Articles & News

MACRA hidden impacts – removal of SSN from Medicare cards

A little publicized change to Medicare beneficiary cards could mean big headaches for providers who aren’t prepared.

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If healthcare is so expensive, why are so many hospitals running on such thin margins?

From CIO.com: Paul Bradley explores the role of technology in ensuring the financial sustainability of hospitals and health systems.

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Reflection on CDI

National ACDIS CDI week is an ideal time to reflect on the accomplishments and trajectory of our profession. It’s also a fitting opportunity to formulate a strategy to continue our development and expand our ability to be a driving force in the transition to the fee-for-value model. Continuous quality improvement is the foundation for success in any business—and the business of CDI is certainly no different. We must not rest on our laurels or lose sight of where the marketplace is heading in the field of healthcare.

Continuous quality improvement can be defined in myriad ways; in the case of CDI, continuous quality improvement incorporates a change in mindset as the fundamentals and structure of chart review performance. Proactivity is the name of the game as the marketplace shifts from volume-based fee-for-service to value-based healthcare delivery models.

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The Tyranny of the Three I’s: Incomplete Information, Inaccurate ICD-10 Coding and Insufficient Documentation

It’s not exactly a secret that the transition from fee-for-service to value-based care has caused a lot of headaches and heartaches among CFOs and revenue cycle professionals at hospitals and health systems. It isn’t so much the destination that worries them; it’s surviving the journey that keeps them up at night.

As we’ve discussed before, one way to offset the loss of revenue from services is to do a more competent, thorough job of coding and billing overall—so you can alleviate unnecessary, avoidable self-inflicted denials. After all, just because you bill for something doesn’t mean you will be paid for it – and even if you are, that doesn’t mean you’re safe from financial recoupments!

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Lessons on Reinvention From HFMA ANI in Las Vegas

With HIMSS having been in Las Vegas only four months prior, many HFMA attendees could be forgiven for believing it was déjà vu all over again. But far from being a mere reboot, HFMA’s ANI represented a timeless Las Vegas theme: reinvention.

Recent re-branding and renaming initiatives, for example, solidified new identities through their presence at the conference. Beyond this straightforward form of reinvention at ANI, there was a clear trend that speaks directly to a shifting health care landscape, namely: vendors moving firmly beyond traditional core competencies and into aspects of health care financial management previously only orbiting their foundational identity.

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Revenue Cycle Management: Costs and ROI

As a provider, if you had the opportunity to improve the effectiveness and efficiency of your Revenue Cycle Management system in the biggest possible way while exerting the smallest amount of effort, you’d jump at it, right?

Well, great news! That can be accomplished as long as you know where your efforts will have the highest payoffs. In other words, know exactly where you are spending the most amount of money trying to get payments from both patients and payers.

Read more to find out three ways to best identify where attempting to get paid is costing the most money.

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Expanding the Role and Framework of CDI

Clinical documentation improvement specialists play a vital role in the hospital revenue cycle world. When one refers to “CDI,” what inarguably comes to mind is clarification of diagnosis, whether it be primary or secondary diagnosis, HACs or present on admission indicators. Our main goal is to ensure documentation of any and all clinically relevant diagnosis to the extent we can truly insure the record reflects and reports an accurate representation of patient severity of illness and risk of mortality in support of communication of patient care as well as ICD-10 code and MS-DRG assignment. Given the current business environment of healthcare with increased competiveness from other hospitals and healthcare facilities—as well as the aggressiveness of third-party payers to question the medical necessity of delivered services and propensity to deny payment—how can clinical documentation improvement specialists more closely align and integrate our role with the goals and objectives of the hospital revenue cycle?

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Healthcare reform, value-based pay bolsters credit ratings, for now, experts say

Sean Cassidy is featured in this article talking about the credits and ratings implications of the shift from fee-for-service to value-based care, and how to lower overall cost of care.

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Weather or Not: Thunderstorms and Healthcare Predictive Analytics

From CIO.com: Paul Bradley investigates the parallels between atmospheric science and healthcare predictive analytics.

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Making Analytics Actionable—and Meaningful

Ric Sinclair takes a deep-dive into healthcare financial data—and explores strategies to solve the Rubik’s Cube that is healthcare data analytics.

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Unlocking the Benefits of ICD-10 Through Data Analytics

Will ICD-10 bring with it the expected benefits of a more granular codeset? That all comes down to how the healthcare industry uses the data, and how effectively healthcare professionals measure and maximize the benefits as they realize them. ZirMed’s Crystal Ewing explores the challenge in a guest article for the Journal of AHIMA.

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Applying the Zappos model to healthcare

Organizations of all industries can learn from the Zappos model. In this post we talk about how to apply the Zappos model to healthcare.

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Optimizing Your CDI Program

The ultimate (and ultimately most beneficial) starting point for a CDI transformation may be to visit your denials and appeals department and ascertain the magnitude and volume of denials and down-codes resulting in lower reimbursed DRGs from all third-party payers as well as CMS contractors—based on clinical validation, medical necessity, and alternate principal diagnosis selection.

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Three common documentation mistakes you can help fix

Documentation can be a headache for everyone, from the physicians who have to take precious time away from patients to document in the EHR to the case managers who have to track the physicians down to fill in gaps when information is missing from the medical record.

At the completion of this educational activity, the learner will be able to identify some common documentation errors and then learn how to correct them.

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How Contract Modeling Could Reshape the NFL—and Help Hospitals Succeed

Ahead of the NFL draft, Paul Bradley illuminates how data-mining and predictive modeling could level the playing field during contract negotiations.

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Information Governance and the New Bottom Line

Stacy State explores how information governance is underpinning the new realities of value-based care.

