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:
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.
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.
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.
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