Highlights of Outreach and Collaborative Efforts of the
Beneficiary and Family Centered Care - Quality Improvement Organization (BFCC-QIO)
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Looking for Coronavirus Disease 2019 (COVID-19) resources? Scroll down for helpful resources from the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS).
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Look Inside Livanta - Part Three |
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Regardless of their size, organizations are often complex entities made up of several smaller working parts that help the organization function as a whole. For maximum effectiveness, each part of an organization must work in conjunction with the others. From private corporations and community groups to government agencies and military units, organizations are usually more than the sum of their parts - and some of those parts can be, at times, the unsung heroes of the operation.
The last two issues of The Livanta Compass have focused on the Livanta Mailroom and Call Center. This week’s issue continues the “Look Inside Livanta” series and highlights the part of the organization that functions as the central nervous system of Livanta’s Beneficiary and Family Centered Care - Quality Improvement Organization (BFCC-QIO) case review activities: Livanta’s Information Technology (IT) department.
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Information Technology - A Growing Field |
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From the invention of the wheel to the advent of artificial intelligence, machine learning, and other recent innovations, advances in technology have always shaped human life in profound ways. Often improving speed, ease of use, performance, or effectiveness, the influence of technology can be felt almost constantly in daily life. However, just twenty years ago, many everyday work processes were still manual and based on paper records - especially in healthcare.
Today, with advances in everything from data storage, secure data transmission, computing power, and high-speed network connections, manual record keeping has become the exception instead of the norm. The IT field continues to evolve, and with that evolution, the landscape of healthcare has also changed in profound ways.
In most organizations, IT experts help ensure that the infrastructure for providing services is available and accessible to the people who rely on those systems. Day in and day out, busy IT professionals ensure that their company’s networks, data systems, and physical workstations are functioning at peak efficiency and speed. IT professionals are also responsible for protecting, hardening, and defending networks from the increasing threats of cyber-attacks and other actors with malicious intent.
The growing field of Health IT, or HIT, is a specialized field that uses information processing systems, including computer hardware and software, to store, retrieve, share, and use healthcare information, data, and knowledge. HIT applications include electronic health records and personal health records, as well as other programs that assist clinicians in communication, documentation, and decision making. HIT differs from IT in that its focus is the delivery of healthcare or health-related services and the stewardship of protected health information (PHI) and other patient data.
Perhaps the most dynamic emerging field within the IT sphere is health informatics. As defined by the Centers for Medicare & Medicaid Services (CMS), health informatics promotes “the secure exchange, access, and use of electronic health information to support better informed decision making and a more efficient healthcare system.” The key concept of this emerging field is the interdisciplinary nature of the activity which aims to break down barriers to sharing data. Data can in turn be analyzed to (1) allow healthcare providers and patients to make better informed decisions; (2) guide policymakers and administrators in setting goals and quality measures; and (3) establishing policy to provide better care at a lower cost. These goals support the most important aspect of healthcare - improving health outcomes.
Read more about health informatics and interoperability:
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Livanta’s IT Infrastructure |
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At the core of its operations, Livanta’s IT infrastructure enables virtually every aspect of the operation to support and execute steps of the case review process. Like the central nervous system of a living being, Livanta’s information systems reach into every aspect of the BFCC-QIO case review process and provide the conduit necessary for all systems to work together seamlessly. Providing case review services for the approximate 33 million Medicare beneficiaries in Livanta’s regions requires an extensive team of IT professionals. These hard-working and dedicated staff design, build, and maintain Livanta’s systems so that the rights of Medicare beneficiaries are protected each and every day of the year. |
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The many ways in which Livanta’s IT department supports case review can be seen in a typical appeals case:
1. A beneficiary or their representative makes a phone call to Livanta’s Medicare Helpline.
At Livanta’s Call Center, both incoming and outgoing calls are handled by Livanta’s powerful integrated telecommunications system. This robust computerized phone system includes a suite of critical functions such as automated call routing, recording, built-in reports for monitoring performance, and other features needed to ensure the effectiveness of a bustling call center. At the time of the phone call, the appeal has begun and Livanta must adhere to strict time limits to complete the case review.
2. Livanta requests the patient’s medical record from the healthcare provider.
To accomplish this task, Livanta’s electronic case review system, CompassWeb, is programmed to auto-generate the fax with the patient’s name and requested records. This automated process saves hours of staff time and replaces the need to manually send faxed requests. At the push of a button, the case review process is underway.