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CDI – Do You Know Your True Return on Investment? Maximizing ROI through Effective Integration with Revenue Cycle Management

Clinical documentation improvement programs are ingrained in the majority of hospitals’ operations, serving primarily as an operational process to enhance and increase financial reimbursement to the hospital through documentation of clinical specificity. Measures of process outcome successes and return on investment (ROI) are fixated on clinical documentation improvement specialist’s effectiveness in querying physician’s for additional clinical specificity that translates into the capture of comorbid conditions/major comorbid conditions and principal diagnosis selection.

The outcome this effort is improvement in MS-DRG case-mix and subsequent increases in reimbursement for all inpatient services provided, coded, and billed. In large part, ROI for CDI is calculated based upon costs outlays for external CDI consultants to build and guide your CDI initiatives, labor and benefits for CDI staff, ongoing training of CDI staff, and Clinical Documentation Improvement Software that might be licensed to maintain and keep track of CDI outcomes.

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Final Four: March Madness Data Lessons

Dr. Paul Bradley dives into what March Madness can teach healthcare CIOs and other technology leaders about data mining.

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HIMSS16: Let’s Talk About what Happened in Vegas

For those who attended HIMSS 2015 in Chicago, the difference at HIMSS this year was visible in vendor messaging and audible in conversations during the conference. Among all attendees the optimism seemed well founded, grounded in reality. We all see significant opportunity to drive improvement in healthcare for our generation and generations to come. That’s why we came to HIMSS – we’ve placed our bets.

In that spirit, let’s talk about where healthcare is doubling down, where it’s hit a perfect blackjack, and which trends pushed as providers look for the next deal.

Read Jeff Kaplan’s full article on Electronic Health Reporter here.

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Modeling Complexity: Iterative Risks and Opportunities

For all your Star Wars fans: Dr. Paul Bradley explores the implausibility of single points of failure—and what the Rebel Alliance can teach us about risks and opportunities hiding in the data.

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Overcoming Practice Management Challenges

ZirMed’s VP of Operations, Ken Edwards, explores practical strategies for addressing the most persistent practice management challenges—so that providers can focus on their core mission of caring for patients.

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Predictive Modeling and Associated Prescriptive (Re)actions in Healthcare

From CIO.com: Paul Bradley explores how understanding how playing pinball can be applied to the greater context of healthcare predictive modeling.

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Unbalanced Data: Finding Rare Needles in the Haystack

ZirMed chief data scientist Paul Bradley shares strategies for overcoming the challenges of rarity in data mining.

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The Consumer Realities of Uncompenstated Care

In a guest blog post for HFMA, ZirMed VP of Product Ric Sinclair shares how the shift toward consumerized healthcare is reshaping the sources of—and solutions to—uncompensated care.

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Applications of Predictive Analytics in Healthcare

Looking ahead at 2016 and beyond, two major applications of predictive analytics in healthcare stand out. These two big-picture categories exist independent of care setting—meaning they are just as true for new-to-market retail healthcare clinics as for established hospital and health systems.

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The dynamics of expectation in patient collections

The patterns of patient collections can often seem difficult to predict, largely because there are factors in play – externalities, to borrow the language of economists – that simply don’t exist in other sectors of the American economy.

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How the Bass-O-Matic explains predictive analytics

Imagine a place where the process of catching a bass is automatically and irrevocably determined by a machine. Sounds good, doesn’t it?

Of course not.

Thankfully, no one in the field of predictive analytics is talking seriously about omnipotent bass-fishing apps that rule our waking lives. Rather, what data scientists are developing is analogous to apps that alert you to the right bass-fishing opportunity on the right body of water at the right time—an opportunity you can choose to take advantage of (or not take advantage of).

As has been said before, we need not fear the Bass-O-Matic 2.0—we need only be the masters of its development.

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Everything’s Different; Nothing has Changed

Now that ICD-10 is here, we can finally set aside the lingering debate about whether the change would occur in our lifetimes—or ever. We can begin to see the pay-off of months and years of training and preparation—and we can look forward to fewer articles about “truly bizarre” ICD-10 codes.

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Predictive modeling and the elusive 1–2 percent

Amidst the multiple major changes occurring in healthcare today, there is a persistent theme across conversations in healthcare boardrooms and executive offices:

“We know we’re leaving money on the table.”

To say there are dozens of instances when hospitals are uncompensated or underpaid for the care they provide is laughable. There are thousands.

These opportunities are scattered across millions of claims and tens of millions of potentially relevant patient-, procedure-, and provider-level data points. The only way to uncover them is through data-mining and predictive analytics – and it is increasingly vital that they be uncovered.

For hospitals, these hidden opportunities translate to millions of dollars a year – in the realm of charge-capture alone, hospitals on average leave 1–2 percent of net revenue on the table. Yet even the traditional processes for preventing and capturing more of this net revenue can drive up costs – and are almost impossible to optimize without machine-learning and predictive modeling.

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Effective big data visualization starts with simplicity

Big data analytics offers lots of opportunities to visualize data for business users. But analysts have to be careful not to overload big data visualizations with too much information.

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Maximizing the value of ICD-10

This is a moment in healthcare when we are laying the foundation for new capabilities, new precision, and new operational enhancements for healthcare organizations. If you embrace it–and if you lead your team to focus on maximizing the benefits of it–you will also be keeping your organization on the crest of the key major changes taking place in healthcare today.

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ICD9 to ICD10 Transition Tips

The path to transitioning to ICD-10 to minimize practice disruptions and claim denials will not be easy. Check out our nine tips below!

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Guiding strategies for keeping acquired practices profitable

As hospitals and health systems acquire independent practices, they must strike a delicate balance – strengthening business operations without disrupting the day-to-day work of staff and the experience that patients are accustomed to.

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Glimpsing the Far Side—How Healthcare Organizations are Applying Predictive Analytics

Anyone who works in healthcare—or who has pondered, even fleetingly, how it differs from other sectors of the American economy—likely won’t be surprised to hear it’s the final frontier for predictive analytics.

