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Vital Decision: How to select the right RPM vendor partner for your healthcare organization?

By MD Revolution

We’ve learned a lot since December 1, 2020, when the Centers for Medicare and Medicaid Services (CMS) finalized new policies for Remote Patient Monitoring — what not to do at the practice level when beginning an RPM program, what realistic revenue expectations should be and why, and how the breadth and depth of “integration” can vary dramatically amongst vendors and EHR’s alike.

Our industrywide predictions that RPM would rapidly overshadow the CMS counterpart Chronic Care Management (CCM) proved largely false, and now we see that RPM and CCM go hand in hand – comprehensive remote patient care requires people and technology.

As we continue to adapt to our new “normal” and practices look to remote care management solutions to keep up with demand, how do you find a solution that is the right fit for your organization? We’ve compiled the questions you need to ask when deciding on an RPM vendor to ensure your program is effective and sustainable.

Questions you need to ask

Do you offer Chronic Care Management and Remote Patient Monitoring, or solely RPM?

Medicare’s remote patient monitoring and chronic care management are better together – that’s what we do best! With a robust, comprehensive platform and clinical support at our core, MD Revolution offers these programs and more to address critical gaps in care, optimizing access for your patients while allowing practices to capitalize on expanding Medicare reimbursement.

  • Chronic Care Management (CCM)
  • Specialized Behavioral Health Integration (BHI) programs
  • Annual Wellness Visits for increased patient engagement
  • Transitional Care Management (TCM) solutions proven to decrease hospital readmission rates

Do you offer comprehensive integration with athenaOne and athenaPractice, or will I need to login to a third-party platform? What does your integration entail?

Not all integrations are created equal. Logging into another platform can be cumbersome and impedes real-time decision-making based on real-time data. At MD Revolution, our two-way integrations mean everything is at your fingertips within athenaOne or athenaPractice, from enrollment to tasking, to vitals, documentation, and automatic claims creation.

Who will enroll and market the remote care program to my Medicare patients?

We do! We know from experience that implementing a successful remote care program is contingent on educating and enrolling patients, efficiently and effectively. Our team leverages built-in athena workflows to enroll qualified Medicare patients for the practice, prompted by enrollment flags and trigger ordering by service. Practices can see enrollment status in real-time in the existing clinical workflow, and patients receive integrated vitals monitoring equipment to their home within 5 days.

Who will perform the work to monitor my patients’ data real-time?

We offer nationwide, multilingual RNs and MAs as an extension of your practice, providing first-line clinical monitoring of all vital sign data 24/7/365 AND fulfilling 20 minutes of chronic care management services for each dually-enrolled patient every month. Practice escalation protocols are in place for biometric data exceeding a critical threshold, and our nurses will alert your practice of patients needing attention.

How and where are devices stored, provisioned, and shipped to my patients?

We manage all device storage, fulfillment, shipping, and returns, beginning with seamless trigger ordering by service, directly within athenaOne and athenaPractice. Providers will never need to store or distribute devices to patients. Before the patient receives their RevUp care Hub and one or more prescribed devices, our engagement efforts ensue to guide your patients every step of the way, from SMS messaging to two-way interactions on the RevUp application to telephonic coaching from our dedicated health coaches.

What kind of devices are available, and will my patients have to setup devices themselves?

We believe in offering the easiest experience to providers and your patients. We have found that the most reliable devices are those with built-in cellular chips that avoid the complexity of Bluetooth and instead send data wirelessly to our platform without any patient interaction. Our cellular-connected home hub device provides configuration-free device connection, on-demand support, and 24/7 emergency response. We offer a wide range of ancillary cellular devices, such as connected blood pressure monitors, weight scales, blood glucose meters, spirometers, and pulse oximeters, requiring no Wi-Fi connection, Bluetooth pairing, or setup.

Have existing wearable devices?
Our RevUp application has the ability to connect with these, too. We’ll work with your practice to determine the best device connections for your unique program, designed for long-term compliance with remote care.

Do you automatically generate claims in athenaOne or athenaPractice each month?

One of the most robust features of our RevUp platform is accurate, automatic claims creation directly within athenaOne or athenaPractice, eliminating the manual process for each patient, each code, each month. We handle the often-complicated nuances of monthly and time-stamped data transmission code adherence, so you can focus on patient care.

How much revenue can my practice expect?

Many vendors offer revenue calculators with unrealistic assumptions of profits. We pride ourselves in setting straightforward, attainable goals for each of our partnerships, customized for your practice’s Medicare population. Contact us today for a picture of sustained program success and a tailored practice pro forma.

