Health Language Blog

The Role of Healthcare Data Governance in Big Data Analytics

Posted on 08/01/16 | Comments

On Friday last week, the online news publication HealthITAnalytics.com published a feature story about the importance of data governance, “The Role of Healthcare Data Governance in Big Data Analytics.” The author, Jennifer Bresnick, does an excellent job of explaining what data governance is, how it differs from information governance, and why healthcare IT professionals need to take a closer look at how data is managed at their organizations. Without strong data governance in place, she writes, “organizations will not be able to move beyond the basics of record keeping and develop the analytics competencies that will become vital survival skills in the emerging world of value-based care.”

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Topics: Analytics, data governance, big data, information governance

Medical Billing and Coding:  Exciting Changes Ahead

Posted on 07/20/16 | Comments

 

It’s an interesting time to be in healthcare, especially medical billing and coding! Over the next few years we will see major changes that will help us spend our healthcare dollars more wisely, and keep people healthier. These changes will have a profound impact on patients’ and physicians’ daily lives.

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Topics: ICD-10, Coding Challenges, LOINC & SNOMED, EHR, CPT, ACA, billing, icd-9

Hierarchical Condition Categories Part 1: What’s all the Buzz About?

Posted on 07/13/16 | Comments

There is quite a bit of discussion around Hierarchical Condition Categories (HCCs) these days. And for good reason: as the risk adjustment model used since 2004 to determine reimbursement for various Medicare plans, the HCC framework is progressively being applied to numerous healthcare reform initiatives. In this two-part series, we break down the basics of HCCs, why they matter and how all healthcare stakeholders should respond to them going forward.

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Topics: clinical documentation, HCCs

How to Use Standardized Healthcare Terminologies to Meet Your Quality Care Goals

Posted on 07/06/16 | Comments

Terminology Standards Blog Series: Part 1

In the seminal work Crossing the Quality Chasm, published by the Institute of Medicine in 2001, there was a clear call to action for the U.S. healthcare system. This work has driven much of what we are seeing in healthcare information management today. Crossing the Quality Chasm called for healthcare to be safe, effective, patient centered, timely, efficient, and equitable. The argument was made that the adoption of information technology is critical to meeting these goals. I would agree.

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Topics: terminology, semantic interoperability, data normalization, quality reporting

Mastering the Data Normalization Cycle

Posted on 06/28/16 | Comments

A healthcare provider or payer that goes through a data normalization project will want to make sure its investment in time and money continues to pay off down the road.

You’ve obtained executive buy-in, conducted a data inventory, identified key constraints, prioritized projects, established a governance structure, and embarked on your first initiative. Ideally your project resulted in more consistent and useful data, with demonstrable benefits for your organization. Your next order of business is to make sure your useful data stays that way. A healthcare organization that fails to continuously monitor its normalized model runs the risk of returning to its previous condition: data chaos.

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Topics: data normalization, governance, data normalization cycle

Maximizing MIPS Reimbursement

Posted on 06/08/16 | Comments

MACRA Part 2

Maximizing MIPS Reimbursement

Laying the Right Foundation for Data Management

In the first edition of this two-part series covering MACRA and MIPS, we provided an overview of MIPS and its impact on terminology management and quality reporting. Part 2 will discuss why terminology management is critical to maximizing reimbursement under the new rule.

The stakes for quality and cost performance continue to rise. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 is a prime example of why providers need to prioritize data access and management on a higher level than ever before.

Semantic interoperability—or the ability of two systems to exchange data in a meaningful way—remains a barrier to accurate data analytics and reporting. As pointed out in the first installment of this series, effective data normalization and terminology management is critical to accurately capturing data. Below I outline why terminology management must become a priority to maximize reimbursement within MACRA’s Merit-Based Incentive Payment System (MIPS).

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Topics: MIPS, MACRA, Reimbursement

MIPS Raises the Stakes on Clinical Documentation and Quality Reporting

Posted on 06/01/16 | Comments

MACRA & MIPS Part 1

MIPS Raises the Stakes on Clinical Documentation and Quality Reporting

Is your data ready?

In this two-part series, we will explore the basics of MIPS and its impact on terminology management and quality reporting.

It’s no secret that quality reporting has presented notable challenges to hospitals and physicians. Access to clean, accurate data is necessary for reporting, yet providers continue to struggle with full and consistent capture of data and strategic management of patient information for forward-looking initiatives.

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Topics: MIPS, MACRA

Implications to Using Old and Outdated Codes

Posted on 05/18/16 | Comments

Many were relieved after the ICD-10 implementation deadline. But, though October 1st 2015 is now long past, it does not mean the end of dealing with healthcare terminologies and the complexities set into motion for healthcare providers and payers.  

As we all know, healthcare is a constantly changing industry. New medical breakthroughs as well as newly discovered diseases lead to new treatments and innovative solutions. All of these changes must be represented in evolving medical terminologies. Terminologies, standards for treatment and care, and scientific developments are rarely set in stone. Code systems and terminology sets may be updated daily. If you and your organization cannot keep up with all of the changes, your entire organization is at risk.  

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Topics: ICD-10, terminology, enterprise terminology management

Data Normalization: Mapping to Existing Standards vs Creating Local Standards

Posted on 05/11/16 | Comments

If you’ve followed the previous steps outlined in this blog series, you should have a good idea of how to pursue data normalization within your healthcare organization. But challenges will continue to arise once you get underway. One of the decisions a healthcare provider or payer will face in the course of a project is whether to use an existing industry standard or create a local terminology. As it turns out, the answer isn’t cut and dried, and will depend to a large degree on the use case involved.

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Topics: data normalization, selecting standards, mapping, local standards

The Benefits of Mapping CPT to LOINC

Posted on 05/04/16 | Comments

Payer-based care and utilization management programs are essential for managing member health, closing care gaps, and managing risk. Research data indicates that capturing members’ vast healthcare histories and normalizing that information for consumption can enable a care management program that enhances the effectiveness of provider-based care initiatives.

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Topics: LOINC, Payers, mapping, CPT, Care management