IntelliSoft Group Blog

It’s undeniable that Federally Qualified Health Centers are feeling the heat of the new Accountable Care Organization network that’s expected to launch in January; funding for these healthcare organizations is tight already, and the ACO threatens to cut finances even more. As a result, many FQHC’s have not implemented EHRs, which forces MSPs to complete the credentialing process on paper. Clearly, this takes a lot more time and isn’t fun for anyone involved.

However, there may be a light at the end of the tunnel for Federally Qualified Health Centers.

It’s a mouthful; the new “Federally Qualified Health Center Advanced Primary Care Practice” demonstration project through the Affordable Care Act is an initiative that will test the efficiency of doctors and health professionals within FQHCs.

Similarly to the Accountable Care Organization, practitioners are expected to work as a team and coordinate care for Medicare patients; as a result, FQHC’s will “improve care and lower costs” (cms.gov).

But here’s the best part. The initiative is going to pay approximately $42 million over three years to 500 Federally Qualified Health Centers. These organizations will be paid for every beneficiary receiving primary care services, and the initiative is expected to affect nearly 200,000 Medicare patients. Crazy, huh?

But before you get up and do a victory dance around the office, there’s a catch; “Participating FQHCs must implement electronic health records, help patients manage chronic conditions… adopt care coordination practices that are recognized by the National Committee for Quality Assurance (NCQA),” and meet a list of eligibility requirements (cms.gov).

Sure, this might seem intimidating. But if you need to make the switch from “paper” to “electronic,” IntelliSoft’s IntelliCred software is a great place to start. Not only does IntelliCred automate the tedious task of credentialing verification, but it manages a practitioner’s criteria-based core privileges, allowing you to view and evaluate the performance of practitioners. If you’re looking to improve the quality of care within your organization, then let us help you!

For more information about IntelliCred, please call us at 855-ISG-LIVE or visit our website at http://www.intellisoftgroup.com/products/intellicred/

By John Eddy

Think back to some of your most important accomplishments. Then answer this- Were they easy to achieve?

As you already know, the best things in life aren’t free. But despite the effort and strain that goes into making them happen, the outcome is well worth it.

Now, apply this concept to the workplace. Verifying a practitioner’s credentials can be tiring, time consuming, and just plain frustrating. An MSP is expected to follow each step in the application process, in addition to meeting Joint Commission, NCQA and URAC standards. Furthermore, violating any of these standards, or OPPE-FPPE tracking, can put a healthcare organization in a very risky position.

But think about it- by taking those extra precautions in the credentialing process, you’re ensuring the safety and well-being of countless individuals. All of that hard work pays off in the end.

Hospitals are striving to provide quality care for their patients, and with electronic health record system implementations on the rise, professionals are pushing for the Joint Commission’s 2011 National Patient Safety Goals to be included in the EHR certification process. Ryan P. Radecki and Dean D. Sittig, two contributors to the Journal of the American Medical Association, outline six national patient safety goals that EHR systems can help achieve: improved patient identification, improved staff communication, safe use of medications, infection prevention, medication reconciliation, and suicide risk. But credentialing lies at the foundation of this change to improve the quality of care in healthcare organizations.

IntelliSoft’s IntelliCred software solution alleviates the stress involved in the credentialing verification process; MSPs can advantage of IntelliCred’s batch processing and automated primary source verification capabilities, but rest assured that the job is still being done efficiently. In fact, IntelliCred ensures accuracy by meeting Joint Commission standards, in addition to the NCQA and URAC credentialing standards. This software solution also manages and organizes important information for you, automatically notifying MSPs of upcoming deadlines and appointments, expiring credentials, and status updates. Make the next move toward achieving quality care, and learn more about IntelliCred at http://intellisoftgroup.com/products/intellicred/

As MSPs, you work to ensure safety in your hospital. When you evaluate a practitioner’s credentials, you’re simultaneously protecting thousands of patients from the wrong doctor, and preventing harm. But unfortunately, mistakes are bound to happen in the medical practice.

“Partnership for Patients,” funded by the Medicare & Medicaid Services Innovation Center (CMS), was recently released by the Obama Administration in an effort to reduce the amount of medical errors that take place every day. The focus of “Partnership for Patients” is to prevent illness, injury, and healing complications.

