ONC Update on AI in Healthcare

ONC Update on AI in Healthcare

By Barbara Carr, RHIA
Strategic Advisor

March 21, 2024

In recent years, artificial intelligence’s (AI) use in healthcare has grown into a realm of profound innovation, promising to revolutionize the very landscape of medical practice and patient care. From performing labor intensive repetitive tasks, enhancing diagnostic accuracy, treatment efficacy, and operational efficiency, AI stands as a beacon of hope to address some of the most pressing challenges facing the healthcare industry.


The Office of the National Coordinator for Health Information Technology (ONC) actively promotes the adoption and responsible use of AI in healthcare. During the February Verisma Academy webinar, Elisabeth Myers, Deputy Director, Office of Policy, ONC, presented their current guidance regarding the use of AI in clinical decision support.


Myers also outlined numerous challenges surrounding the use of AI in healthcare such as perpetuating information asymmetries that may lead to healthcare inequalities. AI can also magnify ethical, legal and social concerns during data collection and use, leading to ineffective or even unsafe recommendations.

Guidelines and Initiatives

Given this, the ONC developed guidelines to facilitate the responsible and ethical use of AI in healthcare, including considerations for data privacy, security, and equity. A few of their key initiatives are:

  • Interoperability Standards facilitating the seamless exchange of healthcare data, crucial for AI applications to access and analyze data from various sources
  • Ethical Guidelines ensuring AI is used responsibly — protecting patient privacy and promoting equitable healthcare delivery
  • Data Governance Frameworks addressing data quality, security, and privacy issues


As a result, the ONC issued a final rule regarding Decision Support Intervention (DSI) which revises existing Clinical Decision Support (CDS) criterion, streamlining and simplifying requirements for all Health IT Modules. In addition, it establishes new maintenance of certification requirements to continuously review and update DSI-related information. Myers describes the policy impact of DSI Certification Criterion as follows:

  • Improving transparency
  • Enhancing trustworthiness
  • Fostering an information ecosystem
  • Advancing health equity by design

The final rule preamble describes each characteristic and associated approaches that can be taken to assess and mitigate risks. Myers provided participants with a link to ONC’s website for more information on their AI initiatives and fact sheets regarding DSI’s final rule.

Education and Training

The ONC also has initiatives to educate and train providers and organizations about the potential benefits and challenges of AI in healthcare. In addition, ONC works closely with other federal agencies, such as the Food and Drug Administration, to develop regulatory frameworks for AI-based medical devices and software applications.

AI is growing rapidly and the ONC is staying on top of it by developing standards and rules for the safe and effective use of AI in healthcare. Interested in learning more? Access Verisma Academy’s on-demand course: Exploring HTI-1, TEFCA and AI in Healthcare – Where are we in 2024?

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What HI Professionals Can Expect in 2024

What HI Professionals Can Expect in 2024

By Elizabeth McElhiney, MHA, CHPS, CPHIMS, CRIS
Director of Compliance and Government Affairs

January 2, 2023

Privacy gets (more) complicated

We’ve said it before – the US is overdue for a national conversation on privacy. 2023 only increased the stakes with the increased adoption of AI, stark state-level differences on social policies, and the prevalence of cybersecurity threats.  Navigating these conflicts – in the absence of a national privacy framework – will be increasingly time-consuming and high-stakes for privacy and compliance professionals.

Patients will be the primary focus

Healthcare consumerism and patient-centered care have been hot topics in 2023 and will remain so in 2024. One area that hasn’t received as much attention is the emphasis on individual patient factors – for example, what constitutes a burden for some patients when requesting records is not for others.  Information blocking exceptions specifically prioritize individual factors in the preventing harm and content/manner exceptions. It will no longer be enough to have a black-and-white procedure manual; instead, organizations may want to consider a “playbook” of factors to be considered.

Expect regulatory activity, especially in early 2024

The last Congress will be one of the least productive in memory – and there weren’t high hopes given the ideological polarization and thin margins in both chambers. Expect to see regulatory agencies attempt to step in through rulemaking.  Early 2024 will likely see the most activity – agencies will want to publish or enact any rules prior to 60 days before a potential change in administrations.

and as always …

Executing on fundamentals is key

This one goes across all areas – we can’t stop emphasizing fundamentals while we handle increasing complexities. It’s the little things that get you in the end. Keep on top of cybersecurity by emphasizing employee cyberhygiene, patient privacy and safety by verifying patients with two identifiers, and patient access by improving request processes and adding new delivery options.

