In this session, we will describe how the EMDI initiative as part of the CMS' Office of Administrator's Burden Reduction Team helps reduce provider burden and promotes interoperability by introducing efficient "Use Case workflows" as part of our provider to provider communication pilots using nationally recognized health IT standards.
Over the past 10 years, most providers have adopted digital technology to record information about their encounters with patients. Most providers have moved away from paper-based medical records and turned to electronic health records (EHR); however, communication providers like Durable Medical Equipment (DME) suppliers, and Home Health Agencies (HHA) still use paper, fax, or proprietary web portals. This communication lacks an integrated workflow that is secure, fast, electronic, interoperable, two-way, and supportive of medical documentation attachments. These limitations result in improper payments, claim appeals, and increased provider burden among service providers.
Service ordering providers suffer from increased burden as a result of the absence of readily available information on requirements, and authorization for a manual paper-based order/referral. Tracking and renewal of paper-based orders/referrals also adds burden. Similarly, service rendering providers find it difficult to obtain missing documentation, and/or signatures from providers in a timely manner exacerbated by the lack of streamlined workflows, inefficient communication, and poor traceability of Additional Documentation Requests (ADRs). The resulting claim denials, and subsequent appeals only adds more provider burden. Common denial reasons include missing documentation due to no response to ADRs, no documentation supporting medical necessity, missing signatures, dates, or invalid orders. CMS' Health IT standards-based approach sheds light on the adoption of end-to-end interoperable use cases that can address the challenges mentioned above in provider-to-provider communication.
Service rendering providers (e.g. DME or HHA) and service ordering providers (e.g. Hospitals) can play a meaningful role in connecting the missing links in interoperability but are hindered by limited awareness and understanding of:
• The current state of interoperability in healthcare today.
• Opportunities for service providers to exchange information with ordering providers electronically.
• Electronic standards and terminology to support the interoperable exchange of order/referral and medical records.