Providers and clearinghouses will populate the database by providing information about 10 key metrics:

Providers and clearinghouses will populate the database by providing information about 10 key metrics:

1. Payer name/line of business.
2. Is the payer indicating that it will map from ICD-10 to ICD-9?
3. Is the payer indicating that it will dual code in ICD-9 and ICD-10?
4. Testing type/testing date/returning information/triggering ICD-10 edits/dates of service.
5. The URL from the payer’s website where information on their ICD-10 testing (including the testing plan) can be found.
6. Does the payer allow for the scheduling of future service testing dates?
7. Will a clearinghouse need to set up a new connection for ICD-10 testing?
8. Will the payer be rejecting or denying claims for unspecified diagnosis codes? 
9. Is provider and submitter registration required? 
10. With whom will the payer be supporting testing?

“As more and more payers’ testing information goes online, this will be the most dynamic tool for providers and clearinghouses to have as they plan and execute their testing strategies,” said CE Executive Director Tim McMullen.

2nd-cecosesola-washington-cooperative-exchange

Payers begin to offer incentives for user's digital health data

Validic, Sponsored

Health plans are helping increase the value of digital health data for providers and patients

September 29, 2015

Health plans need digital health data. That is a given.

With such massive, diverse member populations, payers have realized they can no longer rely on simply averaging data from their independent information systems to affect cost and quality of care. They need a more personalized approach to help their members and have found a way to do so with provider-and patient-reported digital health data. By incorporating this data into a centralized repository, payers can analyze and use this information to create and improve their various member services. For example, in addition to supporting patient-specific care-management models, integrated data could enable the creation of wellness programs, preventive or disease-management care initiatives or even health-coaching programs. This personalized data can go beyond incentivizing and motivating healthy lifestyles; it can also help payers increase member engagement, a critical objective for many health plan providers.

Some obstacles that may have prevented payers from using digital health data in the past have recently been broken down. For example, some technology companies now offer a "one-to-many" cloud-based data-integration platform that enables providers and patients to input digital health data through disparate wearables, applications and devices. This enables payers to then access and analyze the data via a singular, integrated platform. Legislative changes have also helped break down barriers. For example, the benefits of using digital health data in healthcare are explicitly highlighted in the Affordable Care Act and in recent updates to Medicare reimbursement rules.

However, despite these advancements, health plans have realized that they also need providers and patients to buy-in for the information to be robust enough to be analyzed and used for improved patient care.

So, just as providers have been financially incentivized to use various technologies in their practice, payers now are monetarily rewarding them for integrating digital health data. For example, financial incentives, such as bonuses, preferred pricing and tiered models are common health-plan tactics to help drive providers toward incorporating digital health data into their practice. Further, payers also are offering financial rewards to providers for utilizing such technologies as high-speed networks and large data repositories, as these would enable ease of digital data collection and sharing.

Health plans can now collaborate with providers to incorporate patient information into a central source of aggregateclinical data, biometric data and other data.  Such information can be used to not only improve care and lower costs, but also to create health information exchanges, and offer further clinical analytics.

Health plans also are using financial incentives to attract their members to joining digital health data programs. The carrot approach for members includes offers of cash, gift cards, premium reductions or other merchandise for using various devices, applications or other programs to record their health data. Such financial incentives can encourage members to take ownership of their healthcare by engaging in digital health data programs.

And in return, health plans offer their members a consumer/member-friendly dashboard that contains more robustanalytics and insights into their general and specific health trends over time, predictive analysis and other programs in the hopes that they will continue to be engaged in their care -- and in using digital health data technologies.

About Validic:

Validic is the healthcare industry's leading digital health platform. Validic provides convenient and quick access to patient data from mobile health and in-home clinical devices, wearables and applications. By connecting its growing base of customers -- that includes providers, pharmaceutical companies, payers, wellness companies and health IT companies -- to the continuously expanding list of digital health technologies, Validic enables organizations to better coordinate care across their communities, improve their patient engagement strategies and more efficiently manage their patient populations.

Topics: Analytics, Clinical, Patient Engagement, Affordable Care Act, Medicare, Clinical

Technologies With Positive Growth Potential

"While the EMR market itself is pretty saturated, and usage has really improved since the HITECH Act, the challenge for hospitals and health systems is, now that you have all this data, what do you do with it?" says Matt Schuchardt, director of market intelligence solutions sales at HIMSS Analytics.

There's no shortage of technologies out there to help hospitals improve operations. But it may surprise you to realize how relatively untapped they often still are.

Bed Management

Remaining first-time buyers: 49.7 percent

Business Intelligence

Remaining first-time buyers: 40.3 percent

Data Warehouse

Remaining first-time buyers: 39.7 percent

Dictation with Speech Recognition

Remaining first-time buyers: 44.4 percent

Enterprise Master Person Index

Remaining first-time buyers: 39.6 percent

Healthcare Technology Vision 2015

That's according to a new Accenture report, Healthcare Technology Vision 2015, which lays out five key trends in the industry that show adaptation might be the best business model.

