According to experts, disaster recovery (DR) is how a business restarts itself following a disruptive incident that is natural, man-made, or a systems failure. On the other hand, business continuity implies a more comprehensive consideration of how your business continues to operate not only following a disaster, but also the departure of a key member of your management team or department head or any other incident or event which could interfere with daily operations.

Recently, we have witnessed the severe impact that weather has had on entire communities, their people, property, and infrastructure. While these tragic events certainly get our attention and cause us to reevaluate, reinforce, and rehearse our existing disaster plans, do we really give due diligence to planning for business continuity (BC)? To most people, BC and DR go together. That being the case, you will be well served to consider particularly the role IT can play to insure that any interference to your business's work flow is as small as possible.

Stepping back and examining the possible consequences of each type of adverse incident is an important step in performing a business impact analysis (BIA). By doing so, you can anticipate and plan specifically for each such event. Handling the consequences of a fire is much different than handling the sudden departure of the corporate IT manager or payroll manager.

First, you need to consider your most valuable asset – people. After a disruptive event, how will your employees communicate, where will they work, and how will they continue to perform their jobs? Who needs to take the leadership role and under what circumstances? What aspects of the workflow are essential and how will they continue?

Second, determine which systems, processes, and business units are essential. Particularly when it comes to IT assets and resources, you should consider not only your internal and contracted resources and assets, but also the businesses which develop and support the critical software applications you use. For example, while IT Asset Management is useful, it may fail to track which software versions your business is using.

Recent developments in technology, such as virtualization, cloud computing or other data center technology-enabled business solutions, social media, or mobile devices, can facilitate business continuity.

This blog cannot begin to cover all aspects of BC/DR, but anticipating, planning for, and rehearsing how you will handle a disruption to your business is well worth the effort, time, and money. Just ask someone who didn’t. Keep in mind that IT plays a major role and should be an essential part of your planning.

What are your doing to insure BC in your business? To learn more about how PCT can help, contact us.

Ignorance is no excuse. Over the last few months, like me, I’m sure you’ve seen headlines and read articles about the federal crackdown on Medicare and Medicaid fraud. Millions of dollars have been identified as fraudulently paid for services either not rendered or with limited justification. I acknowledge that there are unscrupulous practitioners and providers out there who should be identified, indicted, convicted, and sentenced to the fullest extent the law allows. However, while I don’t have the numbers, I wonder to what extend “fraud” was committed by those who unwittingly engage in poor billing practices, such as miscoding and/or absence of support documentation for procedures provided. The old adage, that if you didn’t document it, it didn’t happen, may put providers and practitioners at risk of investigation and indictment with all the attendant negative results, such as loss of reputation, decline in confidence, and possibly business failure.

If this falls within the reasonable realm of plausible possibility, I have to scratch my head and wonder why. Why place your business and your future at risk, when you don’t have to? Once again, and you have to admit that this blog is consistent when it comes to waving the IT banner, IT can come to the rescue. Imagine the peace of mind you could have while reducing your DSO, assuming you are at risk not for lack of integrity, but credibility, if your organization had a billing and claims management system that would file clean claims each and every time.

Such an automated revenue cycle management system exists, specifically designed for long term care providers. Imagine a system comprised of a comprehensive and configurable user-friendly web portal to manage claims throughout the submission process, with functions for loading, reviewing, editing, and tracking claims online. With this portal, providers can fully leverage enterprise-level security and permissions with user-definable roles to satisfy their specific claims processing practices. As part of a complete health care transaction solution, providers can submit, monitor, edit claims, and review their claims on-line.

Key benefits of the ProClaim Partner’s application:

• Increased revenue stream and reduced DSO through quick claims turn-around and real-time claims management reporting viewable through a user-defined digital dashboard
• Smoother claims flow through direct connections with providers, trading partners, and value-added networks
• Eliminating avoidable payment delays by increasing successful first-pass rates, tracking claims, and automatically checking claim status
• Reduced transaction fees and paper handling costs by enabling direct connection with providers and payers
• Decreased operations costs through automated handling of routine questions and documentation requests associated with eligibility, claims status, and referrals
• Preserving investments in existing systems by offering an off-the-shelf claims management application that easily interfaces with existing adjudication, financial, and membership systems
• Reduced risk through its robust user audit functionality

Providers would be well rewarded for looking into it. At times like these and under this “gotcha” environment of fraud crackdown, doing billing right certainly has its virtues. But a system is only as good as the workflow that leads to the filing of claims – preadmissions screening and documentation; admissions documentation; clinical documentation; therapy services documentation; proper coding; charges compiled; and claims created, scrubbed, triple checked, filed, and monitored. All are critical components of the workflow and are at risk of vital data and information leakage.

In the next blog, we’ll discuss some of these workflow components which are considered industry best practices.

Question: What solid claims management practices have you observed or implemented?

A Major Health Care IT Paradigm Shift

“Best Practices” in the old days – paper pushing.
Historically, health care in general and long term care specifically, has been intensively paper based - forms, spindles, chart tables, racks, and binders. Documentation was (and still is) the name of the game and pushing paper was the only way. Even regulatory enforcement surveys were based on paper compliance with bedside visits to verify the documentation. Paper-based documentation consumed a lot of trees and filled a lot of storage files and storage units.

“Best Practices” today – Getting past the paper paradigm

• How has IT helped your operation?
• If you have embraced IT, how has it benefitted your operation and the services you deliver?