在阿巴拉契亚地区保健中心(ARH), a segment of the patient financial services team is dedicated to manually resubmitting denied insurance claims every month. To address this challenge, ARH has embraced automating insurance claim denial resubmissions. 有些否认很复杂, 需要人工输入和推理, 而另一些则很简单, 但可能非常耗时.

例如, CO-250 and -252 are simpler denial reasons that require additional documentation to support the insurance claim submission. ARH has had a long-standing relationship with Tennessee-based advisory and business consulting firm, LBMC, who designed the idea to automate missing documentation denial submissions for a single-payer and enlisted their technology implementation partner, EnterBridge，发展自动化.

• 手动拒绝处理步骤: 处理CO-250和-252拒绝, 所需要做的就是搜索病人的病历, download any documentation within a date range associated with the denial, 然后传真给付款人.
• 系统效率低下: While simple to execute, the systems have long loading times and are cumbersome to manage.
• 用户体验挑战: 该团队将其描述为几乎“与他们的应用程序作斗争”,而不是现有的技术让他们的生活更轻松. The long loading times could add up to 10 minutes of processing time per transaction.
• 对工作流的影响: This inefficiency in handling patient data significantly hampers the overall workflow.

Some stats to consider for the manual processing of missing documentation denials:

• 最长的拒绝再提交 1小时37分钟.
• 每次拒绝的平均处理时间为 20分钟.

With a disproportionate amount of time spent processing missing documentation denials, 其他拒绝类型的积压也在增加. 这就留下了数百万美元无人认领的收入, 最终影响患者治疗结果和护理质量的因素是什么.

自动化需求

With limited staff 来处理 these denials and a lack of a hiring budget, the financial team turned to automation to unlock revenue potential and improve medical billing efficiency. 另外, 通过自动化这些任务, ARH can reduce the need for extensive staff training on repetitive processes, 允许团队专注于更复杂和更有价值的任务.

整个过程从头到尾都是全自动的. 一天一次, the automation is kicked off and begins by logging into Meditech and the Communication Director fax portal. 在我公司, 机器人导航到“拒绝管理”列表, 在工作列表中找到每个医疗保健CO-250或CO-252拒绝, and opens the EMR Chart Viewer to access the ‘Provider Notes’ in the relevant patient profile. 确保所有相关文件及时提交, 自动化有助于减少未来的索赔拒绝.

The bot finds all relevant documentation that matches the dates of service listed in the denial and based on a list of provided criteria, 决定是否应包括在传真给付款人. 如果确定，应该包括在内, the bot is programmed to download the document using the organization’s fax printer to send it through the fax portal. Once all relevant documentation has been added, the fax packet is automatically sent to the payer. The bot then adds a standard note to the Meditech patient account and closes the denial.

在计算自动化项目的投资回报时, 有多个组件需要考虑. 对于ARH, automating the CO-250 and -252 denial resubmission process offers significant advantages such as labor savings and increased revenue collection. 另外, this project plays a crucial role in improving revenue cycle efficiency.

同样重要的是, the project provides benefits that are harder to quantify – including enhanced employee satisfaction, 开启数字化转型之旅, 让员工有更多时间创新和制定战略. This comprehensive approach not only improves operational efficiency but also fosters a more motivated and forward-thinking workforce.

以下是对该项目的总体好处的总结:

节省劳力

• 每年节省: 每年CO-250和CO-252病例约为3例,500, 每次拒绝都需要20分钟, 平均, 来处理. That’s over 1,000 manual hours annually 来处理 this singular denial type.
• 有效的资源配置: By eliminating tedious work, the team can add strategic value with the time they are saving. They can spend time thinking about other ways to improve the operational efficiency of the revenue cycle.

增加税收

• 初步结果: 当机器人最初部署时, it processed $1 million worth of denied claims in the first month and $2 million in the second month.
• 增强的能力: The automated workflow allows the team to focus efforts on other backlogged denials and increase revenue collectability with the additional capacity.

提高员工满意度

• 减少繁琐的任务: 处理CO-250和CO-252的否认是一件繁琐的事情, 耗时的任务，分散在一个10-11人的团队. The automation will save time by eliminating a portion of their daily work and reducing switching costs across the whole team.
• 战略价值: 从平凡的工作中解脱出来, the team can innovate and strategize to further improve revenue cycle efficiency, 研究更高价值的拒绝类型.

ARH’s success in automating missing documentation denial submissions showcases the transformative potential of technology in healthcare finance. 通过与LBMC和EnterBridge合作, ARH not only saved labor hours and increased revenue but also paved the way for a more motivated and forward-thinking workforce.

您是否有一个想要自动化的流程? 接触 to our team today to scope out the process with one of our expert developers.

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提供的内容 莱恩杰克逊 和EnterBridge.