In the world of medical invoicing, it is soon realised the most efficient way of doing something is to do it once and to do it right. For example:
MHM completed a project for a private hospital recently. The project was to investigate why various private medical insurance companies were not paying.
One insurance company was proving to be particularly troublesome. An analysis of a complete month’s invoices soon identified why. This particular insurance company required all invoices to be submitted electronically. No problem.
Except the invoice was incomplete. The patient’s date of birth was missing for example. The policy number or pre-authorisation was incorrect. Each and every time this caused the invoice to fail. The invoice was not actually being sent to the insurance company. It was put in a “holding” pile instead.
It was imperative, to resolve the problem, to make sure ALL the details were correct. Invoices could then be correctly processed and not placed in a “holding” pile. That was, or so it appeared to be, the root cause of the issue. But why was this proving so troublesome?
Medical secretaries said the hospital receptionist was responsible. The hospital receptionist said the medical secretaries were responsible. Then they both claimed the person who actually raised the invoice was responsible.
The reality was that nobody was making sure the data was right.
The hospital, meanwhile, was short of many tens of thousands. Indeed the holding pile was not only greater than the value of average daily outpatient appointments. And it was STILL growing.
Skip forward a few months. The receptionist obtains the details. She checks them. The medical secretary ensures all the details are recorded in patient records accurately. She checks them again. The person raising the invoices 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.
Is this overkill?
Cash input into the hospital from this ONE insurance company has increased by around 160%. It’s not overkilling at all.