Guest post by Lindy Benton, president and CEO, Vyne.
The world of denials management is a constantly shifting landscape, one that has changed dramatically with the onset of ICD-10. Now more than ever, denials management requires an organizational focus with built-in workflows for prevention, monitoring and tracking of claims through the system.
In the years leading up to ICD-10, providers were apprehensive about the potential drain it would place on both resources and reimbursement. CMS predicted that – with the onset of ICD-10 – denial rates would increase by 100 to 200 percent, days in A/R would grow by 20 percent to 40 percent and claims error rates would more than double. CMS warned that error rates could reach a high of 6 percent to 10 percent, significantly higher than the 3 percent average error rate with ICD-9.
Providers also feared cash flow problems stemming from coding backlogs, expected to increase by at least 20 percent because of the complexity of the new coding system. “A typical turnaround time for claims processing of 45 to 55 days could end up being extended another 10 to 20 days,” cited Healthcare Payer News.
And the change has been momentous. With ICD-10, the number of diagnostic codes increased from 13,000 ICD-9 codes to 68,000 ICD-10 codes. The new system challenges providers to document conditions more specifically, supporting codes with thorough and accurate medical documentation.
Despite the gravity of the change, many providers say it has been a smooth transition thus far, with minimal delays in productivity and reimbursement. But as the industry moves through this period of adjustment, providers must continue to seek opportunities to protect revenue and generate cash flow for a successful claims management strategy in the wake of ICD-10.
ICD-10 requires an organizational focus around the management, prevention and defense of denials. Denials management is no longer an effort reserved just for the revenue cycle but for all departments. For coding to complete a claim, pieces of information must be collected from multiple areas across the organization. For this reason, all departments should be educated on the part they play and how cross-department collaboration can aid the process.
In preparing providers for ICD-10, the Healthcare Financial Management Association (HFMA) noted, “Claims denials will not strictly be a matter of clarification that can be handled by a nonclinical person in the billing office. Denials will raise questions about medical necessity or the clarity of medical documentation supporting a code; such questions will require input from a physician, nurse specialists or outside expertise.”
Workflow processes are also critical as hospitals work to achieve accurate coding and get bills out the door. Technologies that streamline hand-offs between departments can help reduce bottlenecks that often delay reimbursement. A work queue keeps denials moving, assigning and tracking accountability at each checkpoint and monitoring progress to ensure no claim falls through the cracks.
Guest post by Lindy Benton, CEO and president, MEA|NEA.
For nearly 20 years, MEA|NEA has provided secure health information exchange to medical and dental providers. We are growing, in an effort to provide our clients with even more options to achieve the best in secure information exchange and healthcare communications. Recently we announced that MEA|NEA acquired The White Stone Group, Inc., a best-in class provider of healthcare communication management solutions. The reason why is simple: To create a single, integrated platform for the secure exchange of protected health information and communication management between patients, providers, payers and health plans.
The White Stone Group’s products, led by its Trace communication suite, strengthen and complement MEA|NEA’s current portfolio of HIPAA-compliant solutions for health information exchange and revenue cycle management. Combining the two proven technology solutions gives our clients one place to find the best in secure exchange of health information and efficient management of healthcare communication including voice, fax, image, data and electronic documents. Our clients will benefit by seeing a reduction in denied claims, improved cash flow, increased up-front collections, reduced readmissions and improved HCAHPS scores.
Even though we’re growing, the work we do will remain committed to empowering medical and dental providers, payers, health plans and partners who work with us to achieve efficiency and cost-savings. In fact, together as a collective effort, our solutions will better serve clients in their ability to more effectively manage critical patient information that typically resides outside the electronic health record, and close gaps in documentation and improving the continuum care through a fully accessible patient record.
As a combined effort, we’ll go forward serving more than one million customers across the medical and dental markets. Specifically, MEA|NEA will now consist of two complementary business units — one focused on providers, patients and payers in the dental space and the other focused on the same audiences in the medical space. We are now more dedicated than ever to advancing healthcare delivery by improving coordination of patient information and closing gaps in communication processes across the continuum of care. We’ll do this through a suite of highly-integrated software solutions that facilitate the secure exchange of health information and the efficient management of healthcare communication.
As such, we’ll continue to deliver added functionality for each solution in our set and support our clients in their current environments while bringing the best of each solution together on a common client-facing delivery model. We also plan to add new functionality to the foundation of the combined platforms to create best-in-class solutions that establish competitive differentiation in the markets we serve, even expanding into new areas as opportunities present themselves. We also remain dedicated to ensuring that physician, patient and payer information is protected with state-of-the-art security while maintaining client confidentiality.
Medical and dental organizations now only have to partner with a single provider for secure, centralized management and exchange of critical healthcare information and communication through one electronic platform. The result is a complete view of patient information exchanged across the continuum of care from pre-service to post-discharge. Today, more than 500 hospitals and 55,000 dental offices leverage this data to boost financial and operational performance, streamline care coordination and enhance patient experiences.
