Case study: Healthcare company improves revenue cycle
A healthcare company improved its claims processing from three–six months to 30–40 days by automating workflows.
A 1,000–2,000 employee accountable healthcare company providing data-driven virtual care management programs for chronic metabolic disorders.
The situation
Clinical encounters are documented in athenaOne, its Electronic Health Records (EHR) and claims billing system, but nonclinical engagement activity is recorded in the company’s proprietary program management system. This created a bottleneck for the charge capture of nonclinical claims, which were manually entered using reports from the proprietary system. This resulted in delays for claims submission and related payments. Additionally, patient creation in the EHR claims billing system for certain nonclinical programs was a manual process.
There was a critical need for systematic, integrated process workflows across the company’s program related systems to automate patient creation and claims billing.
The solution and results
Our firm was brought on board to provide a solution for automating revenue cycle management for nonclinical encounters and charges as well as nonclinical program patient creation.
Advisors worked with the client to understand the situation, develop requirements for automating manual efforts, create design specifications for the Patient Creation and Claims Billing automation effort, and implemented the automated flows.
Advisors worked to automate the Upstream Encounter Data to the EHR integration by:
- Planning and analyzing
- Designing, building, and testing
- Deploying
- Documenting design and setup documents
- Creating user guides
- Assisting with error resolution
The firm had provided several services to the company as it moved from start-up through commercialization, and initially recognized the bottleneck.
The solution included:
- An automated Patient Creation Workflow into the claims billing system
- Automated Claims Billing Workflow for Nonclinical Encounters and Charges
The company expects:
- Reduction in the time from service date to claim date
- Visibility into unbilled services
- Visibility into accounts receivable
Prior to engaging with the firm, the company typically took three–six months from time of encounter to claim submission. The company is now able to process automated claims within 30–40 days with minimal manual intervention.
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