Earlier this year, MHM was engaged to review the billing process of a private hospital.
The project was to investigate why private medical insurance companies were not paying.
Initial findings
One insurance company was proving to be troublesome. An analysis of a month’s invoices soon identified why. This particular company required invoices to be submitted electronically.
Except the invoices were inaccurate. For example, the patient’s policy number was wrong. This caused the invoice to fail.
Instead, it was put in a “holding” pile.
To resolve the problem, it was imperative to make sure the details were correct. Invoices could then be processed and not placed on hold.
It is vital all the details are 100% correct.
That was, or so it appeared to be, the cause of the issue.
But was it?
Cause of A Problem
It transpired medical secretaries thought the receptionist was responsible. Conversely, the receptionist thought the medical secretary was responsible.
Then they both claimed the person who raised the invoice was responsible. The reality was, nobody was doing the job.
The spat had caused the hospital to be short thousands of pounds. Indeed the holding pile was greater than the value of daily outpatient appointments. And it was STILL growing.
The Solution
The receptionist obtains the details. Then she checks them. The medical secretary ensures all the details are recorded accurately. She checks them again. The person responsible for medical invoicing highlights ANY which can’t be processed.
The holding pile is now less than 0.5%.
Is this overkill?
Cash input into the hospital from this ONE insurance company has increased by around 160%.
It’s not overkilling at all.
pete@medicalhealthcaremanagement.co.uk