Managing Fraud and Compliance in Healthcare
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Technology brings additional resources to the fingertips of nurses and homecare professionals at the frontline to support their clinical decision-making and contribute to improved client outcomes. With day to day changing patient needs, there is increasing evidence that technology and applications will transform the industry and facilitate faster and better communications, prevent fraud, and proactively manage compliance requirements.
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Managing Fraud and Compliance in Healthcare
- 1. Managing Compliance Requirements while Pro-Actively Leveraging Technology Michael K. Wons President & CEO CellTrak Technologies, Inc.
- 2. Speaker Bio Michael K. Wons is an experienced senior executive who is leading all aspects of CellTrak’s strategy and execution of its business plan. With more than 30 years of experience with leading healthcare and advanced technology companies Mr. Wons brings a unique “customer focused technology” perspective to lead CellTrak. Mr. Wons is the Chairman of the Board at CellTrak and actively serves and participates in the National Association of Homecare and Hospice (NAHC), Canadian Homecare and Hospice Association (CHCA) and the National Hospice and Palliative Care Organization (NHPCO) and the Wireless Life Sciences Association (WLSA). Mr. Wons also serves in advisory board roles for HealthCare and Capital Council (HCap), the Electronic Visit Verification (EVV) work group and the Service Oriented Architecture Consortium (SOA-C). Mr. Wons is a noted industry visionary who regularly speaks at events on behalf of the industry, is an author of over 25 published white papers and technical journals focused on security, privacy and industry platforms and is co-author of the Complete IT Framework for Success Book. Michael K. Wons President & CEO CellTrak Technologies
- 3. Why are we here? Technology brings additional resources to the fingertips of nurses and homecare professionals at the frontline to support their clinical decision-making and contribute to improved client outcomes. With day to day changing patient needs, there is increasing evidence that technology and applications will transform the industry and facilitate faster and better communications, prevent fraud, and proactively manage compliance requirements.
- 4. Compliance Super Heroes • Can any agency become a Super Hero when it comes to compliance? • Do you need radioactive strength to be proactively ready for an audit? Answer: All you need is to learn from our 3 objectives… An industry super hero empowering agencies.
- 5. Objectives • Understand how technology can assist in pro-actively managing compliance and risk • Understanding strategies required to manage compliance through indicators to ensure a successful compliant audit • Learn how an agency is embracing technology now and what other added benefits they found
- 6. Macro Industry Trends • Healthcare costs are increasing faster than the GDP • Who owns the patient is still the battle • Move away from fee-for-service to more focus on integrated care • There will be fewer homecare companies in the future as the providers continue to consolidate…same expected for software vendors • The home is the center…it is where people want to be and where they want to stay…technology and improved care models will improve results • Insurance companies are buying homecare providers • Government(s) are focused on reducing reimbursements • Healthcare moving from “population” to “individual” • Explosion in homecare staff • Technology Leaders are emerging…
- 7. Self Service
- 9. • Mobile technology is now, and will continue to become more relevant in every day activities in the healthcare continuum. • Information explosion has occurred and will continue • “Source of Truth” is limiting factor to Success • Providers looking for ways to become more efficient and effective • Compliance, Efficiency, Productivity & Safety via a Mobile Device is a reality • Care convergence is occurring in the home; homecare, telehomecare and medical home Social Networks will Improve Healthcare • “Care anywhere” is what people want… Technology in Healthcare
- 10. 99% of non-compliant visits can be avoided 5% of all homecare visits are not in compliance Fraud mitigation can improve accountability 10% of all healthcare transactions are fraudulent Industry Challenges
- 11. Fraud and Compliance Challenges Process Care Delivery Staff Management Reimbursement Information HIPAA Compliance Interoperability EMR and HIE Technology PHI BYOD Privacy and Security
- 13. A Pill that Treats-n-Tells • Pill is swallowed. • When pill gets wet it triggers a circuit between coatings of copper and magnesium generating a tiny electric voltage for a few minutes. • Skin patch records the digital message along with patients heart rate, body angle and activity and sends the data to a blue-tooth enabled device. • Data is available for viewing by patients, caregivers and physicians. • Users can set alarms to remind them to take medicines or issue an alert if a patient is inactive for a period of time. Proteus Digital Health Solution
- 14. State of the Industry • Fraud and abuse costs payers and taxpayers billions of dollars annually. • The benefits of home-based care delivery are extreme, from both a cost savings and a patient results perspectives. • Fraud mitigation can significantly improve accountability to assure that services are being delivered to care recipients when and where providers claim they are. • Fraud mitigation can set the foundation for improved outcomes across the healthcare continuum.
