IntelliSoft Group Blog

According to Healthcare.gov, “On average, each year, one in seven Medicare patients admitted to a hospital has been subject to a harmful medical mistake in the course of their care.  And nearly one in five Medicare patients discharged from the hospital is readmitted within 30 days”

This statement brings about some serious questions pertaining to the quality of our practitioners. Most of us trust our doctors’ diagnoses; when they tell us that our sniffles are due to allergies, we can’t help but believe them and take their word for it. We typically don’t seek a second opinion because we are inclined to believe that “the doctor is always right.”

But the statistics don’t lie; in a group of seven Medicare patients, one has been misdiagnosed. At one point, could it have been you?

This problem is linked to a practitioner’s tendency to “refer” his/her patients to a doctor that specializes in the medical issue at hand. As a result, a patient often undergoes duplicative tests in the diagnoses process, an expensive error that could be prevented by coordinated care. Or, that practitioner was not qualified for their job, but managed to sneak by the credentialing system.

Therefore, the new Accountable Care Organization (ACO) health network offers bonuses to providers that keep patients healthy and out of the hospital, hence preventing the excessive use of costly equipment and encouraging coordinated care between practitioners. If a hospital elects to join the ACO network, they are expected to provide nothing short of high-quality care to their patients.

You’re probably asking yourself, “What does this have to do with me?” And the answer is: everything! Consider yourself a hospital “gatekeeper”; you determine the fate of every applying/renewing practitioner that wishes to work there.

If a practitioner’s credentials don’t “add up,” then you can’t let them in. But if your credentialing software isn’t efficient, an unqualified practitioner could “sneak” right by you. If your hospital is a part of, or wishes to join, the ACO network, the staff needs to be qualified and capable.  And the process starts with you!

Are you ready?  ACO’s must develop a separate management and quality system including, but not limited to:

• A governing body with a Medical Director, CFO, Executive Director and Quality Team.
• A compliance team for patient outcomes, credentialing and CMS’s 65 Measured Outcomes. After year one it’s a pass/fail system.  Any inability to meet or exceed the 65 quality measures will result in financial risk for the ACO.
• A technology team for EMR, data gathering, Health Risk Assessments, patient satisfaction, etc.

IntelliSoft Group offers two distinctive solutions for ACO’s:

IntelliSoft’s IntelliCVO (formally Cambron Credentials): With a combined experience of 85 years, this credentialing service provides a complete range of Primary Source Verification and Payer Enrollment outsourcing capabilities for any size organization requiring temporary overflow or full-time assistance with primary source verification credentialing, re-credentialing and payer enrollment.

For an in-house solution, IntelliSoft’s IntelliCred software meets Joint Commission, NCQA, and URAC credentialing standards, and alerts you of critical status changes and expiring credentials. It’s important to keep your hospital on its feet, and that necessitates credentialing software that accurately determines capable practitioners.

Version 11.2 of IntelliCred helps manage a practitioner’s criteria-based core privileges, and alerts hospitals to an individual’s personal references and competence to perform procedures. This helps keep unqualified practitioners out of the operating room, and furthermore saves lives and reputations.

Visit us at http://www.intellisoftgroup.com

Before the Technology Age, important information was kept on paper and filed away. Rather than locating information with a search bar, MSPs, as well as other data Entry professionals, were forced to sift through overwhelming stacks of paper to find what they needed.

But the times have changed, and the medical world has become more complex.

Medical Professionals do not have time to pick through hundreds of files anymore; however, some of them have no choice. Many practices continue to store their information on paper, fearing that they may experience “productivity loss” in an electronic record transfer¹.

What they don’t understand is that “using antiquated methods of credentialing can pose risks to their patients by permitting an unlicensed or unsanctioned provider to work there” (Healthcare IT News²). Your job encompasses a great deal of responsibility; the effectiveness of your credentialing software should be the least of your worries.

With the Accountable Care Organization network launching in January, it is incredibly important that MSPs have access to efficient software, and abandon the “paper method.” If a hospital chooses to become a member of the ACO network, their practitioners are expected provide high-quality care to Medicare and Medicaid patients. However, using obsolete credentialing methods will hinder a hospital’s ability to uphold this high standard.

When searching for the right credentialing software, make sure that:

1. The Solution provides automated verification of credentials

2. It can organize information effectively, and is customizable to your specific needs

3. It generates online reports and statuses

4. It manages a practitioner’s criteria-based core privileges

5. It is accredited by the NCQA, URAC, and OPPE-FPPE

IntelliSoft’s IntelliCred Software Solution encompasses each of these important traits. We’re aware of the demands that are placed on MSPs, and our software alleviates the overwhelming task of credentialing.

