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February surprised everyone with its warm weather and rebound from the harsh winter months. Leading up to the March HIMSS conference has also shocked many in Health IT who are seeing major advances in phasing out back-end Coding, CDI and Quality solutions to real-time front-end EHR integrated tools.
These changes are important for physician and nurse satisfaction, health system revenues and most importantly for patient safety. Enjoy this month's newsletter and we hope to see you at HIMSS next week!

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Rising Medical Necessity Denials
Revenue leakage due to medical necessity denials is a major concern for health systems today. The rate of denials is increasing and the success rate for denial appeals is going down, 20% in the past two years. This is money left on the table, according to a study by the Advisory Board there has been a 90% increase of uncollected write offs due to denials in the last 6 years.

Typically the hospital’s approach to this problem is increasing staff resources and acquiring software to manage the ever increasing volume of denials. What is overlooked is the root cause of all the denials. It all starts at the front-end of the clinical care process requiring the physician to provide complete and accurate medical documentation. Without the physician’s support revenue leakage because of medical necessity denials will never be resolved. So what’s the answer, can this be fixed? At Hiteks we have listened to our customers and we have a 3-pronged approach:

1. Identify high volume, high cost procedures which often lack the H&P documentation required for compliance with Payers and create a check-list to ensure these sections are completed
2. Acquire or create note templates compatible with dictation and the EHR which can remind doctors of the necessary content options
3. Implement real-time CAPD (computer assisted physician documentation) suggestions at the point of care in the EHR for real-time CDI

Contrary to the suggestion of many vendors who are looking to be paid for their services, the answer is not through retrospective review of what’s happened in the past with a suggestion to what to do in the future. The answer lies in prospective documentation improvement which can only be achieved in the 3-pronged approach by providing the physicians with tools like real-time prompts at the point of care optimizing the documentation and DRG/HCC coding. Not only are our Hiteks CAPD queries and suggestions real-time within the EHR (e.g. AdvocateMD Powering NoteReader, ConcurDI Powering NoteReader CDI and VigilantQA Sepsis Surveillance), but we also do not require a separate user interface or tool which simplifies working with Hiteks. Our only tools are those to help configure our system which prevents software code changes since Hiteks has the most advanced and configurable NLP and A.I. system integrated with the Epic EHR.

Only Hiteks can deliver this level of performance with its Insight: Real-Time Revenue Rescue suite for proven results. More revenue is collected because of a boost in Case Mix Index (CMI) inpatient (.11 - .14 improvement) and Risk Adjustment Factor (RAF) Outpatient (24% increased). A side benefit is happy Physicians, CIOs, HIM Directors and CFOs because queries are reduced by 50%, and time in the EHR is reduced by 50%. CIOs look good because they empower the vendor’s technology, CFOs can see the numbers rising, while the users feel good because they can perform their work more efficiently with fewer headaches. Hiteks has the only Epic App Orchard approved CAPD products, see for yourself if you are an Epic client: www.apporchard.epic.com
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5 Steps to Using Epic for all your CDI & Quality Workflows
Hiteks has developed a 5-step strategy which allows Epic clients to transition from legacy CDI systems and focus their time at point-ofcare CDI with the industry's most advanced NLP and A.I. engine. Here are the 5-steps and associated Hiteks' products which support them: ...   READ COMPLETE
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Why Can Better Clinical Data Help Physicians Negotiate their Contracts with their Parent Health Systems and Payers?
Since reimbursement is now driven by severity of illness of a patient population, and a medical practice's experience with that patient population, having good data is a must. Until recently, time-consuming and back-end patient documentation systems have forced physicians to rush through the point of care without thoroughly recording their notes with the right levels of complexity.

Now that most physicians are either employed by hospitals, or affiliated with them through contractual obligations, it is even more important for physicians to justify the complexity of their patient population. Relying on administrative departments like HIM or CDI to help with this is time-consuming with low compliance rates by physicians, and ultimately returns back the responsibility to the documenting physician. Documenting complexity is straightforward with the right tools, allowing the addition of ICD-10 specificity during the documentation process. This can only be accomplished through Hiteks' innovation of real-time feedback to doctors as they write their notes, integrated with the EHR. Hiteks' Epic-integrated Insight solutions can accomplish this in as little as 3-months, with an immediate financial ROI of higher revenues from more accurate claims of up to 24% RAF score improvement in ambulatory settings and .14 CMI in inpatient: AdvocateMD Powering NoteReader and ConcurDI Powering NoteReader CDI.