About MD Revolution + Quatris Healthco

Quatris Healthco partners with MD Revolution to provide athenaOne and athenaPractice customers with scalable, high touch Care Management services that enrich the patient-provider experience and reduce the cost of care. Our partnership ensures the deployment process is cost-effective and quick to implement, with a clear path to ROI and patient satisfaction. Deep integration with athenaOne and athenaPractice allows your practice to benefit from fee-for-service payment models today while preparing for value-based care. 

For more information on Quatris Healthco Care Management Services, visit https://www.quatrishealthco.com/chronic-care-management-services/ or email qhco@qhco.com.

HIPAA in 2022

(shared from Medcurity) Looking back at past HIPAA breach trends can give us a more accurate view of where HIPAA is going in the future. Is HIPAA compliance going to be more or less important as we go into 2022? The data shows that preventing a HIPAA breach may be a more crucial focus area this year than ever before.

The average cost of a HIPAA breach in 2021 was $9.23 million, up from the $7.13 million average in 2020, which was up 10% from the year before. The number of major breaches also increased over the year, with 713 major breaches posted so far for 2021, compared to 663 in 2020. 45.7 million individuals were affected by these breaches in 2021, the highest number since the record-breaking Anthem hacking incident in 2015.

Too many organizations went into 2021 with the belief that one of these huge data breaches “could never happen to them.” That’s why we want to make sure we share these alarming statistics, to raise awareness to the fact that the number of incidents is increasing and the financial and reputational costs of a breach have never been higher.

Medical device security risks proved to be a major threat to healthcare security in 2021, but cyberattacks were the number one cause of compromised health information. Many of these cyberattacks used ransomware, now viewed by the DOJ and most security professionals as a threat equal to terrorism. Despite this, we’ve seen communication between healthcare provider executives and cybersecurity experts increase, pointing towards greater provider focus on preventing these threats.

In a landscape that is still affected by ongoing COVID-19 changes, healthcare providers will face many of the same risks in 2022. Once again, cybersecurity is going to have to be a focus area for all organizations, regardless of size.

It’s important for you as a healthcare provider to be aware of the increasing danger of data breaches. Because of trends like the ones above, complying with HIPAA is now about much more than meeting requirements. Activities such as conducting security risk analyses and risk management/business continuity planning are huge steps toward protecting your organization from the time, reputation, and financial costs of a breach.

In the area of compliance, we may be seeing some big changes soon. A proposed change to the HIPAA Privacy Rule may give patients the ability to request that their health records be sent electronically from their provider to any other third party. If passed, this change may increase security risk to data being moved, while expanding the potential of clinical health studies. The proposed change may also remove the requirement for providers to receive written acknowledgement from patients upon receipt of their Notice of Privacy Practices.

Your patients are relying on you to keep their protected health information safe this year. We want to ensure you are fully equipped to protect sensitive data in 2022, while providing the best patient care. Let us know if you have any questions about how the Medcurity platform can help you bring clarity to HIPAA compliance.

Early Actions of 2022: CMS, HRSA Continue to Drive Support of FQHC/RHC’s and Remote Care Management

(shared from MD Revolution) Government payers continue to invest in programs that improve equitable access to health care for the medically underserved, geographically isolated, and economically vulnerable.

With the highest slated Chronic Care Management (CCM) reimbursement rate of 2022 committed to FQHC’s and RHC’s, and recent news that HRSA Slots $13M to Expand Rural Behavioral Healthcare Access, government payers continue to assert their support of expanding access to care through remote care delivery.

FQHC/RHC’s are not like other providers, by way of pay structure and patient populations with a high concentration of Medicare and Medicaid patients. Through Care Management programs, FQHC/RHC’s have a unique opportunity to provide significantly higher continuity of care. CMS has enabled FQHC/RHC’s to offer CCM on a much larger scale, saving money, expanding care, and delivering quality.

Backed by knowledge and significant experience, RevUp is a customizable solution for any FQHC/RHC with any budget, specializing in HRSA grants for Remote Patient Monitoring. RPM is an effective way to ensure populations with chronic conditions receive the continual care they require–whether they’re at home or in the clinic. By offering Chronic Care Management and Remote Patient Monitoring together, all integrated within your EHR, RevUp provides Federally Qualified Health Centers and Rural Health Centers with an opportunity to maximize grant dollars for RPM and now, behavioral health services, and fuel revenue through significantly increased Care Management code G0511.

What does this mean for your FQHC or RHC?

Medical practices have been continuously faced with higher cost of delivery and lower reimbursement in Fee for Service. Coupled with the unique challenges faced by FQHC/RHC’s, such as revenue diversification, accessibility to rural and low-income communities and increased competition from new sources (Federally Qualified Health Centers Troubled by Rising Competition), FQHC/RHC administrators face exceptional challenges maintaining their long-term financial viability. Care Management programs like CCM, RPM and AWV have emerged as an excellent opportunity to capture time spent and higher reimbursement with an often underserved, existing patient base. 

