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Release of Information (ROI): What You Don’t Know Will Cost You

Posted on October 17, 2018 I Written By

The following is a guest blog post by Tarun Kabaria, Executive VP, Provider Operations Ciox.

In today’s evolving healthcare environment, the release of information (ROI) process is not a simple function. It involves up to 45 specific steps, each presenting its own complexities and compliance risks. Adding to those complications, HIPAA privacy and security rules under the American Recovery and Reinvestment Act’s (ARRA) HITECH provisions have elevated the importance of ROI and increased its costs.

Furthermore, the healthcare industry is influenced by a variety of factors that are pushing the limits of operating budgets, including rising volumes of requests from government auditors, the drive to meet Promoting Interoperability criteria for electronic health records (EHR) and rapid-fire advances in medical record technology. The “human” checks and balances that protected health information in the past are slowly disappearing as information moves rapidly from paper-based to fully electronic and online. The stakes continue to rise while the financial penalties for wrongful information disclosures grow.

As a result, many more healthcare facilities – large and small, urban and rural – are seeking cost-effective and efficient ways to manage this process. They are revisiting ROI options, evaluating costs and searching for new, more effective solutions.

As the growing demand for ROI continues to impact our evolving healthcare industry, hospitals are experiencing many repercussions. They are legally required to release medical records and often receive hundreds to thousands of requests a day. At the same time, hospitals must ensure that patient privacy, security and confidentiality are protected. It is a delicate balance that requires the proper management of each request along with the knowledge and expertise of a highly skilled ROI specialist.

According to the Association of Health Information Outsourcing Services (AHIOS), nearly 80% of hospitals nationwide have outsourced their ROI function to alleviate the administrative burden of fulfilling medical requests. Of the hospitals that outsourced, an estimated 40% have done so with at least one vendor-supplied ROI consultant. Significant costs can be incurred when retaining legal counsel and a fully staffed HIM department in addition to paying for the technology necessary to manage high volumes of requests, meet time constraints and comply with privacy demands. However, failure to do so can result in lost revenue due to fines for wrongful disclosures and technical denials from payers and recovery contractors.

Although EHRs have made ROI processing faster, there is also a greater risk for information breach. Many of the human checks and balances inherent within the ROI process have been removed. Furthermore, records are now available to many more people, and much more easily. The advantages of ubiquitous access need to be weighed against the risk for security breaches.

For these reasons, many organizations are choosing to partner with an ROI services company that offers extensive industry experience and understanding of the new laws and rules as well as the new risks. Additionally, by outsourcing ROI to a proven, secure service provider, healthcare executives relieve themselves of rising costs and administrative burdens while also reducing their risk of penalties and fines.

For those who have chosen either a full or shared outsourcing approach, the benefits are clear, with convincing evidence of significant cost savings as well as return on investment. There are three approaches to consider when looking to outsource ROI:

On-site Service

The selected ROI vendor sends a customer service representative to the healthcare organization’s office to perform all aspects of medical record release, including capturing, processing, and conducting QA of the record before sending to its distribution center.

Partner Service

The healthcare organization’s staff uses the vendor’s technology to capture, process and QA the medical record. Then, the record is sent to the vendor’s distribution center.

Remote Service

The vendor’s customer service representatives access the healthcare organization’s EHR through secure technology to capture, process and QA the medical record from the vendor’s centralized facility. Then, records are sent to the vendor’s distribution center.

These three options provide the flexibility to select the approach that aligns best with an organization’s capacity, staffing resources and expertise. An ROI service partner can manage everything from reducing immediate backlog, handling specific tasks for the ROI process or coordinating the entire process.

Achieving efficient and effective ROI services is possible. It simply requires careful consideration and evaluation of costs and resources available to comply with new regulations to determine which path is the best one for your organization.

About Ciox
Ciox, a health technology company and proud sponsor of Healthcare Scene, is dedicated to significantly improving U.S. health outcomes by transforming clinical data into actionable insights. Combined with an unmatched network offering ubiquitous access to healthcare data, Ciox’s expertise, relationships, technology and scale allow for the extraction of insights from structured and unstructured clinical data to create value for healthcare stakeholders. Through its HealthSource technology platform, which includes solutions for data acquisition, release of information, clinical coding, data abstraction, and analytics, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability. Ciox improves data management and sharing by modernizing workflows and increasing the accuracy and flow of information, while providing transparency across the healthcare ecosystem and helping clients manage disparate medical records. Learn more at www.ciox.com

The Secret to Coding Accuracy Is In The Training Tools

Posted on September 24, 2018 I Written By

The following is a guest blog post by Scot Nemchik, Vice President of Coding Education and Auditing at Ciox.

