Health Systems Management Network, Inc.’s comprehensive implementation program for ICD-10-CM focuses on the entire revenue cycle.

Wellington, FL -- (SBWIRE) -- 05/17/2013 -- Health Systems Management Network, Inc.’s comprehensive implementation program for ICD-10-CM focuses on the entire revenue cycle. Their view is that the revenue cycle begins with the first contact with the patient and the collection of their data through account reconciliation.

All parts of the Revenue Cycle are at the same time dependent and independent functions equally important which rely on and affect each other. In almost every Hospital, Ambulatory Care Unit and large Physician Groups a new position exists for “Management of the Revenue Cycle”. This was and has been a terrific innovation that recognizes the interdependence of each aspect.

HSMN’s Consulting methodology projects start at the very beginning with the initial patient encounter and doesn’t end until a clean claim is out the door and paid. HSMN’s comprehensive approach and view has been developed over 30 years of consulting in this field and by the outcomes they have achieved for their many clients.

Health Systems Management Network Assessments begins with an in depth analysis in order to determine the accuracy at every point in the process where data are collected or inputted. They also look beyond what has been captured, asking the questions, “Based on what is known, what wasn’t captured in this encounter and should be?” Their data analytics take a look back at the previous two or three years to understand how well the Hospital or Faculty Practice has done under the ICD-9-CM scenario.

The next step is to concurrently round with and track current cases being treated by the clinical staff and view the cumulative clinical documentation of “live” cases.

An HSMN representative stated, “The goal is to find out: What does it tell us about clarity of diagnosis, treatments, outcomes and prognosis for the patient. Are the elements of patient care documented and reported/coded to the highest level of specificity to support Quality Indicators and produce a clear and clean claim with which the Coder and Biller can move forward for payment? Will it pass through the back end scrubber edits or will it end up in a work queue?”

When the assessment of a “live case” is done, HSMN compares the results of its assessment of the Case to the work done by the Hospital’s revenue cycle team. HSMN then shares its findings with the Medical staff using Case Deconstruction methodology so that each and every element of supporting diagnosis and treatments are clearly related to the reason for admission and subsequent findings that may change the final diagnosis.

Each of the “live” cases is then reconstructed in ICD-10-CM/PCS so that the Medical staff can see where the clinical documentation may have fallen short or could not be converted from ICD-9-CM to ICD-10 CM unless changed. Each of the members of the Revenue Cycle Team who handled the claim/case is invited to the presentation done jointly by a Coder/Biller Team and the Clinicians directly involved in order to understand the case for billing and coding purposes.

This method combines both didactic and practical approaches to the transitions necessary to change thinking about clinical documentation for ICD-10-CM. HSMN’s job is to assess, create a role and process model and leave the organization with a tool kit that is easily used by the Hospital Revenue Cycle staff and Clinical staff to continue improving Clinical Documentation.

HSMN focuses its efforts on how data flow through the System(s). Often mistakes can be made by anyone on the Team and HSMN provides a means for each member to recognize problems and identify them not in a Silo fashion but in an integrated process. It takes a Team to make a Clean Claim.

HSMN advises that once the techniques are learned, then some small percentage of cases should be handled in this way to begin preparing everyone for ICD-10-CM/PCS. There are no courses, webinars, classes or websites that can substitute for the hands on process they have successfully implemented for their clients. Everything about ICD-10-CM must be internalized, instinctive and critically thought through.

We invite you to contact us at 866-908-4226 or via email at info@hsmn.com to discuss how our approach can be helpful to your organization.

For more information on this press release visit: http://www.sbwire.com/press-releases/health-systems-management-network-inc-provides-hospital-administrators-a-pathway-for-revenue-cycle-management-under-the-icd-10-cm-scenario-253056.htm

Wellington, FL -- (SBWIRE) -- 05/14/2013 -- HSMN has previously announced their Start Ten Plus Program that combines transitioning medical staff to ICD-10-CM and creating partnerships with skilled coders who use critical thinking skills and creating an internal clinical documentation improvement program with and for the Medical staff.

One aspect often neglected that is important and perhaps the most critical element is that correct data is flowing into the “System in use” in a continuum that creates a flawless claim for services rendered.

In HSMN’s 30 years of clinical documentation improvement consulting, they have found that often there are larger problems with data collection, input, tools and confluence with other systems that feed the claims. Often these are not picked up especially after the installation of a new system.

Therefore one of the most important aspects of the consulting project is data analytics. The team examines every source of data that feeds the claims. In the “Epic” environment there are interminable work queues that create rework and force incredible amounts of staff time on correction.

In a recent assignment in a large hospital/academic medical center it was clear that claims were missing encounters and procedures; this is aside from the “Edits” through which the claims must pass. HSMN has concluded is that their ‘Start Ten Plus’ must look at every data source to assure that from front end to back end correct data is flowing.

The data collection tools, the human input, the flow and the ultimate outcomes are at the very center of our Start Ten Plus consulting practice. The program is Start Ten Plus Data Analytics.

All sources must be trusted; trust is lost when those working the system make mistakes which create the queues and back up cash flow and affect net revenue or the system has not been able to collect or transfer data appropriately.

HSMN’s reputation has been built on finding what is not there and what should be in the data. They will work to transition the medical staff with their methodology of deconstructing active cases in ICD-9-CM and reconstructing them in ICD-10-CM. In that process they will assure that every facet of data is correct and finding its way to becoming a Clean Claim.

Please call us 866-908-4226 or email info@hsmn.com to find out more about our process.

For more information on this press release visit: http://www.sbwire.com/press-releases/icd-10-cm-preparation-and-data-analytics-consulting-now-offered-by-health-systems-management-network-inc-251272.htm

Health Systems Management Network’s (HSMN) Start Ten Program Plus, has begun to focus its clients on the conversion to MS-DRG’s under ICD-10-CM/PCS.

Wellington, FL -- (SBWIRE) -- 05/10/2013 -- Health Systems Management Network’s (HSMN) Start Ten Program Plus, has begun to focus its clients on the conversion to MS-DRG’s under ICD-10-CM/PCS. HSMN has already announced that they will assist their clients on focusing its clinical documentation improvement consulting on creating partnerships between clinical practice and coding knowledge.

HSMN in its work with clients for almost thirty years has proven that the “Bridge” between clinical decision making and appropriate clinical documentation has always been in a weak state. HSMN has heard that the attending and faculty tell them that they do not want coders telling them how to diagnose or that coders don’t understand what this surgical procedure is all about.

The real issue has been: can a real bridge be built between the way clinicians think, and what is now required under ICD-10-CM clinical documentation requirements. At first glance these entities are miles apart. However, experience has taught HSMN along with the brilliant medical staff with whom we have worked over the last thirty years that the “Bridge” can be constructed and maintained but the construction process must begin this year.

HSMN announces something its client base already knows. The clinical documentation requirements for ICD-10-CM require specificity in the extreme; they are also a logical extension of the unarticulated process that goes on when decisions are made after diagnosis and assessment. Looking carefully at the transition from ICD-9-CM to ICD-10-CM the specificity is logical and serves to focus everyone on the clinical “Team” on the patient problem list in more detail allowing a better integration of “Caring Disciplines” to be more specific in what they do and document.

HSMN has always rounded with care givers to better understand what they do clinically and to help them better articulate in clinical documentation, the problems, assessments, therapeutics and resolutions.

Too often in the past the nursing profession has had a set of clinical documentation guidelines that did not answer the questions most physicians wanted to know about their patients: What is the outcome of treatment today? What is the patient status related to the problem which has been diagnosed?

ICD-10-CM provides a new opportunity to support all of the clinical “Team” in being precise in describing the patient problem list: what actions have been taken, and what are the outcomes and status. In order to do this HSMN’s team of clinical documentation implementation consultants and coding staff deconstruct active cases in ICD-9- CM and present the gaps or problems with those cases together with hospital staff. What follows is a reconstruction of the “live case” in ICD-10-CM/PCS and a presentation of its “Grand Rounds”.

Physician/Clinical involvement is much more focused when we work with real cases and do it on a prospective basis. HSMN has used this methodology for almost thirty years on all of the previous iterations of the coding schema.

The most important thing is to bring the team together around learning at the same time. This will include the coders who will be asked to spend time in the clinical area so that they understand completely. This also assumes that the coders chosen to lead the charge have very good critical thinking skills.

