Health Systems Management Network Unveils The Ultimate Diagnostic Billing Tool – Help Is On The Way for Hospital Billing

Health Systems Management Network, Inc. has created a diagnostic tool that will assist hospitals in unearthing problems in their billing systems. The diagnostic tool has been built for use by hospital, clinic and physician practice personnel in order to be involved in the actual work of uncovering flaws in the system. These flaws could be attributable to people functions, organizational structure, or even provider use of feeder systems such as Cardiology, Radiology and Oncology.

The purpose of the HSMN’s Diagnostic Billing Tool is to provide hospitals with internal intelligence using a methodology that has had a proven positive impact on hospital revenue in large organizations. Health Systems Management Network brings its 26 years of experience in this arena of hospital billing and partners with hospital staff so that such staff can stop looking at what they always see but uncover what isn’t there.

Perhaps this sounds a bit different to many, but the idea of looking at hospital billing as a continuum that flows through revenue cycle and is touched by everyone on the clinical and administrative financial side, rather than isolated and as silo events, gives an entirely new perspective from front end to back end. The medical staff is also engaged in this process as they are asked to help with the deconstruction of encounter events which may have bearing on final outcomes of revenue.

The issue with most large organizations, and even smaller ones, is the tendency to compartmentalize functions and even centralize functions in a way that appears to create superficial efficiencies. The HSMN Diagnostic Billing Tool (DBT) has been built on the basis of working with hospital staffs across the country that has helped to pioneer the approach. The best part of this work is that there is a knowledge transfer that can always be used in the organization.

The elements that drive DBT include structural, data, systems, people, organization and redefined financial objectives based on a consensus of goals. Clients have told us of the joy of gaining a great understanding of how their organizations really work and why they were able to gain important revenue improvements even in the current challenging reimbursement environment.

To reach Health Systems Management, visit us on the web at or call us at 866-908-4226.


CMS has released the final rule that creates new Criteria for meeting the standards under Stage II of funding for those using an Electronic Health Record and are hoping to qualify for additional compensation in this stage. It should be noted that the Office of the National Coordinator for Health IT also issued a companion Final Rule that establishes certification criteria, standards and implementation specifications.

The final CMS rule contains 19 measures for hospitals and 20 measures for physicians. New core objectives have been added:

  • One requires that physicians use secure electronic messaging to communicate with patients about health information;
  • The other requires that hospitals track medications using the technologies that complement an electronic medication administrative record.

Additionally, the final rule changes the definition of hospital-based physicians, creating an application process for physicians to demonstrate that they are eligible to receive incentive payments directly.

Stage II meaningful use requirements will begin in 2014. These final rules have been published in the Federal Register on September 4th.

So many physicians are so overwhelmed by patients that the burn out rate is very high among active practitioners according to a recent article in the NY Times. So the question is “Is it worthwhile to spend the money and time to have an Electronic Medical Record just to reap the meager rewards being offered by the Federal Government. The answer should be that if an Electronic Medical Record adds value to a practice and to patient care, it should be considered. Many practices are discouraged by the amount of administrative time, the investment in infrastructure and training of staff to use the Electronic Medical Record.

There are many practices surviving without it. However in the near future a measurement of outcomes will be the basis for reimbursement. One might think that that idea is well in the future but it is not. Some Commercial payer and other health plans are giving consideration to such programs. But even if that were not a consideration, Practices should be thinking about how many patients they have on their panel; how many have chronic diseases and which ones. How is follow up being conducted to assure these patients are doing well. Of course the only way to measure and track that information is by keeping electronically. Is that a good reason to have an Electronic Medical Record? It is certainly a consideration but foremost is the consideration; does this help me manage my patients better.

In many articles written by physicians in family Practice and medical practice management the consensus seems to be that it takes more time and thus doesn’t add value. But when, for instance, you have a patient with a chronic disease, it might be important to trend the results of past studies to see where the patient has been and how well new meds are helping. The real value of the Electronic Medical Record specifications is that it has to be a tool very much like a diagnostic one. It has to help if it means spending more time doing the data entry. So the incentive cannot be just the possibility of a very little increase in reimbursement but rather a substantial increase in the efficiency of patient management and the ability to communicate information about the patient population you serve.

These are the issues that should be considered along with size of practice, the kind of discipline, the number of offices and the connection to the Hospitals system to obtain results from studies done in that setting.

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Contact info:  HSMN, 2194 Country Golf Drive, Wellington, FL 33414

Health Systems Management Network Unveils The Ultimate Diagnostic Billing Tool – Help Is On The Way for Hospital Billing