Audit Relief Tools and Solutions for Providers and Health Plans

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Daniella Wilson
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1 Audit Relief Tools and Solutions for Providers and Health Plans Bill Matits, Executive Vice President, ROI Sales Jeannie Hennum, Senior Vice President, ChartSecure

2 Topics What is Audit Relief HealthPort s Health Plan Expertise Why HealthPort Contracts with Health Plans Audit Challenges Audit Relief Solution for Providers Audit Relief Tools for Health Plans Getting Connected

Audit Challenges Audit Relief Solution for Providers

3 What is Audit Relief Centralization of Medical Record Request Receipt Centralization of Processing Medical Record Requests Centralization of Delivering Medical Record Requests

4 Health Plan Expertise ChartSecure Division Jeannie Hennum Senior Vice President 54 FTEs Staff Increase 50% 2013 to 2014 Chart Secure, Sales Client Relationship Management New Sales Generation Product Management Provider Education Sales National Account Management National Implementation Data Analysts Call Center High Volume Site Specialists Documentation Processing Fax Chart Secure, Services Account Management Client Relationship Management Project Setup, Management & Closeout Reporting & Invoicing Provider Education Identification Regional Regional Researchers Regional Specialists Mail Client Increase 50% 2012 & 2013 FTP Uploads Remote Access ChartSecure, Services Operations Chart Chase Scheduling (HP, Non-HP) Database Management Chart Retrieval (On-site, Fax, Mail, Upload, Remote EMR) Provider Education Identification

Account Management Client Relationship Management Project Setup, Management & Closeout Reporting & Invoicing Provider Education Identification Regional Regional Researchers Regional Specialists Mail

5 Why Connect? Top 10 Provider Pain Points 78 inches copied, and that was only the beginning! PROVIDER FRUSTRATION 1. Significant Increase in Request Volume 2. Phone Calls, Faxes & Mail 3. Data Entry into Audit Tracking System 4. Duplicate Requests & Incorrect Lists 5. Accommodating Unknown, Third Parties 6. EMR System Partitioning 7. Delivery Acknowledgement 8. Re-use of Chart 9. HIPAA Concerns 10. Impact on Administrative Expenses

Data Entry into Audit Tracking System 4. Duplicate Requests & Incorrect Lists 5.

Chart Retrieval Services Project Manager Receives Request File & Letter Enlists Resource Planning Establishes Secure FTP & Customer Information Loads Request File into Processing Engine Connected

6 Chart Retrieval Services Project Manager Receives Request File & Letter Enlists Resource Planning Establishes Secure FTP & Customer Information Loads Request File into Processing Engine Connected Providers Request File & Letter Providers not yet Connected Operations Retrieval Method: On Site, Remote, Fax, Mail Resource Planning (Retrieval Specialists) Oversees Schedulers & Chart Receipt Electronic Medical Record Request Loaded into Workflow System Processing Begins within 24 to 36 Hours EMR/Paper Records Combined Schedulers Call Scripts Varied Call Times On Site > 20 Charts Fax/Mail < 20 Charts FTP Upload Remote Access Onsite Specialists HIPAA Trained Full-Time Employees Laptops/Scanners Reporting Engine Chart Disposition Exception Providers Reconciliation with Request File Indexing & QA Delivery (sftp or Web Portal) Fax/Mail Documentation Center Documentation Specialists HIPAA Trained Convert Paper to Electronic

Electronic Medical Record Request Loaded into Workflow System Processing Begins within 24 to 36 Hours EMR/Paper Records Combined Schedulers Call Scripts Varied Call Times On Site > 20 Charts Fax/Mail

7 Provider Health Plan Connections Providers 17,500+ Hospitals, Clinics, Physician Groups, Pharmacies Plans 100+ Medicaid, Medicare Advantage, Commercial Clinics/Physicians Hospitals Health Plans Vendors for Plans

