Flexible Workflow Solutions

The Verisma Partnered Service Solution is designed for those health systems that would like to retain the use of their staff to process each request but get the increased workflow efficiencies and reductions in release errors and overall quality improvement associated with our technology and back-end expert support.  This solution is designed to take advantage of the health system’s ROI expertise while helping our clients manage the entire ROI workflow process with greater efficiency and enhanced compliance protections, all under a financial arrangement that will result in the health system keeping a significant portion of the collected release revenue.

Using our Verisma Release Manager™ (VRM) cloud-based technology platform as the core to this shared workflow solution, your staff would process medical record requests from the receipt of those requests to the point of securely transferring records electronically from their electronic record source/s to VRM.  Once your HIM team members have completed their request and record capture steps in connection with a request, our remote team of highly trained Verisma review specialists secondarily review the associated request documents and patient record copies to ensure that the correct patient information has been processed, identify sensitive information, and obtain from requestors any additional authorizations or directions that may be required.  Our remote teams are also responsible for the invoicing and collection of billable requests, for providing an 8:00am Eastern Time to 6:00pm Eastern Time requestor support call center to facilitate requestor inquiries regarding their submitted requests, and for final record copy distribution support via printed paper hardcopies, secure digital copies on CD/DVD, secure electronic download support from our advanced Web-based requestor portal, or by a direct digital exchange established with individual requesting parties.

Verisma provides extensive and measurable on-going process management and training oversight and include regular site visits, access to our technical and compliance training, and our overall quality and performance feedback.

Verisma retains all record images and transactional information for every request processed through our VRM platform for a minimum of HIPAA’s six-year Accounting of Disclosures rule or in accordance with any specific terms noted in the final services contract with our clients.

The Verisma Onsite/Remote Full Service Solution is designed to offer the comprehensive support of our expert Release of Information Specialists (“ROIS”) teams who will manage the front-end request/record capture process while maximizing your working space.  In addition, we provide you with our ROI back-end requestor call center service, secondary quality review, billing and collection, and final distribution support. This solution will help manage the entire ROI workflow process with greater overall efficiency and accountability.

Using our Verisma Release Manager™ (VRM) technology platform as the core to this remote workflow solution, our dedicated, highly trained onsite/remote Verisma team will coordinate the electronic capture of new record requests from each of your locations into VRM and will capture the appropriate medical records from your various record sources that meet the specific instructions with each request.  Once our ROIS team members have completed their request and secure record capture steps, our remote team of highly trained Verisma review specialists will secondarily review the associated request documents and patient record copies to ensure that the correct patient information has been processed, will identify sensitive information, and will obtain from requestors any additional authorizations or directions that may be required.  Our remote teams will also be responsible for the invoicing and collection of billable requests, for providing an 8:00am Eastern Time to 6:30pm Eastern Time requestor support call center to facilitate requestor inquiries regarding their submitted requests, and for final request distribution support via printed paper hardcopies, secure digital copies on CD/DVD, secure electronic download support from our advanced Web-based requestor portal, or by a direct digital exchange established with individual requesting parties.

Verisma provides extensive and measurable on-going process management and training oversight that includes continual workflow quality and performance feedback, regular site visits by our dedicated client support teams, and access to our detailed technical and compliance training resources.

Verisma retains all record images and transactional information for every request processed through our VRM platform for a minimum of HIPAA’s six-year Accounting of Disclosures rule or in accordance with any specific terms noted in the final services contract with our clients.

All of our workflow models include the use of our core ROI management platform, our advanced technology assisted review capability and extensive quality assurance protocol, our suite of reporting and analytic tools, access to our training resources, our teams of remote workflow support staff, and our ongoing support from our dedicated client management team.

During normal business hours, Verisma correspondence support would include but is not limited to front window coverage for walk-ins, phone calls, stat faxes, hospital patient transfers, onsite DICOM image request support, etc. or onsite/remote supplemental labor support to assist you with the request logging and record capture steps noted in our Partnered Service Solution option.

Verisma has a dedicated centralized department solely focused on the full life cycle of audit requests. Verisma coordinates the intake, pricing negotiations, invoicing, production planning, release, collections, and reporting steps of the audit request process.