Please contact HSMN by phone 866-908-4226 or email info@hsmn.com to discuss how they may be of help in transitioning to the new paradigm. They can help you build the bridge between clinical decision making and revenue.

For more information on this press release visit: http://www.sbwire.com/press-releases/health-systems-management-network-inc-hsmn-announces-expansion-of-clinical-documentation-improvement-consulting-team-249949.htm

The Wall St. Journal in a recent article by Stephen Soumerai and Ross Koppel stated that CMS is very focused on reducing rates of readmission of Medicare/Medicaid patients.

Wellington, FL -- (SBWIRE) -- 05/09/2013 -- The Wall St. Journal in a recent article by Stephen Soumerai and Ross Koppel stated that CMS is very focused on reducing rates of readmission of Medicare/Medicaid patients. These findings along with the changes in hospital billing and penalties applied under the Affordable Care Act are now published on the Health Systems Management Network, Inc (HSMN) website.

Findings from the Wall Street Journal article include the following conclusions:

1) Research shows that most readmissions can’t be prevented;
2) Readmission penalties which will be 1%-3% starting in 2015 will incentivize hospitals to keep patients in the emergency room rather than admit;
3) There will be a temptation to change the coding for patients that are readmitted to indicate that they were not admitted with the same Dx or infection;
4) Hospitals serving poor communities will be severely hurt financially.

The authors of this article promote a team approach in which a physician and nurse practitioner can help manage patients better at home. However, if the patient must be readmitted HSMN’s own finding is that that clinical documentation does not always measure up to the need to support readmissions.

Under ICD-10-CM/PCS it will grow increasingly difficult to justify readmission if there is not a significant improvement to the clinical documentation supporting the readmission. Health Systems Management Network, Inc. has worked with many Medical staffs on clinical documentation in it’s almost 30 years of Consulting.

HSMN’s consulting engagements have been clinical documentation projects centered on both the clinical and coding staff. These client engagements have improved revenue and reduced denials by significant margins. In the new ICD-10-CM world significant improvements to both the quality of and the specificity are critical elements for revenue success. The new scenario requires such specificity that any omission will result in denial of payments and penalties to reimbursement.

HSMN has begun a “Start Ten Program” which focuses its efforts on the clinical documentation of the medical staff and its’ partnering with coders who must use both knowledge and critical thinking skills.

“Because of our vast experience in case management and utilization over the past 30 years we are coupling our Start Ten Program with our Patient Focused Clinical Documentation Improvement Program.”

The “program” has been developed with the help many of the best clinical minds in our country. The purpose of the Program is to focus the entire clinical team on patient problems/diagnoses with a view to integration and specificity required by ICD-10-CM. Clearly the integration of care would leave no doubt about the need for the current admission and its treatment and this must be reflected by the “Team” in its clinical documentation.

Health Systems Management Network, Inc. thus announces the “The Start Ten Program Plus”.

Please contact our offices 866-908-4226 or email info@hsmn.com for a consultation on how HSMN can be of service to your organization. This initial teleconference consultation is without cost.

For more information on this press release visit: http://www.sbwire.com/press-releases/health-systems-management-network-inc-publishes-findings-about-changes-in-hospital-billing-and-the-new-penalties-under-the-affordable-care-act-that-will-be-in-place-in-2015-249815.htm

The medical staff in most hospitals or busy physician practices are probably not going to sit down for a didactic session on ICD-10-CM/PCS coding.

Wellington, FL -- (SBWIRE) -- 05/06/2013 -- The medical staff in most hospitals or busy physician practices are probably not going to sit down for a didactic session on ICD-10-CM/PCS coding. With the upcoming rollout of the ICD-10-CM coding changes, the staff’s level of expertise will have a profound impact on revenue for the medical facility. Health Systems Management Network, Inc. has created the Start Ten program to assist hospital and physician staff to transition from ICD-9 to ICD-10/PCS.

While many medical practices have implemented the electronic record that will embed the new codes, they will not have created the clinical documentation needed to support the coding.

Coders, unless they have an intimate working knowledge of the clinical practice/procedures of their physicians (despite the training they may have received on ICD-10-CM/PCS) may not be able to construct an appropriate procedure code or correctly assess the codes for the MS-DRG assignment.

In 27 years of operation, Health Systems Management Network, Inc. (HSMN) has helped transition many medical and revenue cycle staffs to each iteration of the DRG and APC reimbursement methodologies through a very thoughtful process whose main core is combining clinical/technical knowledge with critical thinking skills.

HSMN has used the advice of the many physicians with whom it has worked on all of the transitions. From the advice and the practical work of spending time with the attending staff, house officers, nurse practitioners, primary care and specialty nurses and the revenue cycle staff, HSMN has learned that the clinical and coding staff must have training that reflects their reality.

The reality faced each day by the clinical staff is that no two patients are the same clinically and demographically. Therefore, HSMN’s approach to this new transitioning is to test where the client is, and where they need to go.

HSMN has introduced a very successful technique called Case Deconstruction and then ICD-9-CM Reconstruction into ICD-10-CM/PCS. The concept is simple and elegant. HSMN reviews current cases in ICD-9-CM and parses them to see whether the clinical documentation and the coding/MS-DRG match perfectly.

Based on the case’s existing documentation and coding, HSMN begins by analyzing where the problems may lie in either the clinical documentation or the coder skill level. The “Case” is then reconstructed into the ICD-10-CM/PCS and presented to the medical staff.

While HSMN works closely with coders, it also confers with the medical staff member who was the lead physician/clinician on the “Case”. They then encourage and model a partnership which both clinician and coder are asked to present the entire ”Case” to the clinical staff of that particular discipline and to the coders who will work with them.

Deconstruction and reconstruction are the key elements along with clinical documentation and Coder Critical Thinking Skills for the success of the ICD-10-CM/PCS Transition. CMS in its pronouncements speaks of “Conversion”.

HSMN has stated, “In our experience there can be no conversion without internalizing an understanding of the differences between ICD-9-CM and ICD-10-CM. The understanding can only come about through a process that takes some time and energy.” Clearly the medical staff bare a burden of specificity never envisioned in medical school and for the coders it is the weight of judgment in the PCS assignment.

Medical staff often asks: “What is the incentive for me to improve my clinical documentation with this level of specificity”. The obvious answer for the physician is that better clinical documentation leads to improved quality of care. Another answer is that physicians are more intimately involved in coding then they assume. Consider the physician’s productivity for example. Physician productivity is expected to take a 10% to 20% hit do to an anticipated significant increase in coder’s queries. The physician’s time is better spent providing care, not answering coding queries.

The new coding scheme is about specificity and reporting; it is not about being paid more for procedures or visits. However, HSMN has found that when clinical staff is challenged, they will respond. HSMN’s ICD-10-CM/PC Start Ten Program was created to facilitate this process.

Call us 866-908-4226 or email info@hsmn.com for a consultation today.

For more information on this press release visit: http://www.sbwire.com/press-releases/transitioning-medical-staff-to-icd-10-cmpcs-in-partnership-with-the-revenue-cycle-team-health-systems-management-network-inc-creates-the-start-ten-program-246753.htm

HSMN -Announces the “The Start Ten” program designed to support both the medical staffs and each member of the revenue cycle team to transition to ICD-10-CM and PCS Coding.

Wellington, FL -- (SBWIRE) -- 04/19/2013 -- Health Systems Management Network, Inc -Announces the “The Start Ten” program designed to support both the medical staffs and each member of the revenue cycle team to transition to ICD-10-CM and PCS Coding. The “Start Ten” program was designed by physicians for physicians with help from the best coders and trainers in the country.

Health Systems Management Network, Inc. (HSMN) has been working with hospitals and large practices on clinical documentation improvement and transition to all of the proceeding iterations of Coding. ICD-9-CM has incorporated much more specificity and deconstructing cases in the mode provides a clearer indicator for success in ICD-10-CM.

The HSMN experience with medical staff in every delivery environment has taught them many lessons, with the most important one being the fact that there is an enormous divide between clinical language and coding. Getting physicians to wrap their brains around the kind of specificity the new coding scheme requires is not only a science but also an art form.

For many years HSMN has used a technique that makes physicians more comfortable in learning the new things. HSMN deconstructs existing cases and parses them in exquisite detail enough so that physicians can see how much they have missed the mark in the current coding scheme.

The next step is to reconstruct each case from the current ICD-9 to the ICD -10 and then present them back to the medical staff. In this process the coders also have their role assessed and their judgment analyzed to see if they truly understand what is going on clinically for the patient.

