Health Care Reform has created complex regulatory issues that have a financial impact to healthcare organizations.  To manage these risks, healthcare organizations need a consulting partner with in-depth knowledge and experience of the healthcare industry and its regulations.  HDS combines clinical intelligence, analysis, data management, investigative skills and financial acumen to help our clients determine the best strategy for their organization.

Provider reimbursements are changing from fee-for-service to value-based reimbursements. The Medicare Access and CHIP Reauthorization Act (MACRA) ends the controversial Sustainable Growth Rate (SGR). MACRA allows a new framework for rewarding health care providers for better care instead of patient volume combining existing quality reporting programs for providers into one new system to reduce duplicate reporting. There are two paths to MACRA: Merit-based Incentive Payment System (MIPS) and Advanced Payment Models (APMs).

MACRA Education

Do you know which pathway to MACRA is the best for your providers?  Are you familiar with the new model and what your reporting requirements will be?  HDS can help your providers and teams understand what will be required beginning in January 2017.  We can help you assess the following areas to create the best strategy for you and your providers.

  • MIPS vs. APMs – Benefits and Risks to either pathway
  • MIPS – 4 Weighted Performance Category Review with detailed requirements under each category:
    • Quality
    • Resource Use
    • Clinical Practice Improvement Activities
    • Meaningful Use of Certified EHR Technology
  • Qualified vs. Unqualified APMs
  • APM Examples
  • Reimbursement Implications and Timeline
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Healthcare organizations participating in Meaningful Use are reporting Modified Stage 2 measures in 2016. Modified Stage 2 measures have relaxed with the revisions released late 2015, however preparation for Stage 3 is needed because thresholds dramatically increase on key measures such as patient portal utilization and transitions of care. Additionally, public health measures no longer have exclusions which requires many organizations to utilize clinical registries. Research and collaboration with registries to provide useful and valuable data back to organizations is a time consuming effort.

HDS has experience working with clients through more than 50 Meaningful Use attestations for Eligible Hospitals (EH) and hundreds of Meaningful Use attestations for Eligible Providers (EP).  HDS has assisted numerous clients with preparing for and responding to CMS/Figliozzo Meaningful Use desk and on-site audits. Our team of experienced strategists, project managers, analysts, and technical resources will partner with you to make your Meaningful Use journey a success.

Mock Auditing

HDS mock audit begins with a thorough review of your auditable defense. A successful audit requires documentation of the entire process from build and workflow decisions, logic for measure interpretations, screenshots, to evidence of appropriate value-set and codified language usage. GAPs in auditable defense, build, or process will be highlighted in a final report, with recommendations on how to remediate.  Our mock audit services provide:

  • Review of attestation reports and auditable defense files
  • Highlight areas of audit risk
  • Provide recommendations for more robust auditable defense positions
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Auditable Defense Preparation

A thorough auditable defense can be the difference between a positive and negative audit outcome. During an Auditable Defense Preparation engagement, areas of audit risk will be identified along with recommendations for decreasing those risks. Our Auditable Defense Preparation service includes review auditable defense files and reports for potential gaps, recommendation for any incomplete or missing data and final report that will normally be 80-100+ page pdf document that clearly articulates interpretative decisions, supportive documentation, policies, and workflows.  Our Auditable Defense Preparation service includes:

  • Review auditable defense files and reports for potential gaps
  • Make recommendations for any incomplete or missing data
  • Organize auditable defense by measure and convert to a single PDF document with table of contents

Meaningful Optimization

MU measures need to be more than a checkbox of tasks to complete; MU needs to be seen as an opportunity to evaluate processes, workflows, business partner outcomes, customer service levels, and more. This “bigger picture” approach allows for cost reduction, improved care and patient outcomes, and higher patient satisfaction scores.  The HDS Meaningful Optimization service include:

  • Patient centric Clinical Optimization process
  • Incorporating Meaningful Use measures
  • Customized to the culture and specific needs of our clients while maximizing incentive payments and/or eliminating reimbursement penalties
  • Experienced strategists to assess workflow and engage in workflow redesign
  • Monitor thresholds and investigate high-risk measures for technical or workflow inconsistencies
  • Patient outreach and patient engagement
  • Direct HISP and HIE strategies
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