HSMN, a leading consulting firm to hospitals and clinical practices, is being featured in the most recent edition of Modern Healthcare Magazine published on Sept. 2nd.

Wellington, FL -- (SBWIRE) -- 09/09/2013 -- HSMN (Health Systems Management Network Inc), a leading consulting firm to hospitals and clinical practices, is being featured in the most recent edition of Modern Healthcare Magazine published on Sept. 2nd.

This issue lists the nation's largest healthcare consulting firms that generated the most revenue in 2012 from the consulting fees that were charged to providers. Modern Healthcare conducted a survey that included 83 different consulting companies who voluntarily elected to participate in the survey. The survey has been conducted each year since 2006 and this year HSMN topped the list.

The staff at HSMN has almost 30 years of experience in consulting for hospitals and private medical practices. Their focuses include revenue cycle management, clinical documentation, and transitioning clinicians ICD-10-CM/PCS.

With the full implementation of ICD-10 scheduled for October 1st, 2014, healthcare practices around the country are facing formidable challenges to their entire Revenue Cycle particularly for clinicians and the Coders. HSMN is providing services that address issues in the revenue cycle all the way from the first patient encounter to the a clean claim out the door and paid.

HSMN's approach to revenue cycle management consulting includes the following steps:
- Identify gaps in current documentation & coding
- Use deconstruction methodology to reconstruct every step toward creating a claim
- Create a management plan with defined roles
- In depth training of all staff on the RCM team
- Web-based training by medical staff that can be easily accessed

One of the most important steps is this process is the training of the current clinical documentation team and medical staff. HSMN facilitates this training and leads the way, however, the training is done by in-house members of the staff. HSMN looks for the "Champions" of the staff. According to Theo Tarantini from HSMN: "In many cases, those 'Champions' are likely to show themselves and rise to the challenge without needing to be sought out".

These members of the staff help to create a training program that can be viewed online by the rest of the staff. HSMN has found that using existing in-house staff for this part of the training process is more effective and the information is more easily absorbed by the staff members who need it.

About HSMN (Health Systems Management Network)
For almost 30 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. Right now HSMN is offering consulting services that are specifically designed to help transition hospitals and private practices into the ICD-10-CM/PCS era.

Readers who are interested in finding out what HSMN can do for them may contact this company by phone 866-908-4226 or the following email info@hsmn.com. Visit us- http://www.hsmn.com

For more information on this press release visit: http://www.releasewire.com/press-releases/release-3.htm

HSMN, a leading ICD-10-CM/PCS consulting firm, is advising their clients of new revenue cycle opportunities.

Wellington, FL -- (SBWIRE) -- 08/27/2013 -- HSMN, a leading ICD-10-CM/PCS consulting firm, is advising their clients of new revenue cycle opportunities. They are predicting hospital and physician reimbursement will decline due to the PPACA but there are opportunities in reimbursement to regain the loss that may be missed if medical staff clinical documentation, coding and critical thinking coders don't interact in a seamless and symbiotic process.

Moody investors have recently said that hospital executives expect that "Exchange Health Plans" will pay rates that are close to Medicare rates which will be significantly lower than commercial ones.

Exchange plan reimbursement rates will place downward pressure on overall rates. HSMN has no direct knowledge of whether the Affordable Care Act will be hobbled by congressional action. What they are telling their clients is that by making health care networks narrower and only including lower reimbursement providers, some money will be saved.

"HSMN's recent work with several of our clients indicates that beyond the impact of the Affordable Care Act is the looming presence of the implementation of an entirely new clinical documentation and coding scenario which will further reduce revenue."

In HSMN's recent study of five hospitals, it found that largest category of rejection by their internal claims systems was the result of diagnoses and modifiers. The total was more than 85%.

ICD-10-CM/PCS will require exquisitely specific clinical documentation to support a correct diagnoses for claims purposes and coders who not only have had ICD-10 training but also lots of experience in working closely with the medical staff in order to create the appropriate procedure code.

HSMN suggests that physicians and management look beyond their coding systems and enterprise wide clinical records at the source of information and begin a process of demonstrating to the medical staff that they must translate their clinical decision making in a way that supports the incredibly difficult specificity of ICD-10-CM.