CMS is incentivizing providers to expand their reach to patients with chronic conditions, economic vulnerabilities and geographical challenges, and rewarding providers furnishing care coordination and virtual care. FQHC’s and RHC’s offering both RPM and CCM services have a unique opportunity to diversify revenue streams, mitigate risk, and provide a complete care management program to their chronically ill patient population.

“Medicare has validated what we have known all along; care management works,” said Paul Huffman, VP of Sales and Business Development at MD Revolution.  “As we move forward in 2022 we are excited to expand our services, help more patients, and get connected devices into homes.”

Chronic care management is currently a valuable, revenue-generating service. The actions CMS has taken and continued HRSA grant distribution in 2022 will only further enhance this value. 

To learn more about expanded 2022 CMS Care Management reimbursement, download the guide.  

Farewell 2021, Hello 2022

Don’t let the year-end and new year tasks and responsibilities become overwhelming. Proper planning, execution, and education are essential when closing out the year and preparing for the upcoming year. Use this checklist to help set your practice up for long-term success.

Fee and Allowable Fee Schedules

  • Review and update fee schedules and allowables for January 1, 2022.
  • Review documentation for E&M Coding changes in 2022.

    Tip: Contact payers (at least your top five payers) and request your 2022 allowable schedule.

Schedule Review and Management

  • Review and update your appointment schedule template to reflect 2022 working hours of your providers.
  • Consider alterations to schedules to proactively adapt to changing healthcare landscape (i.e., telehealth visits, sick/well visits, in-office testing, hospital procedures).

Fully Work Receivables, Collections, and Overpaid Claims

  • Identify and resolve any outstanding Accounts Receivable issues and start 2022 with up-to-date Accounts Receivable.
  • Review overpaid claims and issue credits as appropriate.
  • Review and verify collection agency information.
  • Identify the office policy/procedure for working delinquent patient accounts (especially if you’re not working with a collection agency).
  • Review bad debt, collections policies, and update.

Self-pay

  • Consider adjusting self-pay balances of a certain age to bad debt or send the balances to your Collection Agency (per your office policy).
  • Consider new office policies for no shows, cancelations, etc. and communication via statements or other methods.

Deductibles

  • Remind staff of high January deductibles.
  • Be sure you are collecting as much money as possible at the time of service.

Patient (paper) forms and questionnaires

  • Review and update patient forms and questionnaires to ensure none of the hard-copy forms include the year 2021.

Quality Management

  • Satisfy all Quality submission tasks for 2021.
  • Review CMS’ announcement of Extreme and Uncontrollable policy (EUC) and determine if it is applicable to your practice.

Plan Your Hard Close Date

  • Ensure you have a plan to “hard close” your month/year. This process locks financial transactions so that they cannot be changed without creating an audit trail and ensures the financial integrity of your system and the accuracy of your reports. 

    Tip: Best practice recommendation is to close at least once per month. Keeping your “hard closings” current will protect your financials!

Software and Security  

  • Keep your software and security measures up to date. This is critical to protect your data from ransomware, malware, and other malicious attacks.
  • Collaborate with your vendor to plan your next upgrade.
  • The end of the year is a good time to do an audit of the “users” in your system. If an employee is no longer there, speak to your vendor and inactivate them.

Other

  • Revisit the goals your practice set for last year. Adjust accordingly to see how your practice is tracking and schedule monthly or quarterly reviews.
  • Evaluate other product and service solutions that may improve efficiencies throughout the practice.

Patient Payment Options that Drive Revenue to Your Practice

Whether it’s a grocery cart full of food, an oil change at the car dealer, or a burger at a restaurant, you made a purchase and are expected to pay for the goods and services. It seems logical, right?

Now think about what happens when you need to see a doctor, get a diagnostic test, or even be admitted to the hospital. You will likely pay a co-pay, and there will be a patient due balance even after the co-pay and the insurance payment is posted. Sending electronic (and paper) statements has been the historical way to collect the money owed, but there are other payment options available today that should be considered regardless of practice size and specialty. Unfortunately, healthcare has been lenient when it comes to collecting patient-owed balances, and most will agree that it is time to change this long-overdue mentality.

Healthcare entities must be willing to adopt new technologies and implement financial best practice strategies. After all, it’s your money, and you need to collect what is owed to you. When it comes to collecting patient-owed balances, determine if your vendor offers one or more contactless payment options. Offering contactless payment options will surely prompt patients (consumers) to pay faster and will likely help reduce confusion.

In today’s digital world, people spend hours a day on their phones. It makes sense to provide them with options to pay their medical bills. Convenience is key.