HSMN’s approach allows both the physicians, coders and others in the revenue cycle to “Jump Start” the “Ten” process. Many hospitals will depend on vendors and their tools to transition them. They will also have sent Coders for ICD-10 training but the real success comes with working closely with the medical staff and finding champions among them who will act as models for their peers.

The “Start Ten” program is not a magic bullet but it has produced results among medical staff that have made some of them champions of our approach. There is no easy way to transition. In fact for ICD-10-PCS coding much judgment is needed because the coder has to create a procedure and must have a real understanding of the clinical and anatomical connections.

“Start Ten” also works with billers to help them understand what it is that has taken place that can now become a claim.

About HSMN
For over 27 years HSMN has worked with medical staff in every major medical and academic medical center to improve the quality of the documentation and ultimately the resulting revenue and reduction in denials.

Please contact us by phone 866-908-4226 or email info@hsmn.com for a consultation.

For more information on this press release visit: http://www.sbwire.com/press-releases/health-systems-management-network-inc-announces-start-ten-program-to-assist-revenue-cycle-teams-transition-to-icd-10-cm-coding-239853.htm

Epic revenue cycle consulting with post implementation workflow analysis is critical to assuring that what was “built” in the “system” is working well.

Wellington, FL -- (SBWIRE) -- 04/18/2013 -- Epic revenue cycle consulting with post implementation workflow analysis is critical to assuring that what was “built” in the “system” is working well. During a recent engagement at an academic medical center, Health Systems Management Network, Inc. (HSMN) revealed the hospital experienced revenue loss and a higher rate of denials pre and post claims submission. The system as built by the hospital staff turned out not to reflect the reality of needed workflows and the creation of work arounds and redoing of work.

In the engagement, HSMN found additional staff had to be hired in order to address the claims that could not pass the edits and then the aftermath of claims that were denied. At this hospital almost 4% of their revenue had been affected negatively. HSMN was called in as it has been for over 27 years to put feet on the ground who could sort out the problem areas.

The work consisted of the analysis of the hospital’s workflows and their products that were subjected to a “deconstruction” technique that parses the causes for each of the failed claims. Once the parsing is done, the workflow is reconstructed to work so that it reflects the reality of medical staff behaviors and everyone who is part of the revenue cycle management. Epic is an amazing and robust system, but its implementation is in the hands of operations staff who have to pay attention to their work as well as design workflows.

HSMN has worked with the redesign of all workflows, staff behaviors, organizational structure and skill sets and put them in the appropriate context working closely with the hospital staff. HSMN has been very successful in its Epic revenue cycle consulting and post implementation analysis.

One of the common findings by HSMN is that the hospital staff is often so emotionally tied to the “workflows” built for the Epic System that they often lose objectivity when it comes to identifying flaws.

In the engagements, they listen carefully to staff, observe work at all levels including physician behaviors and then help the internal staff to regain their objectivity and partner in identifying the flows that must be fixed after finding the “root cause” of the problems.

The staff at HSMN encourages the use of Epic revenue cycle consulting and post implementation analysis for hospitals as a positive and results-producing activity that can make a difference in the bottom line.

For more information or a free consultation, call 866-908-4266 or email info@hsmn.com.

For more information on this press release visit: http://www.sbwire.com/press-releases/health-systems-management-network-inc-offering-epic-revenue-cycle-consulting-to-hospitals-239849.htm

Health Systems Management Network, Inc Has improved Hospitals Net Revenue on Ambulatory Care Billing.

Wellington, FL -- (SBWIRE) -- 03/25/2013 -- HSMN has learned that MEDPAC (The Medicare Payment Advisory Commission) is set to reduce hospital payments for ambulatory/outpatient procedures to the rates paid in a physicians’ office.

Their reasoning is clear: why should the “people’s money” (taxes) be used to pay higher rates in hospitals for the same service patients can receive in a physician’s office? There are many procedures (66 to be approximate) that will be affected. Health Systems Management Network, Inc. after 27 years of working with charge capture, hospital and outpatient billing throughout the country has an answer. The various hospital associations are lobbying to prevent such cuts but MEDPAC will present its recommendation and call it “Budget Neutral” which means a loss of $275 million dollars to hospitals across the country.

There is only one answer: be prepared by doing a review of the total billing operation for outpatient billing procedures in your organization. A detailed review beginning with the “Orders”, authorizations, actual procedures performed and final claim preparation must be carefully reviewed by looking at each function including how “Orders are placed”.

In HSMN’s experience most outpatient settings are losing up to 20% of their revenue because of faulty authorizations and denials based on clinical documentation.

HSMN has developed a seasoned and professional team to review roles, functions, work processes and organizational structure with a view toward strengthening and adjusting the entire billing cycle so that it can reduce denials by improving every aspect of the cycle.

For 27 years HSMN has reviewed and implemented processes, roles, structure and metrics to improve the revenue stream for outpatient procedures. This is the only answer to cuts that will not be called cuts. They will be referred to as “Leveling the playing field”.

Now is the time to do a comprehensive review and put into place a program to increase revenue through smart work flows and tweaking whatever systems in use to flag errors that are both human and systems caused and correct them before they get to final claims.

Many hospitals tell HSMN that their organization is covered by new systems. HSMN’s experience is that nothing goes into those systems that doesn’t have a human source such as the medical staff, registrar, scheduler, coder, and biller. Therefore, systems don’t solve the problem; they are often part of the problem and solution.

HSMN has found among its clients that improvements of 1-6% will more than make up for any reductions in reimbursement that are put into place. Now is the time to take the decision to and proactively tune up and restructure hospital outpatient billing.

About Health Systems Management
Health Systems Management Network is a leading hospital, physician practice and health services management consulting firm. They have completed complex medical billing and coding engagements and are experts in the ICD-10 coding arena. Their expertise in revenue cycle management, ambulatory care billing and hospital outpatient billing comes from over 25 years of experience in the field.

Call us 866-908-4226 or email info@hsmn.com for a consultation and discussion.

For more information on this press release visit: http://www.sbwire.com/press-releases/health-systems-management-network-inc-has-improved-hospitals-net-revenue-on-ambulatory-care-billing-through-their-revenue-cycle-management-engagements-228443.htm

Wellington, FL -- (SBWIRE) -- 03/21/2013 -- HSMN announces the formation of a “Financial Structural Assessment Team” under its Organizational Structure division. The purpose of this Team is to assess the financial structure within the revenue cycle management and determine how roles should be defined, work processes refined, system efficacy, staff allocation by function and finally the leadership.

HSMN has learned after doing “reorganization” for 27 years, financial goals must be set and confirmed in real time. Once goals are stated, and the financial mission defined, then begins the difficult task of shaping the financial structure to be able to produce the desired outcomes within the timelines stated.

Very important in all of this is the assignment of metrics to monitor progress to completing goals, and putting into place a management team that knows in exquisite detail how each function within the structure is working.

The HSMN process has been established after 27 years of restructuring: it is termed “zero based restructuring”. The process starts with a comprehensive analysis of every data point related to revenue and looks carefully for variants that might have caused up or down changes.

For example, in one organization (a large Academic Medical Center) the revenue was down by 3% but that also coincided with two important factors: the loss of some surgical specialists which meant that medicine was producing more than procedures and at much lower rates.

The second factor was the lack of real time interaction between the coding staff and the house staff who provided the source documentation. In this engagement it was found that house officers (Residents) would keep the bulk of their documentation on their own media to allow for efficient “hand offs” to the next resident. The problem was that critical document elements were not finding their way onto the official hospital record.

HSMN began a program of restructuring that included a new kind of interaction between house officers, attending staff and the coders/billers.

Professional fee billing had one staff and the Hospital another staff. In reviewing cases it was quite clear that often diagnoses did not match. HSMN has had a program in place called “Financial Structural Assessment”.

It is comprehensive and goes through all sources and all functions that affect financial outcomes. The assessments are shared with staff who are asked to challenge the findings and come up with their thoughts about restructuring. At this point in the engagement HSMN asks staff and managers to step back mentally from the current structure and look at a new way to meet goals with appropriate changes.

HSMN’s methodology has worked in many organizations and our client list reflects their success. When ICD-10-PCS and CM becomes reality and when MEDPAC reduces payment in hospital outpatient procedures, it will be too late. Now is the time to think about a “Financial Structural Assessment”.

