In the complex technical, regulatory, and operational world of healthcare, TFG knows it takes more than basic compliance to succeed. Properly implemented, compliant HIT results in revenue enhancement, cost avoidance, and improved quality of care. Even a mandatory independent assessment can reveal new opportunities for ROI. And by participating in the standards development process itself, we don’t just apply the standards, we help improve them.

 

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COMPLIANCE + QUALITY = OPTIMIZATION

Healthcare organizations are doing all they can to improve quality to produce measurable outcomes. That’s what TFG does best. Let us help you improve, and then prove how good you are.

We identify software solutions to make your organization's processes efficient and scalable. Thus, a full end-to-end enterprise assessment can be done for less than others charge for a high-level review.

The advent of value-based reimbursement is making the pressure for solid processes and clean data capture and transmission more acute. It’s not enough to provide the best care— you have to capture proof in the process of delivering it. We’ll help you identify the data gaps and fill them—preferably without impeding the relationship between clinician and patient.

It’s not about the format—it’s about the process

Data Standards Implementation and Optimization: Properly implemented, a standards-based data solution can reduce errors (or prevent them from entering your system altogether) and reduce the costs and delays of manual reviews and paper/fax-based production, storage, and retrieval. TFG goes beyond minimal compliance, with a code- and business-process-based approach that maximizes ROI by replacing costly error-prone manual processes with high-value automated solutions. Phone calls and fax transmissions are reduced. Personnel are freed from repetitive, low-value tasks to pursue more complex activities that further drive revenue recovery and cost reduction.

360-degree risk assessment and remediation

Security and Risk Assessment and Remediation: Recent regulatory action has driven up the cost of privacy and security vulnerabilities. HIPAA Covered Entities are required to perform periodic Risk Assessments (RAs), which include technical, operational, policy, and physical security elements. A security breach involving more than 500 records may require reporting to CMS for posting of the incident online, publication of a notification to local news outlets, and even the provision of identity theft protection to the impacted patients. And you may have much less time to accomplish this than seems practical. (The thousands or millions of dollars in penalties can take some time.) The TFG approach goes beyond readiness and reporting to true prevention. Our cross-industry experience makes us uniquely qualified to integrate risk identification, mitigation, and remediation with regulatory review, and adds a level of physical and operational safeguarding that IT-centric firms are not able to match.

Avoiding icebergs in the sea of change

MACRA/MIPS Readiness and Remediation: Regulation promulgated under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will profoundly change the landscape of both clinical and administrative practice over the next several years. The Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) tie payments and penalties to a provider’s ability to capture and submit clinical quality measures (CQMs) intended to represent how effectively they have managed patient care. More critically, the notion of a baseline for quality care has been virtually eliminated—under MACRA, there will be winners whose results are considered worthy of reward, and losers, whose revenues will be offset to provide the funding for those bonuses. TFG believes there are a lot of good providers who have bad reporting. We’ll help you predict your score, assess any technical or operational gaps that we may uncover, and capture the needed data to optimize your outcome.

Can a few codes save you a million dollars? Let us show you.

CARC/RARC ROI Assessment and Remediation: On the X12 835 Health Care Claim Payment/Advice transaction (also known as the Electronic Remittance Advice or ERA), the Claim Adjustment Reason Code and Remittance Advice Remark Code data elements are intended to inform a provider how a billed charge was adjudicated, and how to resolve any discrepancies. Is it a contractual discount? Were two codes bundled? Do I need more verification? How much is the patient responsible for? Sadly, the codes entered by the health plan often fall short of telling the complete story, leading to costly and time-consuming phone calls for both parties. We can work with health plans and providers to identify and optimize the effectiveness of their coding and reconciliation efforts, to maximize automation and to minimize errors and rework on both sides. Better yet, we will baseline the processes beforehand, then provide ROI analysis of the enhancements we help you implement. And if there is a situation that calls for a new code, we’ll help you submit a request to have one created.

Taking technology, process, and culture into account

Business Process Optimization: TFG is known for balancing diligence and attention to detail with the ability to see the big picture, a skill developed by studying our customer to understand their unique harmony of process and technology with organizational culture and individual motivation.  It is through this holistic lens that we analyze existing processes to develop recommendations for practical, fit-for-purpose solutions delivered in manageable, scalable pieces.  For a TFG consultant, process analysis means coming to the table with an expectation of what we should hear when we talk through a workflow and asking the right questions when we don’t hear it.  Combination of these techniques with TFG's historical commitment to establishing a true learning organization within our customers—one that works to continuously analyze progress while ensuring the bottom line goals of running a great business are met—means that at TFG, Business Process Optimization leads to realized positive transformation.

Let us help you do business, better.

 

 TO LEARN MORE ABOUT OUR
HEALTHCARE IT OFFERINGS


DATA STANDARDS

  • HIPAA Standard Transactions
  • Electronic Claims Attachments
  • HL7 FHIR
  • CORE Operating Rule

SECURITY & RISK

  • HIPAA Risk Assessment
  • BowTie Risk Assessment
  • Physical Security
  • Integrated Mitigation

MACRA/MIPS

  • MIPS Score Estimation
  • CQM Gap Analysis
  • APM/MIPS Remediation

BUSINESS PROCESS OPTIMIZATION

  • Process Mapping
  • Workflow Analysis
  • Assessment & Remediation
  • Refinement & Evaluation
  • Human Factors

CARC/RARC ROI

  • Claim Adjustment Reason Code
  • Remittance Advice Remark Code
  • Compliance, Analysis, Optimization
  • Post Hoc ROI