For indeed, while predictive analytics has long since reshaped retail, shipping & logistics, and even national security, healthcare—to draw an imprecise but nonetheless illuminating comparison—is still in the throes of transitioning from paper to electronic records.

Given this disparity, it’s natural to wonder how established forms of data science are reshaping healthcare, particularly for hospitals and other large healthcare organizations.

Dig a level deeper and it becomes more interesting still. The volume and velocity of health data continue to increase due to government-mandated adoption of electronic health records (EHR) and similarly mandated sharing of data among healthcare providers. The latter might not sound so challenging, but in fact it’s a hot-button issue—the most recent government efforts are squarely focused on countering obstacles to interoperability among health IT vendors.

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Y2K, ICD-10, and What Office Space Got Right

With ICD-10 just two months away, the question I’m asking providers is this:

When was the last time you watched the 1999 American comedy Office Space?

Not just because we could all use a little more levity in our lives — though that’s certainly reason enough. Rather, it’s because Office Space tells a story driven by the very same technological challenges we’re facing in healthcare today.

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5 Denials Management Tips for ICD-10 and Beyond

Denial management is an industry-wide challenge—and despite traditional approaches intended to reduce denial rates, it’s one that continues to grow. Frankly, this is absurd.

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ICD-10 conversion: Partners help healthcare clients prep

Technology and service providers are helping their healthcare customers prepare for the looming ICD-10 code conversion deadline.

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Improving Price Transparency With IT

Providers are leveraging technology and enhancing education efforts earlier in the treatment process to better inform patients of their financial responsibility while gaining a competitive business edge.

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Here are Best Role-Playing Scenarios to Increase Your Department’s Collections

Role-playing exercises can help patient access employees to be comfortable collecting from patients, because they’re able to repeatedly practice what to say to patients.

Give positive reinforcement if employees appear nervous.
Have leaders start the role-playing first.
Use scenarios that come up often, are challenging, and that have the biggest financial impact.

Every patient access department has its struggling collectors: employees who just can’t seem to collect, despite it being part of their job description. For some, the problem could be as simple as a lack of practice.

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Where is population health heading?

Conceptually, population health enjoyed a banner year of promotion and publicity as one of the newest additions to the industry lexicon.

But has its performance and practice so far kept pace with its marketing momentum? Even though some argue that it’s early, reviews largely are mixed.

So what strategies and tactics will it take for population health to progress more this year and next?

Read more to find out!

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What the data doctor ordered

SQL querying support was a crucial factor in making the deployment of a Hadoop cluster feasible for ZirMed. Read more!

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ZirMed Expands Denial Management Solution with Robust Appeals Capabilities

Company Adds to its Proven Denials Management Technology to Deliver a Comprehensive Solution that Enables Healthcare Organizations of All Sizes to Prevent and Recover Denials Louisville, KY – June 22, 2015 – (HFMA ANI Booth #417) – ZirMed®, the premier cloud-based enterprise financial and clinical performance management provider for healthcare, today unveiled it is launching […]

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Inside the Data Scientist’s Tool Box: How to Maximize Information

Paul Bradley, Ph.D. is the Chief Data Scientist at ZirMed, Inc. Having completed both his undergraduate and graduate studies at the University of Wisconsin-Madison in Mathematics and Computer Science, he is skilled in data analysis technology, data mining and strategic business decisions. Prior to ZirMed, he was Chief Data Scientist for Method Care. Paul recently delivered an educational session at the HIMSS 2015 Annual Conference held in Chicago on “Using Data Analytics for Improving Productivity”. His presentation examined how Northwestern Memorial Hospital implemented a combination of technology improvements and best practices to reduce manual tasks, increase productivity and maximized revenue.

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Patient Payments: A Shift in Responsibility for Revenue Cycle Management

At the April HIMSS 2015, Paul Bradley, Chief Data Scientist at ZirMed, spoke on “Using Data Analytics for Improving Productivity and Revenue”. He called attention to predictive analytics for the self-pay process, and how important relationships are with your patients, especially satisfaction levels.

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Tight reins on IT purchases require awareness

The guise of electronic health and medical records software evaluation and implementation, and the specter of Meaningful Use qualifications certainly can distract a healthcare organization from the bigger picture of information technology impacting practice management.

Yet, relying on IT to help manage business operations and clinical workflow also calls for Meaningful Use to be successful. Consequently, it’s important to keep your practice management IT evaluation and purchasing decisions crisp to avert distractions and miscues that might undermine your strategies and tactics.

Just what kind of errors might healthcare organizations commit? Health Management Technology poses that question to a group of IT experts for their viewpoints.

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Sourcing Clinical and Financial Best Practices through Predictive Analytics, and Succeeding Under Fee for Value

While payment reform—the shift toward fee for value—unquestionably has the potential to disrupt traditional revenue cycle processes, it’s worth noting that with the exception of additional granularity, very little is changing about the data.

By that I mean: the story that the data is telling is the same. Each instance is tied to a specific patient and provider or episode of care—and while the field of medicine will continue to develop, it’s not as though fee for value will replace existing disease-management programs with air-guitar competitions.

More on the separate but related importance of those later.

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Integrate and Automate RCM

How revenue cycle best practices helped one health system improve its financial performance.

Even as outcome- and value-based reimbursement models continue to transform healthcare, it’s worth noting how significantly even the best-run health systems and hospitals can boost their financial performance by relentlessly focusing on key revenue cycle best practices, such as automating manual processes.