What follows is a nice, yet concise, infographic developed by Clearwater Compliance — an organization that helps health systems ensure patient safety and improve the quality of care by safeguarding the confidentiality, integrity and availability of protected health information (PHI) – that provides a nice overview of the current state of healthcare breaches.
Clearwater Compliance states that according to Breach Level Index, there were 336 healthcare data breaches reported in the U.S. last year; “the Office for Civil Rights portal on the HHS website cited 165 breaches affecting 500 or more individuals in 2014.”
Interesting, the organization points out that non-digital breaches remain an issue. “Paper data breaches accounted for 9 percent of compromised records in the first half of 2014 – and a surprising 31 percent in the second half. In total, nearly 200,000 paper records were compromised last year, along with nearly 60,000 pieces of individually identifiable health information ranging from lab specimens to radiology film,” wrote the Clearwater Compliance team.
Additionally, insider mistakes and malice can be costly. In breaches examined, there were 45 incidents involving insider actions that resulted in the compromise of more than 478,000 records. “That means that about half of all the incidents we studied involved either mistakes or malice by an organization’s own employees and business associates.”
Clearwater Compliance makes the case that, despite an organization’s best efforts, “it’s almost impossible to eliminate all workforce-related data breaches. But organizations can take steps to foster an atmosphere of compliance and prevention.”
Lindy Benton, CEO of MEA|NEA, recently wrote in a piece for MultiBriefs: “According to the Wall Street Journal, Forrester Research recently conducted a survey of more than 2,100 healthcare IT pros and found that only about 60 percent of them said they encrypt devices like laptops, smartphones or tablets. Also according to the research, 39 percent of healthcare security incidents since 2005 have included a lost or stolen device.
“For some additional perspective, since federal reporting requirements started, the U.S. Department of Health and Human Services has tracked major breaches (those affecting 500 people or more) and has identified more than 945 incidents affecting patients’ personal information, affecting more than 30 million people.
“A majority of these breaches are tied to theft (17.4 million people), followed by data loss (7.2 million people), hacking (3.6 million) and unauthorized access of accounts (1.9 million people), according to The Washington Post. And these numbers do not even include the Community Health Systems numbers.
Lindy Benton, CEO of MEA|NEA, has worked in the healthcare information technology for more than 20 years. Before joining MEA|NEA, Lindy served as divisional executive at Sage Healthcare, managing 1,400 employees, and prior to that she worked at Cerner for 15 years. MEA|NEA has nearly 20 years’ experience in providing revenue cycle enhancement solutions for payers and providers, as well as managing the secure exchange of health information, providing critical functionality to payers, medical and dental providers and other agents. Its solutions facilitate secure electronic requests for medical records and documentation to connected network providers for payment integrity, risk adjustment, audit tracking, performance/quality measures, claim attachments and more. Similarly, its technology enables providers to gain productivity via the electronic capture, storage and submissions of healthcare documentation – and to more effectively manage their revenue cycle and reduce claim denials.
Here she speaks about MEA|NEA, electronic attachments and secure health information exchange, how MEA|NEA serves healthcare and some of the most pressing issues facing healthcare’s leaders today.
Tell me more about yourself and your role at MEA|NEA.
I have worked in the healthcare information technology for more than 20 years. I am currently the CEO of MEA|NEA, a provider of electronic attachment and health information exchange solution.
Who uses the company’s products, and how are they enhancing their health systems and practices?
We have three major client sets. One is providers. They represent the point of origin for most medical records. One is payers or managed care organizations. They are often the requestors of medical record information about the members enrolled in one of their health plans. And the third we call partners who are those organizations who sit in-between the originators of medical record information and the requestors of medical record information. The enhancements you ask about are intuitive and real. We enhance the exchange of medical record protected health information – or phi – by making it 100 percent electronic, trackable and auditable.
In what ways is MEA|NEA evolving and where are you seeing the most change, the most rapidly?
With the increased focus on outcomes in healthcare in America, we are seeing an increase in the demand for medical record reviews. We see this increasingly being driven by the federal government, but the commercial sector is also participating. There are companies whose sole purpose is to audit the care being provided to patient populations and the reimbursement of charges related to that care. “Payment integrity” is commonly referenced in the industry today, and that wasn’t the case until recently. We are leading in process efficiencies to support these changes.
Tell me more about your involvement with CMS. How have the company and its strategy changed since the adoption of electronic claims submission through Medicare?
In January 2012 we began delivering medical records to Medicare contractors as one of a few organizations certified by CMS to do so. Today there are 23 certified organizations and we are the largest serving the acute-care hospitals of the nation. We are the 2nd largest overall. Since 2012 we have been selected by four organizations who are listed on the www.cms.gov website as their technology partner. We have a strong relationship with key leaders inside of CMS and we plan to continue to invest there. With 15 percent of US healthcare being tied to Medicare, this is a key component of our future in the medical marketplace.