Hospital billing processes today are extremely complicated. This case study highlights how some of those challenges can be easily resolved.
SUNY Downstate Medical Center, one of the nation’s leading urban medical centers, serves over 2.3 million people. More physicians who practice medicine in New York City receive their training at their College of Medicine than any other medical center in the country.
Like many hospitals today, multiple billing vendors are involved in patient visits and the use of one taxpayer ID can result in a cumbersome and often erroneous process for Explanation of Benefit (EOB) reconciliations. In SUNY’s case, some payments were made to patients and many others were sent to incorrect lock boxes.
When a payment was sent to an incorrect lock box, the billing vendor holding the unapplied payment would print and mail copies of relevant pages along with a statement of the unapplied funds from the EOB to the hospital finance department. The finance department would then collect and organize the paperwork, make copies for each billing vendor and mail a package of those copies to the pertinent vendors.
Managing the process was difficult, error prone and paper intense. It also incurred constantly increasing overnight courier costs. Since the process took a great deal of time, this length of time decreased the window in which to contest denials of payment; incurring additional costs to the hospital and loss of revenue for uncollected funds write-offs.
How BAE Helped:
BAE recommended that SUNY Medical Center implement a Laserfiche solution to collect all EOBs digitally. BAE constructed the environment and helped engineer a secure, online collaboration engine which significantly improved the unapplied payment process.
Macro-level reporting on unapplied payments was enabled as were detailed vendor claims. This helped ensure accurate, simplified and timely processing. The added indexing of a check number and insurance plans helped vendors quickly locate payments and register funds due their practices and patients. The establishment of an audit trail helped identify which vendors were active in the process and accelerated the denial response cycle and registration of funds.
BAE provided training, documentation and webinars for the hospital billing vendors to learn how to leverage the improved system. Within two weeks all vendors had adopted it and were regularly submitting EOBs and registering insurance payments to their patients.
SUNY MC and its affiliated service providers significantly benefited from the redesigned process. Patients now receive more accurate bills and statements so that missed denials by payers do not become their fiscal responsibility. The hospital can now process bills more efficiently, accurately and securely while its medical service providers can resolve issues and get paid faster. Processing times have been significantly shortened from months to weeks and partners get paid faster all via a secure system that ensures HIPAA privacy compliance.
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