About Health Systems Management
Health Systems Management Network is a leading hospital, physician practice and health services management consulting firm. They have completed complex medical billing and coding engagements and are experts in the ICD-10 coding arena. Their expertise in revenue cycle management, ambulatory care billing and healthcare financial management comes from over 25 years of experience in the field.

They can be contacted at 866-908-4226 or email info@hsmn.com for a consultation and discussion.

For more information on this press release visit: http://www.sbwire.com/press-releases/health-systems-management-network-inc-announces-formation-of-financial-structural-assessment-team-for-revenue-cycle-management-teams-226070.htm

Health Systems Management Network, Inc Develops New Program to Train Medical Staff and Coders in ICD-10-PCS Coding.

Wellington, FL -- (SBWIRE) -- 03/15/2013 -- Recent studies based on current client data show that the revenue cycle of some hospitals are projected to see an impact of a negative 2-3% on net revenue with the implementation of ICD-10-PCS Coding. HSMN in working with its client base has found that clients are counting on tools and systems rather than experience, training, Medical staff behaviors and critical thinking skills.

Each ICD-10-PCS procedure code is unique and not found in a book and therefore coders will build the procedure code based upon the clinical documentation in the clinical record.

HSMN has found that often physicians order procedures that are not performed, at least not in the way they are ordered. The second most profound event is the one in which the scheduler does not understand what the physician is ordering and therefore cannot properly apply a code that will be authorized. Compound these two events and revenue will fall, or at least be denied and may never be recovered.

HSMN has developed a program and methodology for both clinical documentation Improvement and training coders in critical thinking skills as they apply their training in ICD-10-PCS to creating an appropriate code.

The new game demands that coders think about what they are doing not just look up a code in a book. Physicians who already have trouble with doing accurate clinical documentation especially in the area of “Specificity”, will encounter a “Brick Wall” when it comes to documenting for ICD-10-CM and ICD-10-PCS because the level of specificity is so high.

In the new coding scheme there is no correlation between specificity and payment. In other words doing a better job doesn’t bring the hospital or physician any more revenue but each group can lose revenue.

HSMN’s Start 10 program encompasses detailed working sessions with the medical staff using the “Case Conference Methodology” developed by its physician advisors and coding team. In its Methodology “Clinical Documentation equals reimbursement”, current cases are “Deconstructed” and then reconstructed from ICD 9 to ICD 10. HSMN presents recent cases to the medical staff of particular departments and provides a way for them to learn how to be specific.

HSMN then works with the coders to detail their understanding of the clinical work in a particular service and then brings the two groups together to discuss and review current cases and simulate them in ICD 10.

This is a good time to begin to take positive action not only for the clinical staff and the coders but also for all personnel that touch demographic and clinical data. Everyone in the revenue cycle stream must have a basic understanding of the difference between the two and experience in analyzing cases for billing purposes.

About Health Systems Management
Health Systems Management Network is a leading hospital, physician practice and health services management consulting firm. They have completed complex medical billing and coding engagements and are experts in the ICD-10 coding arena. They provide Epic Systems Workflow analysis, revenue cycle management, ambulatory care billing and APC’s, healthcare financial management analysis along with over 25 years of experience in the field.

They can be contacted at 866-908-4226 or email info@hsmn.com to discuss your needs.

For more information on this press release visit: http://www.sbwire.com/press-releases/health-systems-management-network-inc-develops-new-program-to-train-medical-staff-and-coders-in-icd-10-pcs-coding-223030.htm

Health Systems Management Network, Inc. Announces That Its Start Team (ICD-10) Will Also Focus On Complex Procedure Coding Under ICD-10-PCS.

Wellington, FL -- (SBWIRE) -- 03/12/2013 -- Many of HSMN’s clients thought that they could rely on the Encoder to crosswalk ICD-9-CM procedure codes to ICD-10-PCS. The newsflash is that the Encoder, no matter which product is used, cannot convert the ICD-9-CM procedure code to the ICD-10-PCS. HSMN has just announced that its Start Team (ICD-10) will assist hospitals and physician practice management with complex procedure coding under ICD-10-PCS.

The explanation is a simple as it is complex: each ICD-10-PCS is unique; they are not selected from a book but rather they are built by coders based upon the clinicians clinical documentation, the coder’s understanding of the construct of the ICD-10-PCS and the coder’s ability to apply the ICD-10-PCS rules.

It should be noted that while many hospital coders have been sent for training, their scores even when they are high cannot compensate for the lack of experience in ICD-9-CM coding and working closely with clinicians, to gain a deep understanding of what procedures the physicians are doing in the OR. HSMN has developed a methodology called ICD-9-CM “Deconstruction” and ICD-10-PCS “Reconstruction” based upon the clinical documentation in the clinical record.

The program serves to work with the physicians and help train coders at the same time. The program begins with “Deconstructing” real cases some active and others not. It then presents the case back to the medical staff so that they can see differences between what they think they have performed and what the documentation says.

The HSMN team coder working closely with the hospital/practice coders reconstructs the case in ICD-10-PCS to show the coders the gaps in the documentation and the art of building the “Procedure Code”. These methodologies are presented at Grand Rounds with each clinical service. The Case is represented to them in a diagnostic mode. From that point, HSMN helps to sort out those on the medical staff who can be teachers for other members.

HSMN’s methodology involves learning about all of the procedures done by a particular service and rounding with the service members at all levels. HSMN has successfully used these methods to improve revenue based upon solid clinical documentation and critical thinking by the coders.

About Health Systems Management
Health Systems Management Network is a leading hospital, physician practice and health services management consulting firm. They had completed complex medical billing and coding engagements as well as provided revenue cycle management, healthcare financial management analysis, Epic Systems Workflow, Ambulatory Care Billing and APC’s along with other physician practice management projects for healthcare providers.

Call us 866-908-4226 or email info@hsmn.com for a consultation and discussion.

For more information on this press release visit: http://www.sbwire.com/press-releases/health-systems-management-network-inc-announces-that-its-start-team-icd-10-will-also-focus-on-complex-procedure-coding-under-icd-10-pcs-221630.htm

HSMN Creates ReMAP, A Program to Assist in Structuring Revenue Cycle Management & Organization for Successful Outcomes.

Wellington, FL -- (SBWIRE) -- 03/06/2013 -- Health Systems Management Network, Inc. (HSMN) in its 27 years of operation has often found that both hospitals and large medical practices, especially faculty practices, have found that sometimes the installation of new systems has changed their revenue outcomes. They ask the questions: Why is the AR climbing? Why are we realizing fewer dollars from our patient encounters? These revenue cycle management questions challenge every physician practice, hospital and specialty practice groups in the industry.

Despite the amazing technology, it is still the organizational structure that is the major determinant in revenue cycle success. The “Systems” cannot fix bad processes, employees who aren’t skilled enough for their jobs, lack of training, failure to adjust workflows and just sloppy handling of data.

These are fixable with the correct assessment. HSMN with major input from its clients has developed a program called ReMAP (Revenue Management Assessment Program). In it a grade is assigned after the assessment tool is used to analyze each and every segment of the revenue cycle: registration, scheduling, clinical documentation, clinical records, billing, claims management, and denial management. Each of these is reviewed with a view to finding the gaps in the continuity, integrity, quality and productivity as well as quality of staff performance.

Once the assessment is complete, work begins with each group within the revenue cycle including its managers to better understand the history and transition of each of the workflows and each of the roles within the cycle, their design and purpose post “System” implementation.

HSMN counts heavily on the input from the existing staff including the medical staff. They interview medical staff, discuss cases especially ones that have been denied to determine where the breakdown in communication is. Since ICD-10-CM is perched to arrive next year, they work toward helping all staff involved to improve their functioning.

For the medical staff they work with them in “Deconstructing Cases” in the current ICD-9-CM and work to improve those documentation requirements and then move those cases in simulated fashion to ICD-10-CM so that they are challenging what goes on with the current to prepare for the future.

They work with all of the players so that coders, billers, registrars and schedulers are looking at the same cases to see what needs to be fixed as the “claim” moves through the entire cycle.

HSMN searches carefully for how data are transmitted from system to system to final claim. Once the process is finished they recommend an organizational structure with defined roles based on the specific financial goals of the institution and outline the skill sets and training essential for success. The HSMN Tool ReMap is then turned over to the revenue manager(s) for them to monitor outcomes and continue to make improvements.

About Health Systems Management Network, Inc.
In 27 years Health Systems Management Network, Inc. has been very successful with a long and deep list of health care providers whether they are health systems or clinical practices for significant improvements to their gross and net revenue.

