MHM recently completed a project for a private hospital. The project was to investigate why various private medical insurance companies were not paying.
One insurance company was proving to be particular troublesome. An analysis of a complete month’s invoices soon identified why. This particular insurance company required all invoices to be submitted electronically. No problem with that.
Except the invoices were woefully inaccurate. For example, the patient’s date of birth or policy number or pre-authorisation was incorrect. Each and every time this caused the invoice to fail at the point of logging electronically with the insurance company. Thus the invoice was not actually passed to the insurance company for payment. Instead it was put in a “holding” pile.
To resolve the problem, it was imperative to make sure ALL the details were correct so invoices could be successfully processed and not placed in a “holding” pile. It was vital all the details were 100% correct. That was, or so it appeared to be, the root cause of the issue.
Why was this proving so troublesome?
It transpired medical secretaries were of the opinion the hospital receptionist were responsible for getting it right. The hospital receptionist said the medical secretaries were responsible. Then they both claimed the person who actually raised the invoice was responsible. The reality was that nobody was making sure the data was right and this was before the correct CCSD code was being identified and used.
The spat had caused, over the previous six months, the hospital to be short of money by many tens of thousands of pounds. Indeed the holding pile was not only greater than the value of an average daily outpatient appointments, it was STILL growing.
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 and checks them again. The person responsible for medical invoicing highlights on a daily basis ANY invoices which can’t be processed. The holding pile is now less than 0.5% of a MONTH’S worth of invoices.
Is this overkill?
Cash in-put into the hospital from this ONE insurance company has increased by around 160%. It’s not overkill at all.
And the hospital has realised a little pre-emptive medicine has stopped a rubbish in = rubbish out issue.
pete@medicalhealthcaremanagement.co.uk