Consilio in Action: Health Care Provider Maintains Business Continuity While Recovering from Ransomware Attack

Consilio successfully digitizes and analyzes over 15,000 patient encounters within HIPAA guidelines in just two months

Ransomware attacks are not new, but less visible in recent years have been the challenging recoveries that businesses across multiple sectors have faced in the wake of a breach.

In today’s business environments, all processes are electronic, and while the benefits of working paperless are immense, one major downside is the difficulty in maintaining continuity of operations after a ransomware attack paralyzes major business systems.

In the case of a large health care organization, a ransomware breach led to an extensive network disruption lasting for several weeks. The organization had to resort to utilizing physical documents for patient interactions to carry on despite the attack, leading to a substantial accumulation of over 15,000 files requiring conversion into digital format and later harmonization with its electronic systems. The organization urgently sought a prompt, precise and compliant resolution to restore digital records management and guarantee uninterrupted business operations.

An insurance carrier enlisted Consilio’s services to deliver customized solutions, knowing that Consilio’s agile team could quickly learn the health care organization’s billing and other software tools, get up to speed on instruction documents and train and scale a team to address the backlog.

Building the Team

Under the leadership of Consilio project specialist Rebecca Loyer, the team undertook the task of interpreting protocols, acquiring proficiency in medical billing software, designing workflows and conducting quality control searches and workflows. A group of 12 data consultant analysts and managers were trained in medical billing procedures, enabling them to efficiently handle physical records.

Rebecca explained, “This was not simply about digitizing handwritten records. This was also a process of resolving conflicting diagnostic codes to ensure that the client could go back and collect that revenue, whether from the patients themselves or from their medical insurance company.”

Michael Manzo, Director, Business Development at Consilio, went on, “If this were one or two encounters that the health care organization needed digitized, that would have been managed internally. But they had been working off paper for one month. This was a greater challenge, and the team at Consilio rose to the occasion perfectly.”

One considerable part of the challenge was the complexity of the records. There were many references in patients’ files to previous visits or issues. A great deal of training and discretion was needed on the Consilio team to research old files that were relevant to the current encounter. This required careful management of expectations at the health care organization as to how deeply Consilio would delve into connecting all the old records.

Accuracy and speed were equally important to the client, as well as staying in compliance with HIPAA, which added to the complexity of this project. Fortunately, Consilio’s talented and dynamic team is accustomed to quickly adapting to unique tasks and proprietary client systems by becoming expert extensions of each client’s in-house team and providing valuable support for unusual or specialized projects that would fall outside of the scope of a traditional managed review.

Ultimately, Consilio provided bottom-line value to the health care organization. The organization was up against a hard end date to meet insurance deadlines for collecting revenue. Consilio was able to take this on and free up regular staff time to focus on day-to-day operations.

Complexity Demanded Clear and Constant Communication

Frequent communication was critical at the outset, so the health care organization and Consilio teams met often in the beginning, with Rebecca at the helm defining the ultimate cadence and frequency of calls and communication needed. Extensive training calls with the client and her skill set in translating back to the Consilio team were critical.

Throughout the project, strict adherence to HIPAA guidelines safeguarded the privacy of patient data. The team displayed adaptability and meticulousness in tackling challenges, including deciphering handwritten notes from health care providers, resolving discrepancies in billing codes and ensuring compatibility of ICD codes. All of this was accomplished within a demanding time frame.

Ultimate Success

During the span of the two-month project, the team effectively managed and converted 15,000+ patient interactions into digital format. These encounters encompassed various procedures and diagnostic codes. The team’s ability to swiftly adapt to new software and procedures, combined with their meticulous quality control processes, facilitated a seamless shift back to digital records management. The project was accomplished within the allocated budget and schedule, enabling the health care organization to meet state insurance regulations and resume regular operations. This project exemplifies the significance of customized and ongoing business solutions in recovering from cyber incidents and maintaining uninterrupted business operations.