Below are several patient payment trends to consider implementing in your practice:

Auto Pay – Authorize the patient’s credit card upfront and automatically charge the card after insurance has cleared. Not only is this convenient for patients, but it will also save staff time and reduce statement expenses.

Guest Pay
– There is no registration required. The patient statement would include a unique code that makes it easy for patients to pay online and avoid over/underpayments. This can make it easier for patients to quickly access their balance and pay their bills without having to set up a username and password.

Payment Plans – Staff and patients can set up automated payment plans to increase office efficiency. Automated payment plans make it easier for practices to collect money and allow patients to handle large statement balances without the uncomfortable feeling of calling. Set the rules and allow patients to set up a payment plan from the privacy of their home or facilitate it discreetly at your practice.

Text to Pay – Makes it convenient for patients to pay their balance. With over 98% of texts being read within 90 seconds, Text to Pay can speed up the collection process and reduce days in A/R.

Conclusion
Minimize the challenges around collecting patient balances. Look for options that make sense for your patient population and proactively market the convenience to your patients.

Prevent HIPAA Violations and Avoid Hefty Fines.

(shared from Medcurity)

Did you know that the HHS Office for Civil Rights (OCR) can fine an organization up to $1.5 million for breaking a HIPAA regulation? A fine from the OCR isn’t even the only cost associated with a HIPAA breach. Here are 5 key steps you can take to prevent common HIPAA violations and avoid penalties.

1. Properly store your Protected Health Information

It’s very important to guard all your documents containing Protected Health Information (PHI), whether it be physical or digital.

You should keep electronic protected health information (ePHI) password protected and encrypted. Encryption isn’t specifically required , but under the security rule organizations are obligated to “Ensure the confidentiality, integrity, and availability of all e-PHI they create, receive, maintain or transmit.” Industry best practices dictate that ePHI should be encrypted when possible. Encrypting your files can save you from a HIPAA breach in case of theft or a hack.

Ensure that all PHI is only being accessed by personnel when necessary for treatment or payment. If you have PHI in a hard copy document, it needs to be securely locked away in a cabinet, desk, or office. Don’t risk getting fined for simply throwing away a document instead of following proper HIPAA compliant shredding procedures.

Ensure that necessary data is backed up, and test backups regularly. Remember, under HIPAA you are required to maintain Designated Record Sets (which include medical records and billing information) for 6 years. State regulations sometimes require that covered entities retain medical records for a longer period.

 2. Stay on top of your BAAs

HIPAA Business Associate Agreements are required under HIPAA anytime a covered entity grants an outside party access to PHI in the course of their work. The BAA will specify how your vendor will use PHI and what steps they will take to comply with the HIPAA Security and Privacy Rules.

A BAA helps ensure that the OCR won’t hold you responsible should your business associate have a data breach that involves your PHI. Review your BAAs annually or biannually to ensure the agreement remains appropriate.

3. Conduct a comprehensive HIPAA SRA each year

The HIPAA Security Rule requires that both covered entities and business associates regularly conduct a Security Risk Analysis (SRA). The SRA assesses the physical, administrative, and technical safeguards you have in place to protect your ePHI. It’s an important opportunity to uncover any vulnerabilities in information security plan and make any necessary remediations. It also allows you to document all of the good compliance work you’re already doing.

The OCR had repeatedly emphasized the importance of the SRA. If you experience a breach and do not have a current and comprehensive security risk analysis, the OCR is likely to view this as negligence. You are more likely to incur a high penalty as a result.

If you need assistance with your SRA, Medcurity is here to help. Use our intuitive HIPAA platform, or have our HIPAA compliance experts come to you.

4. Create a strong policy program

Strong HIPAA Privacy and Security Policies and Procedures are fundamental to HIPAA compliance. You need thoughtful policies to outline how your organization will handle everything from disciplinary action to social media.

These policies act not only as guidance but also documentation, which is important. It’s critical to be able to demonstrate compliance in the case of an OCR audit.

 5. Train your employees

Most HIPAA violations begin with human error. Educating your personnel to understand their role in HIPAA compliance is key.

HIPAA employee training should take place during initial on-boarding and then recur annually. Employees should attest that they have reviewed your organization’s policies and procedures. Healthcare continues to be a top target for cybercrime, and 90% of data breaches begin with human error, so make sure your HIPAA training includes cybersecurity education as well.

Proactively complying with these requirements are important steps to protect your patient’s sensitive information. It also protects your organization from HIPAA fines and other financial consequences that can follow noncompliance. Even if your organization does experience a breach, the OCR will consider if you have taken appropriate privacy and security measures.

If you have more questions about HIPAA or information security, check out this resources page.