Today’s healthcare providers are still drowning in a sea of paper, even with ever continuous upgrades and enhancements to practice management systems and the push to electronic health records. One key component that is often overlooked, but can provide big benefits in this area is the use of electronic data exchange for claims attachments. Integrating an electronic request and response process into the workflow may be able to help health systems better control administrative and storage costs, comply with regulations, respond to Medicare audits and reduce the time it takes payers to process claims. Additionally, these electronic request and response systems help improve security of records during the transfer process and eliminate the numerous boxes of files that providers may currently be required to ship to payers during the claims adjudication process.
From a claims perspective, electronic data exchange automates and streamlines adjudication, helping hospitals save money each year related to the identifying, processing, storing and tracking attachments; decreasing paper volume; and increasing paid claims volumes. In most cases, electronic attachment and data exchange solutions are compatible with existing PM and EHR systems and they can enable providers the ability to create an electronic envelope containing all requested documents needed for medical record reviews.
Data Security is Key
Electronic health information and data exchange solutions, in a secure and HIPAA-compliant manner, do exist. Most importantly, these solutions address one of the biggest challenges in healthcare — costs and time delays associated with the retrieval and transmission of medical documentation. By providing an information repository that is both HIPAA-secure and readily accessible, health systems and health plans have a means by which protected health data can be shared easily and efficiently while eliminating waste in the process.
Many organizations are seeing a significant impact to workflow efficiency because the process of requesting and preparing paper submittals, claims adjudication and Medicare audits requests is bulky and overwhelming to manage. Recent proof of the efficiencies that can be gained were exhibited by a hospital that added an electronic attachment solution into their Medicare audit requests and claims processing workflow. In addition to implementing the electronic attachment solution, he hired several employees to manage the process and, as a direct result of the changes, the hospital saved nearly $1 million.
For those managing processes for revenue cycle enhancement, electronic attachment and health information exchange solutions provide:
Reduced turnaround time for claims requiring attachments – from weeks down to days
Secure, HIPAA-compliant attachment processing and storage
Document retention for disaster recovery, business continuity and compliance
24/7 online access to attachments
Streamlined receipt and tracking of correspondence via electronic communications containing the Document Control Number (DCN)
Improved staff productivity and billing efficiency
Easily Managing Attachments
The desktop solutions enable information to be gathered and uploaded to the secure repository using a variety of acquisition methods – mobile device capture, scanning images, print capture, screen capture or file import. Rather than relying on a single acquisition method, information can be captured at its source by any contributor using the easiest method possible. Additionally, the information exchange stores a number of many types of documents, images, records and files critical to key healthcare business processes and can connect various stakeholder participants in healthcare information exchange.
For health system leaders concerned about security of multiple claim-related documents, a robust health information exchange solution allows for the creation of a single unique identifier or “electronic envelope” that contains all the required documentation to support the clinical coding on a claim. Providers place the unique identifier in the claim then transmit it electronically to the payer or to Medicare auditors. Once the payer (or Medicare or its third party) receives the claim, examiners there have the ability to view supporting documentation and attachments that are stored in a central repository and are easily accessible. Attachments can include ADRs, lab reports, OP reports, ER records, certificates of medical necessity and any other documentation required by a payer to adjudicate a healthcare claim, and can be sent along with the initial claim submission (unsolicited) or in response to a request for additional information (solicited).
esMD Program Facilitates Medicare Reviews
Electronic submission of medical documentation (esMD) was launched by CMS to provide a mechanism for providers to electronically submit documentation in response to additional requests and audits. By implementing such electronic attachment solutions, providers and health systems can respond quickly and securely to time-sensitive RAC, MAC, MIC, CERT, PERM and ZPIC audits through a connection to the esMD program. Solution providers that are certified Health Information Handlers (HIH) can deliver and track patient medical records for healthcare providers through CMS’ gateway. The gateway is the National Health Information Network’s (NwHIN) transmission mode for esMD and it gives providers an on ramp to submit secure electronic documentation to CMS and participating review contractors with tracking features to ensure records are received within the specified deadline. Once documentation is submitted, the health information exchange solution routes it to the appropriate Medicare review contractor through the gateway.
What to Look for When Seeking an Attachment Solution
Providers and health systems leaders should seek a solution that:
Adheres to the security and privacy requirements of HIPAA to ensure that PHI is exchanged over a secure standardized NwHIN connection.
Provides a variety of document and image capture methods for maximum flexibility.
Supports the transmission and retrieval of multiple file types including PDF, TIFF and other popular file types.
Works with any claims clearinghouse as long as it supports HIPAA-mandated standards, specifically the PWK segment in the 837 file.
Provides connectivity to a wide range of payers.