INTAKE

• You will get a single point of contact at Verisma that coordinates all audit requests and manages them through their full life cycle.
• Your Verisma Audit Coordinator carefully reviews all request packets upon receipt providing you complete control over what is being requested and what patient records will be included with each audit.
• Your Verisma Audit Coordinator will then retrieve a secure electronic file from the requester and upload the pull list into the Verisma cloud-based release management platform for review and processing; eliminating the need to data enter individual requests and limiting the cost of labor and improving the overall audit request turn-around-time.

PRICING NEGOTIATIONS & INVOICING

• Verisma has negotiated pricing in place with many national and regional 3rd party retrieval companies and health plans.
• Before work begins, your Verisma Audit Coordinator will have confirmed the negotiated pricing already in place with the requestor, or if no set pricing is in place, work with the requestor to agree on pricing before work begins. Verisma’s large network allows for pricing power to help ensure you get the proper compensation.
• Our comprehensive solution provides the flexibility to provide records either prior to payment or after the payment has been received based on an individual payer’s payment activity history or based on the request urgency or your specific audit release policies. We will never jeopardize reimbursement or put the client at risk with requests that may have a financial impact for the organization.

PRODUCTION PLANNING

• Your dedicated Verisma Audit Coordinator tracks all deadlines, sets weekly production goals for Verisma Audit processors, and monitors all progress towards these goals. This allows for quick analysis and reallocation of resources to ensure deadlines are met.
• When large audit requests are accompanied with short delivery deadlines, Verisma’s dedicated audit team is your partner every step of the way to ensure every deadline is met.
• If you prefer to process your audit requests with your own team, the Verisma Audit department can assist you with the intake management, negotiations, and production planning steps of each audit request. As well, the Verisma Bench staffing and support is available when you need additional resources to supplement your existing team, ensuring workflow consistency when faced with volume fluctuations, tight deadlines, or when you incur staffing vacancies.

RECORD DISTRIBUTION

• Verisma has secure electronic transfer links set up with many of the major retrieval companies as well as the Health Plans themselves. Delivering records electronically allows for a faster, more secure fulfilment of requests.
• Our electronic transfer options can accommodate any unique requestor upload requirement.

COLLECTIONS

• Your Verisma Audit team will manage the full life cycle of your audits including collections, supported by the many direct relationships it has with requestor accounting departments.
• Your Verisma Audit team will take on the maze of requirements and hurdles often associated with the requestor payment process.
• Verisma collections rates with our centralized audit process are as high as 95%.

REPORTING & FORECASTING

• Verisma offers exceptional transparency for everything related to the release of your patient records. This includes monthly reports on audit volumes for your entire enterprise or for your individual locations that can be summarized by audit Type, by Requestor, and by associated Health Plans. In addition to the Verisma reports, the Verisma Analytics application, with the ability to create customized views, will provides critical feedback on all aspects of the audit request process, 24/7.
• In addition to reporting on what has happened, Verisma can help you forecast future audit request loads for the upcoming Audit season, ensuring proper resource planning ahead of the volume.

Whether wanting to proactively manage your worker’s compensation/no-fault claims process, or needing better oversight with your explanation of benefit (EOB) and aging balance, appeals/denial follow-up process, a well-organized and accountable record process is critical to ensure an efficient and successful revenue cycle program.

Verisma’s business office solution consists of our expert teams who work with your current business office staff to design a best-practice workflow that complements their existing process. Enhancements include ability to establish a proactive record pull/delivery workflow when submitting worker’s compensation and no-fault service-related billing. A proactive record submission process reduces additional payer record requests weeks after billing submission, ultimately improving the revenue cycle. Verisma’s business office solution will also enable turnkey automation support to enhance your ongoing appeals and denial additional documentation needs. Our solution includes a virtual record ordering, review, and a secure electronic delivery process with real-time communication to existing business office platforms consisting of visual links to every record sent.

In addition to our technology solution, our expert records team can be used to supplement existing business office staff when dealing with the often time-consuming task of researching and pulling together specific patient records in support of billing submissions with complicated medical histories. This frees up your highly skilled staff to focus on other claims related activity, improving your overall revenue cycle performance.