The program projects that, “by the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010… [and] all hospital readmissions would be reduced by 20% compared to 2010” (2) Healthcare systems and organizations that sign a contract with the “Partnership for Patients” program would be expected to redesign their care processes accordingly, but that’s nothing compared to the lives and reputations that would be saved.

What many people don’t realize, however, is that the credentialing verification process is the first step to better healthcare. Of course, increased awareness and better technology is important. But it takes the right practitioner to carry out these changes effectively.

IntelliSoft’s IntelliCred is a software solution that simplifies the credentialing process and ensures better accuracy. The new IntelliCred 11.2 alerts hospitals to a practitioner’s personal references and competence to perform procedures through its criteria-based core privileging management, allowing MSPs to make a more educated decision during the credentialing verification process. IntelliCred manages your important documents and automates the primary source verification process. And you can rest assured that you’ll meet or exceed Joint Commission, NCQA, and URAC credentialing standards with this software solution. Find out how IntelliSoft Group can help your organization.  Visit us at www.intellisoftgroup.com

Hospitals have been experiencing increasingly harsher budget cuts, staff consolidations and reduced revenue as   the economy continues to bombard the workforce. Budget cuts force hospitals to decide which departments will get the funding they need and which departments will be reduced in terms of both staff and equipment.

To survive, hospitals have been selling off expensive medical equipment and closing wings to make ends meet. And because the struggling economy has affected everyone, prospective patients are going without procedures. An increased deductible through an insurance provider may outweigh the benefits of the procedure. And then there are the people who can’t afford insurance and continue to go without. Patients are then forced to decide if the healthcare they need is within the budget they can afford out-of-pocket.

A recent article by Keri Forsythe examined the possibilities of hospitals purchasing refurbished medical equipment in order to cut costs, while upholding quality healthcare practices. Aaron Frye, president of Gulfstream Anesthesia, a refurbished surgical equipment dealer, was quite frank on his company’s altruistic stance. “Good, reputable companies, such as mine, will not cut any corners in order to improve profit margins,” he said. “The end product is more important than our profit margins.” Frye elaborated further, explaining that refurbished medical equipment providers are so committed to their product that they will offer warranties that often exceed that of the original equipment manufacturer (OEM).

Refurbished medical equipment is a definite way to continue providing superior care at an affordable price but staffing concerns are another important aspect of hospital budgeting. Consider electronic medical credentialing as a way to cut internal costs, allowing lower patient costs and in turn providing increased revenue by tending to lower-income families who need reduced cost. Electronic medical credentialing can reduce the amount of work a credentialing staff must perform by installing a system that regulates, streamlines and enhances the quality of credentialing.

The IntelliSoft Group offers a wide range of products that will accommodate your healthcare facility, with the ability to train and assist your staff in utilizing electronic medical credentialing software. As an alternative to developing an in-house credentialing department, ISG also offers Credentialing Verification Organization (CVO) services. IntelliCVO provides remote credentialing verification for your facility and ensures complete cohesion with your medical staff.

The need for electronic medical credentialing will continue to increase as we move forward, and by providing several methods of handling your credentialing needs, IntelliSoft Group proves to be a leading force in the credentialing industry. For more information on the line of products offered by IntelliSoft, view our Products page. To learn more about CVO services, view our Services page

by Mike Melville

The increase in telemedicine, or e-health, is being seen throughout healthcare, especially with Critical Access Hospitals that rely on remotely based professionals to provide care.  Often times these physicians will be located in other states raising new questions about privileging, licensing, and credentialing.

On May 26, 2010, CMS published a proposed rule entitled, “Medicare and Medicaid Programs: Proposed Changes Affecting Hospital and Critical Access Hospital (CAH) Conditions of Participation (CoPs): Credentialing and Privileging of Telemedicine Physicians and Practitioners.”  The purpose of the rule is to revise the credentialing and privileging process for telemedicine providers in hospitals and CAHs.

The advantages telemedicine bring to the patient are undeniable.  However, this also creates a burden for the MSP in organizations that often lack resources to fully carry out the traditional credentialing and privileging process required, not to mention the additional requirements that can come when these professionals are located offsite.