Call them at 866-908-4226 or email them at info@hsmn.com for a conversation about the issues that most concern your organization or practice.

For more information on this press release visit: http://www.sbwire.com/press-releases/hsmn-creates-remap-a-program-to-assist-in-structuring-revenue-cycle-management-organization-for-successful-outcomes-217677.htm

Health Systems Management Network, Inc. announces an expansion of its START Program, the program designed to assess the state of readiness for ICD-10-CM medical billing and procedure coding.

Wellington, FL -- (SBWIRE) -- 03/01/2013 -- Health Systems Management Network, Inc. announces an expansion of its START Program, the program designed to assess the state of readiness for ICD-10-CM medical billing and procedure coding. The expansion has been implemented to support providers who want to know how they will do with their payors once ICD-10-CM is in effect. The expansion includes all payors regardless of where the facility is.

The HSMN START Program will include Managed Care. The payors include all of the large insurers and the States’ Medicaid intermediary who are now using Managed Care as a vehicle to reduce outlays.

START is a program whose consultants review the last few years of data to understand payment for procedures and visits as well as the data that shows what has been denied. These data are then compared to HSMN’s database of comparable facilities to determine whether everything that should have been paid has been paid and establishes that every procedure eligible for billing has been billed appropriately.

HSMN Documentation Specialists review a targeted sample of cases to determine whether ICD-9-CM standards for specificity are being met by the Medical staff. HSMN has in its START Program a module to simulate those same cases in the ICD-10-CM coding/documentation structure.

HSMN works to help the current documentation and coding issues while then reconstructing the same cases (targeted based on the data) into a claim which should optimize the revenue and adhere to the appropriate specificity for ICD-9-CM and ICD-10.

Each of these cases is reviewed with the Medical staff and all of those who are part of the Revenue Cycle so that they can see how well they will do in the ICD-10 world. The final step is to emulate how these claims will be paid by your third party payor especially the Managed Care companies.

This effort is essential in determining how well Providers will do. HSMN seeks to go beyond the data and look at the source of the problems that are not allowing the provider to realize the full benefit of the revenue to which it is entitled. START touches every part of the Revenue Cycle and leaves an imprint and model to follow once the assessment is complete.

There are no magic bullets or systems that can suddenly make the Providers have more revenue than they did. In the ICD-10-CM world Physicians/Clinicians are the source of the documentation on which excellent coding should be based.

If a Health System, or Practice or Medical Center is concerned about the revenue based on ICD-10, now is the time to call Health Systems Management Network, Inc. 866-908-4226 or email info@hsmn.com for a consultation.

For more information on this press release visit: http://www.sbwire.com/press-releases/health-systems-management-network-inc-hsmn-announces-an-expansion-of-its-start-program-215273.htm

In their February Newsletter AIS Health Confirms from a recent Study what HSMN had announced recently: Payoffs for smaller MSSP groups with tiny savings are unlikely.

Wellington, FL -- (SBWIRE) -- 02/19/2013 -- In their February Newsletter AIS Health Confirms from a recent Study what HSMN had announced recently: Payoffs for smaller MSSP groups with tiny savings are unlikely. In its previous Press Release in which HSMN announced the implementation of its ARP Teams HSMN also indicated strongly that without the proper assessments neither clinical practice nor any organization can know how they will end up financially.

HSMN is now underway advising Physician Practices and Hospital clients who have asked HSMN to help them decide (as a group or individual practitioner) to join an ACO or create one by acquiring medical practices. Some Physicians are investing with others in trying to acquire the expert knowledge to get them ready to become an ACO (Accountable Care Organization under the Affordable Care Act).

HSMN’s ARP Teams of Healthcare Financial Management Operations/Financial Strategists are looking at many practice and hospital system situations to determine whether such a dramatic step is warranted. The simple question of “Where have we been?” and “Where are we going?” (in practice) must be answered by both the Hospitals and Physicians.

Is this move to develop an ACO consistent with the mission of the Hospital system? Is such a move consistent with both professional and personal goals for the individual practitioners? Most of all what is to be gained financially?

The ARP Teams have begun to focus on two Comprehensive Aspects: a Practice Assessment that includes a financial pro forma looking at all financial scenarios. How much income will be derived from either source? (That is status quo or moving toward the ACO Model). The second Assessment is one that requires a strategic look at where the Practice is going.

The ARP Teams have sat with each of the practitioners or soloist to determine what their professional, financial and personal goals are and where they stand currently in reaching them.

HSMN has been supported in acknowledging that assessments are an essential step in the decision to leave private practice and join an ACO as an employed Physician or even as a Contractor. HSMN’s two Assessments have provided a view into a financial future as well as one that can bring professional and personal satisfaction. An important outcome has been Clinicians who now say they truly need a strategic and business plan as their blueprint for the future.

HSMN has found that years in practice, type of discipline and the cultural and practice values held by the individuals have been huge determinants in the decision making process in moving toward or away from the ACO. HSMN in doing its assessment have sorted out the emotions from the facts. This sorting out makes it possible for the person making the decision to be less emotional and more objective.

HSMN has studied the ACOs in existence and the guidance CMS provides and throughout it the big question remains, “does this make sense for me or for our organization?” All practitioners/organizations who contemplate these changes still have no idea how revenue cycle management still affect them. In theory everything is budget neutral. In reality it is not. So a Physician doing a gross of one million joins an ACO.

The ACO goal is help save some of that money and then reap some benefit by getting a percentage back. Or is it that the Physician will now have the ability to use an electronic record, share data, and provide integrated care in this patient centered endeavor? To what extent will this fulfill all professional and personal goals? We don’t know. What we do know is that decisions about clinical practice must be made by completing understanding of whether the status quo is good enough or whether some thought must go into answering the question, “Where is this practice going?”

HSMN’s ARP Program has created an ACO Simulation. As part of the exercise; we have plopped the physician into the ACO and he/she is able to see the future (virtually). Likewise with large organizations, we simulate what it will be like both financially and as “Mission” fulfillment for their organization.

The goals of the ACO movement are noble and do make sense from a theoretical point of view. Can they really work for the individual practitioner? The forerunners of the ACO are the Medical Foundations which seem to be thriving in California.

The real question is what will really work for the Physicians and other types of practitioners? There is the feeling in the country and among our clients that the ACO movement is antithetical to being an entrepreneur in practice.

The announcement of the study today signals that HSMN has been correct in saying without the proper assessments neither large organizations nor clinical practices should jump in. A link to the latest study on “Payoffs” for the ACO’s is listed here and well worth reading. http://aishealth.com/archive/nabn0213-06.

Call and experience the HSMN Simulation, Financial Assessment and Strategic Professional Performance – Call 1-866-908-4226 or email info@hsmn.com with questions to set up time for a telephone conference.

For more information on this press release visit: http://www.sbwire.com/press-releases/hsmn-publishes-study-from-a-hospital-consulting-aco-assessment-and-physician-practice-management-arp-engagement-208914.htm

HSMN recently announced a new Physician Practice Management Reimbursement Readiness Program in which it would provide Physician Groups with an internal capability to demonstrate outcomes of their practice of Medicine.

Wellington, FL -- (SBWIRE) -- 02/15/2013 -- HSMN recently announced a new Physician Practice Management Reimbursement Readiness Program or PPMRRP in which it would provide Physician Groups with an internal capability to demonstrate outcomes of their practice of Medicine. It is important that Medical Practices begin a transition that allows them to track outcomes. The first order of business is to review cases done by all of the partners or associates in the Practice and establish a standard for every procedure and diagnoses.

Many of these standards are intuitive in that Clinicians almost always know where there should be based on diagnosis, treatment plan and therapeutics. The Standards for the “Practice” need to be quantified against national standards in Evidence based medicine. A good start is within the practice.

So HSMN reviews cases based on algorithms it has developed over the years, the basis for which reside in CMS databases.

A spokesman for the company said, “We study the clinical documentation, review the reimbursement or denial and we begin the process of how the practice will do under the new reimbursement scenarios including ICD-10-CD coding.” This analysis is critical in the denial management process.

HSMN’s system is totally dependent upon the individual practices. It allows each practice to say that based upon our demographic, patient age, diagnoses etc., here are our outcomes. Over the last several years there have been enormous strides in the maintenance of post hospitalization of heart patients who are given certain meds to take including the baby aspirin.