- 15. • More Responsibility with Less Resources • Improve Compliance • Increase Productivity • Improve Communications and Provide Field Staff Safety • Reduced Operating Expenses (Proven ROI) Healthcare Delivery Challenges
- 16. Typical Challenges in Homecare • Bloated Mileage and Travel Costs • High Scheduling Overhead • High Payroll Overhead • Backend Billing Adjustments • Missed Visits • Late Visits • No Visit Verification
- 17. Technology to Manage Compliance Challenges Telephony based solutions Cell phones or mobile devices employing GPS technology Tablet based digital signature capture devices Biometric recognition technologies Electronic random number match devices
- 18. Connectivity is the “Key” to the Future of Healthcare 2. This will likely include greater connectivity and collaboration among providers, payers and other healthcare participants. 3. More expansive use of social networking, and improvements in home-based services and health monitoring using mobile technology are expected… 1. With the rapid evolution of technology, healthcare providers will continue to look to software and devices to connect to patients, families and other providers.
- 20. Homecare Tele-HomeCare Medical Home Care Team • Currently 18 million patients and more than 500 million patient visits each year • Total Field Staff of 5.2 million (including long term care) • Home Healthcare providers drove more than 5 billion miles in 2012 • By 2014, 50% growth among employees is expected • The Technology Needs are evolving Care Convergence in the Home
- 21. Compliance Solutions Requirements Process • Electronically record the exact date services are delivered • Electronically record the exact time the services begin and exact time the services end • Electronically verify the location from which the services are provided • Electronically verify the services provided via patient specific care plan • Include a mechanism to verify whether their employees are present at the location and time where services are to be provided for recipient • Require a personal identification number unique to each caregiver and, if appropriate, a unique password established by said caregiver • The system must be HIPAA compliant; • The system must insure daily back-up of all data collected
- 22. Compliance Solutions Requirements Information • Information includes photo, video, and voice in addition to electronic text based information • Published policies for use of patient information • Continuous HIPAA education • HITech policy alignment • Separation of duties • 256 Bit encryption • Secured pipes • Intrusion detection • Breach management policies • SAS 70 Type II data center certification for cloud services • Preparation for personal health records
- 23. Compliance Solutions Requirements Technology • Published information policies • Independent security review of processing and hosting environments • 256 Bit encryption of information • Virus / Intrusion detection and mitigation tools • Bring your own device (BYOD) • Usage policy • Mobile device management solution • Remote wiping of device • Loss / Leave policy • Separation of duties
- 24. Additional Agency benefits of Compliance Solutions • Electronic documentation tools enforce required information and provide feedback ensuring the record is complete. • Accuracy of the information is increased reducing the amount of rejected submissions due to incorrect information. • Reduced Travel time and Mileage Reimbursement • Reduced Missed and Late Visits • Streamlined communication • Document and sign at the point of care • Quicken reimbursement by payor network • See where your care staff is • Quicker Referral Servicing and Increased Census • Paperless Timesheets 24
- 25. Faculty Contact Info Michael K. Wons President & CEO CellTrak Technologies, Inc. 1051 Perimeter Drive, Suite 950 Schaumburg, IL 60173 847-240-0400 mwons@celltrak.com www.celltrak.com