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ABT NEWS
QUARTERLY NEWSLETTER April2015
Architecting document control systems for healthcare providers and pharmaceutical companies
Release of Information: Your Untapped Source of New “Ancillary” Income
At one time, building a financially successful medical practice was based on clinical know-how. In today’s healthcare climate, however, financial realities require that physicians constantly switch between their clinical hat and their business hat, if they are to remain operational for themselves and their Patients. However, if physicians’ time is already tapped out, what else can they possibly do to stay afloat financially in a rapidly draining pool of compressed reimbursements from the government and insurance companies?
The answer is ancillary income, or “money earned by an organization through an activity that lies outside its normal core activity and purpose.” Physicians must learn how to generate new revenue from as many sources as possible, as ancillary income is “becoming increasingly critical to maintaining the bottom line.”
Income from Release of Information (ROI) processing, or fulfilling requests for Patient medical records, is the least understood opportunity in healthcare for creating ancillary income. If you were to ask any Physician Practice, Physician Group, or Clinic, at any level, how much income is available from their ROI fulfillments, 98% would not be able to quantify the dollar amount, regardless of whether they are processing the records requests in-house or outsourcing them to an ROI service bureau.
It is not unusual for medium- to large-sized physician group practices and clinics to be capable of realizing anywhere from $8,000 - $15,000 per month in ancillary income from ROI. Providers using ABT Medical’s ROI+ automated online fulfillment platform have generated over $10M in new revenue from ROI processing thus far in 2015. The ease of capturing this hidden revenue stream is what makes ROI such a strong revenue cycle initiative for Providers.
Quoted Source:
T. Grogan & A. Soyer (Eds.). (2011). Enhancing Your Practice’s Revenue: Pearls and Pitfalls
(Product No. 05247). Retrieved from AAOS Practice Management Committee website: http://www3.aaos.org/member/prac_manag/enhancing_revenue_primer.pdf
From ABT to You . . . .
There is growing confusion over the proper fee for a Provider or Service Bureau (known as a “covered entity”) to charge for providing medical records to a legitimate requestor. Typically, covered entities charge the state-authorized rate. In the case of patients requesting their own records, the federal Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR 164.524[c])—and the later Omnibus clarification—state that a covered entity can only charge a “reasonable, cost-based fee” for providing medical records to a patient; furthermore, the patient can specify that their records be sent to a third party.
Increasingly, when a third-party request is being made directly by an attorney, the attorney is claiming to not be subject to state fees and to instead be entitled to the same federal “HIPAA rate” as the patient because the records are being requested for the patient. While patients pay the HIPAA rate and can request that their records be sent to an attorney, the US Department of Health and Human Services explains in 45 CFR 164.502(g) that attorneys who originate a request are entitled to the HIPAA rate only if they qualify as the patient’s “personal representative.” Being a legal representative does not mean that the attorney is the patient’s “personal representative,” which is defined as someone with the legal authority to act on behalf of the patient in healthcare decisions.
What does this mean for Providers and Service Bureaus? If requestors say that state ROI fee statutes do not apply because of third-party “personal representative” rights, they need to supply you with a legal, written document proving that they are authorized as the patient’s “personal representative” in all healthcare-related decisions.
Angela Ford
Senior VP Corporate Communications
Angela Ford
aford@abtmedinc.com
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