About HSMN
HSMN has been working with hospitals and clinical practices for almost 30 years helping them to transition to each iteration of reimbursement requirements. They have often heard that "as soon as our new system is installed and the XYZ company does their thing we should be in good shape. "

HSMN suggests that the astute administrator will look more deeply at current physician behaviors (through analysis) and show them how what they may do currently when translated into the ICD-10-CM world will lose money for both the hospital and their practice.

For more information please contact http://www.hsmn.com/contact-us HSMN or call us at: 866-908-4226.

For more information on this press release visit: http://www.releasewire.com/press-releases/release-3.htm

HSMN tops the list of Revenue Cycle Consulting firms in this current issue of Modern Healthcare magazine.

Wellington, FL -- (SBWIRE) -- 07/23/2013 -- For almost 30 years HSMN has worked with providers of healthcare in every setting from academic medical centers to Individual physician practices. The firm was founded by Cathy Idema, BSN, MPH in 1987 and has built a practice that encompasses seasoned healthcare financial, operational, clinical professionals and who represent every function within the revenue cycle. HSMN is pleased to announce that it tops the list of revenue cycle consulting firms in the current issue of Modern Healthcare Magazine.

HSMN is very proud of its record with medical staffs with clinical documentation and revenue improvements throughout the country. HSMN is not a vendor of software but rather a hands on consulting firm.

They work closely with the processes, workflows, organization, medical/clinical and administrative staff, and all systems in order to provide a comprehensive management plan that engages all who touch the revenue cycle and whose outcomes have been improved net revenue and fewer denials for all of their clients over the past 30 years.

HSMN is known in the industry for being completely transparent and straight forward with their clients. The principals of the firm are the ones who do the work and present the plan.

HSMN has encountered every issue in revenue cycle in every setting where the cycle was not performing to reach its financial goals. Their approach is not only about the "systems" in use but the structure, the roles, training, and whether staff use critical thinking skills when they spot anomalies.

So too with the medical staff who often have difficulty in using clinical language that matches things that are billable. HSMN has earned its reputation by building bridges between medical decision making events and the translation of those for optimum reimbursement.

Please contact us through our web site http://www.hsmn.com or by phone 866-908-4226.

For more information on this press release visit: http://www.releasewire.com/press-releases/release-3.htm

Wellington, FL -- (SBWIRE) -- 07/16/2013 -- HSMN announces a program called "Start Ten Plus ICD-10-CM/PCS Systems Analytics". Previous program announcements focused on preparing the medical/practice staff and the entire revenue cycle management team for the transition. HSMN has stated that unless the transition starts at the front end and at the source where the patient encounters and procedures are ordered, documented, and done, the most important aspect of the transition to ICD-10CM will be missed.

HSMN has published a handful of announcements regarding their ICD-10 transition programs with the most recent five being:

- Introducing the Start Ten Program for the Transition of Medical Staff to ICD-10-CM/PCS
- An Audit of Clinical Documentation Practices and Coding is the first step in a successful or transition to the world of ICD-10-CM for the Medical Staff
- Health Systems Management Network, Inc. Now Assists Hospitals with ICD 10-CM Training Through Online Training Programs
- HSMN Announces the Implementation of Web Based Training in Its ICD-10-CM Transition Programs
- Health Systems Management Network, Inc. Tells Clients to Prepare for ICD-10-CM Requirements Even with ACA Corporate Delay to 2015

"This information will help in filling in the gap on what we have recommended as the base for a successful transition. The next most important part of the transition is the detailed and analytic review of how systems are prepared for performing in the ICD-10 environment" states Theo Tarantini.

HSMN's approach to systems analytics is to categorize and prioritize various systems based on functionality. During the analysis they identify the systems that impact the revenue cycle, clinical informatics and HIMS processes.

Taking this approach, they look at systems readiness and adaptability to ICD-10. For example within clinical informatics; an area not immediately thought of in relationship to ICD-10 conversion, they determine if the test ordering systems, pharmacy and registries be able to accommodate the new code set.

