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Get Audit-Ready with Document-Aware Workflow
- 1. Brightree Document Management Brightree is a registered trademark of Brightree LLC. © 2012 Brightree. All Rights Reserved.
- 2. Get Audit-Ready, Avoid Recoupment “There is no way to avoid audits, especially in the current environment. Eventually it is going to happen, so you need to be prepared.” -Wayne van Halem, The van Halem Group “When it comes to audits, no one is immune. Even the best of us are bound to be subject to a pre-pay review or RAC audit, no matter how thorough our documentation practices may be.” - Andrea Stark, MiraVista CMS recovered $3 billion in 2010 and an estimated $10 billion in 2011. - HME Business magazine
- 4. Regulatory Compliance CMS paper audit requests and responses becoming history with esMD initiative • CMS electronic audit response pilot underway • Fall 2012 plan – begin electronic requests and responses • Just storing documents in an electronic filing cabinet is not enough • Reducing recoupment risk requires document-aware processes
- 5. Document-Aware Workflow Intelligence in the software automates document workflow • Knows type of document • Knows related payer rules • Guides process with proactive alerts • Reads information and validates • Creates direct access to documents • Enables context-based searching • Provides security and control Automate Document Overflow to Reduce Risk of Recoupment.
- 6. One-Click Document Capture • Multiple approaches for capturing documents – Interactive single scan from patient record – Batch scanning – File upload – Automated delivery from Brightree processes • Use standard Brightree searches to index captured documents
Editor's Notes
- As many of you know we recently announced our new next generation document management solution. We’ve heard from our customers and understood your requirements for deeper automation related to document management and an integrated solution that will not only provide fast and accurate access to your data but help you be prepared for audits.That’s why we are all here today. To help you understand why document management is so critical and how next generation document-aware capabilities expand on existing document imaging technologies.
- Throughout this presentation you are going to hear a common underlying theme about the relationship between audit preparedness and document aware capabilities. I am certain you all know this much better that I do that the landscape has changed and audit frequency is increasing – both Wayne van Halem and Andrea Stark essentially tell us “its not if, its when are you going to be audited; Are you prepared?”In 2010 CMS recovered $3Billion and $10Billion in 2011. Even commercial payers are now conducting audits.You now have dedicate more and more attention and resources to respond to audits and that costs time and money to support on top of the fact that that reimbursements are reducing.You need help in responding to these changing market conditions and your software needs to help you respond these audits quickly and accurately and save you money through automation. Being fast and accurate is directly proportional to your ability to locate the information and the confidence that the information is there when you need it.That’s what we want to talk about today. How is Brightree helping you be more efficient and more proactive in response to the inevitable audit.
- We live in a document rich environment now. It’s the blood that flows through the veins of every HME provider. Documents can originate from anywhere and everywhere. Let’s focus on the physician orders, test results, certificates of medical necessity, and proof of delivery related to patient care and reimbursement for a few minutes. How much time do you spend searching your electronic filing cabinet to determine if one of the many required documents is on file so you can proceed with billing? How many times do you recreate the required document because you could not locate it? How does that affect your timely filing and write-offs? Even if your documents are in your electronic filing cabinet you have to spend too much time searching for the information or its mis-filed. In either case your electronic file cabinet is not helping you be proactive. Its not automating your processes.What if Brightree could proactively alert you of missing documents and present that in a work list for you to work from or place delivery orders or billing on hold until those missing documents were on file? You would have the confidence that you are prepared for the inevitable audit. Your cash flow would be more stable because your denials related to missing documents would decrease. All the time and effort you spend manually administrating processes could now be devoted to patient centric tasks.
- There are new standards that are being imposed with respect to audits. Medicare’s new electronic submission of medical documentation initiative is a plan that will electronically request audits and require an electronic response. A simple electronic filing cabinet will not be enough to help reduce rick of recoupment. You need a method to manage by exception versus relying on people to remember to keep checking over and over again if the documentation is in place for delivery and for billing. By applying rules and automation, Brightree will never give up until it has what it needs and what is required to deliver and then bill. This ensures that you have the documents required when the audit request comes from the payer.esMD = electronic submission of medical documentationHIH = health information handlerNHIN = national health information networkPlant seeds of automation and efficiency – discuss how BT is dedicated to developing automated tools such as Auto CMN Renewals and BTIV and eClaims
- When we talk about document aware capabilities we are saying that whether you realize or not you are in a state of document overflow. You have more documents to find or create than ever before and you cannot do it without automation tools to help you. Brightree has integrated many subtle things into the new document management solution that you may not realize are there. Knows type of document – Not only are we categorizing the types of documents to make them more easily accessible, Brightree also understands the inter-relationships between documents so that when an audit comes you are able to, not only, find those documents that you uniquely search for but also the related documents that you forgot you needed as well. test results, Face to Face, CMNs, delivery tickets; leveraging the data in BT to make docs more searchable. Knows related payor rules – Different payers have diff rules on what documentation is needed for delivery and what documentation is needed for billing. You know how it is….Today with the electronic or paper filing cabinet approach you have someone constantly checking to see “is the documentation here yet; can I deliver the item? Is the document here yet? Can I release this invoice for billing”. By defining rules based payer requirements and specific document categories, Brightree can proactively guide you and check to let you know when things are there and when they are not, giving you a workflow and tasks to look at so that you are more efficient at resolving the discrepancies of what is missing. Guides process with proactive alerts – Alerts you to missing documents so you can manage by exceptionsReads information and validates – Think about the volume of information that comes in everyday, such as delivery tix. You want to be able to drop them into the scanner and read them in and let the system automatically associate them where they need to be. Being able to read the information is important. Some documents will have bar codes on them that Brightree can work with while others will require Object Character Recognition to actually read the paper and pick up values. Think about CMNs. The Dr. signs them CMN and marks certain bubbles in. Wouldn’t it be nice if the system was Intelligent enough to know that box 1 and box D were checked and if there was a number in a certain field it would lift all of that information and transfer it into the system so now you are working on verifying the information versus typing it in yourself.Creates direct access to documents – How do I get to the data I need when I need it. This relates back to the discussion about the Brightree data. I don’t have to go to the patient folder in the electronic file cabinet and keep flipping until I find the data. I get that selective search so that I can go find what I need when I need it. It also means that documents are accessible directly in the Brightree interface directly in the patient record for example. If I need patient documentation I simply go to the patient record and that documentation is there and I can search and filter to locate selective data. Enables context-based searching – more than just patient documents can be stored in Brightree so you need a way to perform a context sensitive search Provides security and control – Being aware of who can see what documents is very important. Not everyone should see everything that I choose to store in my document management system. Its all about the control and access and the understanding of what is accessible and what is not.These are just a few of the things that define Document Aware Capabilities.