The new CMS rule for Notification of Admission, Exit and Transfer (ADT) for Conditions of Participation (CoPs) and Shared Risk Arrangements formally entered into force on May 1, 2021. This rule was promulgated to improve the coordination of care between hospitals and the post office. -teams of acute providers, both streamlining and improving communication. It is these teams of providers who play a critical role in providing care to patients after discharge.
As part of the larger Interoperability and patient access rule, the latest mandate aims to ensure an efficient exchange of health data between providers that will ultimately lead to better patient outcomes and lower cost of care. However, vendor-to-vendor communication is not the sole focus of this latest CMS regulation.
Lack of information on timely admission, discharge and transfer:
An ADT event notification can give payers great foresight to prepare to engage and support their members more proactively. With real-time notifications, payers have the ability to digest and understand their members with clarity. Without these alerts, payors are unable to successfully manage care and other issues, such as readmissions, and increased costs to the payor and the member.
“Payers are at a significant disadvantage because they do not understand what treatments their members are receiving or, almost more importantly, what treatments they are not receiving. And this gap in care is so important to achieve not only better health outcomes, but also a very long and complicated list of CMS HEDIS quality measures put in place to encourage health plans to think about its members who do not. not receiving the care they should be. “- Bevey Miner Consensus Health IT Strategy / CMO
Proactive care coordination
ADT event notifications provide the necessary patient information that enables payers to quickly track and implement health plans, especially for high usage members or high risk members. If adequate information is not communicated as patients move from one health facility to another, health plans stop because they are unable to commit the necessary resources before the patient is discharged. .
This point was highlighted in the article by my colleague Edie Hagens, Senior Business Development Executive, Healthcare at Consensus, saying: âWell-implemented point-of-care technology enables collaborative decision-making for providers and organizations. health plans in order to effectively sort out care for the best possible results. “
Enabling interoperable real-time notification solutions for payers
Payers have tremendous power to help providers advance healthcare interoperability through the adoption of real-time notification solutions. This exchange of health information between payers and providers will be critical to their performance in risk-based models of care.
“I anticipate that there will be help from the payer community to support more collaborative data sharing in EMR provider workflows versus sending documents to portalsâ¦ Far beyond Simply finding a patient or limb, we need to focus on an interoperability framework that effectively supports clinicians in their existing EMR workflow and beyond with meaningful data. “- Edie Hagens, Senior Business Development Executive, Healthcare at Consensus
Electronic Prior Authorization (ePA)
When evaluating the traditional approach used to submit prior authorization requests, it is clear that the bulk of the responsibility lies with the suppliers. Each health plan is unique in that it has its own payer-specific portal containing different clinical and business rules. Add separate CMS rules and you have a lengthy process consisting of many documents that need to be processed by a payer.
In many cases, the prior authorization request will stay there. This is not good, as some MAs can be life-saving, such as a chemo patient who needs to have pre-clearance before she can move on to another round of chemo treatments. It can also be very difficult for the patient.
Effective and efficient health data exchange is essential to ensure that the right care is delivered at the right time for the right treatment. With the adoption of an all-in-one real-time health event notification solution such as Consensus signal, payers can work alongside providers to ensure their members are on the path to better health that reduces waste and frustration.
About Bevey Miner:
Bevey Miner is Healthcare IT Strategy Manager / Head of Marketing, Consensus Cloud Solutions – the creators of the Consensus platform for sharing health data and eFax Enterprise, the leader in HIPAA compliant healthcare fax technology.