Healthcare providers typically think of revenue cycle systems and HIMS systems when thinking about coding, sometimes forgetting about the role that coding plays in the flow of clinical information.

HSMN's 30 years of operational and clinical experience allows them to understand the interrelated functionality of the multitude of systems employed by healthcare providers of all types and sizes in the delivery of healthcare services.

The goal is to ensure that continuity and quality of patient care is not compromised when legislation brings about sweeping changes such as ICD-10.

About Health Systems Management Network
If you have not started to look at all your IT systems for ICD-10 readiness you are already late! We can help. Contact HSMN by phone 866-908-4226, website http://www.hsmn.com or email theo@hsmn.com for a consultation.

For more information on this press release visit: http://www.releasewire.com/press-releases/release-3.htm

Epic is a fine system and provides something clinicians have long sought but it can be a source of problems especially in coding and clinical documentation. Many clients have complained about claims sitting in queues for so long that they are missing filing deadlines or close to it.

Wellington, FL -- (SBWIRE) -- 07/15/2013 -- Many of HSMN clients have asked for help in solving the coding work queues that are accumulating in many organizations that have implemented enterprise wide systems such as Epic. Epic is a fine system and provides something clinicians have long sought but it can be a source of problems especially in coding and clinical documentation. Many clients have complained about claims sitting in queues for so long that they are missing filing deadlines or close to it.

HSMN has developed and worked with clients in taking over the correction of the coding issues and going back to the source to discover why there was a problem. HSMN has done thousands of cases and then provided a root cause analysis for each of the causes of the "Coding" "Clinical Documentation, Claim" error.

The errors are categorized and then the HSMN team goes to the source such as data collection, systems movement of data, clinical documentation in the record and finally the pure coding issues (needs a modifier" or no documentation to support this procedure.") and helps the organization fix the problems.

HSMN has been able to reduce the coding queues by almost 70% in the early stages of the engagement. Many of clients prefer that HSMN handle such claims on an outsourced basis until the claims are cleaned up and the problems which caused them are corrected.

HSMN will often work closely with the clinical staff and their support team to help correct the issues on the front end. HSMN often works with IT to put in the fixes that stand in the way of success. HSMN is particularly sensitive to IT staff and those clinical managers who helped build what is in the enterprise wide system and work closely with them to logic out the inconsistencies and the duplications and work flows.

The HSMN experience is vast in its work on these issues and we invite you to contact us to discuss such issues. The HSMN philosophy is not to find fault but to find the solution which include organizational structure, identified roles, workflow design, staff skills, training and understanding the history of the implementation.

Please contact HSMN by phone 866-908-4226, website http://www.hsmn.com or email theo@hsmn.com for a consultation.

For more information on this press release visit: http://www.releasewire.com/press-releases/release-3.htm

Wellington, FL -- (SBWIRE) -- 07/09/2013 -- HSMN announces that The White House's delay in implementing certain provisions of the Affordable Care Act does not change the need for hospitals and private practice to get prepared when it comes to making sure they really understand the need to be ready for ICD-10-CM/PCS requirements.

Hospitals and practice groups have argued that automation, enterprise wide systems, automated billing systems will somehow transport those who provide care into the new paradigm of ICD-10 compliance.

"While there are many technical details involved in transitioning claims management from ICD-9-CM to ICD-10-CM that automation will support, it will not replace the clinical judgment and decision making involved in a patient encounter nor the need for exquisitely pristine specificity in clinical documentation. The machines won't do that only clinicians and the revenue cycle management team can make that happen" says Theo Tarantini of HSMN.

Health Systems Management Network, Inc whose principals and staff are seasoned clinical, operational and financial professionals each with over 25 years of experience in every iteration of the hospital/practice coding and clinical documentation and claims management starting DRGs, MS-DRG's, APC's, bundled and every other form of reimbursement. In addition their client list encompasses the very best practices in the country.

In the almost 30 years since its founding HSMN has gathered the advice from the best clinicians in every discipline about clinical documentation and the best practices for engaging the medical staff during transitions to each iteration of coding and clinical documentation requirements.

"What we have learned is that there is a very large gaping whole between clinical thinking and the clinical language essential to making sure that claims are clean and paid. There is no magic, automation or educational materials that fill the gap" continues Tarantini.