3. The healthcare provider transmits the patient’s medical record to Livanta.
Per CMS Final Rule 1735-F, as of October 2020, healthcare providers must transmit medical records to the BFCC-QIO electronically. To support this new development, Livanta’s team of IT experts developed a web-based system so that healthcare providers could easily upload patients’ medical records through a secure online portal. The Livanta File Transfer portal, which is known as e-LiFT, routes uploaded records automatically within Livanta’s case review system, matching them to open cases and notifying designated staff members that records have been received. Other electronic submission options are available, including Direct Secure Messaging (DSM) and esMD. If medical records are received by fax or postal mail, the Mailroom scans and uploads the documents to Livanta’s case review system.
4. A Livanta Physician Reviewer accesses and reads the medical record documentation to evaluate the patient’s concerns against Medicare policy requirements, ultimately reaching a decision on each case.
All medical records, case notes, and related information is stored securely in Livanta’s cloud-based case review system, which allows for remote access anywhere and anytime.
5. Livanta’s clinical staff contact the beneficiary with the outcome of the physician review and healthcare providers receive an automated fax from CompassWeb with the same information.
The case review process is not complete until these notifications are made.
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Innovation and Development |
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Livanta's IT professionals are more than the heartbeat of case review operations - they are also responsible for developing new technology, processes, innovations, and other advancements that allow for greater efficiency and quality service to CMS, Medicare patients and families, and healthcare organizations. An early adopter of cloud-based computing, Livanta has refined its approach to developing IT solutions, ensuring that new products and processes are secure, scalable, and user-friendly.
As noted above, CMS Final Rule 1735-F requires the electronic submission of medical records to the BFCC-QIO. To make the implementation of the Rule a seamless event for healthcare providers, Livanta’s IT team stepped up and delivered new solutions. By leveraging Livanta’s flexible and scalable case review system as well as its robust network architecture, Livanta’s IT team developed, tested, and deployed the e-LiFT system in advance of the go-live date to ensure that healthcare organizations that were not yet ready to use DSM had an alternative method to transmit medical records to Livanta. Livanta’s use of DSM is another example of Livanta’s IT team leading the industry and incorporating new technologies and new standards into existing processes and requirements.
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Rock Star Award
On day one of this year's Quality Conference, an annual event sponsored by CMS, Livanta was honored with a “Rock Star” award for outstanding contributions to the advancement of the BFCC-QIO program.
During this year's virtual event, which took place in March, CMS noted Livanta's development work that supported the electronic transfer of medical records. The Rock Star award specifically acknowledged the Livanta IT team for "their ability to innovate using technology to help streamline their processes, resulting in the more efficient use of scarce Medicare Trust Fund dollars.”
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Using suggestions from patient advocates and healthcare professionals, Livanta’s developers launched the first interactive smartphone app for BFCC-QIO services. The LivantaCares Medicare Helpline smartphone app, which is still available and routinely refined and updated, has had thousands of downloads, and continues to stand out as the only app currently offered by a BFCC-QIO. Not only does the app contain useful information on patient rights but also location services, speed-dial, and real-time case tracking. |
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Coronavirus Disease 2019
(COVID-19) Resources
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CMS Offers Free National COVID-19 Nursing Home Training |
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As COVID-19 surges across the nation, the Centers for Medicare & Medicaid Services (CMS) is at the forefront of the fight. CMS has developed a standardized national scenario-based training that is specifically designed for frontline staff in nursing homes. CMS recommends that all frontline staff complete this critical training as soon as possible.
Visit this page to seen an updated list of recognized nursing homes across the country that have met the 50% threshold for staff completion of this critically important COVID19 training.
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Additional CMS Resources
COVID-19 Vaccine Policies & Guidance
CMS Expanding Efforts to Grow COVID-19 Vaccine Confidence and Uptake Amongst Nation’s Most Vulnerable
CMS proposes to enhance the medical workforce in rural and underserved communities to support COVID-19 recovery and beyond
CMS Data Shows Vulnerable Americans Forgoing Mental Health Care During COVID-19 Pandemic
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Additional CDC Resources
When You've Been Fully Vaccinated
Different COVID-19 Vaccines
Communication Resources
COVID Data Tracker Weekly Review
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12-SOW-MD-2021-QIOBFCC-CP138
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