Healthcare administrators and providers are implementing new Health Information Technology (HIT), or transitioning to new and more robust HIT solutions to meet the multitude of legislative mandates for aligning health services with payment equity. These ever-evolving, fast-paced information systems are intended to optimize patient-centered coordinated care.
Healthcare providers and administrators often face challenges when developing protocols to navigate the various health insurance coverage, program operations, and payment rules found in Medicare, Medicaid, and the Affordable Care Act (ACA). Rules for delivering patient care can be lengthy, confusing, and are often not fully captured during follow-up and billing cycles. Additionally, healthcare providers may not have sufficient resources and skills to successfully develop integrated solutions to meet the needs of our evolving health systems.
Successful HIT systems often require the guidance of outside experts to ensure that those systems properly integrate care coordination with revenue management, and capture the performance measurement for quality and payment. Even more burdensome are the quality assurance and risk management practices that must be in place to ensure that HIT systems create the proper balances among patient-centered care, health outcomes tracking and measures, and payment accuracy.
As a healthcare management consulting firm, ARDX provides exceptional business processes and solutions to help healthcare organizations meet compliance requirements for patient-centered care and payment accuracy. Our business model includes staff experts in health care administration to best support client needs for administering government and private healthcare programs in accordance with regulatory policies, including Affordable Care Act, Medicare Parts A-D, and MACRA.
Contact ARDX to learn more about our integrated HIT business solutions:
- Healthcare Operation and Payment Support (Implementation and Ongoing) including regulatory watch business process models and operating plans operational knowledge of best practices for implementing healthcare legislative requirements system and data support service and payment cycles and internal controls testing plans.
- Education and Outreach Services including technical assistance tools physical and virtual training services and policy guidance development.
- Program Oversight and Evaluation including innovative data modeling healthcare payment and quality evaluations cost-benefit analyses oversight , compliance, and monitoring plans and operations audits.
About the Authors
Lateefah Hughes, DrPH, is Senior Health Policy Implementation Advisor and Chair of the ARDX Healthcare Expert Advisory Board. Dr. Hughes is also the Former Acting Deputy Director of Payment Policy and Financial Management and Director of the Division of Risk Adjustment Operations at the Centers for Medicare & Medicaid Services, Center for Consumer Information and Insurance Oversight (CCIIO). She has been instrumental in the development of policy and operations payment policies for Medicare Part C, Medicare Part D, and Medicare Risk Adjustment Data Validation.
Cecilia Prela, PharmD, is a retired United States Public Health Service (PHS) Pharmacist and an expert on health care delivery and payment systems. Dr. Prela is an independent pharmacist and a healthcare programs consultant on the ARDX Healthcare Expert Advisory Board. She was instrumental in development and implementation of the Competitive Acquisition Program for Part B Drugs policy, the Medicare Part D Plans performance metrics, and Medicare Part C & D Risk Adjustment payment models at the Centers for Medicare & Medicaid Services.