Over a period of 30 years HSMN's proven technique has been to follow the logic of clinical decision making and build a bridge between that process and the documentation that supports the care.

HSMN does it in a way that is comfortable and familiar to clinicians in every discipline. It is done by working closely with them on a prospective basis to see how their cases evolve both clinically and documentationally. They also build a bridge that enables them to be more accurate in their professional fee billing.

We invite you to contact the ICD-10-CM team at Health Systems Management for a brief consultation on our methodology. You can find us on the web at http://www.hsmn.com or call us now at 866-908-4226.

For more information on this press release visit: http://www.releasewire.com/press-releases/release-3.htm

Wellington, FL -- (SBWIRE) -- 07/03/2013 -- Health Systems Management Network, Inc. announces the availability of web based training for ICD-10 transition programs. These programs are part of its "Start Ten Plus" programs which encompass the following elements: reviews of current clinical documentation and coding accuracy of the revenue cycle management team through its "Deconstruction Methodology", reconstruction of such cases by clinical discipline and roles in ICD-10-CM/PCS, and the presentation of such cases by key medical staff and revenue cycle team members to their peers.

Due to the many requests for HSMN's "Educational Videos", they have made these training programs available for their customers. Their web-based education is based on an assessment of how current clinical and revenue cycle management staff is doing with the current ICD-9-CM and procedure coding.

Once the assessment is complete and the gaps or issues found, then HSMN and the hospital staff work together to configure a presentation that will be meaningful to its members. The presenters are going to be recognizable to their peers and the issues raised will be done not by outsiders but by those on the clinical staff who have to improve clinical documentation and then learn the even more arduous specificity requirements of ICD-10-CM and PCS.

HSMN has learned in its thirty years of consulting, that physicians and clinicians are often too busy to sit at a didactic session that for them is often abstract. HSMN has found that clinical staff will relate to a real case, diagnoses, interventions and outcomes within terms they understand within their organizations.

Those who believe they can buy a video or presentation will find many on the Internet from wonderful companies. That is not what HSMN does. HSMN incorporates assessment, deconstruction, and reconstruction of clinical documentation in both the ICD-9-CM and ICD-10-CM. The basis for this approach has been developed after many consultations done and much advice provided by clinical staff members from many hospitals.

In HSMN's many engagements over the years, two comments always emerge from the clinical staff be they faculty or independent: "We are not like that other hospital you have mentioned" and "How do those other guys do it?"

The message is that the culture, history and practice values of the organization are the factors that contribute most heavily to the success of clinical documentation Improvement and transition to the new coding scheme.

HSMN thinks organically in working with Clinical and RCM staffs. Call us 866-908-4226 to discuss what you are trying to achieve or email theo@hsmn.com , website http://www.hsmn.com and we will work with you to make it successful.

For more information on this press release visit: http://www.releasewire.com/press-releases/release-3.htm

Wellington, FL -- (SBWIRE) -- 07/02/2013 -- HSMN's "Start Ten Plus" program has focused on clinical and revenue cycle management staff creating a clinical documentation, coding and claims continuum for hospital billing. In a recent article they announced HSMN's acquired technology to personalize an assessment of the current clinical documentation through HSMN's Deconstruction Methodology of ICD-9-CM and reconstruction into ICD-10-CM using active cases.

The benefit from having this process done internally using the organization's clinical champions and revenue cycle team leading the charge is that it has credibility for the rest of the clinical/practice team.

HSMN's program includes made to order internal presentations for each clinical discipline and each of them available on the web by staff members who could not attend a presentation that HSMN has equated to a "Grand Rounds" presentation.

In a community hospital setting such a presentation would include the care team and members of the revenue cycle management team. HSMN's new configuration includes the kind of technology that allows for interaction of this entire process by those attending and those sitting elsewhere.

Today HSMN announces that their "Plus" program includes the clinical staffs' professional billing components through the same process. It is clear from the OIG's (Office of Inspector General) that there is great concern that there is consistent overbilling for office or hospital visits supported by the reliance on electronic medical records.

