DMX (Denial Management Exchange)

Customer Testimonial, Roy Gomes, HIM Director

“Enterprise Internal Connectivity – now all our clinics, the business office and the hospital departments are all connected so that they can use Request IT and DMX to electronically request and receive records. Using Request IT and DMX dramatically reduced the turn around time for our Patient Accounts requests. Universata’s system has take 2 to 5 days off the turn-around-time with the payers (Accounts Receivable).”

The Central Business Office /Patient Accounting Services (CBO) and Health Information Management (HIM) departments are connected at the hip;

• Sometimes the friendship is mutually rewarding
• Sometimes communications are strained and the relationship turns into a battle of wills.

The CBO may be in the same building or they may be hundred’s of miles away from the HIM department, but they still have to work together to improve the revenue cycle and the hospital’s bottom line.

This relationship between the two departments can be made even close via a new, innovative approach to release of information (ROI) process – secure health information exchange.

Medical record documents are critical to the business office:

• Supporting the initial claim,
• Filling payer ROI requests, and
• Responding to additional development request.

The Healthcare Financial Management Association reports that 75% of claim errors are due to insufficient or unavailable medical record documentation. Deloitte and others track hundreds of reasons that a claim may be rejected/denied. This starts an enterprise cascade, taking 30% of the HIM Director’s time in meetings; 20% of their time in their department’s administration, plus the time of the CBO Director.

Creating the shortest path from discharge to payment of claims touches the entire enterprise.

Universata will enable the exchange of medical records between the Business Office and HIM to improve the denials management process. The Business Office will be trained by Universata to electronically request and receive medical records from the HIM department using their own computers.

• The CBO will e-request records through the use of Request IT.
• HIM personnel will scan paper records or gather electronic records into PHI-nd IT™.
• HIM staff will be trained to support the business office in the use of Request IT.
• The CBO will receive the record electronically. If there are two payers, requesting the same record, it can be repurposed not re-requested.
• The CBO will be able to forward the paperwork generated for billing (UB-92, etc.) plus the medical record directly to the payer if the payer accepts electronic deliver. If the payer does not accept electronic delivery, the CBO can print or eFax.

Payer Electronic Requesting

The Universata will work with HIM and the CBO to get third-party requestors that are not already requesting and receiving e-medical records from Universata to adopt Request IT as their electronic correspondence system for health information exchange (HIE). This electronic exchange can take 2 to 5 days off the accounts receivable timeline.

The CBO or the payer that has been approved to use the system, may do individual requests (takes less than 1 minute per request to input information) or attach an Excel file with hundreds of requests at one time.

Enterprise Version of DMX

In the Enterprise Version of DMX, the CBO can request records from a picklist of healthcare facilities – hospitals, clinics, institutes, nursing homes, rehab centers and physician practices that are all associated with the CBO.

Benefits of DMX

• Reduced Labor/Automation/Integration - As an integrated control system, DMX allows a single user or set of users to systematically manage the denial response and bill submission process. DMX can be integrated into key hospital systems.
• Timeliness - Speeds up collection on denials. Often referred to as “days in AR”, DMX has demonstrated a guaranteed reduction in days in AR of 2 to 5 days at all sites aggressively and correctly using the DMX. Each day is worth several millions of dollars per month (depending on size of the organization) of additional cash-flow the enterprise would not have otherwise realized.
• Efficiency - Prevents subsequent denials to denial responses. There is a cause and effect loop that often triggers additional denials after the first one. Payers tend to loose the medical record and ask that it be sent again. With eDelivery, the CBO knows when the record was received and viewed by the payer. The record can be resent without reworking the entire process. By using DMX functionality to track and route all billing and denial information/content, the hospital has an assurance of absolute accountability via any of the DMX’s delivery mechanisms and reporting tools.
• Improved Bottom Line - Reduces the overall proportion of denials in any organization. Key reports about the entire process will provide business intelligence that allows DMX’s users to understand, compensate for, and take control of why denials are occurring.
• Secure/Private/Auditable – No more records lost in transit. Meets all HIPAA, Security and Joint Commission rules.