Earlier this year, MHM was engaged to review the billing process of a private hospital.
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 invoices to be submitted electronically. No problem with that.
Except the invoices were inaccurate. For example, the patient’s date of birth or policy number or pre-authorisation was incorrect. Each time this caused the invoice to fail. Thus the invoice was not actually passed to the insurance company for payment. Instead, it was put in a “holding” pile.
To resolve the problem, it was imperative to make sure ALL details were correct. Invoices could then 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 of the problem?
It transpired medical secretaries thought the hospital receptionist was responsible. Conversely, the hospital receptionists thought the medical secretaries were responsible. Then they both claimed the person who raised the invoice was responsible. The reality was, nobody was doing the job. Nobody was making sure the data was right.
The spat had caused the hospital to be short of many 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.
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.