$8 million loss… Where did it come from?
As of March 10th , 2016, several third-party administrative agencies face over $8 million in fines for allegedly failing to provide necessary medical documentation in time for independent medical review (IMR). A great deal of risk is involved when managing a large database of medical records if they cannot be easily accessed or located in a timely manner.
Who was affected?
According to an article on Business Insurance, one of the most well-known TPAs in the industry faced a massive penalty charge of $3.5 million because it failed to provide the necessary medical documentation within fifteen days to Maximus Federal Services Inc (IMR Agency). This is just one example as many other TPA’s and Insurance companies in the industry were also hit by significant penalties. The millions of dollars in penalties clearly show there is a need for better control, organization, packaging, and efficient delivery of the medical documents in a timely manner.
How can you protect your organization?
Use the Doc Packager tool! DataCare clients including Fortune 100, Funds, and various other companies have never paid IMR penalties from the performance of the Doc Packager tool. Most utilization review, TPA, and payer platforms store documents in a concise manner, however, a significant amount of time can be saved in the process of locating these documents by letting the Doc Packager do the work. This tool generates a query based on the preconfigured user categories and pulls up all associated documents. It will show the user how many pages total are contained in the query, how many documents, and the total file size. In addition, it also has the capability of auto-generating a table of contents for the user and exporting all documents into a single file in PDF format or separately in a zip folder. There is no need for manual uploads into another database and the documents can be faxed or emailed directly through the system. Lastly, the option of sending the package of documents electronically via EDI is also available for the case of IMR.
This unique add-on has the capability of performing all vital functions from within, which in turn minimize the margin of error for the user. No TPA should have to face the scrutiny of being late, while no patient should have to wait for treatment.
IMR is just one of the applications of the Doc Packager. It can also be used to respond to subpoenas as well as prepare documentation for audits and hearings.
Click here to learn more about the Doc Packager.