Wednesday, July 17, 2013

Helping Decode the Business of Healthcare IT: One Blog Post at a Time

A couple of years ago I made a pledge to myself to make a blog post at least 4-5 times a month. But blogging on a regular basis takes focus and dedicated effort; and due to some major new, positive events on the work and home front, I’ve not made the time needed to work this blog. 

Today I’m starting at it again. And I credit @HealthBizDcoded for providing this post as the inspiration to get me going again.  Being listed along with some real health IT blogging pros has incented me to clean up my act and get back at it.  Thanks @HealthBizDcoded!

In addition to continuing a focus on ICD-10, I plan to offer information and opinion on the IT and service-related aspects on the topics listed below.  Why?  Because these are the primary areas I’m involved with and focus on every work day (and many weekend days too).

Medicare Advantage Rollout
Project to begin offering a MA plan - addressing the IT aspects including eligibility/enrollment aspects, provider network and covering providers, referral capabilities, care management aspects, EOB’s, and product financials.

Medicare Stars Measures
Collecting various data points, interfacing to 3rd party vendor for measure calculations and receiving actual measures and reports.

Medicare Advantage EOB
Project to provide a new explanation of benefits complying with new format requirements.

Risk Adjustment & Reporting  - Edge Server and 3R’s
Project to deploy the Direct Data Entry (DDE) Edge Server mandated by CMS. Includes services to address provider contracting and incentives, suspect identification and outreach, chart review and HCC coding, member outreach and medical risk management and interfacing to various vendors.

Coordination of Benefits Agreement (COBA)
Project to improve the way eligibility and Medicare claims payment data within a claims crossover context is exchanged.

Accountable Health System
Project to rollout IT and services infrastructure to support an Accountable Care Organization (ACO) including provider network and referrals, provider channeling, Capitation payment and risk sharing, and medical/care management tools.

The original topic that got me started in blogging: ICD-10.  I’ll continue a focus on testing, implementation and post-implementation topics.

So if you’re interested in the IT and service-related aspects of the above aspects of healthcare, check back here a few times each month for more information.  You can also get more of the same by following me on Twitter at @ShimCode

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