James Pelletier

Ensure Optimal Care Delivery with OnPage❗ To manage critical results effectively – timely communication is key🔑 So care teams need a solution, like OnPage, that enables them to: 🩺Receive immediate critical result notifications 🩺Extend critical alerting & on-call management to EHR systems 🩺Define escalation policies 🩺Utilize role-based alerting 🩺Securely deliver critical messages Learn more: https://lnkd.in/ej_zezaM  #criticalresultnotifications #HIPAAcompliance #securemessaging #EHRalerts #clinicalcommunicationandcollaboration #healthcare #rolebasedmessaging

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🔍 HIPAA Compliance: Gap Analysis vs. Risk Analysis 🔍 Do you know the difference between a gap analysis and a risk analysis for HIPAA compliance? Our detailed guide breaks it down for you and explains when to use each approach. 🧐 Test your knowledge and improve your compliance strategy is on point. 📖 Learn more: Navigating the Waters of HIPAA Compliance: Gap Analysis vs. Risk Analysis. https://lnkd.in/eqJEN5qh

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Unlike many healthcare transactions, prior authorizations are not a simple inquiry and response. It’s a complex conversation that evaluates medical necessity against a member’s medical record and a health plan’s guidelines. Availity AuthAI™ streamlines this process with a data-first workflow. Hear from Robert Laumeyer, Chief Technology Officer, at Availity as he discusses the innovative approaches and the underlying technology used to develop Availity AuthAI. https://okt.to/pirGzF

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Latest blog post for my Oncology Data Management/Cancer Registry connections!

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Regardless of the weight the CMS places on a healthcare facility — be it an ambulatory surgical center, long-term care facility, hospital, etc. — complying with the agency’s preparedness standards is a must. Learn how Veoci can help. https://lnkd.in/ecd3PC-r

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What elements do you need to assess for legacy application support outsourcing, and what factors are critical to success? Watch the webinar to explore these and other considerations for legacy systems support.

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Our partnership with Oracle Health will include advances in artificial intelligence (AI) and other technologies that hold the potential to revolutionize patient care and outcomes while dramatically reducing the non-productive administrative burden on our providers and caregivers. #VISION2030 #RemarkableReimagined #AcceleratingTransformation

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So I asked ChatGPT: "what are the three main challenges that payers face when scaling up VBC contracts?" Pretty impressed by the reply! --- Value-based care (VBC) contracts offer potential benefits in improving patient outcomes while controlling costs, but scaling them up presents several challenges for payers: 1. **Data Infrastructure and Analytics**: VBC relies heavily on data analysis to measure outcomes and determine payments. Implementing robust data infrastructure capable of collecting, processing, and analyzing large volumes of clinical and financial data is essential. However, many healthcare organizations struggle with interoperability issues, data silos, and data quality concerns. Scaling VBC requires investments in advanced analytics capabilities and interoperable systems to effectively track patient outcomes and ensure accurate reimbursement. 2. **Provider Engagement and Alignment**: Successful VBC implementation depends on strong collaboration and alignment between payers and providers. However, engaging providers and getting them to buy into new payment models can be challenging. Many providers are accustomed to fee-for-service reimbursement and may be hesitant to adopt new care delivery models that require changes to their workflows and financial practices. Payers must invest in provider education, support, and incentives to encourage participation in VBC programs. Additionally, aligning incentives between payers and providers is crucial to ensure that both parties are working toward the same goals of improving quality and reducing costs. 3. **Risk Management and Financial Sustainability**: Transitioning to VBC involves assuming more financial risk for patient outcomes and healthcare costs. Payers need to carefully assess and manage this risk to avoid financial losses. Balancing the risk-sharing arrangements in VBC contracts, setting appropriate benchmarks, and establishing mechanisms for risk adjustment are critical aspects of managing financial sustainability. Payers also need to develop strategies for monitoring and mitigating risks associated with fluctuations in patient populations, healthcare utilization patterns, and external factors such as regulatory changes and market dynamics. Successfully scaling up VBC contracts requires addressing these challenges through strategic investments in data infrastructure, provider engagement, and risk management strategies. Collaboration among stakeholders, innovation in payment models, and continuous evaluation and adaptation are essential for driving the widespread adoption of value-based care.

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🔍 Exploring MultiPlan's Healthcare Billing Practices: A Critical Analysis 🔍 In a recent investigation, concerns have been raised about MultiPlan's billing practices within the healthcare industry. MultiPlan, known for its preferred provider organization (PPO) network product and related services, has come under scrutiny for potentially violating the No Surprises Act. MultiPlan's PPO product offers health plans the flexibility to utilize their networks as primary or complementary options. However, recent revelations suggest that clients may bypass agreed-upon rates, leaving providers and patients in the dark until after services are rendered. The No Surprises Act, implemented earlier this year, aims to protect patients from unexpected medical bills by requiring providers and health plans to disclose specific cost breakdowns before services are provided. This raises questions about MultiPlan's practices and whether they comply with these regulations. While MultiPlan has issued statements defending its mission of affordability and fairness, questions linger about the extent of their responsibility and transparency in decision-making. Expert analysis from Jack Hoadley of Georgetown University's McCourt School of Public Policy sheds light on how the No Surprises Act addresses these issues, particularly through advance explanation of benefits (AEOBs) to provide patients with financial transparency before services are rendered. As discussions around healthcare billing transparency continue, it's crucial for stakeholders to understand the implications of these practices on patients, providers, and insurers alike. Read more about the investigation and expert insights in the full article. Let's ensure transparency and fairness in healthcare billing practices for the benefit of all involved. #HealthcareBilling #Transparency #NoSurprisesAct