Over the years many physicians have under billed because of fear of OIG scrutiny. So this is the time to assess where clinical documentation and coding are in individual/group/faculty practices and determine what is correct for the clinical discipline. This is a process that HSMN has used to help many individual/groups to get it right. While there are two sets of guidelines for E&M there is only one correct way of support to a level of care in either scenario.

HSMN proposes to work with large and small groups using our "Deconstruction and Reconstruction Methodology" for the ICD-10 transition with a view toward having these available for each practice in web based technology.

What is important to note about the HSMN methodology is that it focuses on both the clinicians and the practice management staff and can be used for training new partners or other staff. The cases that will be included will be familiar to the entire staff and will make learning a lot easier. HSMN knows there are many vendors selling educational products that are "canned goods". HSMN believes that clinical documentation improvement is a process that must be individualized and internalized, practiced and constantly reviewed.

Please contact us by phone 866-908-4226, website http://www.hsmn.com or email theo@hsmn.com and let us know what your needs are.

For more information on this press release visit: http://www.releasewire.com/press-releases/release-3.htm

Wellington, FL -- (SBWIRE) -- 06/21/2013 -- The Wall Street Journal recently published an article that expressed two distinct points of view regarding financial incentives for physicians. The first opinion was that some companies believe that it would be suitable to pay physicians based upon outcome because there are sufficient quality benchmarks in place to do this. The second opinion is supported by the Cochrane Collaboration's review which did not find any evidence that patient outcomes are improved by financial incentives.

According to Health Systems Management Network Inc. (HSMN), "When payment is based upon performance it can lead to a reduction in the quality of care that a patient receives because this contributes to a non-optimal mentality on the part of the doctors. Adding a financial incentive into a doctor's considerations can shift that doctor's attention away from where it should be focused."

HSMN has been providing healthcare consulting services for 30 years and their experience in helping facilities improve reimbursements and patient care is nearly unprecedented. One of the common problems that they have found is that clinicians do not have the proper metrics to measure their own performance despite their genuine desire to help their patients.

The electronic medical record has played a large role in improving the scenario, but this still has not yet solved the issue of measuring performance. Many clinicians are still relying on patient feedback as a primary method of measuring performance and success.

HSMN believes an even larger issue that clinical practices often face is the lack of accurate clinical documentation that allows them to receive proper reimbursement. HSMN has examined data from hundreds of different practices throughout their 30 years of operation, and a representative from the company recently stated that physician practices that had a strong focus on improving clinical documentation were able to increase their physician practice reimbursements by 5% to 10%.

It should be noted that this increase did not come as a result of purchasing new billing software or utilizing the electronic medical record, but rather from careful analysis and improvement of clinical documentation. This is the main key to success. However, the needed improvements cannot be achieved without a staff that has been properly trained. The physician/clinicians must take it upon themselves to ensure that the staff truly understands what they do in order to see clinical documentation improvements.

There are several options that can be considered logical with regards to addressing the issue discussed above. HSMN frequently recommends that staff members should be hired who have the appropriate coding certifications and are also capable of doing chart reviews about the documentation in addition to the coding. There are many clinicians who want to do their clinical work as their own boss rather than feel as though they are owned by anyone. In those types of scenarios, the programs that are endorsed and implemented by HSMN have proven themselves to be extremely beneficial.

About Health Systems Management Network
HSMN was formed in 1987 and continues to be a leading hospital consulting and health services management company. Their client list includes hospitals, medical practices, medical staff and clinical departments of large academic medical centers throughout the country. Core services are revenue cycle management, clinical documentation consulting, ICD-10 implementation and post Epic workflow consulting.

Contact Information
Phone: 866-908-4226
Email: theo@hsmn.com
Website: http://www.hsmn.com

For more information on this press release visit: http://www.releasewire.com/press-releases/release-3.htm

Wellington, FL -- (SBWIRE) -- 06/14/2013 -- Hospitals that received a federal bonus in 2011 and 2012 were sent surveys to confirm compliance with "meaningful use" but some of the survey pertained to how clinicians document and code their services. There is no free lunch when it comes to CMS and the almost 18 billion dollars in additional reimbursement paid to hospitals and their medical staffs as a result of meeting "meaningful use" requirements. The implementation of electronic medical records makes it much easier to cut and paste documentation from one visit to another, resulting in a higher E&M level contributing to the increase in physician reimbursement. CMS and HHS have warned that "High Tech" fraud will be prosecuted. HSMN's coding and ICD-10-CM implementation team of consultants assist hospitals and physician practices with these new coding challenges.

