Are You Considering Bringing Back ROI In-house?
By Suma Chacko, RHIA, CCS

A constant struggle for HIM Directors is deciding to keep release of information in-house or outsource. As with any decisions in outsourcing, one of the many aspects of concern is cost effectiveness and efficiency. Release of Information is an area that has the potential to generate revenue for the Health Information Management Department. ROI is a crucial area within the HIM department due to all the federal and state statutes for releasing patient information as well as complying with HIPAA regulations. For those of you who are considering bringing ROI in-house, the following steps will assist you in your assessment.
One facility recently conducted an analysis of transitioning an outsourced ROI back in-house. Is it beneficial for HIM to take over this area? In order to answer this question, an assessment of the ROI area should be conducted. The following areas need to be evaluated:

First, take an inventory of all capital items in ROI. This will illustrate a need for future purchases or leasing of equipment. These items include copier, microfiche reader (if applicable), PC's, and a fax machine. If your current vendor is providing these hardware, only include this as a one-time budget for the first year. Maintenance of hardware should only be included as part of operational expenses. A database can be created or purchased to handle all release of records, however, it will need to be HIPAA compliant.

Second, take an estimate of the number of employees needed to maintain the area. If the current outsourced ROI staffing has functioned well, then use that as a baseline. Staffing should be adequate in order to obtain proper authorization, copy numerous requests (billable versus nonbillable), pulling and filing records. A current manager can oversee this area or an ROI manager should be budgeted with staffing. Additional costs such as copy paper, toner, mailing supplies and postage will need to be added to the projected expenses. The revenue for ROI can be determined by evaluating your billable accounts which include fees from attorneys, insurance companies, patients, etc… In order to ascertain the profit margin, the total annual expenses (excluding one time capital expenses) should be deducted from the annual revenue. The results can assist in making the decision of transitioning ROI in-house versus keeping the current outsourcing company.

There are still other factors that are challenging in operating ROI. The staff will need continuous education to keep up to date on the latest rules and regulations. The cost-fee schedule must be updated frequently to comply with state laws. The issue of non-billable accounts may exceed the billable accounts. In essence, it could be wise to outsource ROI unless the profit margin was considerably high for the HIM department. The resources considered necessary to operate ROI are extensive. It is a critical area due to not only handling confidentiality of patient records but also the prompt nature of releasing medical information for continuing treatment of care. The ultimate decision is left to the Director on taking ownership of the area or the comfort level of outsourcing with a reputable vendor.