Mercy Medical Center’s Insurance Verification department has been using the Trace® platform to document voice, fax and electronic exchanges with the hospital’s payers for nearly 20 years. While the hospital had considered Vyne Medical’s work-from-home solutions prior to COVID-19, the pandemic accelerated these plans and made the move to a remote workforce a top priority.
When the State of Ohio passed stay-at-home orders in response to COVID-19, Mercy contacted Vyne Medical and requested to move its Insurance Verification employees to a remote setting as soon as possible. In a 48-hour period, the team was setup to begin their transition to a work from home model.
“Trace enabled us to work from home during the pandemic with ease,” said Tami Arney, Director of Patient Access. “The staff and everyone I know who comes in contact with the platform all love it.”
Mercy’s Insurance Verification department consists of 14 employees who perform verifications for inpatient, outpatient, surgery, and therapy services. Some of these cases are high dollar procedures, making it critical for the hospital to maintain proof of payer authorization to help ensure full and accurate reimbursement for services.
Using Trace, verifiers record the insurance company’s authorization on their statement indicating that no authorization is required for a particular procedure. If the hospital later receives a denial, Mercy’s Patient Accounts employees – including billing, collections and reimbursement specialists – look up the verification recordings in Trace and send them to the payer for proof of authorization.
In a recent webinar, Tami Arney, shared her personal experience with the documentation proof that Trace can help provide. For example, when Tami’s husband was scheduled for an MRI at the hospital, the insurance verification team requested authorization for the procedure and was told that no preauthorization was required. Later, the payer denied the claim, stating that the scan did in fact require it. The team was able to produce a transcript of the recorded call with the payer, the denial was overturned, and the hospital got paid.
In order to transition to an at-home setting, the hospital needed to ensure that these calls could still be recorded and remain accessible to the organization. “We anticipated the biggest hurdle being the ability to record our calls remotely,” said Tami Arney. “This ended up being a very easy process with Vyne Medical’s assistance, our IT department and telecom.”
In addition to overturning denials, the ability to listen to recorded calls provides assurance that quality and productivity standards are maintained in a remote setting. Quality checks are performed regularly to assess representatives in key performance areas. Patient advocates also listen to recordings and view associated orders and documents to perform root cause analysis of any service issues or disputes.
Vyne Medical’s work-from-home platform has given Mercy Medical Center a way to protect employees in response to the pandemic. In the process, it has helped to increase the department’s flexibility and mobility, reduce its on-site footprint, and improve employee satisfaction. With the success of the program in Insurance Verification, Mercy anticipates expanding the solution to additional departments in the future.