VNS Health Achieves an Efficient Grievance & Appeals Unit with a Digital Mailroom

A healthcare professional in blue scrubs talks to an elderly woman in a wheelchair in a bedroom setting.

Case Study at a Glance

Challenge

  • Achieve best-in-class grievance and appeals unit
  • Improve process efficiency
  • Reduce storage and space expenses
  • Ensure audit preparedness

Solution

  • Outsource grievance and appeals department’s mailroom operations
  • Create a fully digitized, paperless review process

Impact

  • Significant storage and material cost savings
  • Faster, more efficient processing of cases
  • Electronically time-stamped digital documents, which help ensure compliance and audit preparedness

Executive Summary

Though widely known for their long-standing success as a homecare agency, VNS Health is also a health plan administrator, contracting with the Centers of Medicare and Medicaid Services to participate in the Medicare Advantage program.

Within their health plan administration capacity, VNS Health works meticulously to coordinate and respond to appeals and grievances filed by any of their 40,000 members. The company takes careful and proactive measures to ensure each response is delivered in a timely fashion that is both compliant with regulations and reflective of the exceptional service it’s known for.

After being given the directive by management to create a best-in-class grievance and appeals (G&A) unit, VNS Health approached MetaSource. The organization wanted to create additional efficiencies and controls that would help them achieve this goal.

By outsourcing their mailroom to MetaSource, VNS Health was able to do just that. The company now receives their documents in digitized format within 24 hours of delivery, eliminating the stress and anxiety of dealing with paper and helping them become best-in-class.

The Challenge

Prior to partnering with MetaSource, VNS Health was relying heavily on paper-based processes that were inherently cumbersome and inefficient. Mail needed to be opened, unfolded, sorted, and placed into folders, paper documents could easily be lost and misplaced and were difficult to track when passed from employee to employee, and handwritten notes carried the potential for misreading and misplacement.

The company’s paper-reliant processes also resulted in higher space and material costs. In VNS Health’s New York City headquarters, space is both limited and of premium value. With compliance mandates that call for each case to be stored for 11 years, the company needed to reduce the thousands of pages of physical documents it kept both on the premises, as well as in costly off-site storage facilities. In addition to these expenses, VNS Health also wanted to reduce the number of case folders they purchased, which totaled as high as $6,000 per quarter.

Though the company took careful measures to abide by compliance guidelines, audit preparation was challenging as well. Physical date stamps on envelopes of received grievances and appeals made audits more complicated and riskier than necessary. Auditors automatically disregarded blurred stamps and proceeded to the next available date in the paper chain. This practice left the company unnecessarily exposed to timeliness issues in spite of the unit’s stellar response time.

The Solution

Rather than continuing with the inefficient and risky paper-based process, VNS Health chose to outsource their grievance and appeals unit’s mailroom to MetaSource, creating a streamlined digitized process as follows:

  1. MetaSource receives grievances and appeals via a dedicated local P.O. box (pickup takes place daily by noon).
  2. All envelopes are opened by our HIPAA trained staff, which is critical when handling medical-related documents.
  3. Non-urgent “white mail” is immediately separated and returned to VNS Health on a weekly basis.
  4. All grievances and appeals are unfolded and staples and paper clips are removed.
  5. Grievances and appeals envelopes and documents are scanned and indexed
  6. Each image is quality controlled and an electronic time stamp is added as reliable proof of receipt.
  7. MetaSource sends digitized documents through secure FTP within a 24-hour turnaround window directly to VNS Health.
  8. VNS Health coordinators can view all digital documents from their computers, copy and paste information into a database, and forward the digital files to the appropriate specialist for review and action.
  9. The specialist (and other qualified personnel) can copy and paste information directly from the digital document into electronic case notes. They can also use the G&A documents to help create resolution letters. This removes the need to add paper or handwritten notes to each file.

The Results

Outsourcing their grievance and appeals unit’s mailroom helped VNS Health to achieve a number of measurable goals, including increased efficiency, cost savings, enhanced employee productivity and member services, and a more thorough level of audit preparedness. Here are the results VNS Health achieved by partnering with MetaSource:

  • Staff members can now locate and process digitized documents faster and easier. This keeps employees on track and accelerates the resolution of cases all while eliminating the frustration and anxiety brought about by misplaced documents and other paper-based challenges.
  • VNS Health now saves money on the costs of materials (e.g., file folders) and both on-site and off-site storage, which can be very high in the NYC area.
  • Electronic time stamps on each grievance and appeal document ensure maximum preparedness in the event of an audit.
  • Using digital documents adds an additional layer of security and provides further assurance that VNS Health is in full compliance with HIPAA regulations at all times.
  • By scanning all incoming grievance and appeals documents and storing them in a document management system, all files are now automatically archived in one single repository, creating quick and easy searchability and access to documents at any point in the future.

About VNS Health

VNS Health is the largest not-for-profit home health care agency in the United States, and we’re one of the oldest. We’ve been part of the fabric of New York City since 1893. While our patients and their needs have changed over the years, our commitment to the people who need our care hasn’t. Our programs are designed to help patients improve their quality of life, and to reduce the number and length of hospitalizations.

Despite our long history, we are always looking to the future. As medical science advances and health care regulations change, we see numerous opportunities to develop programs that address the needs of our patients.

Smiling man in a light blue blazer works on a laptop at a desk in a modern office, with a notebook, documents, and phone nearby.

About MetaSource

MetaSource delivers intelligent document management, workflow automation, and business process management solutions to help organizations streamline processes, ensure compliance, and improve efficiency. With over 30 years of experience, MetaSource successfully meets enterprise needs with secure, reliable software and managed services.

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