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ZirMed Honored with Corporate Community Service Award

ZirMed®, the premier cloud-based enterprise financial and clinical performance solution for healthcare, announced today that it was honored by Louisville Central Community Centers, Inc. (LCCC), an organization that supports low-income and disadvantaged individuals and families in the local area, with the 2014 Corporate Community Service Award. The Award, presented at LCCC’s Annual Meeting on May 14th, recognizes ZirMed’s exemplary employee volunteer services to support LCCC’s child development and youth services program.

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Health IT Thought Leader Highlight: Jim Lacy, CFO, ZirMed

In the following conversation, Jim Lacy, CFO and general counsel of ZirMed, discusses the company’s mission, goals and growth; his passion for healthcare and serving those who work in it; ZirMed’s transition from a clearinghouse to a revenue cycle management, population health and predictive analytics firm; why privacy has become the biggest issue very few are seriously talking about; and the changing face of healthcare as a whole.

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Don’t Sleep on ICD-10 Testing

The value of ICD-10 testing is deeper than confirming that your software is up to date and your vendors are tuned in and ready to provide support throughout the transition. Testing is a time-sensitive training and learning opportunity for everyone involved in the process, from the health care organization to vendors and payers. However, it’s perhaps most important for key front-line employees.

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Should healthcare IT shoot for the cloud?

In the April 2015 edition of Health Management Technology, healthcare IT executives discussed the virtues of adopting and implementing virtualization within provider organizations, independent of cloud computing or in tandem. All expressed bullishness for both virtualization and cloud computing, which when intertwined can make IT networking more efficient. “If you’re hosting hardware, you almost certainly […]

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How Providers can Tap Analytics to Boost Revenue

Hospitals are adopting predictive analytics to reduce manual tasks, increase productivity, and maximize revenue.

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Revving Up for ICD-10 Amid Wheel-Spinning—Just How are the Coding Enactment Delays Affecting Revenue Cycle?

How much of a roadblock do the ICD-10 implementation delays represent for revenue cycle operations and integrity? How can you keep from spinning your wheels so you can make it to the finish line on time?

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Analytics: Not just for the big facilities anymore

Claims vendor ZirMed, which processes more than $2 billion annually in patient payments, is investing heavily in helping providers get their rightful reimbursement.

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HIMSS15 Recap and Highlights

Check out our coverage and snapshots from the conference—and consider coming to come visit us in Louisville, Santa Monica, or Chicago in 2015! Click here to read our full recap.

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Virtualization takes IT to the cloud

Cloud computing and virtualization may be trending terms in the information technology world and piquing interest in the healthcare industry. Read about insights from industry leaders, including our own CTO, Chris Schremser.

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Increasing Importance of Data Analytics

Much like the paradigm of clinical versus financial data, many of the gospels associated with data analytics in healthcare are little more than malingering relics, holdovers from the manufactured narrative that grew up around early and inadequate rules-based offerings.Many of these products were successfully passed off as “big data” solutions for hospitals and health systems–which is almost staggering given that purely rules-based analytics lacks all mechanisms necessary to work with massive data-sets.

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ZirMed Opens Office in Popular West Loop Building in Chicago

A healthcare tech company officially opened its Chicago office last week, and it plans to bring 200 new jobs with it.

Louisville, Kentucky-based ZirMed, provider of cloud-based financial and clinical performance management solutions for healthcare organizations, cut the ribbon on its 111 N. Canal St. office last Friday. The company first announced the move back in October, shortly after it acquired Chicago-based healthcare analytics firm MethodCare

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Using Predictive Modeling To Detect Meaningful Correlations across Claims Denials Data

The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to […]

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Marrying Math and Science in Healthcare

In the coming years, healthcare organizations’ success managing population health will hinge on capabilities that other sectors of the American economy have relied on for over a decade. These same capabilities will be the key to containing costs and optimizing system utilization, goals that are only becoming more important as providers enter into new value-based […]

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ICD-10 Testing: Why Test – and Why Test Right Now?

ICD-10 will impact nearly all of the processes in your practice or organization, and using that fact as the starting point for your ICD-10 testing will make the process smoother and more worthwhile for everyone involved…

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What healthcare organizations can learn from other industries

Joining forces with ZirMed has given me even more opportunities than before to answer the question of why the future of healthcare is in predictive analytics. Sometimes I can answer in just five words…

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The Power of Predictive Analytics in Healthcare, Told through a Netflix Lens

To better understand the fundamentals of predictive analytics — and why it has the potential to transform healthcare — it can be helpful to use Netflix as an illustrative example.

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Taking a Critical Look at Critical Care Utilization

Incorrect billing may be one reason for the mismatch between the number of critical care services performed by non-physician practitioners compared with physicians.

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Improving Collections and Boosting Patient Satisfaction through Patient Estimation

Learn how Golden Empire Cardiology reduced days in Accounts Receivable from 51 to 24, increased collections by 20%, and improved both office efficiency and patient satisfaction in this HITECH Answers piece by Ric Sinclair, ZirMed’s VP of Product.

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RCM trends reveal haves and have-nots

The money quote in this article comes from Doug Brown, Managing Partner of Black Book: “Most hospitals have no choice but to look for next generation RCM solutions in order to keep their organizations solvent. Increased self-pay volumes, lack of pricing transparency, no patient financial responsibility/estimation technology, and other reimbursement challenges are driving many marginally performing healthcare organizations to the brink.”

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Hospital CFOs Stretched Thin Because of EHR, HIE Investments

Hospitals that are financially struggling are blaming investments into electronic health records (EHRs), health information exchange (HIEs) tools, and patient portals as to why they can’t upgrade revenue cycle software, according to a new survey.

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The Healthcare Turducken

Our director of health data analytics offers a culinary explanation of what it means that clinical outcomes and reimbursement are no longer separate in healthcare. As with a turducken, the three primary components of the new revenue cycle that were once discrete—operational, clinical, and financial performance—are combining into a new and richly interdependent main course.

