By: JULIE PARKER
The not-so-new role is gaining traction, as time and money savings highlight submissions process
Five years ago, the 400-bed Boca Raton Regional Hospital in Florida faced a crush of Medicare audits and penalties. The 47-year-old, not-for-profit hospital made a significant change resulting in a complete turnaround by employing an entity with which many healthcare providers remain unfamiliar: the health information handler (HIH).
“According to hospital officials there, the previous process had been cumbersome, and meant printing, sorting, packaging and mailing documents to Medicare to support claims and to adjudicate their bills,” said Lindy Benton, CEO of Norcross, Ga.-based Medical Electronic Attachment/National Electronic Attachment (MEA/NEA), a certified HIH that has electronically delivered and tracked patient medical records for healthcare providers nationwide via CONNECT, an open source health information exchange software that serves as the National Health Information Network’s (NwHIN) transmission mode for esMD (electronic submission of medical documentation). “Since one patient record can fill a box or more, hospitals are left paying for all materials, labor and shipping involved … enormous financial considerations for every organization.”
Because the Boca Raton hospital is now able to submit documents electronically via an HIH, the Medicare audit process has dramatically improved and denials related to untimely submission of records have disappeared entirely, Benton noted.
Benton explains: “For example, Medicare allows 45 days from the date of request for hospitals to respond, but Medicare still sends documentation requests by paper. Typically, by the time the request arrives at the proper hospital department, more than 10 days has elapsed. Managing the entire process requires a very strict time requirement and hospitals often fail to return records to Medicare on time, which blocks hospitals from making appeals. By automating the process and securely depositing electronic attachments to Medicare’s official information portal, Boca Raton Regional Hospital has prevented the loss of at least $350,000.”
What exactly is a health information handler?
The Centers for Medicare & Medicaid Services (CMS), which manages the HIH program, defines an HIH as “any organization that handles health information on behalf of a provider.” HIHs are often referenced as claim clearinghouses, release of information vendors, and health information exchanges (HIEs), and most also provide esMD gateway services.
“esMD is still a work in progress, an ongoing experiment, spearheaded by CMS to support electronic exchange of information between health systems and Medicare audit contractors,” explained Benton. “Prior to esMD, providers had just two ways in which to respond to documentation requests from Medicare review audit contractors – mail or fax. esMD fixed that problem.”
The esMD gateway isn’t set up like a typical website, Benton pointed out.
“Not everyone wanting to submit information via the gateway can simply jump on, upload files and press the ‘send’ button,” she noted. “To interact with CMS through esMD, organizations need access to the portal. The gateways are costly to develop and maintain so hospitals and providers turn to HIHs to facilitate the exchange process. HIHs build and service an esMD gateway for multiple provider participants and submit electronic documentation on a provider’s behalf. As more providers use HIHs to simplify their audit processes, electronic health information exchange also will increase in usability.”
Slated improvements are poised to further streamline this process. The HIH program has been effective for more than three years – phase 1 went into effect on Sept. 15, 2011 – and phase 2 will allow providers the ability to receive electronic documentation requests when their claims are selected for review … when CMS launches it.
“From a business and enterprise perspective, the move by CMS to launch the program has meant the growth of a number of HIH firms like ours that offer a variety of services and skill sets,” said Benton. “In addition to providing exchange capabilities, some allow for capture of information, scanning, storage and transmission in a secure manner. The HIHs also track data sent, and acknowledge and verify that it’s been received by auditors through the gateway … are considered business associates of the organizations they serve, and are required by CMS to follow HIPAA rules.”
Challenges remain, emphasized Benton.
“There are hurdles to widespread implementation as hospitals resist using the solutions because they’re overwhelmed with current technology,” she said. “They’re already so invested in other projects that many are unable to see the benefits of bringing on additional solutions and being able to exchange information with CMS. A prevailing thought is that those managing hospital IT departments simply are overwhelmed and growing ever more nonchalant about the idea that technology is going to save them or their employers any more than already has been promised.
“In fact, recent reports have begun to surface claiming that CIOs at struggling health systems have little faith that new technologies, on top of recently implemented systems like EHRs, will do much good for them since these other solutions – the EHRs – had such little positive effect on their organizations’ bottom lines. Simply put, they’re sensing a bit of personal doom and growing tired of all the hype. It’s unfortunate.”
Also, for payers, despite the obvious benefits of encouraging HIH relationships with physicians, esMD and electronic exchange aren’t top priority, considering all the issues being managed, including the current federal insurance overhaul.
“Perhaps time will change this, but for the foreseeable future, esMD isn’t likely to gain the traction it needs to become an industry standard,” observed Benton. “What’s fortunate is that service providers like HIHs are having a positive impact on the healthcare environment and are bringing down some pretty mighty horses, while also helping bring about better workflows, improved efficiencies and increased profitability. Despite the lack of awareness surrounding these healthcare partners and their impact across the sector, many are still unaware of HIHs’ purpose and the very term by which they’re defined.”
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