HSMN’s job is to codify and quantify the standards within the practice to be able to demonstrate to any payor the quality of its outcomes. HSMN is convinced that all payors will begin using such standards but still pay for volume of procedures and visits as long as outcomes appear to be reasonable.

While the next stage of paying for quality may be off in the future, it is important for each physician practice to begin the process of understanding the quality of the outcomes in the practice reflected in the clinical documentation so that they can be demonstrated to third party payors.

About HSMN
HSMN has worked with Physician Practices for 27 years on improving reimbursement. Please contact HSMN 1-866-908-4226 or info@hsmn.com for a consultation.

For more information on this press release visit: http://www.sbwire.com/press-releases/hsmn-announces-new-physician-practice-management-program-to-address-the-national-institute-of-health-s-public-recommendation-for-payment-for-quality-instead-of-quantity-207636.htm

HSMN is proud to announce the extension of its Resource Revenue Opportunity Program (RROP) as part of its Hospital Billing Group.

Wellington, FL -- (SBWIRE) -- 02/13/2013 -- HSMN is proud to announce the extension of its Resource Revenue Opportunity Program (RROP) as part of its Hospital Billing Group. In July of 2010 one of HSMN’s Academic Medical Center clients asked whether they had really exhausted all of its avenues to Revenue Improvement. The answer was to look at all of their data on patient encounters and procedures to determine what if anything had been missed.

Using a formulation and an algorithm developed by HSMN, three years of data was retrieved with focus on filing dates for all of the payers. Then examining every patient encounter in detail to determine whether all parts of the encounters resource use had been accounted for on both the professional and technical side of the billing equation.

Once that was accomplished HSMNworked closely with the hospital staff and systems to come up with a means to bill anything that had been missing and that was eligible for payment. In one year alone many millions of dollars was billed legitimately and paid.

HSMN has developed the RRPO Team who are made up of Super Coders, Data Analysts, Billing Managers, IT Software and Hardware staff who know all of the systems especially one like Epic to come in and find the Revenue Cycle Management Opportunities based upon resources that have been used in patient encounters.

The team develops the methodology and algorithms that are passed on to the Hospital staff to use for the future. At that point HSMN can act consultatively going forward.

For the initial main thrust of finding the revenue opportunities, the HSMN teams are on the ground working not only with backend financial folks but also with clinical managers who know their services well.

About HSMN
HSMN has been working with hospitals on billing issues for over 27 years. Please call for a consultation 866-908-4226 or go to HSMN’s website http://www.hsmn.com for more information.

For more information on this press release visit: http://www.sbwire.com/press-releases/hsmn-establishes-new-resource-revenue-opportunity-program-rrop-as-part-of-its-hospital-billing-group-206678.htm

Wellington, FL -- (SBWIRE) -- 02/05/2013 -- HSMN announced two weeks ago a new program to help transition the Medical Staff from ICD-9-CM to ICD-10-CM. The announcement focused on what is the most important element in having correct coding. They emphasized working with the Medical Staff because they are the source of what supports the Patient Encounter.

Clients responded by asking HSMN to widen their scope to include not only Coders but also Billers and others who will touch the Coding. For instance putting in orders for procedures and studies based upon physician requests. This request dovetails perfectly into HSMN’s Physician Practice Management group.

So HSMN has broadened the program to include The Revenue Cycle Continuum. Therefore effective Monday February 3rd HSMN will be accepting client requests to work in a Comprehensive Program to get everyone into the framework of the new coding.

HSMN has called the program “Start 10”. In effect HSMN will look at how ready each aspect of the Revenue Cycle is ready for ICD-10 especially the Medical Staff, Coders, billers and Surgery/procedure Schedulers.

“Revenue Cycle Management is key component of our core services. Other firms are doing ‘Assessments’ for readiness, but HSMN is evaluating the readiness of the entire Revenue Cycle through its ‘Start 10’ program” says Theo Tarantini of HSMN.

The steps in the program are the following: 1) Review current clinical data and cases in all disciplines that have claims attached that are either paid or not paid; 2) Review the role each aspect of the Revenue Cycle played in the performance on selected cases; 3) Review the cases with those involved including the Medical staff and others; 4) Do a case conference which “Deconstructs” the cases evaluated and “Reconstruct” them with ICD-10 requirements. 5) Make separate presentations to each of the elements of the Revenue Cycle involved; 6) prospectively follow cases through claim submission to determine whether the program has been successful; 7) Grade the outcome and prepare a “Management Plan for improvement.

Start 10 today. Call HSMN at 866-908-4226 or email us at info@hsmn.com to have an initial discussion about what your needs are.

For more information on this press release visit: http://www.sbwire.com/press-releases/hsmn-announces-the-start-10-program-to-assess-the-readiness-for-icd-10-cm-and-icd-10-procedure-coding-in-the-revenue-cycle-management-process-203902.htm

Wellington, FL -- (SBWIRE) -- 02/01/2013 -- Big enterprises need big solutions to having an integrated system for keeping patient information in a way that is clinically focused and at the same time is in synchronization with demographic and billing data. In the new environment of Affordable Care where integration of patient care is the most important criteria for the rewards offered by CMS in their program, the clinical data must also be integrated in a way that gives a complete picture of the patient including all trends and updates. HSMN assists hospitals and clinical staff with their post epic workflow issues.

For those enterprises not in Affordable Care Enterprise Wide Systems are the road to becoming an integrated entity so that patient clinical problems, history of current illnesses and trends are kept in a way that allows both the medical staff and the hospital to have access to the same data. There are consequences to the implementation of Enterprise Wide Systems, ones that sometimes could not have been anticipated.

Health Systems Management Network, Inc. has been working with clients to help assess, sort out and reconcile Work Flows and Work Queues that are a result of the Enterprise Wide implementation. We as a company have been doing this for 27 years and now we are in our 28th year of advising many of our clients on a way forward through the problem of redundancy or work arounds.

HSMN finds that the Hospital/Clinic staff who worked so diligently to create the workflows that replicated how work had been done in the clinical areas may find themselves often doing work arounds and rework and then spending time to try and fix the problems.

HSMN has created an Enterprise Wide Work Flow Assessment Tool (EWWFAT) pronounced “UFat” that “Deconstructs” the Work Flow or Work Queue into the following elements:
- What was it intended to do?
- Is it working as designed?
- What data elements should the workflow or work queue be monitoring for completion?
- Are there any workarounds or rework associated with the work queues?
- Which work queues can be consolidated and which should be eliminated?

In the best of worlds the Hospital/Clinic staff that has spent hundreds of hours on the workflows and work queues cannot suddenly stop their daily work and get back to reworking the problems. Instead our clients have found it useful to bring in the HSMN UFAT team to work alongside the Hospital staff in a hospital consulting capacity to think through each of the problem areas and then recommending solutions for elimination, change or consolidation.

HSMN has worked with every system in small and large organizations and has gathered a deep and wide client base from which it brings much experience to each new client. No two organizations are the same and the first thing that HSMN does is assessing culture and values before it plunges into problem solving.

Their assessments don’t sit on shelves or hard drives; they are implemented as soon as there is consensus among the Hospitals staff about the solutions. Understanding client goals and staff operational needs drives our analytics and on the ground assessment.

Call them at 866-908-4226 or email them at info@hsmn.com for a discussion about the issues that have arisen in your organization since your implementation.

For more information on this press release visit: http://www.sbwire.com/press-releases/how-hsmn-assists-hospitals-to-cope-with-post-epic-implementation-work-flow-issues-202247.htm

Hospitals all over the country have reorganized their old Revenue Cycle Departments into “Revenue Cycle Management” with a new department head. Sometimes that position has been elevated to Vice Presidential status.

Wellington, FL -- (SBWIRE) -- 01/18/2013 -- Hospitals all over the country have reorganized their old Revenue Cycle Departments into “Revenue Cycle Management” with a new department head. Sometimes that position has been elevated to Vice Presidential status. While many of them have been successful with their efforts at reorganization, some have not. HSMN has announced their Revenue Cycle Reorganization Plan called RCM2.

For over 27 years HSMN has been assisting Hospitals in every aspect of reorganizing their Revenue Cycle Departments from Silos to Contiguous, seamless revenue flow operations. In doing so they have encountered much resistance to change as we went about testing how each department was functioning by looking at outcomes such as Claims Denial and other anomalies such as Physician and patient complaints about claims.

HSMN’s new program RCM² relooks at each structure, staffing, skill sets, systems, work flow, and all of the processes including Clinical Documentation and coding that come to us with a grade on how the entire Revenue Cycle is functioning.

