I had the great opportunity to sit down with HIPAA expert, Rita Bowen from HealthPort, at HIMSS 2013 and learn more about the changes that came from the recently released HIPAA Omnibus rule. The timing for this video is great, because today is the day the HIPAA Omnibus rule goes into effect. In the video embedded below, Rita talks about what you should know about the new HIPAA changes, the new business associate requirements, and restricting the flow of sequestered health information.
Lori Brocato is Director of Audit at HealthPort. With more than 15 years in health care technology, Lori serves as HealthPort’s resident government and third party audit expert, sharing educational information and best practices with health care facilities via Webinars, media interviews and industry articles. Additionally, she is the AudaPro product manager for HealthPort and authors her own blog, Audit Insights, on the HealthPort website. Lori is also a monthly contributor for RACMonitor, an online knowledge source for healthcare providers. She is RAC certified by the Medicare RAC summit and a member of HIMSS and HFMA.
Taking Paper Out of the Audit Process
The amount of provider and governmental resources now dedicated to processing and managing recovery audits is staggering. According to the American Hospital Association RACTrac Survey in May 2012, 76% of participating hospitals reported that RAC activity had increased their administrative burden including additional costs, training, software and full time equivalents needed to manage the workload. Similar findings were reported in the August 2012 RACTrac report.
Costs to cover the growing administrative load range from $10,000 to over $100,000 per quarter. Nine percent of hospitals spend over $400,000 annually to manage audit. And when multiple auditors come after the same encounter, expenses rise. The majority of these costs come from producing copies of medical records, sending them to review contractors, and managing appeals.
Making RACs a Paper-Free Zone
When RACs and other auditors need medical records to conduct their reviews, they request them by submitting a formal letter to the provider. These request letters land in the Audit or HIM department where internal staffs or outsourced Release of Information (ROI) companies find the requested records, produce photocopies and submit paper to the auditor.
Efforts to streamline this paper process began in 2011 with the introduction of CMS’s Electronic Submission of Medical Documentation (esMD) project. Since then, information exchanges designed solely for provider-auditor medical record transfer have grown and matured.
Three Provider Options
Along with esMD, many ROI companies and other Health Information Handlers (HIH’s) have developed private exchanges. Providers have three choices to reduce the paper burden of RAC and other audits. They can build their own esMD gateway using the CMS CONNECT architecture, connect to esMD through an HIH, or use the HIH’s private exchange. All three options result in the following four benefits:
- Elimination of paper and postage
- Increased automation request delivery
- Improved tracking
- Faster delivery
However, since HIHs have already established connections either through esMD or a direct, private audit exchange, providers save time and IT expense by using an HIH.
Direct Connections: What Providers Need to Know
Because the number of auditing bodies continues to expand and reach of recovery contractor activity continues to grow, the use of direct audit connections (or exchanges) may outpace submissions through esMD. Direct exchange by an HIH uses a one-to-many connection with auditors and provides four benefits:
- Request letters from RACs and other auditors can be received electronically.
- One access point is established by the provider and from there, the HIH is responsible for establishing all the various auditor connections; saving time and IT resources.
- Providers have a secure, private portal with end-to-end tracking capability for all audit record requests.
- Providers can obtain a FedEx comparable tracking number instead of just a date and time stamp confirmation.
Paper’s Coming Out of the Process….It’s Only a Matter of Time
Audits will continue. Demands for medical records will expand. Administrative burdens will increase. These are the realities of today’s pay-and-chase model. However, new technologies to cope are emerging.
These technologies, in concert with centralized audit management and EHR advances, are poised to reduce administrative burdens and move audit processing from “paper-intensive” to “paper-free”. The future of audit management will be paper-free: one way or another!
I got into a recent discussion about the role of HIM professionals in an EHR implementation. I thought this was also a timely post since I got a request today to again attend the AHIMA annual conference. I had such a good time at the AHIMA conference last year, that it looks like I’m going to attend AHIMA 2012 in Chicago, but I digress.
In response to the discussion about the HIM professionals role in EHR implementations, I offered the following comment:
I think they’re an essential part of the implementation. The place I see them most used is in how to deal with the old paper charts. The challenge is usually turning them on the idea that they’re useful and valuable even in an EHR world. Many just assume (incorrectly) that their job is gone. It’s not, but it does change.
Just a few places where they will still have to be involved post EHR implementation can include:
-ROI (Release of Information) from the EHR and the old paper charts
-Scanning Loose Paper into EHR (or overseeing that process)
-Quality Checking (similar to paper chart audits)
I’m sure there are more, but those are a few off the top of my head.
Personally, I loved talking with our HIM staff during our EHR implementation. In many ways they were a great “sanity” check for me. They weren’t afraid to point out things that I may not have considered. I did feel bad, because I could tell that the HIM director always felt like HIM wasn’t really listened to during the EHR implementation. I can’t speak for some of the other clinical leadership, but I was always grateful for the role that HIM played in the EHR implementation.
This being my first time to attend the AHIMA Annual Conference I thought I’d do a post talking about my experience for those who haven’t attended. Plus, a look at some of the major topics of discussion that I’m sure to write about in the near future.
I must admit that it feels like a very different conference for someone who’s use to attending conferences in the predominantly male driven IT world. I’m certainly not complaining about it at all, but it is interesting to see the subtle differences based upon the predominantly female AHIMA attendees. For example, I have a bottle of nail polish in my pocket from 3M. That’s definitely something you wouldn’t find at a male dominated IT conference. Although, even I as a male took one for my daughter. Can you imagine how much she’ll love me for it?
I must admit that I’m still a little torn about the AHIMA conference, because I can’t help but wonder how many of the AHIMA members really exert influence over decision makers in their organization. This was partially highlighted to me by the choice of AHIMA keynotes which focus on leadership. It seems that AHIMA is making an effort to help their members become leaders in their organization and not just “worker bees.”
I’m sure my perspective is tainted a little bit when I think back to times where I’ve seen some of my HIM friends come back from conferences that taught them about EMR. They have all this energy about the interesting technologies or new products, but they far too often say something like, “Not that anyone cares, since they won’t really listen to me about EHR.” I really hope that this is a rather broad generalization. Plus, while it might be true that many in healthcare don’t listen as highly to HIM (or doctors in many cases) when it comes to EHR, I think HIM does have more of a voice when it comes to things like managing Release of Information, ICD-10, document imaging, etc.
The micro industries that exist has been one of the interesting things I’ve found at AHIMA. For example, there’s some really interesting and relatively large companies working in the Release of Information space. It’s quite amazing to me to see something so niche be so successful.
One thing I have really enjoyed about the people at AHIMA is how supportive they are of each other. There seem to be really tight bonds and great relationships between those that attend.
Overall I’ve really enjoyed my AHIMA experience so far. I’ve only been able to attend one session (see my post on EMR and EHR about the Healthcare Social Media session I attended), but the people I’ve met have been interesting and beneficial. I guess that’s true for most conferences. It’s all about the people.