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Why do Healthcare Systems Need Policies and Tools for CMS and OIG Updates in CDI Programs? To ensure the success and sustainability of Clinical Documentation Improvement (CDI) programs, healthcare administrators, CDI professionals, and compliance officers must play a pivotal role in implementing robust policies and utilizing effective tools. This is how they can stay updated with CMS (Centers for Medicare & Medicaid Services) and OIG (Office of Inspector General) regulations. 📊 Ensures Consistency: Clear policies and reliable tools guarantee that all staff members follow the latest guidelines, promoting uniformity in documentation practices. 🛡️ Enhances Compliance: Policies combined with advanced tools help prevent compliance issues by ensuring that regulatory changes are systematically tracked and implemented. 🏥 Enhances Patient Care: Proper policies and tools ensure accurate and up-to-date documentation, directly improving patient care quality and leading to better health outcomes. 💼 Safeguards Revenue: Well-defined policies and efficient tools reduce the potential risk of claim denials and penalties, protecting the organization's revenue stream. 📚 Supports Training: Policies provide a framework for continuous education, while tools ensure CDI professionals can access the latest information and resources. 🔄 Facilitates Adaptability: Having policies and utilizing tools allows for swift adaptation to regulatory changes, maintaining operational efficiency and compliance. By integrating comprehensive policies and leveraging the right tools for CMS and OIG updates, healthcare systems can ensure their CDI programs' ongoing success and effectiveness. 🌟 #CDI #HealthcareCompliance #PolicyMatters #CMS #OIG #PatientCare #HealthcareManagement #TechInHealthcare

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Navigating the complexities of HCC coding can be daunting for many health systems. Learn how UConn Health overcame this challenge through a strategic partnership with PINC AI™ Stanson, leading to significant improvements. Check out their journey: https://lnkd.in/e_XjRteD

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CFOS ARE SHIFTING ATTENTION TO THESE 4 MAKE-OR-BREAK TRENDS This article from HealthLeaders caught my attention for the following- CFO's take note, if your CDI vendor pitches their software as a tool that enhances CDI efficiency in reviewing records that have the best opportunity for documentation improvement, i.e, securing a CC/MCC and raising the CMI, do not take that sales pitch on face value. If your CDI software vendor sends you reports indicating a jump in CMI and CC/MCC from using their AI software, please validate the data. You must analyze your own financial data and determine if your CDI program and its use of technology are generating net patient revenue. My personal experience time and time again is that CMI is a warm fuzzy feel-good number unless you factor in clinical validation denials and missed CDI opportunities to improve physician documentation and alleviate the steadily increasing costly payer denials and financial takebacks. These add up and impact the bottom line. Watch this short 1-minute video and learn if your CDI program is as successful as your CDI vendor and CDI leadership is leading you to believe. https://lnkd.in/eHGXaYSK Attendees agreed that CFOS must assess the true ROI of their technology solutions and initiatives, especially since many vendors don’t come armed with any data. Implementing technology that streamlines workflows and enhances patient care may lead to shorter LOS, but CFOs must evaluate the financial impact of these efficiencies. “At our hospital, we implemented new technology that reduced our LOS, but I had to add 20 other FTEs to accommodate for the tech,” Wallace said. “So, CFOs need to be aware that a reduced LOS does not always equal an increase in revenue.” By conducting thorough financial analyses and performance evaluations, finance leaders can ensure that their technology investments are generating sustainable revenue growth and improving overall financial performance. #technology, #ROI, #returnoninvestment, #donotbelieveyourCDIvendor, #vendorsstretchthetruth, #validatedenials

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Our #EHR captures the clinical encounter electronically without making you change your workflow, which is why so many have trusted ChartLogic with their paperless office needs. Learn more here: https://buff.ly/3U8gZmr #ehrsoftware #ehrsolution #electronichealthrecords #electronichealthrecord #ePrescribe #VoiceDictation #PatientTracker #ReferralReply #DataShare

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Combat therapeutic inertia with free resources! Gain insights on glycemic management, prior authorizations, leveraging EHR data, and more. Drive timely treatment and improve care plan adherence using our webinars, toolkits, and assessment tools. Access them today! https://lnkd.in/eTb5d-8e

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#MakingYouMoney #NoChangeToYourSystem #GetPaidWithUnisLink ✅💰If you want to learn out how message me directly… I promise you that you’ll find something valuable out of my conversation to take skills back to your practice to see where the revenue gaps are in your billing operations and processes.

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Choosing the best clinical communication solution is foundational in efficient and effective healthcare delivery. But how do you decide? Our “Cheat Sheet” outlines the eight must-ask questions to guide your evaluation process when looking for a CC&C solution.​ 🔎Asking the right questions will help you select a solution that meets your organization’s needs and improves patient care delivery.​ Don't miss out on these insights. Download the eBook now and elevate your clinical communication.​ 🕮 Download the eBook​: https://buff.ly/4e9dYd9​ #ClinicalCommunication #Healthtech

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