Quality, Revenue Impacts Loom as Patients Now Have a Clear Look Behind the Revenue Cycle Curtain

Patients are now required access to medical records and information regarding enrollment, payment, and claims adjudication, adding stress to revenue cycle staff.

In October, the definition of electronic health information within the 21st Century Cures Act was expanded to include all electronic protected health information for patients. This means patients are now required access to their medical and payment records and any information used to make decisions about their care.

For example, this includes most data found in a patients' health record including medical records and billing records, enrollment, payment, claims adjudication, case or medical management record systems, and more.

In September, the AHA advocated for a one-year extension to this update citing a lack of resources to streamline these requests. According to the AHA's letter, "Despite our best efforts to educate our members, significant knowledge gaps and confusion still exist within the provider and vendors communities with respect to implementation and enforcement of information blocking regulations."

HHS obviously did not grant this one-year extension, and as access has been granted to patients for more than a month now, revenue cycle leaders are now seeing an influx of patient confusion and even demands for changes to their record—which goes beyond just the initial regulatory implementation worries cited by the AHA.

While access to information is of the utmost importance, should there be a line drawn for how much a patient sees behind the scenes?

When reviewing the updates under the Cures Act, Brian Murphy, branding director at Norwood, said a patients' access to "medical and billing records of course jump out at me. But so do the rest. Patients will have a much wider window into coverage determinations, cost of visits and procedures, nursing notes, op notes, and on and on."

Earlier this year, Chris Johnson, vice president of revenue cycle at Atrium Health, spoke with HealthLeaders about the patient billing experience and how access to too much information has been causing confusion for their patients.

"Quite frankly, when some patients see an insurer's use of CPT and ICD-10-CM codes, it can be like a foreign language, and it can cause real confusion," Johnson said.

Now patients have access to this information before the bill is even sent—and then some.

"Most coding/CDI/revenue cycle leaders expect scrutiny from payers, or peers, but typically don't think of patients. The patient has now entered the equation. I've already heard stories of patients objecting to coded diagnoses like major depressive disorder, drug abuse, and other sensitive conditions," Murphy said.

With these changes now in full swing, updating and streamlining processes may be needed.

"I think hospitals need to develop policies for how they plan to deal with patient objections, especially those that could result in quality or revenue impacts," Murphy advised.