How To Handle High-Volume Health Plan Requests

Do you struggle to keep up with a high volume of health plan requests? You’re not alone.

Managing patients’ protected health information (PHI) can be challenging without the right software and services. As the demand for health plan requests for medical documents rises, you may worry that your team will fall behind on the ever-increasing paperwork.

Scaling the record release process doesn’t need to cause you stress during the workday. You can overcome high-volume requests by investing in the right technology and developing a comprehensive release of information (ROI) policy.

In this article, we will discuss why keeping up with requests before they spiral out of control is crucial. We’ll also share five strategies for simplifying the medical documentation release process and helping you control your business operations and compliance.

Once you finish reading, contact us at ChartRequest to plan a custom solution that works for you.

Record Requests Are on the Rise

Today, more patients are accessing their medical records than ever before. Data gathered by HealthIT.gov indicates that only one in five individuals did not attempt to access their health records in 2022 — nearly a 50% reduction since 2017.

Consequently, healthcare providers are scrambling to implement new technology to streamline the verification and release process for high-volume requests.

We can attribute numerous factors to the sharp rise in health plan requests, including:

Spikes in insurance claim denials
Higher need for risk adjustment reviews
Frequent and mandatory HEDIS reporting
A more informed and curious patient mindset
And more

Healthcare providers should expect the demand for digital health information to continue rising throughout the 2020s. Proactive planning can reduce operational delays and help staff manage their time efficiently.

The Problems With Falling Behind on Health Plan Requests

Drowning in a sea of protected health information requests can lead to issues affecting your entire health IT department. Not only does it impact the operational efficiency of your healthcare institution by redirecting workers and resources away from quality patient care, but it can also lead to confusion and lower cohesion between employees.

Patients may encounter delays in getting necessary treatments authorized. They may also face financial complications if their insurance company does not receive the required documentation on time. These issues can sink your company’s reputation and reverse all the progress your team worked so hard to achieve.

Furthermore, pressure on your IT and administrative staff, who must handle this increasing workload, will inflate as the backlog of unprocessed requests grows. This problem can lead to staff burnout and decreased job satisfaction.

Recent statistics suggest that medical staff burnout can cost a healthcare organization over $7,600 per employee every year.

Don’t Forget Your HIPAA Obligations for Health Plan Requests

The Health Insurance Portability and Accountability Act (HIPAA) imposes strict regulations on the handling and sharing of patient health information. Failure to meet HIPAA standards can result in severe consequences, including hefty fines and an increased risk of your organization experiencing a breach.

Hence, it’s crucial to ensure that your data release procedures meet HIPAA deadlines, protect patient privacy, and maintain data integrity year-round when processing high-volume health plan requests and documentation.

Still, navigating through endless requests is not just about speed. You must also stay mindful of accuracy and privacy when disclosing sensitive patient information.

When considering HIPAA compliance, you must be mindful of:

Timeliness of Response: Under HIPAA, your healthcare organization must respond to patients’ requests for their medical records within 30 days. Many providers who experience high-volume requests struggle to meet this standard because completing a single request can take several days.
Patient Consent: Consent is a critical aspect of HIPAA. A healthcare provider must sign consent forms from the patient before releasing their medical records to any third party.
Minimum Necessary Standard: When disclosing PHI, healthcare providers must adhere to the “Minimum Necessary Standard.” This rule means you should only disclose the minimum necessary information to satisfy the request — no more, no less. The Minimum Necessary Standard reduces the risk of accidental PHI disclosures that may compromise a patient’s identity, safety, or reputation.
Safekeeping of PHI: Healthcare providers must implement appropriate physical, technical, and administrative safeguards to protect PHI from unauthorized access, use, or disclosure.
Training: Staff members should have thorough training in HIPAA compliance. It’s crucial that they understand the importance of protecting patient data and the potential consequences of non-compliance.

Data Indicates Over 80% of Physicians Have Reached Their Limits

A study published by the Annals of Family Medicine revealed that physicians spend an average of nearly two hours on administrative tasks — including electronic health record (EHR) management — for every hour of direct clinical facetime with patients.

In other words, nearly half of a physician’s working day goes toward interacting with the EHR. This imbalance significantly contributes to delays in effective care coordination.

Furthermore, a survey conducted by Medical Press found that more than 81% of surveyed physicians described their workload as being at capacity or overextended. Much of this workload is managing health plan requests, often resulting in slower response times for patients seeking treatment approvals.

Information published by Becker’s Hospital Review states that primary care physicians spend an average of 1.8 hours per day on paperwork, including handling PHI requests, outside of office hours. This additional time could significantly improve healthcare delivery and patient satisfaction if otherwise directed toward patient care.

These statistics demonstrate the burden high-volume health plan requests place on medical practices.