Plans 100+ Medicaid, Medicare Advantage, Commercial

8 Request Waves: Risk Adjustment & HEDIS PROJECT TYPE January February March April May June July August September October November December Medicare Advantage Risk Adjustment (MRA) HIGH MEDIUM LOW LOW LOW MEDIUM MEDIUM MEDIUM MEDIUM HIGH HIGH HIGH HOSPITAL FOCUS SWEEPS SWEEPS SWEEPS Health Effectiveness Data & Information Set (HEDIS) LOW MEDIUM HIGH HIGH HIGH LOW LOW LOW LOW LOW LOW MEDIUM CLINIC FOCUS FILE 5/15 Medicaid MRA & HEDIS HIGH HIGH MEDIUM HOSPITAL & CLINIC FOCUS LOW MEDIUM HIGH HIGH LOW MEDIUM RA FILING HEDIS FILING RA FILING HIGH HIGH HIGH Commercial/HIX MRA HIGH HOSPITAL & CLINIC FOCUS HIGH HIGH HIGH FILE 4/30 LOW LOW LOW LOW LOW LOW LOW LOW

(HEDIS) LOW MEDIUM HIGH HIGH HIGH LOW LOW LOW LOW LOW LOW MEDIUM CLINIC FOCUS FILE 5/15 Medicaid MRA & HEDIS HIGH HIGH MEDIUM HOSPITAL & CLINIC FOCUS LOW MEDIUM

9 Audit Challenges

10 HealthPort Audit Relief

11 What are the Benefits? Elimination of Administrative Expenses No Paper No Phone Calls No Onsite Appointments No Data Entry No Postage Increased HIPAA Compliance No Unknown, Third-Parties Accurate Log of Who is Requesting Chart and for What Purpose BAA with Health Plan Secure Electronic FTP Delivery Improved Turnaround Time

Appointments No Data Entry No Postage Increased HIPAA Compliance No Unknown,

More Benefits Verification of Minimum Required Documentation NCQA/HEDIS CMS Medicare Risk Adjustment & RADV Health Plan Advocates Due Date Extensions Adherence to Provider s Preferences and

12 More Benefits Verification of Minimum Required Documentation NCQA/HEDIS CMS Medicare Risk Adjustment & RADV Health Plan Advocates Due Date Extensions Adherence to Provider s Preferences and Rules Relay of Concerns Payment by Health Plans Medical Record Retrieval Service, not Provider Copy Fees Improved Provider Health Plan Relationships Quality (HEDIS) Medicare Medicaid Commercial

and Rules Relay of Concerns Payment by Health Plans Medical Record Retrieval Service, not

Audit Relief Models 1 2 3 Facility based

13 Audit Relief Models Facility based Solution Remote Solution Overflow Remote Solution

14 Audit Relief Solution Getting Started Before a Provider can begin using the Audit Relief Solution, we need: Agreement to the Types of Covered Requests Quality (HEDIS), Risk Adjustment (Medicare Advantage, Commercial/HIX, Medicaid Definition of Processing/Special-Handling Guidelines Requires Electronic Delivery to Requestor Remote Connectivity List of Provider Locations: Name, Address, Phone and Fax Numbers, NPI and/or Tax ID HealthPort Site ID Confirmation/Activation from ChartSecure Audit Relief Solution Team

Processing/Special-Handling Guidelines Requires Electronic Delivery to Requestor Remote Connectivity List of Provider Locations:

15 After Implementation 1. Callers & Requests Directed to Phone/Fax/ Hotlines 2. Electronic Delivery Verified/Established for Requestor 3. Full Reporting Available to Provider

16 Audit Relief The Health Plan s Provider Relationship Tool Designed to Expedite the Request & Delivery Process Eliminates Provider Frustration/Aggravation Reduces Administrative Expenses Improves Chart Collection: Speed & Quantity Ability to Offer Software and/or Services to Provider Excellent Tool for High-Volume and Geographically Challenging Sites Additional Resource Pool of Release of Information Specialists (Onsite or Remote) Partner Model for Providers who use HealthPort Software and their Internal Personnel to Process

Services to Provider Excellent Tool for High-Volume and Geographically Challenging Sites Additional Resource Pool of Release of

17 How to Get Connected HealthPort Release of Information Bill Matits, Executive Vice President, Sales , Office; , Cell HealthPort ChartSecure Jeannie Hennum, Senior Vice President , Office; , Cell

How To Do In-House What You Do Best, Outsource The Rest

How To Do In-House What You Do Best, Outsource The Rest Do In-house What You Do Best, Outsource the Rest: The Shared Services Model for Release-of-Information (ROI) Processing that Lets Healthcare Organizations Maintain Control, Work Efficiently, and Generate