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AHIMA Convention Product World Presentation—PHI Disclosure Efficiency in the Business Office


During the 2018 Annual AHIMA Convention & Exhibit in Miami, MRO hosted the Product World presentation “A Case Study for PHI Disclosure Efficiency in the Business Office—Yale New Haven Health.” I was fortunate to have the opportunity to co-present the session with Cindy Zak, Executive Director of Corporate Health Information Management, Yale New Haven Health.

In her position, Zak is well aware of the challenges HIM professionals face in response to the rising volume of Release of Information (ROI) requests made to business offices to support payment of claims. Business office personnel can spend up to 40 to 45 percent of their day pulling and attaching medical records, taking them away from their core responsibilities. Mostly billers and collectors, these staff typically lack expertise in ROI and Protected Health Information (PHI) disclosure management. And, whenever medical records are handled, HIPAA concerns must be top priority, such as the minimum necessary requirement. Other industry challenges include:

  • Increased backlogs
  • High-priority requests requiring timely fulfillment
  • Complicated/disparate processes
  • Incomplete and inconsistent data collection and trackability
  • Convoluted issue resolution processes
  • Lack of transparency
  • Strained relations among business office, HIM and payers

Together we explored new PHI disclosure management technologies and workflows for improving collaboration between HIM and the business office when fulfilling additional documentation/claim attachment requests.

Addressing PHI Disclosure Challenges in the Business Office

Yale New Haven Health experienced many of the common industry challenges, especially the need for transparency in HIM and an efficient HIM procedure for billing releases. Because the business office maintained ownership of payer requests, HIM was uninformed, serving as a middleman to process thousands of pages. Averaging 20 cases of paper a week resulted in an additional $3,000 per month expense just in paper costs. And, once records were pulled and copied—often including more than the minimum necessary—the information was sent back to the business office for shipping to payers.

As an early adopter of MRO’s business office medical record attachment solution, Yale New Haven Health has already achieved positive outcomes:

    • Business office staff is focused on billing and collecting.
    • HIM staff is focused on pulling the requested medical records.
    • Only the portion of the medical record that is requested is being sent.
    • Paper processes have shifted to electronic delivery.
    • Workflows are based on payer specifications.
    • Medical record claims attachments are sent within 24 hours of receipt.
    • Requests are now trackable to promote transparency.

According to Zak, “Our system business office and HIM personnel collaborate more effectively, focusing on their core responsibilities to maximize productivity and efficiency. The new technology and workflows have reduced paper processes, creating significant cost savings and enhancing enterprise-wide compliance.”

As MRO extends its expertise for health information exchange into business office functions that support revenue cycle management, health systems can benefit from improved efficiency, cost savings, reduced financial risk, trackable delivery, and enhanced interdepartmental and payer collaboration.

To learn more about strategies to improve PHI disclosure efficiency in the business office, fill out the form below to receive a copy of AHIMA’s 2018 Product World Presentation

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Five Takeways from the HFMA 2018 Conference

“Efficiency is doing things right; effectiveness is doing the right things.” Peter Drucker

Peter Drucker, world-renowned business management guru, reminds us to focus on both efficiency and effectiveness to improve long-standing processes, procedures or policies. Healthcare finance leaders and revenue cycle professionals were charged with the same goal—creating efficiencies and building effectiveness—during the recent HFMA 2018 Annual Conference held in Las Vegas, June 24-27, 2018.

For central business offices (CBOs) and patient financial services (PFS) departments, the need to address stubborn problems and improve performance is paramont to cut costs and reduce risk. One way to achieve these goals is by fostering innovation.

This blog shares HFMA’s call for innovation, summarizes four other takeaways from the 2018 event and lays out an important MRO strategy to improve business office efficiency and CBO effectiveness.

Foster Innovation for Business Office Efficiency and Better Outcomes

Kevin Brennan, FHFMA, CPA, the new chair of HFMA’s 2018-2019 board of directors and recently retired Executive VP, Finance and CFO at Geisinger Health System, welcomed attendees by discussing the importance of promoting experimentation and new ideas to bolster efficiency in revenue cycle workflow and operations. Brennan encouraged revenue cycle leaders to resist the fear of failing and build new business models to promote performance. As Brennan stated, a good new motto to follow might be “Never be fearful of making new mistakes.”

Build Collaboration through Better Tools and Workflows

By coupling innovation with collaboration, Brennan urged HFMA attendees to build new bridges with other departments, providers, payers, consumers and the government. The call for better collaboration was reiterated by Tuesday’s keynote speaker, Dr. Rubin Pillay, medical futurist, physician and professor.

