Key Takeaways:
At Appalachian Regional Healthcare (ARH), a segment of the patient financial services team is dedicated to manually resubmitting denied insurance claims every month. To address this challenge, ARH has embraced automating insurance claim denial resubmissions. Some denials are complex, requiring human input and reasoning, while others are simple, but can be very time-consuming.
For example, CO-250 and -252 are simpler denial reasons that require additional documentation to support the insurance claim submission. ARH has had a long-standing relationship with Tennessee-based advisory and business consulting firm, LBMC, who designed the idea to automate missing documentation denial submissions for a single-payer and enlisted their technology implementation partner, EnterBridge, to develop the automation.
Some stats to consider for the manual processing of missing documentation denials:
With a disproportionate amount of time spent processing missing documentation denials, the backlog on other denial types builds up. This leaves millions of dollars in unclaimed revenue on the table, which ultimately affects patient outcomes and quality of care.
With limited staff to process these denials and a lack of a hiring budget, the financial team turned to automation to unlock revenue potential and improve medical billing efficiency. Additionally, by automating these tasks, ARH can reduce the need for extensive staff training on repetitive processes, allowing the team to focus on more complex and valuable tasks.
The process was fully automated from end to end. Once a day, the automation is kicked off and begins by logging into Meditech and the Communication Director fax portal. In Meditech, the bot navigates to the ‘Denial Management’ list, finds each Wellcare CO-250 or CO-252 denial on the work list, and opens the EMR Chart Viewer to access the ‘Provider Notes’ in the relevant patient profile. By ensuring all relevant documentation is included and sent promptly, the automation helps to reduce claim denials in the future.
The bot finds all relevant documentation that matches the dates of service listed in the denial and based on a list of provided criteria, determines if it should be included in a fax to the payer. If determined it should be included, the bot is programmed to download the document using the organization’s fax printer to send it through the fax portal. Once all relevant documentation has been added, the fax packet is automatically sent to the payer. The bot then adds a standard note to the Meditech patient account and closes the denial.
When calculating the return on investment of an automation project, there are multiple components to consider. For ARH, automating the CO-250 and -252 denial resubmission process offers significant advantages such as labor savings and increased revenue collection. Additionally, this project plays a crucial role in improving revenue cycle efficiency.
Just as importantly, the project provides benefits that are harder to quantify – including enhanced employee satisfaction, a jumpstart on a digital transformation journey, and more time for staff to innovate and strategize. This comprehensive approach not only improves operational efficiency but also fosters a more motivated and forward-thinking workforce.
Here’s a summary of the overall benefits of the project:
ARH’s success in automating missing documentation denial submissions showcases the transformative potential of technology in healthcare finance. By partnering with LBMC and EnterBridge, ARH not only saved labor hours and increased revenue but also paved the way for a more motivated and forward-thinking workforce.
Have a process in mind that you want to automate? Reach out to our team today to scope out the process with one of our expert developers.
For further advisory and business consulting expertise, be sure to contact us to skyrocket your growth.
Content provided by Lane Jackson and EnterBridge.