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Top Reasons to Optimize Payer Audit Management

Top Reasons to Optimize Payer Audit Management

By Barbara Carr, RHIA
In today’s ever-evolving healthcare landscape, navigating the challenges posed by increasing payer audits and denials demands a proactive and expertly crafted approach to claims accuracy and compliance. To effectively tackle these challenges, healthcare organizations must adopt an integrated solution that tracks the entire audit process from initial request receipt to denial and appeal resolution. This comprehensive and systematic approach is vital for mitigating the financial risks associated with payer audits and ensuring sustained success.

Herea are some top reasons you should focus on optimizing your payer audit management process:

Enhanced Efficiency and Organization: The integration of all audit-related information and documents into a centralized system streamlines the entire audit process. This eliminates manual tracking, reduces administrative burdens, and safeguards against missing critical deadlines.

Timely Response to Audits: By diligently tracking audits from the moment of request, Release of Information Specialists (ROIS) can promptly respond to audit inquiries, reducing the likelihood of delayed or incomplete responses that may lead to denials. An integrated system also provides valuable data on the status of audits, ensuring that deadlines are met.

Improved Visibility and Transparency: Payer audits involve multiple steps and stakeholders. A comprehensive system offers real-time visibility into the audit status, empowering coding teams, clinical documentation teams, compliance officers, and management to stay informed about audit progress, denials, and appeals.

Identification of Patterns and Trends: With an effective audit management process, organizations can identify patterns and trends in coding audits and denials. Analyzing this data enables a proactive approach to address root causes and prevent future denials, ultimately leading to improved financial outcomes.

Compliance and Regulatory Adherence: Adherence to coding and billing regulations is critical for healthcare organizations. Your audit tracking solution should be built to ensure systematic compliance with these requirements.

Effective Appeals Management: Tracking audits through the denial and appeal process is essential for efficient appeals management. With proper audit management technology, an audit team can identify common reasons for denials and develop targeted strategies to overturn them.

Data-Driven Decision Making: Comprehensive reporting capabilities (beyond spreadsheets) enables an audit team to gather data on audit outcomes, denials, and appeal success rates. Armed with this critical data, financial teams can make informed decisions regarding coding practices, training needs, and resource allocation.

Proactive Risk Mitigation: Vigilant monitoring of audits and denials allows organizations to proactively address potential compliance risks and coding errors. This approach reduces the financial impact of denials and minimizes the risk of audits leading to legal or regulatory issues.

Verisma Claims Audit Manager

Verisma recently announced the launch of Verisma Claims Audit Manager (VCAM) in collaboration with Office Ally. VCAM connects ROI with business office in an end-to-end solution that offers unmatched enterprise reporting capabilities.
A comprehensive approach to payer audit management supported by advanced technology is essential for healthcare organizations to achieve sustained success in an increasingly complex healthcare landscape. By focusing on optimizing this process, organizations can stay ahead of payer audits and denials, safeguard financial stability, and maintain a commitment to delivering high-quality patient care.
Overcoming Staffing Challenges in Healthcare Information Leadership 

Overcoming Staffing Challenges in Healthcare Information Leadership 

By Connie Renda, MA, RHIA, CHDA
In my role as the CHIA President-elect, I had the privilege of addressing our California members on a pressing topic that resonates with healthcare information leaders across the industry. Every day, managers grapple with a multitude of human resource challenges, and this struggle is particularly pronounced in the healthcare information sector. In this article, we’ll delve into these pain points, offer a comprehensive understanding of the challenges faced, and present innovative solutions to help healthcare information leaders reach their goals. 


Challenges in HI Staffing



Understaffing is a perennial issue that plagues healthcare information management. The demand for skilled professionals often surpasses the available talent pool. A report from the Society for Human Resource Management (SHRM) notes that finding suitable candidates and retaining employees will be paramount for organizations in 2023. However, this search for top talent often collides with budget constraints, creating significant challenges, especially in an era marked by concerns over inflation. Many organizations find themselves handcuffed by hiring freezes or grappling with staff shortages due to employees on FMLA leave, compounding the problem further. The critical HIM duties cannot be deferred and require a dependable workforce, which isn’t always readily accessible when needed.

Skill Gaps

In the ever-evolving healthcare landscape, skill gaps are another major headache for healthcare information leaders. As Forbes aptly points out, the industry is grappling with substantial talent shortages as skill sets struggle to keep pace with rapidly advancing technology. This disconnect between the demands of modern healthcare and the available skill sets places additional pressure on organizations striving to maintain efficiency and compliance in their operations.

