At the LeadingAge Illinois 2022 Annual Meeting, Elizabeth McLaren, VP of Reimbursement and Community-Based Services, along with Steven Wermuth, MPA at Strategic Health Care, presented their analysis on the top billing mistakes. What did they find? Within long-term care providers, 8-10% of Medicare Advantage claims were denied. Shockingly, the 10% denial rate impacted revenue by $200 million! They also found that 80% of denied claims are due to missing or incorrect information used during intake and admission.
So, why are so many errors occurring during intake and admission and what is the solution? Let’s face it, clinical care teams are already overburdened, we cannot ask them to take on a larger role. In fact, a recent study by the American Hospital Association showed an increase in job vacancies for nursing professionals at 30%. Staff turnover has increased between 18% and 30%, according to some estimates, which means already burned-out staff are being asked to do even more. Another study showed that 39% of hospitals will likely have negative operating margins in 2021. Therefore, long-term care facilities cannot simply buy their way out of the problem by adding more administrative staff.
What if fax is the answer? What if the solution that your long-term care and skilled nursing facility already use to receive hospital discharge plans and health plan information could also become your manual data entry team? That’s right – a digital fax solution has the ability to automate the tedious task of extracting structured data from an unstructured document and integrating that data into your workflows and EHR.
Some may still consider fax a four-letter word in healthcare, or even refer to it as the cockroach of technology, but the truth is that faxing has evolved far beyond two modems hissing at each other. Today, it’s all about secure document delivery between two agnostic endpoints. Digital fax solutions can even enable the off-ramp to fax and the on-ramp to interoperability. It’s time to look at modern fax the same way as we look at email and texting: an innovative way to send a message between two endpoints. Regardless of how any two institutions view interoperability, it comes down to the ability to share data. There simply isn’t an easier way to share data than via a connected delivery network, and the foundation of that network is in fact fax! This four-letter word needs to be expanded to say ‘digital fax’ in the same way ‘snail mail’ is now considered email.
The three unique types of interoperability are classified as: Foundational, Structural, and Semantic. Faxing, as archaic as it sounds to some people, can provide the onramp to ‘Structural’ interoperability: “the ability of the recipient system to interpret information at the data field level.” Digital fax is easy, it just works, and the sending entity doesn’t have to worry about how the receiving entity wants to receive their documents. Yet, what about the person on the receiving end of a 10-, 100-, or 1,000-page fax? They care how that document is delivered. The right digital fax partner has the technology to enable the receiving entity to turn a fax into a ’structurally interoperable’ document and data. Need to transform the incoming fax into a FHIR-based message? The right digital fax partner can do that. Need to transform the incoming fax into a Direct Secure Message? The right digital fax partner can do that. Need to extract critical patient data from a form such as first name, last name, and date of birth? You guessed it – if you take your time and explore your options, you can find a digital fax partner that can do that. If an incoming fax is transformed into a FHIR-based message, with all of the standard fields already mapped, and it is ready to be ingested at the ‘data field level’ into an EHR, is it still a fax? Yes, that is the power that digital fax, with the right partner, brings to healthcare.
In turning back to the problem of claims denials that was presented at the LeadingAge conference, let’s examine how the right digital fax partner can help solve that problem. Most long-term care and skilled nursing facilities are already receiving the bulk of their hospital discharge plans via fax. Leveraging AI technology, digital faxing now allows you to turn unstructured data locked in faxed images into structured data. For example, when the long-term care facility receives the hospital discharge plan via digital fax, a fax provider can extract the patient’s name, date of birth, primary diagnosis, medications, PCP, etc. All of this becomes actionable data that can automate workflows. More importantly, it can greatly reduce what causes 80% of denied claims – incorrect information that is keyed in during the manual data extraction process.
Overall, digital faxing is not only a secure method of document exchange, it also allows for data extraction that can create real value for your long-term care or skilled nursing facility. Utilizing the document delivery solution you already use – fax – as the on-ramp to interoperability, the right digital fax partner can help you to reduce manual data entry errors that typically cost up to $200 million in denied claims. A modern fax solution can also be utilized to extract structured data from unstructured images. Once you have the right data in the right place through an automatic extraction and integration process, creating claims forms such as a UB04 is simple and efficient.
About Ben Manning
As Director of Product Management at etherFAX, Ben Manning will help guide the mission and vision of etherFAX by aligning the product roadmap to the long-term strategy. Ben has a proven track record of driving profitable growth for products and services across healthcare IT, pharmaceutical market research, and HR consulting firms. Previously, Ben was the Vice President of Product Management at both Vyne and Cerner.
