Establishing Undeniable Proof to Fight Denials and Win at Community Health Network
Document authorization, insurance verification and notification activities – voice, fax and electronic – for proof to prevent and overturn denials.
Convert to paperless workflow with electronic faxing and image export to the EHR.
Centralize insurance exchanges for enterprise access to reduce rework and shorten appeals process.
Community Health Network uses Trace by Vyne Medical to record phone conversations, send/receive faxes and capture activity from web sites and other hospital systems. All activity is tied to the patient account and centrally stored for enterprise access and exchange.
Denial team receives denial or request for more information
Team checks EHR for reference number to voice recording, fax or image; retrieves record for proof to fight denial
If proof is found in voice recording:
team sends transcript of recorded call showing proof of authorization or agreed-upon level of care
If proof is found in fax:
team sends documentation letter showing content of fax and date/time stamp for proof of timely notification or of clinicals being delivered
Denials routinely overturned using proof of these interactions
No more rework and back-and-forth between departments
Disconnect between care management and patient access
Care Management absorbed employees from patient access center and surgery authorization verification team
Streamlined workflow and strengthened denial management with additional patient insurance representatives
Disconnect between care management and backend departments
Trace® applications implemented for voice recording, electronic faxing and image capture
Authorization, notification, clinicals and level of care activities are documented, indexed and centrally stored
Time spent on manual tasks such as printing and scanning
Care management implemented Trace electronic faxing and integration tools for automatic export of images to the patient record
Streamlined care management workflow and eliminated the need to print, scan and manually fax information
Denials team references voice recordings, electronic faxes and images to win appeals
Utilization Review references voice recordings to verify patient coverage and stop denials before they start
In 2018 alone, Community overturned over $30 million in initial denials.
Time and Cost Savings
Utilization Review has direct access to information needed to support claims
Electronic faxing and image export reduce paper and machine costs. Non-clinical staff process faxes and alert appropriate case manager, to reduce administrative burden for RNs
Back-end works accounts faster with fewer manual touches and less rework between departments. Denial management team completes reviews in a more timely manner, leading to earlier discharges and reduced length of stay
Community has responded to increasing demands from payers without increasing FTEs in UR or Denial Management. Initial plans to hire 5 additional RNs became unnecessary because of efficiencies gained with centralized access to care management data. This saved the network the equivalent of 5 FTEs with benefits.
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