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A Transparent Effort

ZirMed client Golden Empire Cardiology was among providers featured in this Health Data Management article exploring how healthcare organizations are successfully navigating the still-growing challenges of high-deductible health plans—and how cloud-based health IT solutions are the lynchpin of collecting more from patient sooner while also strengthening patient engagement and satisfaction.

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Small Fish Get Bigger

In this article for Group Practice Journal, ZirMed VP of operations Ken Edwards and Leanne Mason, COO of Northwest Orthopaedic Specialists, explore best practices for improving the collection of patient payments. The article highlights how Northwest Orthopaedic leveraged ZirMed’s patient engagement and payments solutions to slash average days in AR for patient payments by 10%—while simultaneously improving patient satisfaction.

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How technology helped Knoxville Orthopedic Surgery Center boost collections, improve workflow

Becker’s ASC Review highlighted a presentation delivered by Teresa Copeland, director of managed care/contracting at Knoxville (Tenn.) Orthopedic Surgery Center/OrthoTennessee, and Sean Troklus, enterprise client manager at ZirMed, at the Becker’s ASC 21st Annual Meeting. Teresa and Sean detailed how ZirMed’s cloud-based patient estimation and eligibility solutions helped the ambulatory surgery center boost collections—and how the right technology transformed Knoxville Orthopedic’s workflows from cumbersome and manual to streamlined and more efficient than had seemed possible before they implemented the right cloud-based solutions.

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Why a failing bookstore holds a key to the future of healthcare

This week our leadership team was featured on the Becker’s Hospital Review blog—the editor detailed how our predictive analytics powers modern healthcare business decision-making, and how the roots of our solutions are the same powerful technology that revolutionized inventory management and e-commerce recommendation engines.

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Patient Billing Experience is Tied to HCAHP Scores

How you bill a patient has a tremendous impact on patient satisfaction and therefore your HCAHP scores.” In a post for emrandehr.com, industry journalist John Lynn discusses the critical role that patient billing plays in patient satisfaction—and credits ZirMed for opening his eyes to the correlation between HCAHP scores and patient billing & payments processes.

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Want to feel more relaxed about ICD-10? Test.

Worried over the impact ICD-10 will have on your bottom line—and on your operational efficiency? Step 1: Read our regulatory expert Betty Gomez’s article in HIMSS Business Edge about the initial results of testing with payers. Step 2: Jumpstart your testing efforts. Step 3: Understand the details of how it will impact your organization—because one of the most stressful things in the world is uncertainty!

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The Impact of Delay: ICD-10 Preparations Continue, Though the Effect on Organizations Varies

In this HealthLeaders article, ZirMed client St. Claire Regional Medical Center shares the challenges—and the successes—of their ICD-10 preparations leading up to and in spite of the most recent delay. Learn more about how St. Claire is keeping their momentum and continuing to build on the gains they’ve already made and ensure they’re ready for go-live.

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7 steps for effective ASC revenue cycle management

Becker’s ASC Review offers a fresh perspective and seven key tips on managing revenue cycle effectively. Tip #3: “look for a partner that can integrate with your existing revenue cycle management software such as ZirMed…” Read the full article and learn how to transform your RCM today!

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Health IT’s Future: 9 Issues To Watch

Information Week senior editor Alison Diana explains why she expects the pace of innovation to pick up as healthcare providers increasingly leverage IT to improve patient care, make competitive gains, and save costs, and ZirMed’s Doug Fielding shares his perspective on the effects of the ongoing shift to value-based pay.

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25 Years Of Health IT: A Complicated Journey

Policy changes and consumer pressures have spurred huge changes in health IT. Information Week senior editor Alison Diana takes a look back at how the industry got here and where it’s going, and includes thoughts from ZirMed’s Doug Fielding.

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Implications of Big Data Analytics on Population Health Management

“Knowing when a patient is likely to shift to a less healthy, higher risk category allows the provider to intervene to avert or delay the shift. These automated, proactive alerts are critical in maintaining and improving the health of a population of patients.” Ready to learn more? Check out this article from ZirMed’s Paul Bradley, first published in Big Data.

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Testing with Payers: Feedback and Good News from Two Blues and a Commercial Payer

Betty Gomez shares feedback from payers following end-to-end testing with a Blue and a commercial payer, as well as syntax testing with another Blue. One common theme: “Payers are just as concerned with testing as providers are. Or, to be more precise, payers are just as concerned as providers should be.”

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Analytics in the era of value-based care

The power of revenue cycle management and population health analytics multiplies when you manage them together. Doug Fielding discusses why population health and the revenue cycle are two sides of the same coin, and offers insights about what it takes to succeed in the era of value-driven care and reimbursements.

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ZirMed’s Betty Gomez elected Vice President of the Cooperative Exchange

The Cooperative Exchange, the National Health Clearinghouse Association representing organizations in the healthcare information technology and transaction industry, today announced the election of its new 2014 executive team, including Betty Gomez of ZirMed as its new Vice President.

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Coders teeter on tightrope of relief and tension

From “Now what?” to “What now?” healthcare organizations surely are scratching their heads over yet another delay in implementing ICD-10—ZirMed’s Doug Fielding and other industry leaders share their perspective in this Health Management Technology article.

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ONC Releases 2014 Edition on EHR Certication Critera Final Rule

In a move intended to provide flexibility and clarity while enhancing health information exchange, ONC has released the 2014 Edition Release 2 EHR Certification Criteria final rule and adopted ten optional 2014 Edition EHR certification criteria, as well as two revised 2014 Edition EHR certification criteria. The final rule also includes a few improvements to the ONC Health IT (HIT) Certification Program and removes some outdated regulation text from the Code of Federal Regulations.

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Encouraging Results and Important Lessons from ICD-10 End-to-End Testing

ICD-10 may have been delayed until 2015, but many payers are continuing with their original testing schedules. That means providers can’t wait either, because if they do, they risk missing out on opportunities that may not come around again. ZirMed conducted end-to-end testing with multiple payers this past spring and during the early summer months. […]

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Population health best practices: Diet, exercise, and data

Effective population health management doesn’t just require the right data. You need specific capabilities that enable you to dig in to and make sense of that data. Learn why the right kind of cloud-based population health management IT holds the key to improving patient outcomes—and why it’s also to critical your organization’s long-term financial and operational stability.

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ICD-10 Guide for Healthcare Executives & Health Information Professionals

Betty Gomez was among the regulatory and industry experts invited to contribute a chapter to a new ICD-10 e-book from Executive Insight. Check out Betty’s chapter—“Keeping Providers and Staff Engaged Between Now and Go-Live—and How to Realize Financial and Operational Benefits Along the Way”—for powerful strategies that can jumpstart your preparations and help you build fresh energy behind your ICD-10-related initiatives.

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Get Ready For The New Realities Of The Revenue Cycle

Mary Hardy, ZirMed’s director of health data analytics, provides a deep dive into the world of healthcare analytics—clinical and financial—in this guest column for Health IT Outcomes. What does the rise of fee for value mean for your organization? And what role does analytics play in you successfully navigating the shifting waters of healthcare?

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Delivering Analytics for Value-Based Healthcare

ZirMed’s Mary Hardy discusses how the ability to leverage structured and unstructured clinical data—as well as claims data—underpins the actionable analytics that providers need to deliver high-quality, highly coordinated care.

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Predictive Analytics can Support the ACO Model

Predictive analytics can be used to rapidly spot hard-to-identify opportunities to better manage care—a key tool in accountable care. In this hfm feature story, ZirMed’s Paul Bradley details how this powerful form of analytics can accurately identify patterns and trends that help drive improved outcomes.

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Road to Medtrade – Steps to Streamline

Find out how one HME business streamlined the claims and collections process, reduced denials and reimbursement delays, improved upfront collections while increasing patient satisfaction—and boosted staff efficiency by 300%.

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How to Improve ICD-10 Testing and Achieve More Significant Results: Tips for Providers, Payers, and Clearinghouses

ICD-10 testing isn’t going away — for the most part, it’s not even being delayed. That’s why many payers, including Medicaid, are taking advantage of the additional time before implementation to conduct more end-to-end testing. What does this mean for providers, payers, and clearinghouses? And how can these groups work together to create richer, more productive, and ultimately more valuable ICD-10 testing initiatives?

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Keying in on KPIs

In this Medical Practice Insider article, editor Frank Irving interviews two ZirMed clients about the KPIs they track—and explains why data analytics benefits small and midsize practices, not just large health systems.

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Countdown to ICD-10: Are you preparing to succeed or preparing to fail?

A new addition to the HIMSS ICD-10 Playbook—Countdown to ICD-10—is full of advice for providers who are behind in their ICD-10 preparations, as well as those who are further along in the process and ready to start testing with payers and vendors. In this HIMSS Business Edge article, ZirMed’s Betty Gomez provides a quick overview of how providers can get the most out of this new resource.

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ZirMed Offers What’s Needed to Succeed in the Value-based World

What does success look like in a world where revenue cycle management includes optimizing not just costs but also patient outcomes? ZirMed’s VP of Health Analytics explores the question in a recent HIMSSwire article.

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How Does Your Ambulatory Clearinghouse Rate on Service?

Health Data Management covers the results of a recent KLAS® report on ambulatory clearinghouses, which surveyed customers’ satisfaction with 12 clearinghouses: “On a 1-100 scale, ZirMed scored highest at 91.5…”

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Technology 101 for CFOs

ZirMed CFO Jim Lacy discusses which aspects of technology CFOs should worry about—and which they shouldn’t—as they help their CIO make financially sound decisions.

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Getting to the bottom of the IT list

ZirMed’s Kent Rowe and other industry and technology experts share advice and insight on effective IT purchasing, including the current trends in the market and what to look for when evaluating vendors.

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RCM Keeps Cash Flowing For Surgery Center

Health IT Outcomes explores how the right RCM partner—ZirMed—enabled the Carolina Center for Specialty Surgery to transform their workflows and dramatically increase efficiency. How dramatically? Processes that once took “upwards of 45 minutes to complete” now take no more than “1 to 2 minutes.”

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Introduction – The role, and actual meaning, of analytics in healthcare

Ric Sinclair, ZirMed’s head of product, separates the reality of analytics from the hype—and explains how healthcare organizations can realize real benefits from comprehensive, meaningful analytics.

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Big Data becoming a mined-over matter

ZirMed CTO Chris Schremser and other technology leaders share their top concerns about the concept and the realities of Big Data—and offer advice on what healthcare organizations can and should do to address fears of security breaches.

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The Right Patient Approach Increases POS Collections

Jyl Nieto, billing manager of Advanced Medical Imaging (AMI) in Colorado, explains how ZirMed’s solutions and a shift in front-office policy enabled AMI to realize a 315% increase in point-of-service patient collections.

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How ASC Leaders Can Make the Most of ICD-10 Delay—Q&A With Betty Gomez of ZirMed

ZirMed’s Betty Gomez shares tips and insight to help leaders of Ambulatory Surgery Centers (ASCs) make the best use of the extra time afforded by the ICD-10 delay—no matter how far along they are in their ICD-10 preparations.

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The Delay Is an Opportunity — Not a Reason to Put Off Action

ZirMed’s Betty Gomez shares tips to help organizations across the spectrum of ICD-10 readiness make the best use of the extra time they now have—and explains why it’s so critical for all organizations to keep pushing ahead with their ICD-10 preparations.

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Transitioning to ICD‐10: What your RCM and clearinghouse vendors should be doing to help you now.

