HEALTHCAREfirst Announces Business Intelligence Enhancements That Help Reduce Medicare Denial Rates

Earlier this year, Palmetto GBA announced new medical prepay audits based on certain HIPPS codes that have the highest denial rates. While they have internally identified the top 20 HIPPS groupings with the highest denial rates, they have currently published and set up pre-pay audits for two code groupings. When an End of Episode (EOE) claim is submitted using one of these two HIPPS groupings, Palmetto GBA could place the claims into ADR status and providers will be required to submit additional documentation from the chart in order for a payment determination to be made.

In response to this announcement by Palmetto GBA, HEALTHCAREfirst developed Business Intelligence reporting that will enable home health agencies to identify and monitor episodes that will be audited upon EOE submission. Agencies can then focus on the charts that make up these at-risk claims, ensuring that their documentation is accurate and complete should the claims go into ADR status.

In addition, HEALTHCAREfirst has expanded the HIPPS code groupings beyond the two identified by Palmetto GBA to include ten additional code groupings that may be subject to audit, based on internal statistics. This assists home health agencies in preparing for potential upcoming audits, regardless of their MAC. In addition, Episode Master, the automated QA tool within Business Intelligence has received a number of enhancements that include more detailed messages and suggestions to help protect agency review and ensure documentation is as accurate as possible due to increased industry scrutiny. These edits focus on many of the issues that typically result in take backs when agencies are targeted.

“Like never before, home health agencies must know where their money is at all times in order to avoid interruptions in their revenue cycle. These new enhancements are important additions to our Business Intelligence analytics tool, providing the information needed to make informed business decisions before it’s too late,” said Stan Bell, Vice President of Product Management.

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Turkish Healthcare Takes Big Strides Forward

Turkish Healthcare Takes Big Strides Forward

Turkey's health care system illustrates well how health standards have improved rapidly in recent decades, partly as a result of higher health spending. In 2003 the government introduced major health reforms aimed at solving the problem of poor rural healthcare resources and making health care available to a larger share of the population. As a result of these changes, the private healthcare sector has developed quickly, with the reputation the state run hospitals have for long queues and poor personal service acting as a catalyst. In 2006 there was one doctor for every 700 people, one nurse for every 580 people, and one hospital bed for every 380 people. In general, though, the rural population is still poorly served by the healthcare system, which is much more developed in the western half of the country. Turkey has no national health system designed specifically for expatriates. The Turkish government planned to roll out a public healthcare system in 2010, however this was postponed and has yet to advance.

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