Lighthouse Healthcare Advisors

For centuries lighthouses have served as a beacon for navigational aid. Cathy Zito, with her more than three decades of experience in the healthcare industry, believed healthcare providers should have assistance in navigating the non-clinical aspects of their practices and founded Lighthouse Healthcare Advisors (LHA) in 2013. LHA works with providers across the country and prides itself on being able to adapt to each client’s unique needs. “We take time to understand our client’s needs and vision for the future. Our team guides clients to find the best strategies to achieve their desired outcomes” says Cathy.

LHA has two main sectors of the business: Healthcare Management Consulting; and Coding, Compliance and Education (CC&E).

Healthcare Management Consulting

• Payer Contracting & Fee Negotiation

• Practice & Revenue Cycle Assessments

• Due-diligence reviews

Coding, Compliance & Education

• Coding Services, including HCC Risk Adjustment

• Coding Audits

• Customized Provider Education

The firm has been focusing its efforts on value-based reimbursement and its impact on providers. LHA is one of the largest providers of payer contracting services in the Mid- Atlantic area, working with more than 2,300 providers, and has noted an increasing number of their clients are being asked to help create and participate in reimbursement methodologies outside of the traditional fee-for-service models.

“Now is the time to get providers to focus on these changes.” says Cathy “The industry is seeing a transition from volume-based to value-based reimbursement. Payers are moving away from mainstream fee-for-service compensation and negotiating reimbursement based on the risk of the provider’s patient population. The changes are happening rapidly and at Lighthouse, we want to educate and prepare our clients for what is to come.”

LHA recently developed its own proprietary software specifically targeted to help organizations achieve optimal Hierarchical Coding Category (HCC) risk scores. LHA’s Premier Optimization Risk tool or P.O.R.T, is used by certified risk coders to review patients’ documentation and identify opportunities to capture HCC eligible diagnoses. “Accurately documenting and capturing all patient diagnoses has never been more critical.” says Cathy. “Clinicians are focused on providing patients with the best possible care. It is unreasonable for us to expect that they are selecting the most accurate diagnosis codes when they have never been trained to do so. Our tool, along with expert Certified Risk Coders (CRCs) help to bridge that gap.” P.O.R.T provides robust analytics and efficient workflows to allow organizations to review their population on a retrospective, concurrent or prospective basis.

LHA has already helped several Accountable Care Organizations (ACOs) identify HCC opportunities and assisted them to submit corrected claims within the timely filing limits. “The dollars are real. One of our reviews uncovered an estimated $1.6 million in revenue for our client.” states Cathy. To date, LHA has performed their reviews on a retrospective basis, meaning that claims had already been submitted and corrections needed to be filed. Cathy, however, believes that organizations will gain even more value by reviewing historical documentation and educating providers before the patient even walks through the door. “When this type of work is done on the front end, you are setting your providers up for success and insuring appropriate reimbursement for your population. This model eliminates the end of year scramble to submit corrected claims and opens the door to new opportunities for physician incentives.” says Cathy.

LHA is helping their clients by guiding them to a forwardthinking approach so they can stay ahead of the curve. The company is passionate about their work and are committed to successfully leading their clients through the diverse challenges of the healthcare industry. They provide invaluable leadership to their clients as trusted advisors in the everchanging healthcare environment.