关键外卖:

  • 1,000+ Manual Hours 保存d: Automation saves ARH over 1,000 hours annually.
  • $2M+ Denied Claims Processed: Over $2 million in denied claims processed in two months.
  • Increased Revenue Collection: Focus shifts to backlogged denials, boosting revenue.

通过自动拒绝提交丢失的文件，增加了200多万美元的收入

At Appalachian Regional 医疗保健 (ARH), 患者金融服务团队的一个部门致力于每月手动重新提交被拒绝的保险索赔. 为了应对这一挑战，ARH采用了自动拒绝保险索赔的重新提交. Some denials are complex, requiring human input and reasoning, while others are simple, but can be very time-consuming.

例如, CO-250和-252是更简单的拒绝理由，需要额外的文件来支持保险索赔提交. ARH与田纳西州的咨询和商业咨询公司有着长期的合作关系, LBMC, 谁设计了为单一付款人自动提交缺失文档拒绝的想法，并招募了他们的技术实施合作伙伴, EnterBridge, to develop the automation.

Current Manual Process Challenges

  • Manual Denial Processing Steps: To process CO-250 and -252 denials, all that is required is to search the patient’s medical chart, 下载与拒绝相关的日期范围内的任何文档, and fax it to the payer.
  • System Inefficiencies: 虽然执行起来很简单，但这些系统的加载时间很长，管理起来也很麻烦.
  • User Experience Challenges: The team described it as almost “fighting against their applications,” instead of the existing tech making their lives easier. 漫长的加载时间可能使每个事务的处理时间增加到10分钟.
  • 对工作流的影响: 这种处理患者数据的低效率严重阻碍了整个工作流程.

手动处理丢失的文件拒绝时需要考虑的一些统计数据:

  • The longest denial resubmission took 1小时37分钟.
  • The average processing time per denial is 20分钟.

浪费了大量的时间来处理丢失的文件, 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.

自动化需求

因为处理这些拒绝的人手有限，而且缺乏招聘预算, 财务团队转向自动化，以释放收入潜力，提高医疗计费效率. 另外, by automating these tasks, ARH可以减少对重复流程的大量工作人员培训的需要, allowing the team to focus on more complex and valuable tasks.

Automated Denial Submission Process

The process was fully automated from end to end. 一天一次, 自动化被启动，并通过登录Meditech和通信总监传真门户开始. 在我公司, the bot navigates to the ‘Denial Management’ list, finds each Wellcare CO-250 or CO-252 denial on the work list, 并打开电子病历查看器以访问相关患者档案中的“提供者说明”. By ensuring all relevant documentation is included and sent promptly, the automation helps to reduce claim denials in the future.

机器人根据提供的标准列表查找与拒绝中列出的服务日期匹配的所有相关文档, determines if it should be included in a fax to the payer. If determined it should be included, 机器人被编程为使用组织的传真打印机下载文档，并通过传真门户发送. 一旦添加了所有相关文件，传真包就会自动发送给付款人. 然后，机器人向Meditech患者帐户添加一个标准注释，并关闭拒绝.

好处 of Automation

When calculating the return on investment of an automation project, there are multiple components to consider. 对于ARH, 自动化CO-250和-252拒绝重新提交过程提供了显著的优势，如节省劳动力和增加收入. 此外，该项目对提高收入周期效率起着至关重要的作用.

同样重要的是, 该项目提供了难以量化的好处——包括提高员工满意度, a jumpstart on a digital transformation journey, and more time for staff to innovate and strategize. 这种全面的方法不仅提高了运营效率，还培养了一支更有动力和前瞻性的员工队伍.

Here’s a summary of the overall benefits of the project:

节省劳力

  • 每年节省: The annual population of CO-250 and CO-252 denials is approximately 3,500, and each denial takes 20分钟, 平均, 来处理. 每年处理这种单一的拒绝类型需要超过1000个人工小时.
  • Efficient Resource Allocation: 通过消除繁琐的工作，团队可以在节省时间的同时增加战略价值. 他们可以花时间思考其他方法来提高收入周期的运营效率.

Increased Revenue Collection

  • 初步结果: When the bot was initially deployed, 它在第一个月处理了价值100万美元的被拒绝索赔，第二个月处理了200万美元.
  • 增强的能力: 自动化的工作流程允许团队将精力集中在其他积压的拒绝上，并通过额外的能力增加收入.

Improved Employee Satisfaction

  • Reduced Tedious Tasks: Processing CO-250 and CO-252 denials is a tedious, time-consuming task that is spread across a team of 10-11 people. 自动化将通过消除他们的一部分日常工作和减少整个团队的转换成本来节省时间.
  • 战略价值: Freed from mundane work, 团队可以创新和制定战略，进一步提高收入周期效率, and work on higher value denial types.

EnterBridge and LBMC

ARH在自动化遗漏文档拒绝提交方面的成功展示了技术在医疗保健金融领域的变革潜力. By partnering with LBMC 和EnterBridge, ARH不仅节省了劳动时间，增加了收入，还为更积极、更有远见的员工铺平了道路.

Have a process in mind that you want to automate? 接触 今天明升体育app下载团队与明升体育app下载一位专家开发人员一起研究这个过程.

For further advisory and business consulting expertise, be sure to contact us to skyrocket your growth.

提供的内容 莱恩杰克逊 和EnterBridge.

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