MHM recently completed a project for a private hospital. The project was to investigate why medical insurance companies were not paying.
One insurance company was proving to be particularly troublesome. An analysis of a month’s invoices soon identified why. This particular insurance company required all invoices to be submitted electronically. No problem with that.
The “Holding” Pile
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. Thus the invoice was not actually processed 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. That way invoices could be correctly 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. But what was the cause?
Lack of Communication
Medical secretaries were of the opinion the hospital receptionist was responsible for getting it right. The hospital receptionist said the medical secretaries were responsible and then they both claimed 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, over the previous six months, the hospital to be short of many tens of thousands of pounds. Indeed the holding pile was not only greater than the value of average daily outpatient appointments, but 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 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 input 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 rubbish in = rubbish out issue.