Accurate coding has become more important to healthcare organizations and more critical to their bottom lines than ever before. While the traditional value of coding to an organization was simply in its effect on timely reimbursement, outside entities like IBM Watson Health and the U.S. News & World Report, among many others, are today utilizing the same broader organizational coding data to assess outcomes, provide company profiles, drive news, assign ratings and rankings, and determine value in the healthcare organizations they assess.

Because the impact of accurate coding in the modern era extends beyond reimbursement into reputation, perception, and new business development capabilities, it’s clear that the stakes have been raised for most organizations. With added importance assigned to coding accuracy, many of these companies are today assessing how to drive greater coding accuracy within their organization. Yet, the methodologies by which organizations assess new hires for coding capabilities, and by which they train and enhance their existing workforce, are largely unchanged in the last decade or more.

Coding is an industry that requires specialized skills, and so it is important for several reasons to make quality hires at the onset. It is far more profitable for an organization to retain its coders, which requires better upfront assessment. A study from the Society for Human Resources Management (SHRM) on employee retention suggests that the cost to an organization in replacing an employee is between 50 and 75 percent of their salary. In an industry like medical coding, better screening measures must be in place to get the right people involved on the team the first time.

One of the primary ways companies can look to achieve better candidate hires is by moving away from simple multiple-choice assessments of coding skill during the screening process, as those assessments are not as predictive of coding aptitude as modern measures. A more effective approach is achieved through the use of platform-based assessment techniques, in which the candidate can respond to hypothetical medical reports with actual codes, providing more meaningful insight into coding aptitude.

Those same training platforms also serve as a solution for companies looking to bolster the accuracy of their existing coding teams. Traditionally, organizations have relied heavily on passive forms of training (e.g., webinars, LMS assignments) to convey important coding instruction, hoping that instruction is put into practice in the daily work settings. Today, through active, platform-based training, the results are far more scalable and effective.

Coders Learn by Coding

By training in an active coding learning environment, coders learn by doing, a proven method which accelerates learning and optimizes retention. Through a hands-on learning approach, coders can put their skills to the test and learn from any mistakes in real time.

Platform learning provides not only pre-hire testing, but also baseline performance assessment. By giving new hires and existing teams alike the same metric tests, organizations can identify their best assets. Additionally, platforms for coding training offer effective and efficient cross-training, allowing organizations to diversify the capabilities of their coders and cross-pollinate or backfill specific coding teams for more flexibility. Beyond cross training, existing teams benefit from the development of their assets through ongoing education. Coding is a dynamic field with annual changes, and access to the newest codes and guidelines is critical. A comprehensive learning platform offers all of these capabilities and measurements in real-time.

As companies look for ways to improve the accuracy of their coding staff, whether through new hires or incremental improvements to existing teams, transitioning to a platform-based training and assessment environment, with a host of experiential and measurement capabilities, can provide the solution.

About Ciox
Ciox, a health technology company and proud sponsor of Healthcare Scene, is dedicated to significantly improving U.S. health outcomes by transforming clinical data into actionable insights. Combined with an unmatched network offering ubiquitous access to healthcare data, Ciox’s expertise, relationships, technology and scale allow for the extraction of insights from structured and unstructured clinical data to create value for healthcare stakeholders. Through its HealthSource technology platform, which includes solutions for data acquisition, release of information, clinical coding, data abstraction, and analytics, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability. Ciox improves data management and sharing by modernizing workflows and increasing the accuracy and flow of information, while providing transparency across the healthcare ecosystem and helping clients manage disparate medical records. Learn more at www.ciox.com

Creating a “Clinancial” Model: Bridging the Gap Between Clinical and Financial

Posted on July 25, 2018 I Written By

The following is a guest blog post by David Dyke, VP Product Management at Ciox.

Healthcare at a broad level divides its business into two types of work: The clinical, and the financial. The groups that serve each effort are traditionally siloed. Doctors and nurses, for instance, focus on the clinical health of their patients.  Clinical pathways define the day: What is the plan of care? How do we improve the quality of care? How do we deliver the right course of treatment for this patient in the time we have, based on all of their individual variables?  And how do we apply that broadly to entire conditions and communities?

Separate from clinical practices are the equal and opposite financial forces within the business of healthcare. Healthcare CFOs, for example, are chartered with caring for the financial health of their organization.  Financial pathways rule the day: Ensuring administrative processes, patient experience and strategic plans align to the best operational outcomes.  How can we survive until tomorrow if reimbursement, risk, denials, cash, collections, debt and financing issues are not addressed today?

