I received this note from a customer of ours this week, Charlene Burgett, Administrator for North Scottsdale Family Medicine.
I just have to tell you of my recent "win" and [our voice document system] made it happen! Just last week, I receive a phone call from a patient who was extremely upset because she received a statement from the imaging facility we sent her to for a CT scan. She states that her insurance denied the claim because WE did not get a prior authorization and now she wants us to pay the $1,400.00 since it was our mistake. I told her that these calls are normally called into the health plan and that we record all the incoming/outgoing phone calls and if she gave me a little time, I would research the issue and call her back. I first pulled the patient's chart and found where the medical assistant documented the date and time that she called the insurance company for the prior authorization and we were told that we didn't need a prior authorization. From there, I went to [our voice document system] and searched the date and extension of the phone call going outbound, looked at the times and found the telephone number that was called to the health plan. I listened to the entire 4+ minutes of the phone call and we, indeed, were told that we did not need a prior authorization. BINGO! I called the patient back and played the pertinent part of the phone conversation and told her to call the health plan to let them know I had it recorded and would be more than happy to play it on the phone for them. They did call back with the patient on the other line and I played the recording. Of course, there was some hemming and hawing, but I just received today that they will "make a one-time exception" and pay for the test! (I can guarantee you that they will pay again if I have a similar situation!)
So, the patient does not have to pay the $1,400.00 and the insurance company wasn't successful making it look like it was our fault (which is usually how they play it)!
Our healthcare system has too many competing interests and the power is in the hands of the payers. Simply using electronic records for health management will not change the situation. Medical providers must be vigilant documenting their communications in a manner that makes it easy to rapidly provide documentation when necessary to speed access to payments and externally provided services.
Voice documentation has a lot of promise in this field to streamline the flow of money and remove some of the operational inefficiencies plaguing the system.
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