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Surprise Billing in Healthcare: The No Surprises Act Takes a Stand for Patients

Mikki Fazzio, RHIT, CCS

Content Integrity Consultant, Principal

Most providers aim to protect patients from unexpected and unmanageable medical bills. But on January 1, 2022, this responsibility becomes law under the No Surprises Act. The upcoming legislation targets surprise medical bills, which occur when a patient unknowingly receives care from out-of-network providers and is subject to higher charges than for in-network care. These unexpected bills degrade the patient experience and decrease the likelihood of payment for care. Surprise bills may also be more common than many consumers and providers realize—according to the Centers for Medicare and Medicaid Services, in 2016, 42.8 percent of emergency room bills resulted in out-of-network charges. With greater price transparency, the No Surprises Act seeks to protect patients but also impacts providers and facilities, ambulance services, and more, who must comply to receive timely payment and avoid penalties.

Find the Right Term for Your Goals: How to Choose Healthcare Terminology Standards

Cessily Johnson

Vice President of Terminology & Master Data Management

With an overwhelming number of healthcare terminology standards, how do industry professionals determine which ones they need to know? Terminology users can start by matching their purpose with the correct standard. Because different healthcare terminology standards fulfill distinct purposes, matching purpose to standard generally leads users to the right term for their goals. Terminology users can match their purpose with the correct standard by first identifying the standard’s purpose. Purposes encompass billing, clinical, laboratory, and pharmacy terminology standards:1. Healthcare billing terminology.2. Clinical terminology.3. Clinical and laboratory terminology.4. Pharmacy terminology.

Three Reasons Augmented Intelligence Is the Future of AI in Healthcare

Health systems increasingly turn to AI to help all team members make more informed decisions in a shorter time frame. Instead of an artificial-intelligence approach that threatens the critical role healthcare experts play in decision making, organizations should define AI as augmented intelligence. In his first podcast, Dr. Jason Jones, our Chief Analytics and Data Science Officer, explains how augmented intelligence can help health systems accelerate progress toward achieving the Quadruple Aim. The three unique opportunities augmented intelligence offers health systems include the following:1. Augmented—not artificial—intelligence.2. Think “change management.”3. Address and overcome healthcare disparities.

Advancing Health Equity: A Data-Driven Approach Closes the Gap Between Intent and Action

Jason Jones, PhD

Chief Analytics and Data Science Officer

Trudy Sullivan, MBA

Chief Communications and Diversity, Equity, & Inclusion Officer

Improving health equity is gaining traction as a healthcare delivery imperative. Yet, while equity is indivisible from healthcare quality, many initiatives targeting disparities fall short. Organizations too often rely solely on leader and stakeholder passion and perseverance without sufficiently leveraging data and analytics to understand, measure, and support equity improvement efforts. It’s time for the industry to pursue equitable care with the same resources it uses in other key dimensions, such as safety and efficacy—by leveraging data. A data-driven approach to equity opens health system’s most advanced predictive resources to equity efforts, thereby driving massive, measurable, data-informed improvement that benefits all.

Three Ways AI Can Earn Clinicians’ Trust

Ed Corbett, MD

Medical Officer

Over the last decade, many health systems have found that augmented intelligence (AI) technologies have overpromised and underdelivered. The promises of AI in clinical care were grand—to ease physicians’ burdens and deliver the most relevant information at the point of decision making. However, more technology has increased the demand on providers along with clinicians’ doubt of AI’s capabilities.Organizations can still deliver valuable AI-derived patient insight to providers at the front lines of care by taking a collaborative approach to AI that enlists clinicians in three key areas:1. Development.2. Implementation.3. Results.

HAS 21 Virtual Reaches Its Final Destination: Day Three of a Whirlwind Multi-Domain Analytics Journey

After virtual stops in Singapore and London, HAS 21 Virtual attendees might have thought day three couldn’t top the previous two. However, global analytics travelers were wowed when Paul Horstmeier welcomed them to the Grand Dubai Hotel. Not to be outdone by its extravagant surroundings, the final day’s agenda again exceeded expectations with the likes of Amy Compton-Phillips, MD, who oversaw the care of the first known COVID-19 patient in the U.S., a robust set of breakout topics, and a special healthcare analytics edition of Jeopardy. Day three also included the much-anticipated announcement of #SockofHAS winners, results of the HAS points competition, the esteemed Flywheel Award recipient, and more. Event organizers and fans are already excited to gather again September 13-15, 2022—in person!

HAS 21 Virtual Day 2 Tackles Health Equity, Redefines Value, and Presents 30+ Data-Fueled Projects

Day two of the Healthcare Analytics Summit™ Virtual again opened with a warm welcome from “Captain” Paul Horstmeier and his flight crew. Keynote speaker Patrice Harris, MD, MA, FAPA, former President of the American Medical Association, then took the stage to discuss common health equity challenges and solutions. Chris Chen, MD, CEO of ChenMed, followed to share how his organization has redefined value by using a fully capitated economic model. After a quick break, attendees chose between industry outlook sessions focused on health equity and population health. By lunchtime, participants were ready to explore over 30 data-centric projects at the Analytics and AI Showcases and learn about new Health Catalyst products. Attendees wrapped up an action-packed day two with Braindates, one-on-one or group networking sessions to learn more about trending topics of their choice.

Wheels Up on Healthcare Analytics Summit 2021 Virtual! Day One Recap

A fireside chat with NBA great Steve Kerr, a virtual journey to a premier international destination, a glimpse at robots changing the world, and an investigation into the parallels between motocross and healthcare analytics are just some of the experiences offered during day one of the Healthcare Analytics Summit™ (HAS) 21 Virtual. From a digital platform for the second consecutive year, HAS 21 Virtual kicked off three days of extraordinary education, inspiration, and entertainment on September 21. With experts from healthcare and beyond, attendees explored the digital trends and best practice experiences driving healthcare success in the new digital era. Additionally, two waves of breakouts offered insights into increasing revenue, decreasing cost, improving quality, and more.

Deliver a First-Class Patient Experience with Five Financial Tactics

Marlowe Dazley

Senior Vice President and Managing Director of Financial Advisory Services

Healthcare organizations continually strive to improve each patient’s experience to ensure quality care delivery and qualify for financial reimbursements. Health systems try to optimize the patient experience through traditional methods, including better access and appointment reminders. However, organizations can improve the patient journey and deliver a first-class experience by taking a different approach—by targeting the following five aspects of the billings and collections process, providers can proactively inform patients about their financial expectations and avoid surprise bills:1. Pricing strategy.2. Charge description master management.3. Real-time eligibility verification.4. Patient cost estimation.5. Propensity to pay.

World Patient Safety Day 2021 Focuses on Safer Childbirth

Heather Schoonover

MN, ARNP-CNS, PHCNS-BC, FCNS, Clinical Ops Value Architect, Vice President

Around the world and within the United States, pregnancy and childbirth still carry grave, often avoidable risks for mothers and newborns. According to the World Health Organization (WHO), 810 women die worldwide daily from preventable causes related to pregnancy and childbirth. In the U.S., approximately 6,700 newborns die each day, comprising 47 percent of all deaths under the age of five, and two million babies are stillborn each year, with 40 percent occurring during labor.For World Health Day 2021 (September 17), the WHO is calling for action around “safe and respectful childbirth.” Individual health systems can contribute to childbirth safety improvement by leveraging their data and analytics to better understand risks to mothers and newborns within their populations and identify ways to avoid preventable harm.

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