Although there is a final rule expected in March 2011 (it is now April 1st) it would be interesting to hear what things MSPs are currently doing to help ease the burden of credentialing telemedicine professionals.  As a software and service provide it will also help us with future development efforts.  I look forward to hearing your feedback on this important topic.

by Mike Melville

I was discussing revenue cycle management with a hospital CFO the other day and was shocked to find out he could not pin a cost on salaried physicians that are not enrolled in any/all of the hospitals accepted health plans.  He said it is difficult to get accurate information from his staff on what reimbursement is being missed due to lack of enrollments for doctors that are collecting a check from the hospital.  Sometimes he even gets conflicting information on whether a doc is enrolled or not, something I assumed would be obvious.

As we all understand there are often lags between physician hiring and enrollment, but these decisions should be made with “eyes wide open”.  In other words, if you are going to hire a doctor knowing there will be this lag time you should understand the cost implications.  You may still make the decision to bring them on board because the short term cost is outweighed by the benefit of having the individual on your staff – maybe because it is a key opening or the doctor brings a certain specialty or prestige to the organization – but you have to understand the underlying costs to make an educated decision.

I am not writing this to shine a harsh light on the CFO, because this is not an isolated case.  My point is there is true value in understanding how much it is costing the organization, day by day – week by week, to have employees that are not generating revenue.  This is near and dear to my heart since some of our core products, IntelliApp and IntelliApp SMART, will help organizations get at this very information quickly and easily.  As time goes by and metrics are established you can have excellent predictability in your costs of adding a doctor to your staff so you can make a more educated decision.

To learn more about how our state-of-the-art Automated Provider Enrollment software solution can maximize your organization’s efficiency and reduce liability and risk please visit our product page.

by Lynne O'Connor

The New England Journal of Medicine suggests that using hospital-wide mortality rates as the means to evaluate quality of care must be done with caution.  As this article indicates, the tools used to gather and measure what is very similar data from 83 very different Massachusetts hospitals produced sometimes significantly different results.  It would be unfortunate for consumers to rule out certain hospitals based findings that may not provide the most accurate picture of the hospitals’ overall quality of care.  It would also be unfortunate for hospitals to be at risk for reduced or denied incentive payments based on those reports as well.

There are many fine healthcare institutions in this country.  Some of the most prestigious hospitals having the most advanced equipment and providing the most highly specialized services are located in Massachusetts.  One could expect the mortality rates to be higher at hospitals where both cutting edge technology and the most critically ill patients are.  Read the rest of this entry ?

By John Eddy

      Recently the Agency for Healthcare Research and Quality released a guide to “Using Workforce Practices to Drive Quality Improvement.  A key component of these guidelines is recommendations on “Staff Acquisition” and “Development Practices”.  Interestingly the guide recommends what are almost competing practices- aggressive recruiting and selective hiring.  In practice these seem to be competing initiatives which amount to filling quotas (i.e. numbers) vs. only hiring the most qualified providers (i.e. quality).  The reality of healthcare is that aggressive recruiting of providers is necessary.  Healthcare continues to specialize and the number of patients is increasing, so more providers are needed.  However, governance, compliance, patient safety and ultimately revenue via reimbursement dictate that staffing with only the most qualified providers is essential.

It seems like this environment creates opportunity for professionals who specialize in credentialing to be leaders in managing these workforce practices and be key to driving quality.  Operationally efficient credentialing that employs best practices such as automation can significantly improve the number of physicians that can be recruited.  And, of course good credentialing will ensure that only the most qualified providers pass muster.  And, ultimately an organization that has a fast on-boarding process with the best providers will ultimately attract providers en masse.

By John Eddy

I recently came upon an article in Bloomberg Business Week titled “Quality Care at US Hospitals Shows Improvement”.

The article is a report on positive healthcare trends as reported by the Joint Commission. The article essentially concludes that evidence-based measure of care for heart attack, pneumonia, surgical care and children’s asthma has steadily improved over the last 8 years.

A positive trend in patient outcomes is always good news.  And, ultimately it is the most important benchmark in all of healthcare.

 However, I find the fact that a major business magazine is covering a Joint Commission report very interesting.  Hospitals spend a lot of time and money achieving accreditation and must contend with the very intensive surveys required to maintain accreditation.  It is my hope that more main stream media will expose the public to the Joint Commission.  With more coverage, the public will be educated on the value of being treated at a Joint Commission accredited hospital.