Fluctuating Workloads

Fluctuating workloads compound the woes of healthcare information leaders. The volume of work can oscillate dramatically, leading to unexpected spikes in demand that strain an already stretched workforce. Coping with these variations efficiently while maintaining a high standard of service becomes an ongoing challenge.

What Can We Do?


Develop a Flexible Workforce Strategy

Maintaining staff agility is one way to ensure operational continuity and peace of mind. My colleagues had many great ideas to achieve this from cross training to assigning multiple job roles. More experienced staff (or outsourced partners) are motivated by new learning experiences and can help address staff shortages, workload surges, and unique projects. In fact, this is such an effective strategy that Verisma launched a team dedicated for this purpose called Verisma bench.  

Consider Efficiency Gains Through Outsourcing

In addition to ROI, many other administrative HIM tasks can frustrate staff who could be spending more time working at the top of their license. Outside partners can alleviate these burdens and improve efficiency, while eliminating the headaches of hiring and training. Verisma, for instance, can manage tasks like prior authorizations, purge projects, inbound document management, and referral management. so staff can focus on what matters most – patient care. 

Leverage Technology-Enabled Strategic Partnerships

Strategic partnerships are more than supplemental staff. They’re relationships built on experience, consistency, time, and effort. Better yet, technology-enabled service companies do more than complete tasks – they build for the future. Working with a trusted company like Verisma to help with staffing challenges makes sense and allows you to share the burden of finding a qualified, reliable team to address talent shortages. 

Five Ways an FQHC Can Save on Administrative Costs

Five Ways an FQHC Can Save on Administrative Costs

Federally Qualified Health Centers (FQHCs) provide critical care for underserved patients nationwide, but on a limited budget supported mostly by donations and grant funding. By focusing on decreasing administrative costs, FQHCs can make their dollars more impactful to patient care initiatives, improving the lives of millions of people across the United States. The following are five ideas FQHCs can consider to reduce their administrative costs to focus their attention on more impactful care within their communities.


In an ever-changing healthcare industry, all organizations are constantly updating process and operations workflows to meet new requirements. FQHCs can implement regular analysis of all workflows to analyze for operational efficiencies. Reviewing patient activities while in the waiting room, as well as what administrative staff may be able to do prior to the patient visit, can ensure that patients are registered, roomed and seen as quickly as possible.

Because of the demand for FQHC visits and services, FQHCs need to make every minute a patient is in the office count. Part of the analysis may include whether offsite staff or partners can provide a more focused, cost-effective way to remove burden and time-consuming administrative tasks from patient-facing personnel. Streamlining staff, provider and patient interaction can create more impactful visit time and allow providers to see more patients in a day.

FQHCs can also find efficiencies by analyzing workflows and refining their tasks and best practices. By optimizing everyday functions and administrative tasks, FQHCs can find areas of savings and eliminate waste. Good examples of common culprits are paper and ink/toner, which can be greatly minimized with smarter filing and scanning workflows.

Streamlining staff, provider and patient interaction can create more impactful visit time and allow providers to see more patients in a day.

Information Technology is often seen as an investment and expenditure, but it comes with an upside. In many situations, IT updates can improve and thereby cut administrative costs for the future. Some government incentives like Pay-for-Performance programs also exist to help organizations offset the costs of implementing technologies. Using information technology to capture structured quality data about patient care can be reported to government and commercial entities, in some cases leading to increased reimbursement.

Additionally, as the industry moves from paper to electronic records, converting paper charts to electronic documents stored in the Electronic Health Record (EHR) can reduce administrative spending on chart storage, as well as free up space for FQHCs to pay less rent or utilize space in other ways that support the patient care mission. Ultimately, IT improvements can lead to increased efficiency and functionality and decreased administrative spending in the future.


Compliance doesn’t just mean HIPAA. Other regulatory programs require complying with certain objectives in exchange for funding. As the industry changes, meeting grant requirements and alternative payment model metrics is critical for keeping the doors open. By focusing energy into maintaining compliance protocols, FQHCs can avoid losing invaluable revenue sources. Of course, HIPAA is also important! Ensuring the proper protocols are implemented, staff is periodically trained, and quality assurance is in place in accordance with the HIPAA Privacy and Security rules is critical for preventing threats. Good compliance practices also help FQHCs avoid a costly and unexpected HIPAA breach adding to administrative costs and detracting from the mission.


One of the biggest administrative costs to a FQHC is staffing. These costs not only include payroll, benefits and other overhead expenses but also where the staff expends their time while they are on the clock. As FQHCs have a laundry list of items to achieve throughout the day, many staff members find they have too much on their “to do” list and something has to give.