¹http://www.healthcareitnews.com/news/docs-fear-productivity-loss-ehrs

² http://www.healthcareitnews.com/news/8-tips-choosing-credential-verification-solution?page=0,1

After a long day at the office, does your back hurt from sitting at a computer? It’s natural to feel this way, especially considering the fact that “computer posture” (arching the back and leaning over a desk) is not favorable for your muscles and joints. However, did you spend your time manually entering each application at your desk?

Unfortunately, this monotonous and repetitive method is still commonplace in the medical office. It’s frustrating to feel as if you’re “wasting your time” on simple tasks when you have been given so many other significant responsibilities.  With so many challenges to face daily, it has become more and more difficult for practices to free time to focus on what is most important; the patient.  IntelliSoft understands, and we want to help!

We know you have a lot on your plate.  As responsible MSP’s, you want to be meticulous in your Medical enrollment Processes; however, you need the time to do so!

IntelliSoft’s “IntelliApp” has been continually adjusted to meet the needs of an ever-changing health care profession.  Our software program is designed with your specific needs in mind, and contains data Entry features that save you a great deal of time (as well as your back!):

- Replication options to increase efficiency when preparing applications and forms in mass quantities.

- Downloadable and importable templates for a wide range of forms and applications.

- Batch processing capabilities that allow you to auto-populate many different applications from a single data entry source.

-allows office staff to work on separate tasks simultaneously, lessening expenses, and enabling your practice to meet its goals.

Additionally, IntelliApp can be set up to release automatic reminders when important dates are approaching.  We keep track of it for you!  And although this may seem overwhelming, the IntelliSoft staff is eager to assist you with learning this innovative software program. So sit back, relax, and give your back a break!

A helpful tip to alleviate “computer posture” pains: When you’re at work, try pulling your shoulders back and tucking in your chin. This brings immediate relief by taking a significant load off the back.

by Mike Melville

All the recent reports I have read indicate that capital budgets in hospitals are getting scrutinized.  In most cases budgets are being cut back or held flat in relation to previous year spending.  Many hospitals report reduced or flat capital spending levels for the last three years.  The result is important projects get delayed or cut.

There is money being spent, but most is going to EMR system purchasing and implementation.  Hospital executives also site that those purchases that can be tied to an improvement in quality of care will be the first in line to receive capital dollars. Interestingly the role of return on investment (ROI) is rarely mentioned as a key driver in allocation of capital dollars, something that would be at the top of the list in any other business.

So where does this leave the needs of the medical staff professional?  They can not claim that the robust software programs they need to credential physicians are tied into EMR.  It is difficult to make a link to quality of care although we all know that the hospitals quality outcomes are directly associated with the physicians providing care and the MSP plays a key role in for vetting these physicians.  The only answer seems to be to stay away from the capital budget and try to find the money in other places.

Some companies, like IntelliSoft Group, offer the solution in the form of SaaS and subscription buying models.  In most cases these purchases can pull money from the hospitals operating budget allowing the software program’s to be paid for with less money upfront.  Also, software hosting like that provide by IntelliSoft allows users to avoid the costs associated with hardware purchases that can often accompany a software purchase.

The goal is to make it easier for you to gain access to the latest technology available in these difficult economic times.  Having SaaS and subscription options is our way of helping you fight against the continued cuts made in capital budgets – a trend that doesn’t appear to be ending anytime soon.

Recently, the Michigan appeals court ruled that credentialing files are confidential in the case of Yolanda Jackson against Detroit Medical Center.  The court said that, “the privilege prohibits the disclosure of any information acquired under the requisite circumstances, even if the patient’s identity is redacted.”  But what this ruling also highlights is that reliable and auditable record keeping systems need to be in effect, especially in the event of a law suit such as this.

By John Eddy

Accurately tracking a practitioner’s credentials and privileges is crucial to the well being and financial stability of any medical facility.  IntelliSoft Group’s families of products were designed with that idea in mind.

“Our IntelliCred credentialing software suite meets all NCQA, JCAHO, and URAC credentialing standards,” said John Eddy, Vice President of Sales and Marketing at IntelliSoft Group.  “The software automates the entire primary source verification process and includes all the features needed to manage the complex task of physician credentialing, re-credentialing, quality data – including OPPE/FPPE requirements, and privileging.  Every aspect of the IntelliCred credentialing software suite has been tailored to ensure the highest level of productivity, accountability and cost savings for the busy Medical Staff Services department.”

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