Acronyms, Audits and Automation – Oh My!

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Like Dorothy following the yellow brick road to Oz, new adventures lead to new discoveries and observations. During our most recent adventure introducing the new cloud-based Refyne™ healthcare platform, our team here at Vyne Medical made a few observations we thought are worth sharing.

Acronyms

Everyone in healthcare knows there are likely more acronyms associated with this market than any other line of business. Combine healthcare with government, and the pool of acronyms quickly becomes a sea of letters. You end up with conversations that go something like…‘the CMS esMD initiative enables providers to submit ADRs in response to eMDRs via a CMS-Certified HIH to respond to Medicare FFS and RAC audits.’

If you’re not in healthcare, you need a decoder ring just to understand the basics of this alphabet soup. To translate it for you, ‘the Centers for Medicare & Medicaid Services (CMS) Electronic Submission of Medical Documentation (esMD) initiative enables providers to submit Additional Documentation Requests (ADRs) in response to Electronic Medical Documentation Request (eMDRs) via a CMS-Certified Health information Handler (HIH) to respond to Medicare fee-for-service (FFS) and Recover Audit Contractor (RAC) audits.’

Those of us in healthcare know these acronyms are key to managing audits and reducing denials for any successful organization.

Audits

Speaking of audits, as we mentioned in a previous blog, the Medicare Fee for Service (FFS) Recovery Audit Program has restarted after taking a brief hiatus starting in March 2020 due to the COVID-19 pandemic. Things are ramping back up to previous levels, with RAC auditors soliciting responses to inquiries as they work to make sure proper payments are being made for services rendered.

Medicare audits require strict response timelines and missed deadlines can lead to denied claims, which are akin to flushing revenue down the drain. It could be a rude awakening for organizations who aren’t adequately prepared, particularly those who have new team members due to recent trends in employee turnover. Now more than ever, processes and tools that support the automation of audit responses are key to meeting deadlines and preventing claim denials.

Automation

Healthcare leaders are constantly assessing workflow processes. Solutions that automate time-consuming, manual tasks are key to workflow management. With all of the buzz around artificial intelligence (AI) and robotic process automation (RPA), there’s no shortage of technologies that can help providers do more with less, but integrating these types of solutions can be a daunting task.

The words ‘change management’ are often met with groans of displeasure from many businesses, and healthcare is certainly no exception. Striking the right balance between solutions that empower change and workflows that drive business operations is critical. Take, for example, the Refyne Audits solution which enables audit teams to leverage an easy-to-use, convenient, web-based tool to receive and respond to CMS FFS audit requests. The software doesn’t disrupt the response process; it streamlines the way employees manage audits by eliminating the need to print and mail medical necessity documentation, chart notes, etc.

Teams save time, organizations save money, CMS receives less paper, and ultimately, we all save some trees in the process. Maybe new adventures aren’t so bad after all.

Contact us to find out how Vyne Medical can help guide you down the pathway to reduced denials.

 

 

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