Ken Edwards, ZirMed’s VP of Operations, provides a behind-the-scenes look at RCM and clearinghouse vendors—including how to tell if your vendors are truly ready for ICD-10.

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Applying the Principles of Krav Maga to Your ICD-10 Preparations

ZirMed’s Ric Sinclair explains how a martial art focused on training for real-world scenarios—and going on the offensive—can serve as a model for taking charge of your organization’s transition to ICD-10.

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Claims Data ACO

Organizations that manage population health are only as good as their data. And as more of the healthcare industry moves to an ACO model, the limits of clinical data are becoming more apparent–it’s not standardized, it doesn’t go through a rigorous review for accuracy, and it’s not easily sharable across disparate systems…

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Patrolling for Dollars

How should your ACO gear up for the ACA? This article explores the financial challenges inherent in the shift towards “accountable” care—and features answers from ZirMed’s CFO and general counsel Jim Lacy about how ACOs can meet those challenges in the current era of healthcare reform.

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ZirMed’s Ric Sinclair on Healthcare Now Radio

As part of their series highlighting thought leaders at HIMSS14, HITECH Answers interviewed Ric Sinclair, ZirMed’s head of product, about the article he wrote explaining ZirMed’s vision for patient portals and the importance of “seeing beyond Meaningful Use.”

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ZirMed’s Betty Gomez shares ICD-10 tips with Becker’s ASC Review

In this interview, Betty joins three other billing and coding experts to offer advice on how ASCs can minimize ICD-10-related denials and prepare for the unique challenge of supporting ICD-10 codes while continuing to be reimbursed based on CPT codes.

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Are you Ready for Consumerized Patients?

The scene is increasingly common: A doctor tells a patient it’s time to draw blood for a test and is met with questions — Does my insurance cover this? Either way, how much will it cost?

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8 Tips to Help With the ICD-10 Transition

Despite a crowd of over 38,000 attendees, MedPage Today managed to track down several of the leading experts on coding and billing at HIMSS14—including ZirMed’s Betty Gomez—and ask them for their top tips on preparing for ICD-10.

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The Big Reveals this Year at #HIMSS14

For those attending HIMSS14—and those tracking the event from afar—HITECH Answers is providing an online guide to the exciting new features and solutions that companies are introducing at the conference this year. ZirMed—and the new ZirMed Workcenter—are at the top of the list.

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Testing Is the Key to ICD‐10 Readiness‐and Contingency Planning

We’re entering the heart of the ICD‐10 testing period. Whether your organization is well into the process or just beginning it, now is the time to assess your testing plan to ensure that it’s comprehensive‐and that you’re ready to incorporate the results into your contingency planning […]

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5 Ideas to Avoid Claim Denials & Keep ASC Revenue Cycles Efficient Through ICD-10

Here are five key ideas to make ambulatory surgery center revenue cycle management better.

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Imagine a World Without Meaningful Use

There’s more to MU than requirements, as ZirMed’s head of product Ric Sinclair explains in this HITECH Answers article.

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Meaningful use Stage 2: Seeing beyond compliance

Looking beyond MU2 compliance can help you spot the real value in MU-certified technology, ZirMed’s vice president of product strategy Doug Fielding writes in this Medical Practice Insider blog post.

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HHS To Strengthen Enforcement Of HIPAA Transaction Rules

Health plans will have until the end of 2015 to get certified for compliance with HIPAA transaction operating rules.

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Do high deductibles mean high risk for physicians?

As millions more people join the healthcare system in the next few years, the burden to collect money will fall more heavily on the small and solo practitioner—especially as patients are also shouldering more of their own healthcare costs with high deducible insurance plans.

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Open Letter on Advancing Interoperability and Health Information Exchange

ZirMed recently sent an open letter to the Office of the National Coordinator (ONC) for Health Information Technology. Reproduced here, the letter focuses on the future of interoperability and HIE, based on current trends in technology and healthcare, and on the regulatory, clinical, and business issues involved.

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Three keys to successful RCM in 2014

In the coming year, ICD‐10, new payment models, and HIEs will all impact the revenue cycle of healthcare providers. In his latest article, Jim Lacy, ZirMed’s CFO and General Counsel, covers three big ideas you’ll need to keep on your radar in 2014 if you want your organization to succeed.

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Betty Gomez to Discuss ICD-10 Risk Mitigation Strategies at WEDI 2013 Fall Conference

On November 19, ZirMed’s Betty Gomez will present on a panel titled “Can ICD-9 and ICD-10 Co-Exist?” at the Workgroup for Electronic Data Interchange (WEDI) 2013 Fall Conference. The panel presentation will include the perspectives of payers, providers, clearinghouses, and other healthcare technology vendors.

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Patient Estimation Reduces Aged Payments, Increases Revenues

Improving revenue performance is a challenge for any provider, and collecting co-pays prior to services can go a long way towards accomplishing that goal. In this Q&A, Sherry Dwyer, MBA, practice administrator, Bariatric Medical Institute of Texas, explains how her office was able to reduce aged payments nearly 50%, improve communication with patients, and grow its business.

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ZirMed Wins THINKstrategies’ Best of SaaS Showplace (BoSS) Award

THINKstrategies, Inc., the leading strategic consulting company focused on the business implications of the Cloud Computing services market, announced today that ZirMed, a leading health information connectivity and management solutions company, has been named a winner of the Best of SaaS Showplace (BoSS) Award. This program promotes the measurable business benefits delivered by today’s Software-as-a-Service (SaaS) solutions.

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For ZirMed, 2013 has been a good year

Business First reporter David A. Mann covers ZirMed’s performance over the first nine months of 2013 in the publication’s “Healthcare Inc.” section.

