The challenge

Healthcare IndustryToday’s hospital billing process can be extremely complicated. SUNY Downstate Medical Center, one of the nation’s leading urban medical centers, serves over 2.3 million people. Like many hospitals, using a single taxpayer ID with many billing vendors involved in patient care can result in a very cumbersome process for Explanation of Benefit (EOB) reconciliation. Some payments were made to patients, and many others were sent to incorrect lock boxes.

When a payment was made to the incorrect lock box the billing vendor would print and mail copies of the pages along with a statement of the unapplied funds from a given EOB to the hospital finance department. The finance department would collect and organize the paperwork. They would photocopy pages to generate a package for each billing vendor and mail those packages to the pertinent vendors. The process was paper intense, slow, and increased the monthly FedEx bills. With decreased time windows to contest a denial, there were additional costs to the hospital for write-offs for uncollectable funds. Plus the costs to correct the statements that were mailed to patients which didn’t reflect the proper balance due.

How we helped

KEY TAKEAWAY:

A slow, paper intense billing process was transformed into to improve cash cycle and lower expenses of collecting payments.

Laserfiche is used to collect all the EOBs from the service providers. Business Automation Experts set up an environment and helped to engineer a secure online collaboration engine to significantly improve the unapplied payment process. Macro level reporting on unapplied payments, and detailed tracking of which vendor has claimed a unapplied payment for a patient help ensure accuracy and timely processing. The added indexing of check number and insurance plan helps a vendor quickly locate a payment and register the funds due to their practice and the patient. The audit trail helps identify which vendors are actively working the process and has accelerated the denial response cycle and the registration of funds.

We provided training, documentation, and webinars for the hospital billing vendors to learn how to leverage the improved system. Within 2 weeks all vendors adopted the system and are regularly submitting their EOBs and registering insurance payments to their patients.

The result

An improved cash cycle and lower expenses to collect funds.
All parties have benefited. Patients get more accurate bills and statements, so missed denials by payers will not become their payment responsibility. The hospital can process bills more efficiently, accurately and securely, while it’s medical service providers can resolve issues and get paid faster. This means processing times have been significantly shortened and partners get paid faster, all through a secure system that ensures HIPAA privacy compliance.

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