The HFMA 2023 Annual Conference wrapped up earlier this week at the Gaylord Opryland in Nashville, TN. Our team attended insightful presentations and had meaningful one-on-one conversations with attendees, all centered around cost-effective health. A common theme among health systems in attendance was their continued struggle with razor-thin margins, increased regulatory requirements, and scalability, all while patient volumes increase in this post-pandemic environment.
As we announced at the beginning of the conference, our new Payer Exchange solution can address some of these challenges. Payer Exchange supports both providers and payers as they navigate the rising volume of medical records and clinical data needed to meet risk adjustment and other mandatory reviews and reporting.
Rising Payer Requests = Burdensome Tasks
Providers continue to see a significant increase in payer requests for medical records, due in part to the uptick in claims denials, more risk adjustment reviews, and additional reporting requirements. With CMS releasing their 2030 value-based care goals, payers are requesting even larger amounts of patient data to ensure risk adjustment premium accuracy, earn higher STAR ratings and manage their medical costs.
As payers increase demand for requests, health systems must manage the growing demand while also remaining focused on accuracy and disclosure integrity. So, as the industry continues to move toward interoperability and smoother data exchange, these challenges need to be addressed – and technological advances, such MRO’s Payer Exchange, can assist.
Exchanging Data Between Payers and Providers
By digitizing and automating the ROI process between providers and payers, MRO’s Payer Exchange removes manual burdens and reduces payer/provider friction. Payer Exchange automates work previously performed by hospital staff in the following ways:
- Requests are digitized, with specific data requirements tagged, and communicated directly to the provider organization’s EHRs and other systems.
- Automated chart retrieval is performed at scale, leveraging modern HL7 FHIR APIs and MRO’s Enterprise Connector.
- Specific requested data is intelligently pulled to fulfill the request—from over 200+ EHRs.
- Developer sandbox is available for IT teams to review API specifications and test payloads.
Final Thoughts
It was a productive and active week at the Annual HFMA Conference, but there is still more work to be done. If your organization is wondering how you’re going to manage the rise in payer requests, consider digitizing your release of information processes through MRO’s Payer Exchange. MRO’s team of experts, combined with our innovative Payer Exchange technology, create the solution needed to reduce administrative burdens, while closing costly reporting gaps – for both providers and payers. We are excited for the future as we continue to bring new products to the marketplace, meeting the needs of all our provider and payer partners.
