Healthcare / Medical
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.
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.
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:
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.
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.
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.