Some have pointed out that ICD-10-CM is more voluminous, with a more complex set of diagnostic codes that require more granular documentation of patient encounters with specificity hitherto unknown in the medical field. Likewise, procedure coding under ICD-10-PCS requires choices to be made on the basis of evidence and then a construction of a code.

HSMN has been working with many clients who now have an electronic health record (EHR) and where the claims for encounters are finding themselves in work queues that are established in-house as part of the electronic system. These work queues have grown exponentially to the point at which outside coding staff is brought in to fix the coding issue so that the claim can be processed. However, the problems don't go away because the "Root Cause" of the problems is not addressed.

Health Systems Management Network, Inc. was recently asked to assume responsibility for clearing up the work queues related to coding issues. HSMN made it clear that it would identify the problems, categorize them, and provide the hospital with the information to begin a process of getting at the root causes of the coding issues.

The graph and chart that follow display a categorization of the identified coding issues. And because the coding is done by highly trained and certified ICD-10-CM trainers, HSMN has been able to work with its client in going to the front end and the back end to begin fixing the problems of the work queues.

The OIG sees the electronic health record as the most fertile ground for recovery of Medicare and Medicaid reimbursement. When ICD-10-CM becomes effective in 2014, it will be easier for the auditors to find fault with the previous "cut and paste" documentation. The real question will be, "What did you do for the patient today?" Were you specific in the diagnostic documentation requirements, and the interventions?

HSMN has added a program in its arsenal to address three problems related to coding: They clean up the work queues, identify root causes for the coding problems, eliminate or reconfigure the work queues and use the information derived from the HSMN intervention to begin preparing both the electronic health record and the medical staff for the coming of ICD-10-CM. The program is called Work Queue Intervention and Preparing the System and the Medical Staff for ICD-10-CM for October, 2014.

Please visit our website http://www.hsmn.com, contact us by phone 866-908-4226 or email theo@hsmn.com for a consultation.

For more information on this press release visit: http://www.releasewire.com/press-releases/release-3.htm

HSMN, Inc. Creates a Program for Resolving the Conflict between Integrated Care and Clinical Documentation in the ICD-10-CM Transition.

Wellington, FL -- (SBWIRE) -- 06/13/2013 -- In a recent article written by Cathy Idema, BSN, MPH, FAAHCC, Ms. Idema discusses the conflicts which exist between clinical decision making and the demands of the clinical documentation in the ICD-10-CM transition era beginning in 2014.

Based on research done over a period of 30 years on clinical documentation and work with hundreds of clinicians, HSMN introduces a new program based on data from its extensive work with them in every possible setting.

The program is called "The 2014 Clinical Documentation Paradigm". There is no black box nor is there software or a magic bullet. This is a process/program bringing the medical staff to an intersection where integrated patient care meets integrated clinical documentation.

The program begins with an analysis of the current clinical documentation using patient specific criteria which are applied to every clinical discipline: what is the working diagnosis, what are the interventions; which are working and which are not? What is the status of patient problem list?

These are some of the criteria applied to the communication provided by each team member. Does a picture of the patient emerge clearly? Do we understand the management plan and each participant's role in addressing the patient problem list?

The next step parses or deconstructs the clinical documentation in a way that allows for a judgment as to whether it will support a clean claim for the actual services rendered. Was the documentation able to be translated into current and correct coding? If not, the parsing is used as a teaching tool to link the clinical decision making to the correct supporting documentation.

"In 30 years of experience, we've often heard two phrases spoken by clinicians: 'Cookbook medicine' (related to both clinical documentation and clinical pathways) and 'Coders never went to medical school'" said an executive at HSMN.

"In our process the physician becomes a teacher and the coder becomes the technician on clinical documentation. In our process we use live cases because it keeps everyone's attention especially in a teaching hospital."