All payer reimbursement models now focus on the resource utilization and predicted expenditures of a patient population, in addition to tracking inpatient readmissions. These models are so accurate that they can take last year's claims codes for a population whose lives they are covering in the health plan, and predict 90% of what the costs will be, including how much for physician services. The recent implementation of an expanded ICD-10 coding system has further helped to bring better data into higher importance.

Moreover, a trend of hospitals employing physicians is shifting the risk to large group purchasers. For these reasons, clinical documentation improvement (CDI) and point-of-care complexity requires high compliance with reimbursement requirements and efficiency as the core to revenue cycle improvement. Being able to track readmission risk (i.e. LACE plus scores and Medicare Value Based Purchasing) and ensure the appropriate patient complexity is considered by the scoring can allow physicians using Hiteks to have an informational advantage compared to others.

Hiteks Solutions Inc., a medical informatics software company specializing in Computer Assisted Physician Documentation (CAPD) and Quality Care optimization, has released a software solutions suite as part of the Insight: Real-Time Revenue RescueTM platform that is quickly filling this void in our healthcare system’s documentation for physicians. Hiteks immediately provides value by optimizing the data, providing the Health Enterprise Revenue Cycle with streamlined workflow to reduce physician queries and immediately produce accurate claims codes which can justify a higher revenue and payment to physicians in their contracts to a health system since the payer models will ultimately reimburse those physician services at higher levels.

Noteworthy Features Of Hiteks’ CAPD Solutions
Easy For Physicians To Use

With the exhaustingly complex documentation system that physicians are legally bound to follow, finding a user-friendly interface for physicians without sacrificing thoroughness and accuracy has become crucial. Other CDI solutions only focus on the CDI Specialist as the primary user and place lesser emphasis on the user experience for physicians. Hiteks however, has the most intuitive physician-centric CAPD solutions available since we have been supporting them since 2011.

Both AdvocateMD Powering NoteReader and ConcurDI Powering NoteReader CDI in Epic are specifically optimized to help physicians focus on key areas within the note that they are writing in real time. They prompt physicians through any evidence of inconsistent documentation, discrepancies in coding rules and gaps in medical necessity. All who use Hiteks quickly become educated on the latest documentation requirements with only a very brief amount of time spent learning the software’s functions.

Insightful and Constructive Feedback
The software’s feedback function collaborates with its users in real-time (the only NLP and A.I. vendor able to do so) by suggesting more thorough specificity with regards to history & physical sections, possible diagnoses not mentioned by the provider but important to consider, and procedure consistency with what was actually performed. All of this occurs as the physician dictates or types the information into the EHR at the point of care.

Lightning Fast Processing
Among the more remarkable aspects of Hiteks’ solutions is their sub-second response time per note. Most other companies’ solutions require 10-60 seconds for processing. Waiting ten seconds every time a physician wishes to consult his or her device for information or guidance ultimately defeats the purpose of utilizing a fast-acting software solution. But with Hiteks’ AdvocateMD and ConcurDI, which employs multi-tenant architecture that enables multiple users to simultaneously leverage the scalability of the platform, wait-time is virtually non-existent.

Hiteks’ ConcurDI Powering NoteReader CDI in Epic's 2017 and later versions, is the second CAPD solution for hospitals and medical offices throughout the country, joining AdvocateMD Powering NoteReader. Hiteks' InsightTM tools have been powering EHRs and Epic since 2014. To learn more about ConcurDI, or any of Hiteks’ other solutions in their Insight: Real-Time Revenue Rescue™ suite, please contact us online via info@hiteks.com, or by phone by calling 212-920-0929. We’d also like to encourage you to schedule an informative demonstration of our product suite. Finally, customers who sign up before the end of this quarter may be eligible for as much as 25% off their first year’s service or longer depending on the length of their contract. We provide a 100% Customer Satisfaction Guarantee in our services, or your money back!
 
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