management (RCM) technology. First, continuous training is critical due to AI-driven changes; RCM staff must evolve from manual tasks to monitoring automated processes. Leaders must address AI-related job concerns and help staff adapt to their new roles. Technology alone isn’t a solution; it’s a tool requiring effective utilization to improve revenue cycle performance, as seen in WVU Medicine's predictive denial tool that lacked actionable value. Second, health systems must proactively address root causes of common RCM pain points, such as denials and prior authorizations. Third, cross-department collaboration, particularly with IT and clinicians, is essential; RCM staff should understand clinical workflows and find clinician champions to improve technology alignment. Fourth, securing a clear ROI is crucial to justify AI investments, and fifth, balancing new and established tech requires strategic decisions on in-house versus outsourced solutions. Sixth, learning from other industries like retail and banking can bring fresh perspectives to RCM, fostering innovation and adaptability across healthcare systems. Our RCM team supports effective revenue cycle technology management by offering tailored training on evolving tech, fostering cross-department collaboration, and addressing root causes in areas like denials. We help healthcare entities maximize ROI, balance new and established tech, and adapt successful strategies from other industries for seamless integration. #HomeHealthServices #HospiceCare #FrontEndServices #BackOfficeSolutions #HealthcareManagement #RevenueCycleManagement #HealthcareCompliance #PatientSupport #CareCoordination #MedicalBilling #ClaimsManagement #PatientEngagement #HealthcareOutsourcing #MedicalCoding #ProviderSupport #CliniqonCare #HealthcareSolutions #PatientCareExcellence #HomeHealthRCM #HospiceBilling

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