Ultimately, staff members being tasked with too many duties can cause burnout, distractions and procrastination, all of which lead to costly mistakes, extra expenses and, in some instances, tasks not getting done altogether. Organizations like Verisma can help FQHCs reduce administrative costs by providing focused expertise related to specific administrative functions.

Utilizing a Business Associate can reduce the need for certain admin staff functions, in turn alleviating some payroll costs as well as the management tasks inherent in supervising hourly staff. Where workforce is in short supply, one of the greatest benefits of utilizing a partner for functions like document filing and release of records is the ability to focus or repurpose existing FQHC staff. When a partner is handling the administrative tasks, the FQHC staff can focus on patient needs and care. In an era of patient satisfaction and engagement tying to reimbursement, focusing on patients is of the utmost importance to FQHCs maximizing their dollars and serving the community.


Changing goals means fluctuating costs; by deploying and following a clear mission FQHCs can zero in on their wildly important purpose. Because FQHCs rely heavily on funding sources, planning too far into the future can be challenging. The mission of the organization, though, will remain steadfast and is the ultimate litmus test in financial planning for FQHCs. If an administrative expenditure doesn’t directly support the mission, is it worthy of investment? Administrative costs can often seep out unexpectedly, especially when the goal line is constantly moving. Reviewing the budget with the mission statement in mind can help FQHCs analyze their supportive and detractive administrative spend.

Need help implementing some of these strategies for maximizing your staff and minimizing administrative costs and workloads? Get in touch at verisma.com/contact-sales.

How Leveraging an HIM Partner Helps Decrease Staff Stress

How Leveraging an HIM Partner Helps Decrease Staff Stress

“Everything Everywhere All at Once” isn’t just the title of an award-winning movie that many viewers found quite confusing. It’s how a lot of health information management (HIM) employees feel about their jobs. There aren’t enough hours in the day, and one person can’t do everything at once.

Many providers are exploring HIM support from outside partners to take all or some of the weight off their shoulders. The right Release of Information (ROI) and HIM partner can be a reliable and cost-effective solution for ensuring your quality standards are met without burdening you or your internal staff.

Following our acquisition of ScanSTAT Technologies, Verisma now offers a full suite of outsourced HIM solutions in addition to our industry-leading ROI service:

Prior Authorizations

Inbound Document Management

Chart Abstraction

EHR Conversion

Forms Completion

Document Scanning


Contact us to learn more!

Imagine a world where your team’s health information management responsibilities are supported by industry-leading experts at Verisma. What would that look like?

1. You would spend less time recruiting, hiring, training, retaining and scheduling employees.

Finding and hiring new talent has never been more challenging. HIM partners ensure you have the resources required to meet the demands on your organization. Your employees take time off for vacations, illnesses, and leaves of absence, but Verisma is always ready. We have the people and resources to meet your needs every day.

2. You could finally address your backlog.

When you partner with Verisma, you can breathe. Because Verisma:

  • Allows your in-house staff to focus on patient care
  • Keeps your medical records department current on requests
  • Assumes responsibility for HIPAA compliance
  • Fills the gaps in your department while you still maintain your own processes and standards


A dedicated team of experts can improve turnaround time and thus reduce staff stress while improving patient satisfaction.

3. You would reduce risk and achieve or maintain compliance.

As stewards of data integrity, health information managers understand that Protected Health Information (PHI) responsibilities—from compliance, workflows, training, and coding to document completion—are top priorities. But, realistically, each one of these PHI responsibilities is a full-time job. Recent regulatory changes related to release of information (ROI) are a potentially expensive pitfall as there are steep fines for violations. Verisma has in-house experts dedicated solely to staying on top of compliance and legislative activities. Working with an outsourced team of knowledgeable HIM experts can help you feel confident that your organization meets the new requirements for releasing electronic information. Furthermore, your organization will be compliant with laws regulating strict timeframes under which requests and information must be handled to avoid stiff fines.

4. You would have happier, more focused employees who are more likely to stay with your team.

Additional HIM functions, such as prior authorizations and faxing and scan filing, often fall on staff members with multiple other responsibilities. This necessity to multitask drains staff and contributes to lower job satisfaction.

By working with Verisma, you’ll know dedicated experts are:

  • Completing forms and requests efficiently and accurately
  • Improving your physicians’ satisfaction by eliminating the additional work and stress of tracking down accurate patient information
  • Helping ensure your processes are compliant with current regulations
  • Available to help train internal staff on new technology or processes

Get back to being in one place and thinking about one thing at a time. Reach out to us today to get started.