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Why Should You Invest in Health Information Governance?

Posted on July 14, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Hospitals are becoming large data centers of health information. In some ways, they’ve always been the storage facility of health information, but how we store, transfer, access, and share health information is dramatically changing in our new digital world. Plus, the volume of information we collect and store is expanding dramatically. This is why health information governance is becoming an extremely important topic in every hospital.

In order to better understand what’s happening with health Information Governance, I sat down with Rita Bowen, Senior Vice President of HIM and Privacy Officer at HealthPort, to talk about the topic. We shot these videos as one long video, but then chopped them up into shorter versions so you could more easily watch the ones that interest you most. You can find 2 of the videos below and 3 more over on EMR and HIPAA.

Who Should Manage Information Governance at Healthcare Organizations?

Why Invest in Health Information Governance?

RAC Audits Infographic

Posted on July 6, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

RAC audits have quickly become a reality in every hospital system. Plus, the costs of managing these audits is increasing for many hospitals. HealthPort has put out this RAC Audits Infographic that highlights some of the trends with RAC audits.

The Year of Audits Infographic.Rev1.6.11.15

Needless to say, managing these RAC audits effectively is going to be extremely important to a health system going forward. From the AHA RACTrac survey which was the source for the infographic it says that “53% of all hospitals reported spending more than $10,000 managing the RAC process during the 4th quarter of 2014, 32% spent more than $25,000 and 8% spent over $100,000.”

What’s even more interesting is that HealthPort notes that many of the other payers are starting to make similar audit requests to measure the acuity of new patients entering the health system thanks to Obamacare (ACA). As this increases, the financial implications continue to increase as well.

What are you doing to make sure your RAC audits and other similar audits are managed effectively?

Why Can’t Release of Records Be Automated Through A Patient Portal?

Posted on March 31, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was in a recent discussion with one of the leading providers of release of information services, HealthPort about EHR’s impact on the release of health records. In our discussion, I asked why the release of health records can’t be completely automated through a patient portal. In my mind, meaningful use is requiring that healthcare organizations put a patient’s record up on a patient portal, so shouldn’t that mean that the release and disclosure of patient records would become obsolete?

Of course, I was applying a limited view to what’s required when a disclosure happens and who is making the records request. In most cases, it’s not the patient requesting the record and these third parties don’t have access to the patient’s portal. Plus, the release and disclosure of patient records often requires accessing multiple systems along with assessing which information is appropriately included in the disclosure. The former is a challenge that can be solved, but the later is a complex beast that’s full of nuance.

In order to clarify some of these challenges and explain why a patient portal won’t replace all records requests, here’s a short interview with Jan McDavid, Esq., General Counsel at HealthPort.

Q: What are HIPAA requirements around “charging” for copies of records, and what are considered “reasonable” costs?

A: HIPAA is very clear that its pricing applies only to copies provided to “individuals,, which HIPAA defines as the person who receives treatment—the patient. HIPAA guidance pertains only to patient requests for medical records, approximately seven percent of all requests received by healthcare providers.

The majority of records are requested by physicians for continuing care, governments for entitlement benefits, insurers, and inquiries from attorneys, according to internal data from HealthPort’s 2014 record release activity nationwide.

Within the realm of patient requests, providers can charge patients no more than their labor costs to produce the record, plus supplies and shipping. No upfront fee to search or retrieve records may be charged to patients.

Q: Why shouldn’t records just be free now that they are electronic?

While many believe the cost to produce records should be negated once information is digital, there are misperceptions and logistics that must be understood. The process of disclosure management (release of information) involves many steps that still require human intelligence and intervention—especially on the front end of the process (receiving, validating and approving the request). Here are three examples:

  • The authorization must be adhered to strictly, which often requires contacting the requester and explaining that some of the records they requested may not be available, or may require very specific patient authorization.
  • Information is commonly pulled together from multiple sources and systems (paper and electronic) to fulfill a request. While providers are working toward completely electronic environments, almost all still have a combination of paper and electronic. Depending on who makes the request, every single page of a record may require review.
  • Staff releasing records must be trained on HIPAA, HITECH, the Omnibus Rule, state and federal subpoena requirements, and specific state and federal laws for drug, alcohol, HIV/AIDS, mental health, cancer, genetics, minors, pregnancy, etc.

Q: If the EHR is in the portal, what other records aren’t in the EHR that HIM staff has been aggregating in a records request?

A: Not all patient information is automatically included within the patient portal view, nor should it be. Each provider organization determines what EHR information is posted to the portal and what patients can do within the portal (e.g. requesting refills, scheduling appointments, viewing lab results, etc.). HIM experts are key in these decisions.

Physician Office Records Boost Audit Success

Posted on June 10, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post from Dawn Crump, Vice President of Audit Management Solutions at HealthPort

Medicare Administrative Contractors (MACs) audit hospitals claims. They compare Part A and Part B claims and look for discrepancies. While these reviews have historically been performed post-discharge, the MACs also conduct pre-payment reviews. MACs ask for documentation to support claims—and hospitals are obliged to provide it. This is nothing new.