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Patient Estimation—Critical to patient satisfaction and your imaging practice’s bottom line

With healthcare reform and the rise of high-deductible health plans (HDHPs), the financial viability of your practice will increasingly depend on your ability to get paid directly and consistently by your patients. Learn how to collect more from patients—and spend less time and money doing it—with these best practices and helpful tips from ZirMed’s own Kim Labow.

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4 Current Billing & Coding Issues for ASCs From Michael Orseno of Regent Surgical Health

Michael Orseno, revenue cycle director at Regent Surgical Health, shares four important billing and coding issues for ambulatory surgery centers to consider and master, in order to operate under best practices and minimize the chance of any lost revenue.

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Using the Revenue Cycle to Contain Costs

From the ACA to ICD-10 to the continuing saga of Meaningful Use, every provider organization is trying to optimize resources and focus on succeeding at a time when the ground is shifting under their feet. In this article, ZirMed’s CFO, Jim Lacy, offers ways to optimally allocate your organization’s resources with revenue cycle management best practices.

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One year to go, are you ready for ICD-10?

With the ICD-10 deadline just one year away, providers are in various levels of readiness, from completely unprepared to organized and on-track. To determine where you fall on the continuum and what you should do to be ready, Betty Gomez, ZirMed’s Director of Regulatory Strategy, recommends these top tips and tricks.

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ICD-10 GEM May Not be Flawless, But It’s Still Highly Valuable

Chris Schremser, ZirMed’s Chief Technology Officer, IT Enterprise Infrastructure, explains why you’ll need a good ICD-10 General Equivalent Mapping (GEM) tool—also known as a crosswalk tool—and why it can’t replace the need to learn the new codes and use careful, informed diagnostic judgment in the coding process.

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How to Increase Patient Engagement and Satisfaction Through Patient Estimation

“How to Increase Patient Engagement and Satisfaction Through Patient Estimation” was written by our own Ric Sinclair. The article speaks to how recent healthcare policy (PPACA) has impacted patient responsibility and has become intertwined with patient satisfaction.

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Grasping the network—A first step to ACO financial success

“Grasping the network: A first step to ACO financial success” which was written by our own Doug Fielding. The blog post speaks to how ACOs are making strides in raising the quality of care but having difficulty lowering costs. ZirMed through referral pattern analysis can help identify trends and provide information to help improve the process.

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ZirMed on Overcoming Health System Challenges

ZirMed CFO Jim Lacy discusses how to overcome healthcare system challenges.

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How Patient Estimation Technology Helps Physician Practices

Getting paid at your medical practice is only going to get harder, our recent PayerView 2013 data revealed. One big reason why: your patients are increasingly responsible for a greater chunk of their medical costs.

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ZirMed Maps Out Ambitious Agenda with Innovative Solutions

Ric Sinclair, Head of Product at ZirMed, recently connected with mHealthWatch to discuss ZirMed’s impressive growth and lofty goals for the remainder of this year and throughout 2014.

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2013 Healthcare Informatics 100

Every year Healthcare Informatics ranks the 100 vendors with the highest revenues derived from healthcare IT products and services earned in the U.S. based on revenue information from the previous year. ZirMed is on the HCInformatics 2013 Top 100 List.

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ZirMed first pass claims acceptance rates among best in industry

ZirMed, a leading health information connectivity and management solutions company, today announced that the company is consistently achieving a 98 percent or greater running average on its first pass claims acceptance rates. This acceptance rate performance is among the highest in the healthcare industry, where company research found that most practices experience significantly lower rates and according to HFMA’s”HFMA Toolbox: key revenue cycle metrics,” the best practice target rate for clean claims is 97%.

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Collect Every Dollar your Practice Deserves

According to the AMA, practices miss $3 million in revenue due to reworked claims…ZirMed’s Betty Gomez weighs in on how ICD-10 will impact this statistic.

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A Louisville Clinic Races to Adapt to the Health Care Overhaul

A Clinic Braces for Change: Patients and caregivers at Family Health Centers in Louisville, Ky., wonder how the Affordable Care Act will affect them. Part I in a series about the new health care law in action.

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How automation helps steer the revenue cycle process

While the goal of revenue cycle management remains essentially the same, healthcare reform will make it infinitely more complex.

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Fighting For Provider Revenue

ZirMed Client Carrie Moneymaker Advises Providers to be Proactive in Determining Patient Responsibility before Service.

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John Muir Health Selects ZirMed’s Health Information Connectivity and Management Solutions

ZirMed, a leading health information connectivity and management solutions company, announced in a press release that John Muir Health, a not-for-profit integrated delivery system of physicians, hospitals and other healthcare services, has selected ZirMed’s suite of cloud-based revenue cycle management, clinical communications and analytics tools to enhance its financial and operational performance.

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4 Approaches to Promote Customer Satisfaction at ASCs

Ambulatory surgery centers have two main customers outside of the physicians practicing in the center — referring physicians and patients. Great relationships with both of these customers are crucial to an ASC growing and thriving in any community.

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ZirMed® Launches New Patient Estimation Solution

Patient estimation is a critical best practice that enables provider organizations to get paid faster and more accurately, while reducing days in A/R and ultimately improving cash flow.

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Revenue Cycle Management Company Launches Patient Estimation Solution

ZirMed’s Patient Estimation solution leverages the company’s national database of healthcare payment information, ZirMed is able to accurately predict patient financial responsibility based on data that is largely already within the ZirMed platform.

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ZirMed® Launches Patient Estimation Solution, Leverages Massive Data Network

ZirMed’s Patient Estimation solution reduces the time it takes a provider organization to collect revenue from the typical 120 days to an average of only 30 days.

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ZirMed launches new Web tool for health care providers

Louisville-based ZirMed Inc. has launched a new Web-based product, Patient Estimation, which lets health care providers more accurately determine a patient’s financial responsibility prior to receiving care.

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