Visiting Nurse Service of New York CHOICE Health Plans

Case image

Industry

  • Healthcare / Medical

Challenge

  • Create a best-in-class grievance and appeals unit
  • Improve process efficiencies and controls
  • Reduce storage and supply costs
  • Improve audit preparation
  • Ensure responses are delivered in a timely fashion, meeting or exceeding regulation mandates

Solution

  • Outsource grievance and appeals mailroom operations
  • Outsource document scanning and indexing of grievances
  • Electronic timestamp all envelopes as a reliable proof of receipt
  • Create a fully digitized, paperless review process, eliminating the need for handwritten notes

Impact

  • Over $6,000 in storage and materials savings annually
  • Accelerated resolution of grievances and appeals
  • Additional protection from audits and increased compliance assurance
  • Eliminated frustration and anxiety brought about by misplaced documents and other paper-based challenges

Executive Summary

Though widely known for their long standing success as a homecare agency, Visiting Nurse Service of New York CHOICE Health Plans (VNSNY CHOICE) is also a health plan administrator, contracting with the Centers of Medicare and Medicaid Services to participate in the Medicare Advantage program.

Within their health plan administration capacity, VNSNY CHOICE works meticulously to coordinate and respond to appeals and grievances filed by any of their 40,000 members. The company takes careful and proactive measures to ensure each response is delivered in a timely fashion that is both compliant with regulations and reflective of the exceptional service it’s known for.

VNSNY CHOICE approached Digiscribe after being given the directive by management to create a best-in-class grievance and appeals unit. As such, they wanted to create additional efficiencies and controls that would help them achieve this goal.

By outsourcing their mailroom to Digiscribe, VNSNY CHOICE now receives their documents in digitized format within 24 hours of delivery, eliminating the stress and anxiety of dealing with paper and helping them become best-in-class.

Challenge

Though VNSNY CHOICE processed member appeals and grievances through its New York City headquarters’ mailroom for years, they needed to take certain proactive measures in order to achieve best-in-class.

Create a more efficient process: Relying heavily on paper created processes that were inherently cumbersome and inefficient. Mail needed to be opened, unfolded, sorted and placed into folders; paper documents could easily be lost and misplaced, and were difficult to track when passed from employee to employee; and handwritten notes carried the potential for misreading and misplacement.

Cost of space and materials: In VNSNY CHOICE’s New York City headquarters, space is both limited and of premium value. With compliance mandates that call for each case to be stored for 11 years, the company needed to reduce the thousands of pages of physical documents it kept both on the premises, as well as in costly off-site storage facilities. In addition to these expenses, VNSNY CHOICE also wanted to reduce the number of case folders they purchased, which totaled as high as $6,000 per quarter.

Audit preparation: Though the company took careful measures to abide by compliance guidelines, physical date stamps on envelopes of received grievances and appeals made audits more complicated and risky than necessary; auditors automatically disregarded blurred stamps and proceeded to the next (previous) available date in the paper chain. This practice left the company unnecessarily exposed to timeliness issues, in spite of the unit’s stellar response time.

Solution

Rather than continuing with the inefficient and risky paper-based process, VNSNY CHOICE chose to outsource their grievance and appeals unit’s mailroom to Digiscribe, creating a streamlined digitized process as follows:

  1. Digiscribe receives grievances and appeals via a dedicated local P.O. box (pickup takes place daily by noon).
  2. All envelopes are opened by our HIPAA trained staff, which is critical when handling medical related documents.
  3. Non-urgent “white mail” is immediately separated and returned to VNSNY CHOICE on a weekly basis.
  4. All grievances and appeals are unfolded; staples and paper clips are removed.
  5. Grievances and appeals envelopes and documents are scanned and indexed; each image is quality controlled, and an electronic time stamp is added as reliable proof of receipt.
  6. Digiscribe securely FTPs the digitized documents within a 24-hour turnaround window directly to VNSNY CHOICE.
  7. VNSNY CHOICE coordinators can view all digital documents from their computers, then copy and paste information into an access database, and forward the digital files to the appropriate specialist for review and action.
  8. The specialist (and others) can copy and paste information directly from the digital document into electronic case notes; they can also use the G&A documents to help create resolution letters; this removes the need to add paper or handwritten notes to each file.

Impact

Outsourcing their grievance and appeals unit’s mailroom helped VNSNY CHOICE to achieve a number of measurable goals, including increased efficiency, cost savings, enhanced employee productivity and member services, and a more thorough level of audit preparedness.

  • Staff members can now locate and process digitized documents faster and easier. This keeps employees on track, and accelerates the resolution of cases, while eliminating the frustration and anxiety brought about by misplaced documents and other paper-based challenges.
  • Thanks to the paperless process implemented with the help of Digiscribe, VNSNY CHOICE now saves money on the costs of materials (e.g. file folders) and both on-site and off-site storage, which can be very high in the NYC area.
  • Electronic time stamps on each grievance and appeal document ensure maximum preparedness in the event of an audit; auditors can clearly see when each case was received by the company, providing an additional layer of security in meeting compliance guidelines.
  • Using digital documents adds an additional layer of security and provides further assurance that VNSNY CHOICE is in full compliance with HIPAA regulations at all times.

By scanning all incoming grievance and appeals papers, and storing them in a document management system, all files are now automatically archived in one single repository, creating quick and easy searchability and access to documents at any point in the future.

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Testimonial

Having a paperless system reduces stress, frustration and cost in any environment, but particularly where you need to have employees work both efficiently and effectively, in a timely fashion.


Paulette Wunsch, VP, Grievances & Appeals
Visiting Nurse Service of New York
New York, NY