What is new is the detail of proof they are requesting. MACs are seeking deeper documentation than ever before. A typical request from the MACs might include language as follows: “We need any and all information to substantiate this treatment.” In many cases, this depth of information only resides within the physician office records.

MACs Seek More Detail

Many hospitals are continuing to respond to MAC requests as they always have—by submitting the appropriate portions of the hospital medical record. Typically, approvals have been granted. But there is smoke on the horizon.

Hospitals have reported receiving denials when they fail to submit physician office records that further substantiate every preventative and therapeutic effort taken prior to more aggressive, in-hospital care (e.g. surgery). And now word on the street is that the RACs are moving toward seeking similar levels of validation for certain medical procedures.

In the immortal words of Bob Dylan, “The times, they are a changin’.” There is no sense in denying the inevitability of deeper MAC (and ultimately RAC) requests. I can summarize my advice in two small words: Be proactive.

Six Steps to Prepare for the Inevitable

Follow these steps to begin incorporating physician office records into your MAC, RAC and other auditor responses. In doing so, you may mitigate the risk of more probing audit requests and prevent revenue take-backs.

  • §  Start now in providing the full extent of what the MACs may soon expect—detailed physician office records that substantiate cause and what preemptive treatment was provided.
  • §  Endeavor to create a process that proactively satisfies these new-style MAC requests. Train your team to include appropriate physician office records in submittal packets. Assume that the RACs will soon seek similar documentation.
  • Meet with your physician groups and their practice administrators as a matter of course to discuss issues, obtain consent and agreement to obtain their records for this purpose.
  • Gather all documents that demonstrate a history of prior conservative medical treatment; showing any time the patient had preventative therapy and indicating surgery was the last resort.
  • Develop internal documentation protocols and guidelines for high risk MAC procedures.
  • Once a MAC request is received, via email, paper, fax or hand-delivery, scan it in and merge it with hospital records.

Though these efforts are above and beyond what has been customary to this point, they’ll prepare you to satisfy the next generation of audit request, both from MACs and potentially RACs. And isn’t it always best to change with the times?

Dawn Crump - HealthPort
Dawn Crump is Vice President of Audit Management Solutions at HealthPort. She formerly served as Network Director of Audit and Compliance at a large regional healthcare system in Missouri. 

Level the Playing Field with RACs as They Enter Practice Settings

Posted on February 5, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Lori-Brocato-Healthport
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.

In my most recent blog post here, I presented some helpful hints for reducing the impact of typical RAC audits. In a nutshell, I emphasized that moving toward a centralized, more fully automated, paper-free environment would soften the blow of the ever-increasing administrative burden of audits. Maximizing technology, I concluded, will bolster efficiency and enhance organization, the traditional keystones of corporate success.

But now, to complicate matters, RACs have widened their nets. Nearly all hospitals have deepened their relationships with physician practices, and the RACs have taken notice. Hospitals must now be vigilant of audit activity surrounding the physician practices and take appropriate steps to mitigate the interruptions and expense wrought by additional inquiries.

RACs Make First Move into Practices

Two RACs have already promised upcoming reviews focused at physician practices and medical groups. RACs have also promised to expand E/M coding, the most likely source of overbilling or duplicate billing as hospitals accustom themselves to working in concert with these new business partners. Additionally, RACs now often request physical copies of medical records. In the past, automated reviews based on data analysis of claims an remittance information were the norm. To make matters worse, long-standing, regional health plan auditors are also getting in on the action, requesting and reviewing patient records.

Obviously, RACs have made some game-changing enhancements to their efforts to locate and retrieve billing errors and overcharges.

Here are four ways hospitals can level the playing field with RACs as it relates to their owned or affiliated physician practices and medical groups; minimizing the impact these inquiries have on staff and budgets.

Knowledge is Power –Provide your physician practices with access to RAC managers, historical program information and revenue impact reports. Inform them of key RAC targets for medical groups and deliver real, practical tips on how to mitigate risk.

It’s a Team Effort – Interview each practice administrator to identify and track all RAC activity and record requests. Explain the importance of centralization and incorporate practice administrators into the organization’s overall audit program.

Connect the Dots — Create a specific workflow or use database and tracking technology that follows a specific process to manage audit requests across both inpatient and outpatient settings; including physician groups and medical practices.  Open the lines of communication with practice administrators to ensure all RAC requests are properly communicated, logged and processed.

Learn from Mistakes — Conduct internal audits and track and review the results regularly. Take educational action based on findings. And finally, use data from internal audits and key reports to validate that any and all vulnerability are identified and fixed.

Audits are disruptive and a real threat to your revenue, and they are growing in frequency. The trend towards stronger hospital-physician relationships enforces the need for hospitals to take action, bring physicians into their centralized RAC strategy, and ensure everyone’s revenue is protected.