MHM recently completed a project for a hospital. The project was to investigate why the hospital was not getting paid.
One insurance company was proving to be particularly troublesome. An analysis of a month’s invoices soon identified why. This particular insurance company requires all invoices to be submitted electronically.
Except the invoices were woefully inaccurate. For example, the patient’s date of birth or policy number or pre-authorisation was incorrect. Each and every time this caused the invoice to fail.
To resolve the problem, it was imperative to make sure ALL the details were correct. That way invoices could 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 what was the cause?
Medical secretaries said the hospital receptionist was responsible for getting it right. The hospital receptionist said the medical secretaries were responsible. Then they both claimed the person who raised the invoice was responsible rather than either of them.
The reality was that nobody was making sure the data was right.
The spat had caused the hospital to be short of many tens of thousands of pounds. Indeed the holding pile was not only greater than the value of average daily outpatient appointments. Worse 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%.
Is this overkill?
Cash input into the hospital from this ONE insurance company has increased by around 160%. It’s not overkilling at all.
And the hospital has realised a little pre-emptive medicine has stopped rubbish in = rubbish out issue.
pete@medicalhealthcaremanagement.co.uk
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