How to do it... Information Technology1 System integration is the single most important feature of an IT system, experts say.
“CMS [the Centers for Medicare & Medicaid Services] is looking to pay-for-performance based on clinical acuity, so billing supported by accurate, compliant clinical documentation is essential,” says Crista Stark, senior vice president, sales and marketing, HealthPRO Rehabilitation.
“With the electronic health record, facilities really need to have comprehensive reporting capabilities that allow key clinical outcomes to be tied to the actual cost of care,” adds Brandi Smith, senior manager, marketing communications, PointClickCare.
Todd Bransford, senior vice president, product management, Harmony Information Systems, points out that effects can be wide-ranging. “An IT system that directly connects state and/or local agencies with providers, insurers, and more helps build stronger relationships and accelerates payment,” he says.
2 Advisors also say providers should maximize an IT system and leverage its capabilities.
“A mountain of data flows through a nursing home in any given day, so effectively managing multiple data sources allows you to make proactive, not reactive, decisions,” says Andrew Porch, founder and CEO, Team TSI.
“Analysis of things like outcomes, how well admissions are handled and readmission rates will be just as important as gathering data,” adds Doc DeVore, director of Clinical Informatics and Industry Relations for Answers on Demand.
3 Giving broad access to your IT system, and considering web-based solutions, reduces redundancy and ensures robust documentation, advises Cheryl Field, vice president for healthcare, PointRight.
Richard Mainzer, PharmD, vice president, clinical programs and technology at Remedi SeniorCare, adds, “Well-designed, user-friendly software systems will not only drive medical record documentation but also ensure the content is accurate, stable and submitted on time.”
4 Don't overlook time-saving automation features that allow you to perform tasks such as coordination of benefits, updating payor requirements and invoicing, experts advise.
“Many funding sources and fiscal intermediaries still maintain different requirements, which without the right technology, can become a compliance nightmare,” says Dan Dwyer, vice president of sales and marketing, Health Care Software, Inc. (HCS).
Joshua R. Shupp, executive vice president of SOS Corp., believes, “Your system should also have a claims management component and allow for the direct submission of invoice files to each intermediary without the need for the extra expense of a clearinghouse.”
5A great IT system is only as good as the humans behind it, of course. Communication is the key to bridging the two.
“One line of defense is maintaining a direct line of communication with one or two helpful people at the intermediary or commercial insurance company, who can alert the biller of any bumps in the road as the claim is being processed,” says Cindy Ford, product manager for NTT DATA Long-Term Care Solutions (formerly Keane).
6You should also allow room for growth, and that means having a system that's flexible enough to adapt to myriad rules and regulation changes.
Consider modular systems and services offered beyond the technology such as billing, time clock, payroll management, billing services and scheduling, advises Les Mackie, Optima Healthcare Solutions' director of communications.
“The important thing is procuring a system or software tailored to the industry you're in,” says Keith Farley, vice president, Prime Care Technologies. There are a lot of choices out there for claims processing but most have been designed for acute care.”