Healthcare Providers Must Insist HMOs Accept Electronic Filings
An appeal recently filed with a health maintenance organizations (HMO) on behalf of a hospital was rejected because medical records were provided on a CD-ROM rather than on paper. That case involved 3,647 printed pages. As requested, a banker’s box full of the patient’s chart was printed and then mailed to the HMO’s appeals department. Seven reams worth of paper were required to have an appeal considered by the HMO.
In this age of electronic medical records (EMR) the fact that some managed care organizations still refuse to receive clinical documentation in a format other than paper is unacceptable. To change this outdated practice, healthcare providers must insist that payers accept electronic filings of clinical records. Aside from the obvious environmental impact, during this time of a global pandemic, any such paper-intensive filing process is very pre-coronavirus.
People-safe policies must be our priority. In response to the current COVID-19 health crisis, offices throughout this country – and indeed, the world – are working remotely and with reduced staffs. Requiring people to come to their offices to print large charts for mailing is truly unsafe and unnecessary. By accepting CD-ROM files, human exposure to the COVID-19 virus would be reduced. Reducing exposure at copiers, post offices, and mailing centers is one small, but important, step in keeping people healthy.
If claims can be filed electronically, why not provider appeals? CD-ROMs are already accepted with appeal letters by many managed care plans. The easy answer of network security is no longer a realistic or convenient response. If under-resourced hospitals have already resolved concerns about electronic medical records, then HMOs can certainly ensure that healthy policies are deployed. I still hope that is what good HMOs are about: keeping people healthy.
Contracts must allow for EMR submissions. Healthcare providers must insist that HMOs accept electronic records with appeals. One clear way to help ensure people-safe processes are implemented is by including such provisions in executed managed care agreements. All providers should insist on this change to allow for PDF medical records. In the future, electronic filing of appeals will be industry standard. Due to the COVID-19 pandemic, the time to begin making that happen is now. And the environment will thank us, as well.
Gustavo Matheus is a member of Anderson & Quinn, LLC, a law firm based in Rockville, Maryland, that provides individuals, businesses, corporations, and healthcare institutions in Virginia, Maryland, and Washington, D.C. with the legal and litigation support they need.
