SUMMARY
Organization: Large Management Group
Size: More than 2,000 physicians across the country
Top-line Requirement: Take action to reduce compliance risk and associated liability with collecting and submitting documentation
CMS and commercial payers are all getting better at analyzing large volumes of claims data – that’s why it’s critical that healthcare organizations provide proper documentation to support their claims. Even well-respected organizations have been hit with denials or negative audit outcomes.
One area of concern for practice management groups is access to clinical documentation when rounding at hospitals with disparate EMRs. Last year, Ingenious Med conducted a research survey of 63 executives at practice management groups; more than half (54 percent) of respondents were not highly confident in their ability to immediately access clinical documentation to support clinician charges in the event of an audit. Despite rounding at facilities with leading EMRs, these organizations are uncertain about meeting compliance standards due to this lack of access, which is a cause of concern since they will bear the burden of the penalties.
This case study discusses how one large management group partnered with Ingenious Med to build a tool to mitigate its compliance risk.
The Client
- Ingenious Med partner for over a decade
- Physician management company operating nationwide
- Employs almost 20,000 physicians – Founded over 30 years ago
- Serves hospital-based practices, ambulatory, and post-acute care
The physician management company uses Ingenious Med for charge capture for more than 2,000 physicians. This organization does not have at-will access to the EMRs in the various facilities they contract with across the country, making it difficult to pull documentation to support their claims. Though the organization can easily bill out for services delivered by its physicians, it can be a challenge to match the bills with the correct documentation.
Background
The company was employing a full-time employee (FTE) at the majority of its acute care facilities where its physicians were contracted. This employee’s job was to make sure that they received a copy of each patient’s medical documents sent to the central billing office. This involved physically making copies of the documentation, which was then mailed via FedEx, or scanning the documentation electronically if that option was available. This multi-part workflow caused delays because the FTE had to wait for the clinical documentation to be finalized prior to compiling and sending to the central billing agency.
Key problems with submitting physical clinical documentation through a mail service:
The Issue
The IssueThe client acquired another physician management company with a strong footprint in the post-acute space. The newly acquired physicians moved frequently from location to location without access to an EMR, and without an FTE collecting and submitting the documentation.
After the acquisition, the client began reviewing policies and procedures of the acquired company and realized very quickly that there was a significant compliance risk in the way it had been operating. The acquired company was simply billing what the physicians were submitting, without documentation, and without an official process to gather the documentation. The client knew they needed to take action to reduce compliance risk and associated liability as this issue would only continue to get bigger as the client expanded its post-acute footprint.
Unfortunately, the acquisition was audited and received a negative outcome. The client was hit with a massive (tens of millions of dollars) fine from CMS – an event that validated their need for a solution that would mitigate any further liabilities. As a long-time partner, the client came to Ingenious Med seeking help.
How the solution was conceived
As the client described the business problem they were facing, Ingenious Med realized that this was likely an issue for other organizations as well. There was a clear need for the clinical documentation and the Ingenious Med charge capture solution to coexist within the same footprint. Ingenious Med did not choose to collect documentation via an HL7 feed because post-acute facilities are not required to have EMRs under Meaningful Use regulations.
Many are still on paper. Those who have EMRs do not typically have the IT resources to create handshakes between various technologies.
Therefore, Ingenious Med developed a HIPAA-secure feature within the application that allows physicians to capture documentation images from their mobile devices and send both the charge and supporting clinical notes to the organization’s central billing agency via a billing interface.
Ingenious Med developed the document image capture tool through an agile approach, allowing the client to review iterations through the development process to ensure that the solution would satisfy both the documentation need and the usability expectations of the physicians who would be using the tool. In less than 6 months, 100 percent of the physicians who were part of the acquisition were live with the solution.
Global application and results
Since deploying the Ingenious Med document image capture solution, the client organization has captured over 50,000 images to support their clinician charges in the post-acute space.
Once the solution was launched with the client, Ingenious Med adapted it for broader use on the acute care side as well to post-acute care. These additional features can help reduce costs associated with the previous, more time-consuming and expensive workflow of using an FTE for documentation capture. The solution ensures the client’s billing department has direct access to the original physician notes, giving clarity to their charge capture and billing process and ensuring better compliance and lower risk across their organization.
Additional resources: