Khristina Kisner

HCMT1005C 003
Module 14 Assignment 2: ROI
The process of release of information (ROI) is a complex, costly and time-consuming
process consisting of over 32 distinct steps (Healthport). In 2014, U.S. hospital systems began to
see their profitability erode for the first time since 2008. This is due to rapidly rising expenses
outpacing revenue growth at providers across the country (Kutscher, 2014). Hospitals are
businesses concerned with revenues and expenses like any other business. Any fluctuation in
revenue can affect how patient care is delivered and also affect the health of the hospital as well
(Feigenbaum). Hospitals therefore have to stick to a budget, part of this budget includes the
expensive process of ROI. A hospital can receive fines of up to $1.5 million from HIPAA and
other regulatory violations if they dont strictly adhere to proper ROI procedures (Rohs).
An assumption must be made before starting the budgeting process for ROI, these include
direct cost and indirect costs. Direct costs are those that are directly accrued by the department,
for example salaries and supplies (Sayles, p. 1115, 2014). Indirect costs are those expenditures
not directly traceable back to the department, heating and cooling, electricity and housekeeping
are examples (Sayles, p. 1115, 2014). Mixed (semifixed and semivariable), fixed and variable
costs must also be taken into consideration when creating a budget. Fixed costs stay the same no
matter how much work is done. Variable costs are employee salaries, materials and other
expenses, these deal with how much work is done. Semifixed costs change depending upon
output (Sayles, p. 1115, 2014). All of these must be considered when making a ROI budget.
Expenses for ROI:
Labor costs: As of 2008, employee wages and benefits made up close to 60% of a hospitals
expenditures. According to the American Hospital Association, other labor costs accounted for an
additional 10.6% (Rohs). With the ROI process, this would be the employees whose job is
specifically dedicated to the ROI process. Most expenses for ROI staffing is incurred to retain a
fully trained ROI department, legal counsel and technology. All of these are needed to manage
the high volumes of requests and also to meet the time constraints and to comply with privacy
demands (McDavid, 2011).
HIPAA Compliance: The expansion and enforcement of HIPAA regulations adds expenditures
to a hospitals ROI operation (McDavid, 2011). This requires legal oversight, a
privacy/compliance office, well-defined policy and procedure manuals, and HIPAA-compliant
forms and updated business associate agreements (McDavid, 2011).
Logging, Tracking and Verifying the Request: These involve steps 1-4: receiving the request,
logging the request into the tracking system, validating the request and if the request is not valid,
notifying the requestor of the denial (Healthport). An additional expense is for accounting for the
disclosures, ARRA requires those facilities using EHRs to provide accounting or auditing trails
for all record disclosures (Rohs).
Retrieving Patient Information: These are steps 5-8 for ROI: If the request is valid,
determining the correct medical record number, retrieving the medical record is the correct
format if it is onsite, if onsite retrieving the record through proper channels and if on microfilm,
printing the record.

Releasing Only Authorized Information: Steps 9-13 are for the standard that only the
minimum necessary to fulfill the request must be released. Confirm the medical record is
complete, authenticating the patients signature, matching the medical record request with the
record, making an initial assessment if the request can be processed and if it cannot be processed
they notifying the requestor (Healthport).
Safeguarding Sensitive Information: Steps 14-16 are locating the exact information needed to
fulfill the request and reviewing each page of the patients record for confidential and legally
protected information (Healthport).
Monitoring, Completing and Invoicing Request: Steps 17-32 detail capturing the information,
working with the media (paper chart/microfilm), disassembling and digitally capturing the pages
with the requested authorized information. Also designating pages within the EHR and package
as requested. The patients identity is identified on every page, and the requests are reviewed and
pages are chosen from the record to review for accuracy of the information (Healthport, 2012).
The paper chart is then reassembled and the request log status is updated. The documents are
prepared for mailing or delivery and an invoice is created. When payments are received for ROI
services they are recorded and requested documents are sent to requestor. This is done if payment
was not sent with request. Patient file is returned to original location or sign out of EHR. Track
outstanding invoices, perform collections are needed, monitor status and completion of pending
requests and expedite time-sensitive requests (RAC, audit, Meaningful Use). Close out request in
tracking system when payment is received (Healthport, 2012).
Liability costs: Professional liability insurance accounted for about 2% of hospital expenditures
in 2008 (Feigenbaum). Hospitals must protect themselves, mistakes do happen despite healthcare
providers and administrators best efforts (Feigenbaum).
Supplies and Capital Expenses: Supplies make up about 15% of a healthcare facilitys
expenses (Feigenbaum). The amount and percentage for each hospital varies, depending on
layout. Postage, printer ink, envelopes, fax machine paper and printer paper are the supplies
needed to fulfill ROI requests.
Outsourcing: If costs are a serious issue, ROI can be outsourced when revenue has decreased
and access to capital is reduced (McDavid, 2011). This can reduce immediate backlog, just
handle specific tasks of the ROI process or take over the complete operation (McDavid, 2011).
Revenue for ROI
Fees for medical records: For the State of Ohio there are different rates for patients, attorneys,
insurance claims and workers comp claims. This covers the clerical and labor expenses involved
in reproduction of the medical record (St. Vincent, 2015).
For Patients (2013):
1-10 pages: $2.98 per page
11-50 pages $0.62 per page
51+ pages: $0.26 per page
Attorney, Insurance Claims and Workers Comp Claims
Initial fee is $18.34
1-10 pages: $1.20 per page
11-50 pages: $0.62 per page
51+ pages: $0.26 per page

Insurance Billing: Billing private, Medicare and Medicaid for patient care (Feigenbaum). When
not paid for by insurance, patients are billed for services provided.
Research and Teaching: Hospitals affiliated with University and educational foundation
facilities receive federal, state and private grant funding (Feigenbaum). These grants for the most
part fund experimental procedures and medical studies, however some of these funds are
received for the purpose of making improvements to the facility (Feigenbaum).
Reference
Feigenbaum, E. (n.d.). Categories of expenses and revenues in the hospital business setting.
Retrieved from smallbusiness.chron.com
Healthport. (n.d.). Compliant, flexible solutions for fulling medical record requests. Retrieved
from https://www.healthport.com/
Healthport. (2012). 32 steps to process a medical record request. Retrieved from
https://www.healthport.com/docs/default-source/info-sheets/roi-32-steps-to-fulfill-arequest.pdf?sfvrsn=2
Kutscher, B. (2014). Hospitals, systems see operating margins shrink as expenses climb.
Retrieved from http://www.modernhealthcare.com/article/20140813/NEWS/308139963
McDavid, Jan. (2011). Release of information: the cost of compliance. Retrieved from
http://health-information.advanceweb.com/Features/Articles/Release-of-InformationThe-Cost-of-Compliance.aspx
Rohs, M. (n.d.). EHR implementations and the HIM department. Retrieved from
www.fortherecordmag.com/news
Sayles, N. (2014). Health information management technology: an applied approach.
Chicago, IL: American Health Information Management Association.
St. Vincent Charity Medical Center. (2015). Medical records. Retrieved from
https://www.stvincentcharity.com/patients-visitors/billing-insurance-medical-recordsprivacy/medical-records/