With collaboration as the central theme of this year’s event, revenue cycle professionals were encouraged to “try new tools and make existing workflows work better” as one pathway to foster collaboration and improve business office efficiency within CBOs and PFS departments.

Go to a New Level in Healthcare Delivery

Dr. Pillay also discussed the role of artificial intelligence and technological innovation in spurring healthcare collaboration. Pillay provided examples of growing organs for corneal transplants and using robotics to help paraplegics walk as important ways healthcare organizations can take patient care to a new level. According to Pillay, “Technology and data, their convergence with policy, and provider and payer strategies are driving major trends to transform healthcare.”

Enhance the Patient’s Financial Experience

The final takeaway from the HFMA 2018 Conference was a continued cry to improve the patient’s financial experience. Best practices from HFMA’s 2017 MAP winners were referenced as innovative ways to make steady, incremental changes and improve performance. In reviewing these MAP winner strategies, we are reminded of the need to continually speed processes and streamline operations—this is especially true for CBOs.

Improve Business Office Efficiency by Reducing Biller Distractions

Consistent with HFMA’s themes of efficiency, effectiveness, innovation and collaboration, MRO is laser focused on improving business office performance. For most CBOs and PFS departments, biller distraction is an important issue—one we intend to reduce for MRO clients. We continue to hear from clients that billers and collectors become distracted with trying to process payer requests for medical records. Our latest service was discussed with HFMA attendees during the conference and received rave reviews.

Challenge:

Business office personnel release millions of medical records annually to commercial health plans and government payers to expedite payment of claims, appeal denials or fulfill auditor requests. However, it doesn’t make sense for these business office staff—billers or collectors—to handle payer requests for medical records when they should be focused on reimbursement. There are also HIPAA risks to consider when billers release Protected Health Information (PHI) versus having Health Information Management (HIM) professionals manage this task.

Receiving, processing and managing payer requests for health information is what MRO does best. So we’re applying this expertise to cut cost and reduce risk for CBOs and PFS departments.

Solution:

Instead of distracting billers and collectors from their core objective of collecting revenue, MRO disclosure management experts apply new workflows and HIM collaboration to the process of Release of Information (ROI) in the business office. Here is a high-level summary of how the new MRO service works.

  • Business office logs requests and attaches billing documents
  • MRO adds medical record documentation
  • MRO quality checks and releases billing and medical documentation to the payer
  • MRO sends documentation by payer-requested delivery method

Results:

MRO clients who are using this service from MRO are achieving both efficiency and effectiveness in their CBOs and PFS departments. Specific improvements include:

  • Heightened efficiency and cost savings
  • Minimized breaches and more compliant PHI exchange
  • Payer request trackability for analytics
  • Enhanced collaboration between HIM and the business office
  • Maximized production by keeping teams focused on what they do best
  • Improved visibility and transparency for both teams

Request information about MRO’s business office ROI services

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RACs Moving Forward: Year of Uncertainty is Over

RACs are back! Following several delays and multiple lawsuits, the Centers for Medicare and Medicaid Services (CMS) has finally awarded the new RAC contracts. After a standstill in 2016, as RAC regions remained unresolved, RACs now have the green light to fully reengage and return to business as usual.

In the May 2017 issue of HCPro’s HIM Briefings, I covered the topic of the return of RACs and outlined what Health Information Management (HIM) professionals can do to prepare for the next round of audits, including four tips to stay proactive and avoid becoming overwhelmed.

Four Tips for HIM Pros on Dealing with RACs

  1. Review and refine processes – Implement effective processes to maximize reimbursement and minimize takebacks. Conduct internal reviews and audits, review all clinical documentation, and continually refine workflow processes for these cases.
  2. Document and track – HIM’s most important role is to document and track every step of RAC reviews for every case. Use spreadsheets or an IT application, such as MRO’s AUDITRENDS® Online, in conjunction with a vendor partner.
  3. Increase collaboration – Effective RAC risk mitigation extends beyond your designated RAC team. Increase communication and collaboration among RAC teams, coders and CDI specialists. All should work together to reduce RAC risk.
  4. Continually develop staff – Team members must also become RAC experts. This includes education and training on how to deal with everchanging program parameters, meet tightening deadlines, and manage a deluge of auditor requests. RAC specialists must determine which audit data is most important and be able to uncover data integrity issues in collaboration with the audit and coding teams.

To learn about MRO’s payer audit management solutions, visit the MRO website or visit us at the HFMA ANI convention June 25-28, 2017 in Orlando, Florida – Booth #1150.

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