How Technology Enabled ROI is Transforming Clinical Revenue Integrity

By Jeff Gartland, President, Clinical Revenue Integrity Solutions, Ciox Health

Medical records are thought to contain some of the most sensitive and in-demand data. These records include information the patient provides, medical history, examination results, diagnoses, and treatment plans–all of which can instantly alter a provider’s patient care plan if made available. Yet, in today’s technologically advanced hospital environment, providers are still facing obstacles when retrieving patient medical records.

The way we manage medical records, whether advantageous or not, is transforming within Health Information Management (HIM) at a rapid pace. Evolving from traditional copy service through disclosure management and release of information (ROI), the technology enabled future of ROI is at the foundation of clinical revenue integrity.

As the healthcare industry grows more specialized and complex, challenges that come with managing health information increase in turn. The complicated realm of state and federal laws governing medical records means that compliance requires ongoing research to avoid accidentally stepping outside the bounds of the law. Inconsistent and, often at times, antiquated record keeping systems dispersed across multiple providers are hard to manage, and actually obtaining relevant data from these records can take time.

Every time a patient receives health care, a record is maintained of observations, medical interventions, and treatment outcomes. While medical records supply providers with relevant, real world data, the process of abstracting those records is riddled with potential pitfalls that can lead to delays and ineffective data retrieval.

When retrieval of data is delayed, it not only impacts real patients but also the provider bottom line, as the need for clinical information is increasingly part of the broader revenue cycle. Despite these obstacles, though, the future of ROI can be bright if providers effectively implement technology and leverage the process of clinical revenue integrity. A major advantage of technology-enabled ROI are the additional insights and analytics offered to the clinical revenue integrity process. ROI has always been thought of as beneficial mostly for HIM departments, but it truly sits at the convergence of clinical data and financial performance.

The more advanced ROI technology allows for constant patient feedback for specific points of improvement

Hazards can easily be maneuvered around using standardization technology, allowing health records to more easily produce actionable insights to use in the operational performance of ROI workflows as well as unique insights into patient and population-centric health data, leading to improved patient quality care outcomes. Once they have organized the multidisciplinary histories of care, providers can use them to learn about progression of chronic disease, more rapidly identify best practices for plans of care, and extract information that’s nearly impossible to quantify without technology. Health systems can identify and track network leakage across patient groups as well as develop programs to support high-risk revenue streams.

Providers can also maintain a better understanding of where requests are coming from and what for, allowing them to track volume trends and time-sensitive requests. This can be critical, as time-sensitive health plan based requests continue to grow. Healthcare providers are being strained by growth in these critical health plan requests, routinely 30 percent year-over-year, with some experiencing even higher demand.

Patients themselves also appreciate the ease that technology brings to securely and safely manage their own medical record. Given medical information may be the most important personal information to a patient – real-time, self-service tracking means they’re always confident their request is being addressed. With detailed reporting available, requesters can avoid having to follow up with phone calls and creating additional requests. Electronic request and delivery also allow patients and other requesters to harness technology, saving them from having to deal with manual requests, cumbersome fax inquiries, hold times and call backs to providers, or making a special trip for an in-person request. And, when special handling or authorization is needed, the more advanced ROI technology allows for constant patient feedback for specific points of improvement.

No matter what kind of requests are being dealt with, managing compliance and health information laws is complicated and ever changing. Technology is helping navigate these challenges and given the right tools, appropriate security levels, encryption, and continued assurance that users handling data have authorized access to it can be accomplished.

Changes at this scale require significant time and energy, not to mention the additional effort it takes to earn stakeholder buy-in. The road to full digitization can be long, but ultimately, it brings major quality improvements for providers and patients. According to a study by the Commonwealth Fund, administrative costs accounted for 25 percent–or more than $200 billion–of total hospital spending in the United States. Providers have the opportunity to reshape several of these high-value processes by integrating a scalable ROI technology platform into their clinical revenue integrity strategy, and the change needs to begin sooner, rather than later.


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