Medical Chart Software

Vicert developed a web-based workflow app for efficient and automated medical chart analysis. The fraud detection team used our solution to detect duplicate and fraudulent medical information. Health payers could also use it to review claims and charts received for payment.

Full Stack: Java, jQuery, Oracle

9 months

Challenge

Vicert had to develop a Health Care Reform (HCR) compliant solution. Its purpose was to review large quantities of claims and act as software for medical chart review.

Our client was facing issues related to the technical side. Their system at the time wasn’t adequately developed - the original estimate was that they would need to process about 10 000 records on a given day. Revised estimates later showed that the expected number of records was about 1 000 000 daily.

We recommended that the client revise their system and rely more on web services. The biggest threat our software for medical records faced was the CMS-mandated requirements and the client’s constantly changing interpretation of said requirements.

Vicert needed to develop an app that would be highly customizable and configurable to accommodate future changes in the requirements.

The client identified three main problems:

• Centers for Medicare and Medicaid Services (CMS) Mandate

  This mandate required the review of claims by the payers requesting reimbursement for balanced payments through the Health Care Reform legislation.

• Health Care Reform (HCR) Requirements

  Our app for medical chart review needed to comply with the HCR requirements - we needed to change the client’s current system as it failed to meet all the requirements.

• Manual Claims Processing

  Our client manually processed their claims, drastically reducing their processing capabilities. It was necessary to develop an automated solution to filter most suspected fraudulent claims and leave the rest for manual human review.

Solution

Vicert developed a medical chart repository within our medical charts software. It stored electronic versions of charts and identified those that needed risk adjustment.

We built logic by following CMS requirements to identify potentially fraudulent cases, and then we integrated the cases with external solutions for chart and claims data. In doing so, the client’s staff could review specific cases manually and locate fraudulent claims more efficiently.

Updates made by the staff were stored and transmitted to CMS using the standard format. We built our medical chart software using a Java web-based app with Spring and Hibernate frameworks. The web-based solution was flexible, secure, and scalable. The solution had a configurable workflow, allowing for automated processing and indexing of medical data.

Vicert implemented integration with third-party vendors, Epi Source and Record Flow, using them to automate chart retrieval and processing.

Benefits

• Improved overall workflow: our client gained the ability to process larger quantities of data.

• Time-saving: our medical chart software filtered most of the claims, leaving the client’s staff with a small subset of claims for manual analysis.

• The solution's flexibility allowed our client to utilize it better in the long run and increased the client’s ROI.