The "live" case is reconstructed in ICD-10-CM/PCS language and coding and then presented by the lead clinician and lead coder. This entire process requires time with clinicians in all disciplines in order that a greater understanding is gained of what they do clinically. The coder is made a part of the team so that they can follow cases and have a better sense early on about the final diagnoses and procedure.

HSMN has worked with hundreds of physicians to successfully create a program and knowledge transfer to the hospital/practice staff. The lead people become the trainers in each clinical discipline. HSMN believes that only through knowledge transfer over a period of a few months with many cases being parsed can the clinical staff become comfortable and successful with ICD-10-CM Clinical Documentation requirements. This is the new Paradigm.

Please visit our website http://www.hsmn.com, contact us by phone 866-908-4226 or email theo@hsmn.com for a consultation.

For more information on this press release visit: http://www.releasewire.com/press-releases/release-3.htm

Wellington, FL -- (SBWIRE) -- 05/30/2013 -- HSMN's clients are asking what new system they should be using to help with the transition of their revenue cycle management team to the ICD-10-CM/PCS environment. There are many systems whose vendors have done a great job in creating innovative and accurate systems. There is only one problem: culture, history, and practice values of the organization must be the basis for creating the specifications for the purchase of any new system to support the revenue cycle.

Understanding clinical practice documentation, communication between and among each part of the revenue cycle and the culture of the organization must be the first consideration in choosing.

If the medical staff is having difficulty with the specificity essential to ICD-9-CM and the coder/biller teams are redoing work and sending many inquiries to the medical staff about documentation, then some intervention is essential. It must start with an assessment of the quality of documentation done by each of the clinical disciplines. Without that diagnosis, it is impossible to find systems.

The next most important item is to have clinical leaders partner with the coding/clinical documentation specialists in deconstructing documentation of current active cases to determine where the strengths and weaknesses are. Once deconstructed, the coder and clinical team must look at where and why the gaps occur.

HSMN's experience is that often there is no bridge between the "Clinical Decision Making Mind of the clinical person" and the essential need to document in a way that supports the care. For over 30 years HSMN have worked with clinical staff on every iteration of coding and it has found that clinicians resent being told how to document by coders or anyone else.

Even with the "Build" that occurs with the enterprise wide systems such as Epic and others, large gaps exist. So the medical staff and each component of the revenue cycle management team must create a bridge that all can cross together. How does an organization accomplish this after so much effort has been placed in "building the system"?

HSMN believes it begins when everyone on the team looks at "live" cases to understand what is going on clinically and then focuses the clinical decision makers on how to use the logic of ICD-10-CM.

The truth is that while some have called the specificity of the new system absurd, in reality the best clinical practices are built upon specificity. So there is where the bridge must be built. Together the revenue cycle/coder/clinical team must reconstruct the active case with the specifics. This must be an ongoing exercise.

Then each and every member of the revenue cycle team must also learn from first contact with patient how specific and correct data collection must be. Thus the new paradigm not only affects the clinical documentation but the way each of the members of the RCM team relate to the events of the patient encounter.

HSMN is not only focused on the specificity but also on integration of documentation so that everyone on the team understands what is going on clinically. The goal is to focus on the patient, the patient problems and to clearly express both in the clinical language and the translation of the clinical event into a claim that can be paid.

For many years HSMN has worked in reorganizing not only the structure of the revenue cycle team but the way it thinks about clinical care.

Please call us 866-908-4226 or email us at info@hsmn.com so that we can share our Teams' knowledge perhaps help model some of the processes we have described. For more visit- http://www.hsmn.com

For more information on this press release visit: http://www.releasewire.com/press-releases/release-3.htm

Wellington, FL -- (SBWIRE) -- 05/29/2013 -- Many of Health Systems Management Network's (HSMN) clients have asked what systems they should buy to transition to the ICD-10-CM /PCS coding in 2014. HSMN's answer and one that has been given over a period of 30 years is "It's the clinical documentation Mr. CFO".

Every hospital's clinical staff, and particularly individual clinical disciplines, has their own cultures, traditions and clinical training which often are at odds with clinical documentation requirements. The clinical mind, the one bringing together all of the clinical data that makes clinical decisions is the number one computer that matters.

