Situation ...
This medical services company's business has grown exponentially since its inception. Our client's billing and collections system, while accurately recording transactions, did very little to enable efficient and effective issue research and resolution by collections representatives.
Problem ...
Billing and collection efforts are complex because of industry practices – this company's services are used by health care providers (such as doctor offices and hospitals), who are referred to as "clients," and who collect insurance and other billing-related information from their patients. Mistaken, incomplete, or outdated insurance and patient information causes reimbursement claims to be rejected by the insurer. Researching and resolving these issues requires reviewing information from various internal sources, as well as contacting the provider for additional information. Receivables affected by these issues were increasing much more quickly than the related revenues and overall accounts receivable, hurting cash flow.
Solution ...
We reviewed how collections representatives researched and resolved claims requiring calls, and designed and developed an application to:
- Integrate information and tasks from various systems via a single screen.
- Enable corrections to patient and insurance information.
- Make adjustments to the bill.
- Bill the specified insurer directly from the single screen by initiating a transaction directly in the Billing system.
- Lookup physician orders and other related documents, such as the patient's insurance card, from the document management system.
- Place claims worked by the representatives into an appropriate queue for subsequent processing.
 |
Various counts are presented, including the number of total cases in the queue, total cases for this client, and total cases for this patient. |  |
Users select the major insurance plan via picklist, and then specify the appropriate insurer from the choices displayed. |
 |
Detailed client information and images of supporting documents are retrievable from the Billing and Document Management systems. |  |
Call Center users may quickly select one of these 3 common dispositions, which automate all required actions and move on to the next case. |
 |
Detailed Patient information can be displayed, as needed. Detailed Insurance information has been requested and is displayed. |  |
The application tracks all changes made by users or the application itself, providing an audit trail of steps taken to resolve the case. |
 |
The web link takes the user directly to the provider section of the specified insurer's web site. A planned future enhancement will submit information to the insurer via web services. |  |
The user picks a Result Code to indicate a case's status and next steps – for example, if the office is closed, "Client Closed" places all calls to this client on hold for one workday. |
Results & Benefits ...
Over 100 users now use this application to make calls to obtain accurate insurance information and patient information. Paper usage has decreased and detailed audit trails are now kept, as all actions are now initiated and recorded in a single application.
Managers and supervisors finally have tools to monitor employee workload and effectiveness. Measures of process effectiveness, such as the percentage of calls made versus disposition as billed to insurance or billed to patient, are automatically accumulated and presented in a dashboard format via the company intranet. Executives can now devise tactics to more quickly collect accounts receivable and adjust staff levels.
When the new technology-enhanced process was deployed 3 months ago, our client also launched a task force of both in-house and temporary call representatives to attack past due receivables by calling providers to obtain information. These efforts have significantly improved collections, with active receivables quickly dropping nearly 9%.
Conclusion ...
Calling and obtaining accurate insurance and patient information is now more efficient and effective. The process and technology changes we made are bolstering our client's cash flow, both by keeping staff increases below revenue increases and by speeding resolution of claims.
For More Information ...
To discuss how technology usage and business process improvements could be applied to the issues facing your business, call us at 336.297.4200 to schedule a no-obligation consultation, or click here to contact us online.