They have a Methodology that uses their “Deconstruction” technique that allows then to see where there are opportunities for improvements to net revenue and cash flow.

The last step in their process is a “Reconstruction” or Reorganization that redefines the mission of the Revenue Cycle Departments and adjusts the structure, the staff, role definition, work flows, processes and systems to meet the new goals of the RCM².

HSMN’s technique has been successful in hospitals throughout the country and the reason it is stems from the HSMN presence in the organization, and its work with the hospital staff. Hospital staff often provide some of the new thinking and ideas on how work should flow. HSMN works closely with the hospital administrators to craft solutions to revenue cycle management challenges. The HSMN success is no accident.

Call us at 866-908-4226 or email us info@hsmn.com for a consultation.

For more information on this press release visit: http://www.sbwire.com/press-releases/hsmn-announces-its-revenue-cycle-management-reorganization-plan-rcm-197158.htm

Wellington, FL -- (SBWIRE) -- 01/16/2013 -- HSMN announces its new program designed to prepare physician practices for the new reimbursement environment. It is called “Physician Practice Management Reimbursement Readiness Program".

“The program was created as a response to many of our small and large Practices who have been concerned about ICD-10-CM coding coming soon and the CMS program that will bonus the quality or subtract the amount of payment based on outcomes” says Theo Tarantini, CEO of HSMN.

The Accountable Care Organization also looms large in the future. Does it make sense to join one, or start one? What are the financial rewards if any? These are the questions hospitals and physicians face when researching whether or not to join an ACO.

For 27 years HSMN has worked with Physicians in solo, groups and faculty practices in improving reimbursement and reducing denials of claims by improvements to documentation coding and claims processing. HSMN Teams can come into a practice and assess its current status in handling reimbursement.

The Team creates a simulation of how the Practice will do under ICD-10-CM and (procedure coding) given the current work that is being done in the Practice. The second tier of the assessment is to determine whether the Practice can demonstrate outcomes for its patients.

Whether it has a database that tracks patients so that it can report and demonstrate to CMS or to other payors the quality of its work. The last tier of assessment is to determine whether the Practice would be better off belonging to an ACO.

These are the reimbursement scenarios for years to come and HSMN stands ready to come into a Practice to help its leader or leaders determine whether they are prepared. If they are not prepared, HSMN lays out all of the steps the Practice needs to take to be successful in the new reimbursement environment.

Call us at 1-866- or email us at info@hsmn.com for a consultation.

For more information on this press release visit: http://www.sbwire.com/press-releases/hsmn-announces-its-physician-practice-management-reimbursement-readiness-program-or-ppmrrp-196412.htm

Wellington, FL -- (SBWIRE) -- 01/10/2013 -- For 27 years HSMN has worked with Medical staffs in Faculty Practice, Group Practice, and Individual medical practice in every possible setting and with every iteration of Coding. They have worked with Professional fee coding and hospital coding and found that there is a deficit of information by both Coders and Physicians in understanding each other’s work. To address this gap, HSMN has created their PCD/ICD-10 and hospital ICD-10 specialty practices.

Coders do not always understand the clinical context for the root basic procedure; Physicians, depending upon training, do not fully understand the level of specificity required in the ICD-9-CM (also procedures) and ICD-10-diagnostic and procedure coding.

While many of HSMN clients have focused on the training of Coders and choosing software to support the new coding scheme, the training of Physicians for medical coding and billing have not been as high a priority. When HSMN sorted coding errors and claims denial they found something very curious among many of their clients.

More than 50% of the errors were a result of poor or inadequate documentation and lack of understanding by the coders of the Clinical content. When this was presented to the clients, it was clear something had to be done. The result was the creation and implementation of HSMN’s program, PCD/ICD-10.

In this program they look at cases from the previous year based on targeted extrapolation of data. Cases are parsed using HSMN’s Case Deconstruction Methodology (CDM). They examine the claims to determine what was billed versus what was performed during the encounter/procedure.

After the analysis, a grand round is set up for each Clinical discipline to discuss the cases, each of which is presented by a Physician and a Coder. HSMN provides the analysis, the training of staff and role modeling for a more interactive relationship between Physician and Coder.

HSMN has developed a program that works and we invite you to call us 866-908-4226 for a consultation or email us at info@hsmn.com to determine how your Medical staff and your revenue can benefit.

For more information on this press release visit: http://www.sbwire.com/press-releases/hsmn-announces-new-physician-clinical-documentation-pcd-and-hospital-icd-10-pcdicd-10-billing-coding-practices-194918.htm

HSMN announces the formation of the ACO Readiness Program or (ARP). The purpose of this group being formed within HSMN is help both Physicians and Hospital Organizations/Systems decide whether such a step is feasible financially and what next steps must be taken.

Wellington, FL -- (SBWIRE) -- 12/26/2012 -- HSMN announces the formation of the ACO Readiness Program or (ARP). The purpose of this group being formed within HSMN is help both Physicians and Hospital Organizations/Systems decide whether such a step is feasible financially and what next steps must be taken.

“Many of our Physician and Hospital clients are asking for help as they respectively decide to join an ACO or create one by acquiring medical practices” says Theo Tarantini of HSMN. Some Physicians are investing with others in trying to acquire the expert knowledge to get them ready to become an ACO (Accountable Care Organization under the Affordable Care Act).

The HSMN ARP Teams of Operations/Financial Strategists are looking at many practice and hospital system situations to determine whether such a dramatic step is warranted. The simple question of “Where have we been?” and “Where are we going?” (in practice) must be answered by both the Hospitals and Physicians. Is this move to develop an ACO consistent with the mission of the Hospital system? Is such a move consistent with both professional and personal goals for the individual practitioners?

The ARP team will focus on two important assessments: A Physician or Hospital Practice assessment that includes a financial pro forma looking at all financial scenarios. How much income will be derived from either source? The second Assessment is one that requires a Strategic look at where the practice was headed.

The ARP Teams sit with each of the practitioners or soloist to determine what their professional and personal goals are and where they stand currently in reaching them. Unless both assessments are done the decision to leave private practice and join an ACO as an employed physician or even as a Contractor are difficult at best to make. HSMN’s two Assessments provide a view into a financial future as well as one that can bring professional and personal satisfaction.

Years in practice, type of discipline and the cultural and practice values held by the individuals are big determinants in the decision making process. HSMN sorts these out in a way that makes it possible for the person making the decision to be less emotional and more objective.

HSMN has studied the ACOs in existence and the guidance CMS provides and throughout it the big question remains, “does this make sense for me or for our organization?” All practitioners/organizations who contemplate these changes still have no idea how the financial theme still affect them. In theory, everything is budget neutral. In reality it is not. So a physician doing a gross of one million joins an ACO.

The ACO goal is to help save some of that money and then reap some benefit by getting a percentage back. Or is it that the physician will now have the ability to use an electronic record, share data, and provide integrated care in this patient Centered endeavor? To what extent will this fulfill all professional and personal goals? We don’t know.

HSMN’s ARP Program has created an ACO Simulation. As part of the exercise, we plop the physician into the ACO and he sees it from the inside (virtually). Likewise, with large organizations we simulate what it will be like both financially and as “Mission” fulfillment for their organization.

The goals of the ACO movement are noble and do make sense from a theoretical point of view. Can they really work for the individual practitioner? The forerunners of the ACO are the Medical Foundations which seem to be thriving in California. The real question is what will really work for the physicians and other types of practitioners?

There is the feeling in the country and among our clients that the ACO movement is antithetical to being an Entrepreneur in Practice. Our announcement today signals that HSMN has the staff, the experience and the depth to help organizations and individuals decide what is best for them and their patients.

Call HMSNN and experience the HSMN Simulation, hospital consulting, and Financial Assessment and Strategic professional performance.

Please call us 866-908-4226 or email us theo@hsmn.com cathy@hsmn.com with questions or to set up time for a telephone conference.

For more information on this press release visit: http://www.sbwire.com/press-releases/hsmn-announces-the-formation-of-the-aco-readiness-program-or-arp-for-physicians-and-hospitals-191479.htm

Wellington, FL -- (SBWIRE) -- 12/18/2012 -- HSMN has worked for over 25 years in consulting on all of the iterations of ICD-CM coding for both Diagnostics and Procedures. We believe that the greatest challenge will be in coding ICD-10-PCS procedures. We know that from our experience of working with physicians/surgeons over these many years. We believe that in order to code ICD-10-procedures accurately, the Coder must first understand the clinical intent of the procedure being performed in order to first identify the “Root Operation”.

