Managed care contracts made more accessible

Optical imaging puts data within easy reach

Details of complicated managed care contracts are at the fingertips of registrars, billers, and medical records personnel, thanks to a new optical imaging system at Hoag Memorial Hospital Presbyterian in Newport Beach, CA.

With the implementation of the new system, one of the first items on everyone’s agenda was to scan all the hospital’s managed care contracts into an optical image file, says Sheri Hughes, director of business services.

The contracts are indexed by category of information — admission requirements, utilization review guidelines, and medical records regulations, for example. There are security controls that allow employees to access only the parts of the contract that are appropriate to their areas, she says.

Getting the latest information

Previously, personnel had to depend for reference on abstracts prepared by the hospital’s contracting staff and mailed to the various departments, Hughes says. Now, rather than searching through a set of binders — which might or might not have been updated with the latest contract information — employees will be able to access the data they need with a few computer keystrokes and know the data are from the latest version of the contract.

"There are no filing and retrieval problems, and if there are questions, [employees] can annotate the file, noting decisions that are interpretation issues," she explains. "They can say, ‘This is how this was determined,’ and then look for the outcome." Such annotations do ot change the file, but rather "lay over it," Hughes says.

If there’s an issue of concern, users can type in key words to conduct searches across contracts, rather than leafing through an 80-page document. If the contract’s requirements on the release of medical records differ from the hospital’s requirements, employees can see that immediately and comply with the contract, Hughes adds.

And utilization review personnel can quickly check continued stay requirements in a cur- rent contract and then compare them with those in previous contracts, which also will be on file.