MHM recently completed a project for a group of consultant surgeons. The project was to investigate why they were not getting paid.
One insurance company was proving to be particularly troublesome. An analysis of a month’s invoices soon identified why. This particular insurance company requires all invoices to be submitted electronically.
The “Holding” Pile
Except the invoices were woefully incomplete. For example, the patient’s date of birth or policy number or pre-authorisation was incorrect and each and every time this caused the invoice to fail.
To resolve the problem, it was imperative to make sure ALL the details are correct and invoices correctly processed and not placed in a “holding” pile. That was, or so it appeared to be, the cause of the issue.
Or was it?
Lack of Communication
Medical secretaries though the hospital receptionist was responsible for getting it right. The hospital receptionist thought the medical secretaries were responsible. Then they both said the person who raised the invoice was responsible rather than either of them.
The reality was that nobody was making sure the data was right.
The spat had caused each consultant to be short of many thousands of pounds. Indeed the holding pile was not only greater than the value of average daily outpatient appointments.
Worse it was also STILL growing.
The New Process
Skip forward a few months. The receptionist obtains the details and checks them. The medical secretary ensures all the details are recorded on patient records accurately. The person responsible for medical invoicing highlights ANY invoices which can’t be processed. The holding pile is now less than 0.5%.
Is this overkill?
Cash input from this ONE insurance company has increased by around 160%. It’s not overkilling at all.
And everybody has realised a little pre-emptive medicine has stopped rubbish in = rubbish out issue.
pete@medicalhealthcaremanagement.co.uk