In our many years of experience in working with surgeons in every possible setting, the communication of the order sets a chain of events that will determine reimbursement. Should the order differ from the actual procedure, then the authorization will be voided and no reimbursement. HSMN provides a new program from order to final claim that includes working with the medical coding and medical billing staff in order to create a Continuum in the ICD -10 world of procedure and diagnostic coding. Our program is called “Getting to know you and what you do”. It is a program that develops both communication patterns and a common language embedded in the clinical documentation to allow both the surgeons and the Coders to have a correct claim.

How does it work? We start with a basic premise that Coders are not Clinicians and Clinicians don’t always document to the specificity needed in the ICD-10-CM world. Therefore, the Coder who knows anatomy, physiology and clinical language will act as a consultant to the physician, while the physicians will coach the Coders are the procedures they are doing. The will emphasize the underlying root operation, reasons for doing it and the potential complications and additions that might take place. So this satisfies “what we do” and “why we do it”. The Coder in turn works with the physicians to explain what needs to be documented to satisfy ICD-10-procedure requirements.

The “Getting to know you and what you do Program” is one that HSMN has modified over the years in order to achieve a symmetry and continuity and clear communication between Coder and Physician. HSMN has worked in hospitals of all sizes, surgical centers and other settings to help clients make sure that they are receiving the appropriate reimbursement based upon the resource use.

We have put into place “Assessment Teams” to see how organizations are doing with ICD-9 so that the transition to ICD-10 is a bit easier. But there is no easy way to master ICD-10 except to create “Team” and “Partnerships” of well-trained Coders (who will need didactic updates to their knowledge base) and physicians who will need to have current cases deconstructed or parsed to allow them to see what they are doing now versus the specificity they will have to use for ICD-10. Once the Teams are formed, a well-targeted training program has to be in place so that current work does not slow down and it also provides the opportunity for the Deconstruction Methodology that physicians find so useful in discussing cases. HSMN sees ICD-10 as an opportunity to bring physicians and Coders together working in ways that have not been typical.

Please call us so that we can discuss an Assessment and putting in place a Program that will launch your organization successfully into the ICD-10 World.

Contact Us:
Phone ................................ 866-908-4226
Fax .................................... 866-801-4949
Email ........ cathy@hsmn.com / theo@hsmn.com
or visit http://www.hsmn.com

For more information on this press release visit: http://www.sbwire.com/press-releases/the-icd-10-cm-medical-billing-challenge-and-hsmns-coding-answer-188355.htm

Wellington, FL -- (SBWIRE) -- 12/14/2012 -- Health Care Financial Management begins at the Medical/Physician Practice Management level and in any clinical enterprise; best practice requires two basic tools: A Business/Financial and Strategic Plan. HSMN has developed and used these tools to help make the difference between success and failure in Clinical Practice. HSMN’s tools create a clear understanding of the goals and objectives for the next three to five years. These financial and program projections have been critical to our successful clients whose outcomes in physician practice or Medical Staff initiatives have been noteworthy.

Competing entities are making the health care environment very complex so that physicians are questioning whether they should continue battling third party payors or sign on with an Accountable Care Organization or become a hospital employee. This new environment is slowly killing the entrepreneurial spirit. Yet third party payors are looking at those entities who truly understand Healthcare Financial Management and who can deliver quality services cheaper, help patients avoid emergency room visits and provide care in a less intense delivery environment. The providers who can provide those services will do very well in this new environment. HSMN clients are turning to us to help them navigate these very rough waters.

HSMN has found that the fear of third party payors especially Medicare is driving Physicians away from private Medical Practice and into employee status. Physicians and clinics who use HSMN’s Health Care Financial Management’s tools, (Practice Management Business/Financial and Strategic Plan), have succeeded in making much better decisions about their future.

In HSMN’s work with physician practices across the country, we have learned that every practice needs to assess where it is, and where it is going. HSMN has developed a tool which we call the Practice Management Business/Financial and Strategic Plan. Our basis for creating the methodology comes from examining how the real world deals with Business planning and adapting those techniques to the unique field of Medical Practice. Our clients find it easy to use and instructive. It is easily updated.

Health Care Financial Management at the Medical practice management and clinical level, require that specific questions must be answered before any decision is made to start or stop a service. These questions probe where organizations have been and where they are headed. While seemingly simple, it underlies everything that is important about success. Asking the right questions and formulating the answers requires tools to estimate costs, revenue, market place, start-up, financing, capital investment, recruitment, space, growth, and reimbursement for services. HSMN’s tools require both a financial and time investment but our clients tell us that those investments have paid off.

HSMN’s tools play a pivotal role in determining whether or not a market exists, how large and how old it may be; these facts help to define the audience and its geographical specifics, and they also help to give a clearer financial picture. HSMN has been doing such Plans for over 26 years; it isn’t only about software and calculations; it is about understanding the nature of the clinical practice, the audience for the practice and what can be reimbursed especially under the “Affordable Care Act”. The decision to move ahead, stand still or leave practice should be made on the basis of fact and not only emotion. One of the major products of the Plan is a three-five year Pro Forma; it is essential for financing and for attracting partners or doing an expansion.

For many years Health Systems Management Network (HSMN) has helped clinicians focus on what is important to them both professionally and personally. Personal and financial goals must be clearly defined and agreed upon by the partners as they would in any business. First there has to be an overall Strategic Plan and then interim objectives which are called the tactical plans. This is the road map and the very heart of Health Care Financial Management. As the private practice or entity grows the same principles will apply.

HSMN has found that the most successful Physician practices and clinical ventures have been able to answer the questions through the creation of both a Business/Financial and Strategic Plan that are part of an overarching Health Care Management Plan. With its strength it can attract the right partners, investors and financing for its growth. Some may question whether it is worth the money to invest in such plans; in this environment it is absolutely essential. We urge you to contact us if you are thinking about going into practice, joining a practice, leaving a practice or considering employment.

Email us at theo@hsmn.com or go to our web site http://www.hsmn.com and send us a note about your current situation. HSMN has a breadth of experience and a very deep client list of successful practice outcomes.

For more information on this press release visit: http://www.sbwire.com/press-releases/hsmn-announces-the-formation-of-its-business-and-strategic-planning-unit-for-its-medical-practice-management-clients-183310.htm

Wellington, FL -- (SBWIRE) -- 11/23/2012 -- Health Systems Management Network has created a diagnostic tool that will assist hospitals in unearthing problems in their billing systems. The diagnostic tool has been built for use by hospital, clinic and physician practice personnel in order to be involved in the actual work of uncovering flaws in the system. These flaws could be attributable to people functions, organizational structure, or even provider use of feeder systems such as Cardiology, Radiology and Oncology.

The purpose of the HSMN’s Diagnostic Billing Tool is to provide hospitals with internal intelligence using a methodology that has had a proven positive impact on hospital revenue in large organizations. Health Systems Management Network brings its 26 years of experience in this arena of hospital billing and partners with hospital staff so that such staff can stop looking at what they always see but uncover what isn’t there.

Perhaps this sounds a bit different to many, but the idea of looking at hospital billing as a continuum that flows through revenue cycle management and is touched by everyone on the clinical and administrative financial side, rather than isolated and as silo events, gives an entirely new perspective from front end to back end. The medical staff is also engaged in this process as they are asked to help with the deconstruction of encounter events which may have bearing on final outcomes of revenue.

The issue with most large organizations, and even smaller ones, is the tendency to compartmentalize functions and even centralize functions in a way that appears to create superficial efficiencies. The HSMN Diagnostic Billing Tool (DBT) has been built on the basis of working with hospital staffs across the country that has helped to pioneer the approach. The best part of this work is that there is a knowledge transfer that can always be used in the organization.

The elements that drive DBT include structural, data, systems, people, organization and redefined financial objectives based on a consensus of goals. Clients have told us of the joy of gaining a great understanding of how their organizations really work and why they were able to gain important revenue improvements even in the current challenging reimbursement environment.

To reach Health Systems Management, visit us on the web at http://www.hsmn.com or call us at 866-908-4226

For more information on this press release visit: http://www.sbwire.com/press-releases/health-systems-management-network-unveils-the-ultimate-diagnostic-billing-tool-help-is-on-the-way-for-hospital-billing-176227.htm