Yet, for all the division of labor and effort in the healthcare space, the reality is that the two sides of the business exist as the heads and tails of the same coin. When a patient walks into a healthcare provider’s office, clinical and financial pathways alike are opened up, and their relationship is far less siloed and far more symbiotic than the current model of care reflects. What if we approached these two traditionally separate parts of the healthcare system as two halves of the same? How do we break down the paradigm that these are two separate pathways? How do we connect the clinical and the financial?

Perhaps what we need is a new word; one that better reflects the concurrent pathways in healthcare. Maybe we are not laboring along two separate clinical and financial pathways, but a single “Clinancial” pathway.

cli·nan·cial (adjective)

Relating to both clinical and financial pathways in healthcare.

As the cost model in healthcare has shifted, the patient’s interest level in the financial side of the healthcare continuum has shifted dramatically. Health plans are increasingly prescriptive in their services.  Whether specifically defining limitations on choices, options, and access to specific providers, or implicitly influencing behavior through out-of-pocket cost motivators, the financial aspects of healthcare are increasingly top-of-mind.

Even for patients, the Clinancial pathway to care is here already. It’s not just simple decisions that intersect financial and clinical pathways. These meet again at the intersection of in-network, copays and out of pocket expenses, year to date costs, and whether a patient has a flex plan. All of these financial decisions have bearing on the patient’s end clinical pathway and could be better understood earlier in the process by those whose traditional focus is strictly clinical.

What clinical choices would be different if the outlook included financial realities and variables. What choices would be made in a Clinancial model? Similarly, what financial choices could be made with better clinical information?

From the way we code clinical services to the way we seek to manage reimbursement activities and claims, from denials to audits and at every point where Clinancial lines cross, we in healthcare have an opportunity to improve both our patient experiences and our bottom lines by better rolling together our clinical and financial information for all involved.

If case managers aren’t approaching patient care from the perspective of preventing denials, then they are missing a huge opportunity to improve not only the patient experience and clinical outcomes but also the organization’s ability to do the same thing systematically again tomorrow, and the day after that.

The landscape is continuously changing. Health Insurance Plan Designs vary widely today, and will have more variabity tomorrow. Medical guidelines are always evolving too. The barriers to adopting Clinical Guidelines are well documented, it’s most often a factor of information or population overload.  For example, in 2017 the guidelines for High Blood Pressure changed, effectively “giving” High Blood Pressure to 30 million more Americans.  It’s a business model where we need to know how to be continuously adaptive, how we are engaging with all parties involved, from the healthcare recipient to the insurers, and building a trust network around risk. Yet we traditionally do not evolve, or change, or update ourselves particularly efficiently.

Some organizations are doing this better than others – integrating even just their reporting structure. They ask themselves questions like “Are medical records part of the clinical or the financial operations of a hospital?”

Groups that see the shift have moved within their organizations to form teams with names like ‘Revenue Integrity’, and because of those new delineations they are more closely aligning the “how” and “why” of the clinical process with the “what” and “when” of the financial workflows. And as they have shifted into Revenue Integrity teams, they are looking at things more holistically to uncover key findings. Much like an integrated care team takes a holistic look at a patient, their direct conditions and their social situations. These integrated Clinancial teams can find connections between coding workflows and reimbursement speed, and can design and implement Clinancial Workflows to measure and improve their outcomes.

No matter the structure, integrated Clinancial Teams are doing three things well: They communicate regularly across the siloes, they collaborate across teams on opportunities that affect both the clinical and financial aspects of the business, and they share data, findings and ideas.

The victories are twofold: Organizations have a chance within a Clinancial model to improve patient satisfaction and outcomes, while at the same time better flowing clinical data through into reimbursement. We have entered a new financial reality where the patient’s experience has an increasingly material impact on a provider’s bottom line. By unifying around Clinancial Pathways, we can make strides to improve patient outcomes and experiences, while at the same time gaining operational efficiencies to drive margin improvement now, when we need it most.

And all we needed to do was invent a new word for it.  #easy

About Ciox
Ciox is a health technology company working to solve the clinical data illiquidity challenge by providing transparency across the healthcare ecosystem and helping clients manage disparate medical records and a proud sponsor of Healthcare Scene. When stakeholders do not have timely access to the complete clinical picture of patients, critical decisions about patient care, medical outcomes research, disease prevention, reimbursement, and payments are sub-optimized. Ciox’s scale, expertise, expansive provider network and industry leading technology platform make it the most reliable clinical data company in the US. Through its standards based technology platform, HealthSource, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability.  Learn more about Ciox’s technology and solutions by visiting www.ciox.com