ROI’s future in technology and clinical revenue integrity

Medical records management is on the cusp of a sea change within Health Information Management (HIM), evolving from traditional copy service through disclosure management and release of information (ROI). The technology-enabled future of ROI is at a cornerstone of clinical revenue integrity. As healthcare grows more specialized and complex, the difficulties of managing health information increases in turn. A morass of state and federal laws governing medical records means that compliance requires ongoing research to avoid accidentally stepping outside the bounds of law. Disparate and, at times, antiquated archival systems dispersed across multiple providers are tough to manage, and actually obtaining the appropriate records can take time.

When retrieval is stymied, it not only impacts real patients but also the provider’s bottom line, as the need for clinical information is increasingly part of the broader revenue cycle. Despite these difficulties, though, the future of ROI can be bright if providers effectively harness technology and leverage this process for clinical revenue integrity.  A major advantage technology-infused ROI offers to the clinical revenue integrity process is additional insights and analytics. ROI processes were often thought of as advantageous mostly for HIM departments, but ROI truly sits at the convergence of clinical data and financial performance.

The standardization technology offers for health records, along with advancements in artificial intelligence and natural language processing, can more easily produce actionable insights into 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 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 glean information that’s nearly impossible to quantify without technology. Health systems can identify and track network leakage across patient groups, and develop programs to shore up high-risk revenue streams.

Providers can also better understand where requests are coming from and what they are coming for, allowing them to track volume trends and time-sensitive requests.  This can be critical, as volumes of time-sensitive health plan based requests, which should align with providers’ contractual guidelines, continue to grow.  Healthcare providers are being strained by growth in these critical health plan requests, routinely 30% year-over-year, with some experiencing even higher demand.  A comprehensive platform to support ROI as part of the clinical revenue integrity process can empower providers with insights to materially impact their revenue cycle performance.

Patients themselves also appreciate the ease that technology brings to securely and safely manage their own medical record. Real-time, self-service tracking means they’re always confident their request is being addressed, and notification checkpoints are built into end-to-end tracking at every step in the request. With detailed reporting available, requesters can avoid having to follow up with phone calls to providers or creating duplicative requests. Electronic request and delivery also allows patients and other requestors 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 to navigate these challenges. The right tools offer built-in levels of security, encryption, and continued assurance that users handling data have authorized access to it. According to a 2016 survey by Ponemon Institute, data breaches cost healthcare organizations an average of $355 per record, and with incredibly sensitive information, it is particularly important to safeguard against exposure.

Changes of this magnitude 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. Today, 25% of healthcare provider costs in the U.S. are administrative. 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.