Introduction
Axis Technical Group has delivered many IT outsourcing services for a wide variety of Dental and Healthcare organizations. This experience was gained over the past 20 years. The lesson learned is that most companies operating in these industries are challenged by complex billing processes and reconciliations while striving to perform this process with the highest level of accuracy and performance. Skilled systems integrators can often help overcome these challenges – provided they have industry and product knowledge to perform this task correctly. An effective Epic ERP software integration to the right billing system can operate as a highly efficient patient records management system and deliver substantial business scalability and growth.
This case study reflects the challenges faced by a large Healthcare organization, which preferred to remain anonymous. For the purpose of this case study, this company will hereinafter be referred to as “Healthcare Inc.” This Axis Technical Group client sought to improve the accuracy, efficiency, and performance of their Epic ERP software integration and billing process.
Enterprise Resource Planning or ERP applications are an enterprise category of business management software—typically a suite of integrated applications—that an organization can use to collect, store, manage, and interpret data from many business activities.
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Challenge
While most Healthcare organizations’ primary purpose is to provide services that maintain or improve the health of their patients, every company must ensure satisfactory financial health to continue forward with its primary mission statement. Quality healthcare services are not cheap, so must be paid for and billed appropriately to sustain operations.
As a Healthcare organization, Healthcare Inc. was tasked with maintaining the security and integrity of many data repositories distributed across a diverse geographic environment. Not only must confidential patient health data be safeguarded according to HIPPA regulations, but billing and insurance data must be correctly captured, managed, and maintained to accurately bill and collect funds as due.
Of all the IT systems that Healthcare Inc. maintains, the company’s internal billing and supporting systems were perhaps one of the most difficult to manage. One factor contributing to the complexity is that patients are billed at different rates based on not only the services provided but also the office location where services were performed. With up to 1,000 different service variations available, the total number of billing combinations exceeded 300,000. Given this high number, accurate billing systems were of critical importance.
Healthcare Inc. needed a better patient records management system. Leveraging their existing Epic ERP software and improving the integration with its billing systems could overcome this challenge.
Another issue Healthcare Inc. faced was the number of legacy IT systems and departments required to collect and process insurance data. Having grown by acquisition, the inherited systems and processes were preventing the timely performance of this business-critical process. Healthcare Inc. initially established a Revenue Operations Center as a separate department tasked with ensuring the accurate calculation and invoicing of every patient’s bill. This new department then required a new set of IT systems to gain access to the right services data to generate accurate, timely invoices for every billed service.
Evaluation
An important part of the vendor selection process was to identify IT systems integrators that were experienced with integrating four sets of data repositories as part of a holistic, end-to-end business process. Each of these data tables must be maintained to remain current, including the addition or removal of records as new services are offered or discontinued. Secure integration must also be maintained between each data table so as to ensure the entire billing system can operate effectively.
The four data repositories include:
- Service Rate Schedules – These tables include a list of prices charged for every dental procedure performed by Healthcare Inc., which includes different rates charged by insurance carrier; over 300,000 schedules currently exist
- Schedule Groups – Groups are a way to organize schedules applicable for a set of offices; these depend upon the geographic region and office; there are currently over 150 different Schedule Groups
- Reimbursement Contracts – These schedules determine how each insurance carrier processes claims and calculates patient bills; Reimbursement Contracts comprise data collected and merged from Schedule Groups and Service Rate Schedules, which are then aggregated prior to being processed by each insurance carrier
- Financial Divisions – These reflect the various billing entities that ultimately send out invoices to each patient, based on the insurance plan, services provided, and location delivered; every Service Group requires its own Financial Group
Solution
Due to this project’s large size and scope, it was broken down into a series of phases with successful project completion points being required before the next phase could begin. Axis Technical Group applied an Agile development and integration strategy to ensure that the project stayed on track, within budget requirements.
Upon completion of the project, an entire billing ecosystem was established and is now currently being maintained by Axis Technical Group. Not only has billing accuracy improved by a factor of 4x, but the time required to complete each billing process and audit has been cut in half. New service can be easily added, by location, with no disruption to existing service billing processes.
An additional benefit is that Healthcare Inc. can now run better reports that can be accessed as often as needed. Audit reporting requirements were simplified, billing accuracy increased, and virtually no internal resources are required to research billing calculation accuracy.
Next Steps
Based on the success Healthcare Inc. achieved with this billing data aggregation and systems integration project, the company next sought to automate the process of assessing what insurance coverage existed and what co-pay amounts should be applied. Given this process involves both structured and unstructured data collected from websites and other sources, the company began researching what Robotic Process Automation (RPA) options existed.
Learn more about how to evaluate an RPA project here, When You Should Consider Business Process Automation vs. RPA
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