Strategies To Help You Overcome High-Volume Health Plan Requests

Healthcare providers can no longer ignore the challenge of managing high-volume health plan requests, as it poses significant implications for healthcare professionals and patients.

Adopting practical measures to streamline the record release process is essential, thereby enhancing operational efficiency and reducing the risk of non-compliance. In this section, we will explore five key strategies to consider when deploying a modern ROI solution:

The first step towards managing high-volume requests is to find a great release of information solution. Modern systems can efficiently handle large quantities of data while ensuring informational accuracy and security. They can provide features like batch processing and queue management, enabling healthcare providers to process multiple requests simultaneously and prioritize them based on urgency.

ChartRequest offers one of the most intuitive and effective release of information platforms on the market. Its encrypted SOC 2, HITRUST, and ISO 27001-certified workflows improve the data retrieval process without compromising sensitive information.

2. Training and Support

EHR system effectiveness and optimization are highly dependent on the skills of its users. Therefore, regular training and support for your team is crucial for consistent results.

Training ensures that your organization can make full use of its EHR tools. At the same time, ongoing support provides a safety net for any issues that may arise in the future. These advantages help minimize disruption in patient care and support a productive workflow behind the scenes.

Training with some EHR platform tools could take several days or even weeks. That is why investing in easy-to-use software is the best way to ensure speedy results.

Your healthcare organization may not have the time or resources to learn new software for PHI. Fortunately, you can outsource the work with a Full-Service ChartRequest partnership and enjoy our 5-day turnaround time guarantee.

3. Timely Auditing

Timely auditing allows you to assess the efficiency of your organization’s current record request management process. This strategy involves routinely examining record request logs to identify bottlenecks or inefficiencies.

In effect, your health IT team can proactively address any issues that might arise, making the process smoother and faster.

Most healthcare organizations undergo several medical chart audits every year. While most audits are external (federal or third-party), conducting an internal audit is an excellent way to scale your ROI process for high-volume requests.

4. Automating Processes

Automation is another effective strategy to manage high-volume health plan requests. Automated processes can handle routine tasks, like sorting and categorizing requests, freeing up time for staff to focus on more complex tasks. This advantage improves efficiency and reduces the risk of human error, ensuring more accurate and timely processing of record requests.

Automating human reviews to maximize accuracy allows you to streamline data retrieval and free up your workforce to respond to more patients.

According to recent studies, over 90% of the healthcare industry leaders are automating processes to scale their organizations. Benefits of EHR scaling with automation include:

Sorting various types of medical record requests
Verifying personal information for data access
Sending automated messages to custodians based on prompts
Notifying users of potential breaches
Updating deadlines for individual health plan requests

5. Routine Reviews for Compliance

Maintaining compliance should be your first and foremost concern during a PHI request. You must adhere to the rules and regulations set by governing bodies regarding record request processing.

Utilizing a robust release of information solution — like those offered by ChartRequest — can assist you in maintaining compliance and preparing for possible audits.

Remember, your record requests may continue to rise in coming years, so leave room to improve where needed. Conduct reviews regularly to ensure that your solutions meet compliance standards and auditing demands.

Strong Release of Information Policies Help Your Team Keep Up With Health Plan Requests

It’s essential to have operational policies that support and guide your record retrieval process. These policies form the backbone of your health plan request system and ensure that all staff members are on the same page regarding how to navigate ROI workflows.

Successful policies should define the standards for record request processing, including response times, prioritization criteria, and security. These characteristics provide a clear and consistent framework for handling requests smoothly.

At a minimum, your release of information policy should include:

Responding: Specify the maximum allowable time for responding to health plan requests to ensure timely service delivery. Communication with the patient should be clear and effortless.
Priority Action Items: Define how your healthcare IT team should prioritize requests based on factors like urgency, complexity, and regulatory requirements.
Privacy Considerations: Outline the steps to ensure data security and patient privacy when processing and transmitting health records. Consider federal laws and regulations to develop the most air-tight policy.
Policy Review and Updates: Establish a regular schedule for policy review and updates to keep the policies current and effective.
Staff Training: Outline procedures for training staff members on policy updates to ensure consistent understanding and implementation of these policies.

Operational policies should be dynamic, incorporate technology advancements, and be amenable to feedback from staff and patients.

Partnership Can Make Health Plan Requests a Breeze

When it comes to keeping up with high-volume requests from health plans, trust the team with an average rating of 4.8 out of 5 stars.

ChartRequest partnership makes keeping up with the never-ending flow of records requests easy. We offer a robust, user-friendly platform that helps healthcare providers and requestors easily share, request, and receive the right records quickly.

Partnering with ChartRequest is about ensuring a future of efficient, compliant, and patient-focused healthcare service delivery. Are you ready to simplify your health plan requests for medical documents?

See ChartRequest in Action and Find Out How We Can Help You.