HSMN advises its client hospitals and their medical staffs to audit their own clinical documentation practices because the best set of specifications for whatever systems are going to be introduced to the hospital are the ones determined by clinical practice.

How does the CFO or CEO get an entire staff to agree on a system? HSMN's experience has been to collect the clinical practice documentation from every clinical department and do an audit of both the clinical documentation and the final claim in order to determine how close the supporting documentation matched the final claim discharge diagnosis and the basis for payment.

The first part of this exercise tells the organization how well they are doing or not doing under the current ICD-9-CM with specificity and accuracy through parsing and documentation deconstruction. The second phase is to reconstruct active cases into ICD-10-CM.

These exercises engage the medical staff in looking at how they practice, how they document and how well they will do under ICD-10-CM. In some hospitals a performance metric is assigned by the clinical department to see how many of a clinicians encounters are denied or rejected on both the hospital and professional fee side.

Hospitals tell HSMN that they have already invested a great deal of money in coder training and systems and are cynical about doing more. HSMN has been very successful in working with the medical staff who are the key to success in the new coding environment.

It must be mentioned that the exercises described above involve partnering with the coding staff who have much to learn about the content of clinical practice. HSMN is well known in the industry for pioneering "Role Modeling" for these exercises, which are then transferred to the hospital and its staff.

"There is no black box that can fix poor clinical documentation practices. Improvements have to be internalized and champions on the medical staff or practice leaders must take ownership of this process on a continuing basis" says Theo Tarantini of HSMN.

They urge potential customers to call them so that they can share the ways in which they have helped many client hospitals and practices improve their clinical documentation and coding.

Please contact our offices by calling 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. To know more visit http://www.hsmn.com

For more information on this press release visit: http://www.releasewire.com/press-releases/release-3.htm

Wellington, FL -- (SBWIRE) -- 05/23/2013 -- Health Systems Management Network, Inc. has announced that it has enhanced its clinical documentation and coding audit division to include a full staff of certified hospital coders, who are also ICD-10-CM/PCS trainers, to support our clients in handling, overflow, training and the re- coding of accounts that require corrected coding for claim submission.

HSMN has the capability of taking on large projects in which hospitals find themselves with high volume work queues consisting of accounts whose documentation and coding need to be reviewed as a result of failing claim edits.

HSMN is supporting a number of clients who have had an explosion of work queues after the implementation of enterprise wide systems such as Epic. While Epic has been a great improvement for patient care there has been much fall out of claims which need to be reworked in order to produce a "clean claim."

HSMN also retains a full staff of certified professional fee coders who have experience with coding for large practices and faculty of academic medical centers. In addition, HSMN has a staff, which for years has worked with medical staffs on clinical documentation improvement and Integrative coding. These skills are vital to their engagements with hospitals that need expert assistance preparing for the ICD-9 to ICD-10 transition.

The HSMN staff, in all of their divisions, has a depth of experience that has allowed the company to educate medical staff, improve coding and clinical documentation resulting in a gain in net patient revenue for their clients.

Many of their clients such as The University of Michigan have referred to their work as having been a "phenomenal" success with benefits lasting past the completion of the engagement.

When the HSMN coders are doing what has become known as "Outsourced Coding" it is done well and provides feedback to their clients on the quality of the clinical documentation and coding.

While HSMN cannot refer to this process as auditing, what they can say is that the experience and integrity of the coding/clinical data staff helps provide insights for the clients who make their clinicians better at clinical documentation and the coder much improved in understanding the clinical substance.

Please contact their offices by calling 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.releasewire.com/press-releases/release-3.htm

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.releasewire.com/press-releases/release-3.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.releasewire.com/press-releases/release-3.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.releasewire.com/press-releases/release-3.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.releasewire.com/press-releases/release-3.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.releasewire.com/press-releases/release-3.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.releasewire.com/press-releases/release-3.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.releasewire.com/press-releases/release-3.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.releasewire.com/press-releases/release-3.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.releasewire.com/press-releases/release-3.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.releasewire.com/press-releases/release-3.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.releasewire.com/press-releases/release-3.htm