A healthcare organization dedicated to children’s health needs wanted a better system for insurance payments. Manual payment processing threatened to cost unnecessary time and money in added staff. CommerceHealthcare® offered a solution to help automate manual payments so that the system could focus on patients.
Based in the Midwest, the rare, freestanding children’s health system provides comprehensive care to children from birth to age 21. With an acclaimed Genome Center, the region’s only Level IV Neonatal Intensive Care Unit (NICU) and more than 700 pediatric practitioners in 40 specialties, the health system welcomed approximately 543,000 patient visits in 2016 alone.
With each visit, the Patient Financial Services team must submit a claim to insurance, which then triggers a corresponding payment and remittance advice. Depending on how payment is received, the team either manually keyed in or downloaded the information into their patient accounting system. Looking to simplify processes, consolidate legacy systems and achieve compliance with new healthcare technology standards, the health system decided to convert to a new patient accounting system.
While deploying a new patient accounting system would provide many benefits, it would require the team to post some of their payments manually, in a time-consuming process. The health system’s Patient Financial Services team estimated they’d need as many as eight new staff members to handle the additional workload.
Ninety percent of the health system’s claims were sent as a Business Electronic Remittance Advice (ERA), also known as an 835. An ERA is an electronic transaction that provides claim remittance information in a HIPAA-mandated format that can be downloaded. But the remaining 10 percent of claims, approximately 6,600 files, were paper-based Explanation of Benefits (EOBs) files that had to be processed by hand.
The health system wanted to explore ways to turn EOBs into ERAs to streamline the process, speed payment posting and improve cashflow.
They elected to implement RemitConnect, a healthcare lockbox automation system offered by CommerceHealthcare®. The solution integrated with their patient accounting system, GE Centricity, to turn EOBs into ERAs, automating manual payment posting and streamlining the revenue cycle.
Each payer’s EOB format is different, which is part of what makes manual posting difficult and cumbersome. RemitConnect uses Optical Character Recognition (OCR) technology to image each EOB and lift the remittance details. If data is missing from an EOB document, the healthcare lockbox automation program searches the provider’s claim file to add those missing data elements to the ERA. The technology then reorganizes the data to create a complete, properly-formatted 835 file for automated posting back to the patient accounting system.
The healthcare lockbox automation solution includes a web-based portal with an easy-to-read dashboard of the day’s activities, including exception items. That gives hospital staff the ability to quickly retrieve and view an image of the paper EOB and post the item manually if necessary. This gives staff more visibility into the claim-to-payment life cycle as well, which aids in payment research and problem resolution.
To determine how healthcare lockbox automation would fit into the workflows already in place at the health system, the CommerceHealthcare® Payments team worked on-site to perform a comprehensive process review. “The Healthcare Payments project manager brought a great deal of healthcare industry knowledge to the job – including an understanding of remit codes and different payer’s trends,” the Patient Financial Services manager said.
The Commerce team determined that the best course of action would be to implement healthcare lockbox automation jointly with the new patient accounting system, which would require an aggressive timetable. Even though the healthcare lockbox automation deployment was part of a staggered implementation with the patient accounting system, it was integrated in only a few months. The project kicked off in the fourth quarter of 2014 and concluded early in the second quarter of 2015.
"We knew that if we had a concern, that we could pick up the phone and it would be handled."- Patient Financial Services Senior Manager
During implementation, the hospital’s financial team and the CommerceHealthcare® team held weekly phone conferences and on-site meetings to understand potential issues before they occurred.
Healthcare lockbox automation has accelerated the payment posting process and provided a higher level of posting accuracy for the hospital. “Since deploying healthcare lockbox automation, we estimate that we’ve achieved a 99 percent conversion rate of paper EOBs to ERAs,” said the Patient Financial Services manager for the hospital. “In other words, of the 10 percent of paper EOBs received, 99 percent are now automated."
The team says Commerce eliminated the need for overtime, and that they no longer get behind. Not only did the deployment prevent the need to hire new staff, it enabled Patient Financial Services to reallocate one full-time person to another department.
Commerce had served as the health system’s bank for quite some time. According to the Director of Treasury, the strength of that relationship helped them feel confident about the lockbox automation solution. "Commerce is our lead bank and this is another piece of the relationship between our two organizations, which stretches back longer than anyone can remember,” he said. “We knew we had a good partnership with Commerce in place and that they were going to do what they said they would do.”
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