First, Accenture analysts are calling it the "platform revolution" – that is the ever-increasing ubiquity of mobile and cloud platforms that far surpass merely the ability to track in real-time a patient’s health. Rather, this is a platform that addresses interoperability, "that captures the data from disparate sources such as wearables, phones and glucometers, and pulls it all together to give a patient and caregiver a holistic and real-time view of the patient's health," they write.

[See also: Healthcare to enter 'third wave of digital'.]

The second trend, as the report emphasizes, is around the "outcome economy." In other words, "it's about delivering results." Hardware, nowadays, brings with it new intelligence. Better intelligence than ever before. And that's going to make patient data accessible with a mere click. It's going to give patients the convenience, and it’s ultimately going to lead to better outcomes, according to the report.

The third trend is around data, what's billed in the report as the "intelligent enterprise" – essentially a "data explosion" that will lead to tremendous clinical outcomes opportunities.

In fact, big data has gotten so big that some 41 percent of healthcare executives say the data volume their organization manages has increased by a whopping 50 percent just from a year ago.

Tomorrow, Accenture officials say, this trend will turn into an EMR including a "lifetime's worth of data"; it will be used regularly to predict ER visits. Consumers will be able to snap a photo of a skin rash and have a diagnosis shortly. Considering this trend, it may come as surprising that still only 28 percent of docs say they routinely use CPOE systems.

Coming it at No. 4 is the "Internet of me" trend – that is personalized medicine. And as more healthcare organizations invest in this technologies and system capabilities, they’re seeing positive results. In fact, an overwhelming 73 percent of health execs surveyed say they've seen ROI after investments in personalization technologies.

The last trend may make some feel a bit uneasy. And it's about the emergence of machines. It's the "workforce re-imagined." Think digital self-scheduling, sharing your own electronic medical record, training machines and connecting with physicians via social platforms.

According to Accenture data, 66 percent of health systems in the U.S. will have self-scheduling by the start of 2020. And nearly half of health execs strongly agree that within three years, they'll need to focus on training machines just as much as training employees. What does this mean exactly? Just think algorithms, machine learning and intelligent software.

"Patients can actually begin to care for themselves – relieve the burden of the delivery system and get a better result," says Kaveh Safavi, MD, global managing director of Accenture's healthcare business, in a video announcing the report. "That's truly workforce reimagined, because now you've made the patient part of their own care-giving team, and the technology makes it possible."

Based on your answers, an S Corp may be best.

Based on your answers, 

an S Corp may be best.

This result does not substitute for the advice of an attorney and/or accountant familiar with your unique circumstances.

Advantages of an S Corporation

• Owners (shareholders) are typically not personally responsible for business debts and liabilities.
• S corporations allow for pass-through taxation.
• S corporations may have self-employment tax savings over LLCs.
• Capital can be more easily raised through sale of stock (as long as IRS guidelines are met).

Incorporate Now as a S CorpLearn More About S Corp

More research to consider

• Benefits of Incorporation
• Understanding Incorporation Requirements
• LLC vs. S Corp: Which Makes Sense for Me?
• S Corporation vs. C Corporation: A Comparison

Related: 6 Things I Wish Somebody Had Told Me When I Started My Small Business - 5

                                                                                           5. Sustainable competitive advantage

Every solution has competitors and alternatives, or it has no market. Thus, it needs an advantage to rise above the crowd, such as a patent and trademarks, unique market positioning or support from industry partners. Too many competitors or a product with minimal differentiation makes a startup risky.                                 

Related: 6 Things I Wish Somebody Had Told Me When I Started My Small Business

1. An experienced and skilled team on board

Even the best solution won’t rise above the crowd unless it is driven by an equally outstanding team. In fact, most investors will assert that the team is more important than the solution in startup success. They look for a balanced mix of people with complementary skills, experience and determination.

4 SIGNS YOU NEED TO OUTSOURCE

     



"As reimbursement pressure 
grows and underlying costs rise,
 margin pressure will persist."

-You may be 

told by your team 

that there are

 no costs left to cut. 

"Respectfully disagree."

Here are some highlights to look for in a premium health care clearinghouse:

– Eligibility Verification – Determine patient portion before appointment
– Electronic Remittance Advice (ERA) – Automatically updates Payments & Adjustments
– Claim Status Reports – Know the status of a claim at all times
– Rejection Analysis – Have error codes explained in plain English
– Online Access – Edit and correct claims day or night online
– Printed Claims – Have claims automatically dropped to paper when necessary but still be able to track and manage them online.
– Patient Statement Services – Have your patient statements put on ‘autopilot’ at a cost less than what you can mail them out yourself.
– Real-time Support – The best clearing houses offer 1-on-1 personal support and training provided by experienced billers.
– Affordability – When you take into consideration the cost of purchasing forms, the cost of printing, envelopes, postage, and time spent; a clearinghouse ends up costing far less than processing paper claims, plus electronically you have the many added benefits.