In 2001, West Jefferson Medical Center evaluated and implemented the Trace communication management system by Vyne Medical to improve workflow and profitability in its case management department. The Trace system captures communications—voice, fax, e-mail and other media—and stores records in a simple, searchable web interface. Hospital staff can quickly recall information about a patient to provide proof of insurance approval, confirm treatment instructions, and enhance patient care.
The case management department at West Jefferson received a large number of medical necessity denials as a result of an inability to document routine communication for denial management efforts. In 2000, the hospital’s medical necessity denials totaled more than $700,000. While staff spent significant time working to secure payment for services through communication with payers, they were left without proof of their efforts when needed in payment disputes.
By implementing Trace within the case management department, West Jefferson began to immediately see a reduction in claims denial. In fact, denials dropped from more than $700,000 in 2000 to less than $25,000 by 2007, a reduction of 83%. The ability to collect and replay phone conversations with insurers provided the proof the hospital needed to stop unwarranted denials.
“We only had to play a call for each payer one time; after that, they didn’t need any more proof. We never needed to submit written appeals for those claims,” said Darlene Gondrella, Director of Case Management.
Trace provided additional benefits as well. Medicaid patients represent 26 percent of West Jefferson’s inpatient population. Timely notification was critical to the hospital’s reimbursement, as failure to notify Louisiana Medicaid within 24 hours of a patient’s admission resulted in denial of the patient’s claim.
Processing these claims was time consuming—from 45 to 90 minutes per claim because of the time staff had to spend completing hard copies of forms, faxing them, and following up to make sure they weren’t misplaced. With Trace, this process became digitized, with online forms that auto-populated many of the entries. This reduced the time need to process a claim by over 93%, allowing case managers to handle more patients with their freed-up time.
The process also reduced Medicaid response time from 48 hours to less than an hour, dramatically reducing hospital costs for processing claims and preventing the hospital from having to absorb care costs for claims denied after several days’ stay for a patient. Faster processing also means faster payments to the hospital. Communications chaos is one of a hospital’s biggest revenue enemies. It can cost a 500-bed hospital as much as $4 million in the course of a year, through denied claims, miscommunication, and other errors.
Trace Benefits at a Glance
- Avoided initial denials from payers by showing documented proof of calls
- Improved turnaround time on claims payments by 30 — 60 days
- Increased percentage of medical necessity denials overturned from 56 percent to nearly 83 percent
- Reduced number of medical necessity denials from $716,000 annually to less than $25,000 per year
- Allowed case manager previousy handling appeals to take on full case load of 40 patients
Trace is a communications management solution that has been proven to dramatically reduce revenue loss. With Trace, all communication—voice, fax and electronic—can be captured, consolidated, and retrieved through a simple web interface. There’s no more lost correspondence. No more “he said, she said” issues that can result in denied claims. No more wondering if a message was properly delivered to the right department. Trace is in use nearly 400 hospitals nationwide. In some institutions, it has been responsible for reducing denied claims by as much as 25%, and generating millions in extra revenue. Trace is a simple, remarkably effective way to eliminate communications chaos.
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