Investing in the internet: a community hospital finds that Web-based applications can help it increase cash flow, reduce claim denials and optimize internal business processes - Internet applications/ASPs: case history

Health Management Technology, Feb, 2004

In fact, the analysis identified a $250,000-per-month opportunity, along with immediately tangible benefits associated with imaging and automated workflow. As a result, Rex selected i.suite from Third Millennium Healthcare Services Inc. of Decatur, Ga. The products included Web-based denied claims management, document imaging and electronic remittance advice management systems. The systems overlay Rex's existing patient financial system.

IT at Work

Implementation was complete within 90 days, and Third Millennium's integration methodology required about 80 direct hours of Rex resources. Third Millennium trained the Rex staff on-site. The patient accounting users were trained in about four hours.

Third Millennium maintains the servers and software, reducing Rex's equipment cost to two scanners and several large monitors and upgraded monitors for staff using the workflow product. Fees are based on the number of subscriptions and transactions. Utilizing existing Internet access allows campuswide access to information without hard-wiring the facility.

Rex uses the information technology to convert paper explanations of benefits, correspondence, insurance cards and waivers into electronic document images and index all of the documents to the patient level. Now, PFS and other departments can rapidly access the documents on their desktops.

Third Millennium receives electronic remittance advisements via the transfer technology. The files are parsed into single electronic payment records and indexed to the patient level. At the time of indexing, table-generated rules create automated work lists via posting processes or electronic feeds.

Denial management is seamlessly integrated through the product's incorporation of Rex business rules with the electronic and manual images. This process automatically creates critical workflow and simultaneous issue-tracking. The system then automatically routes claims to predesignated staff or departments for follow-up and completion. All staff queued within the work lists have access to work lists and the associated documents on their desktops, sorted in priority order. The automated workflow eliminates numerous manual reports, e-mails and spreadsheets.

For Rex users, a key feature of the Internet system's denial management functionality is efficient access to information. Third Millennium produces numerous detailed reports on the status of rejected and denied claims. Staff reliance on availability of other resources to run reports on denials has been virtually eliminated. Rex managers can access and extract data within seconds of the request. Preset report parameters allow access to claim issues by payer, which are uniformly categorized and quantifiable.

The extracted files are downloaded to Excel, where root cause and pattern analysis occurs by standardized criteria, including payer, physician, location of service and responsible party. Access to the information needed to pinpoint problem areas and direct staff has been greatly enhanced. Tracking and monitoring problem claims, medical record requests, time-dated correspondence and other critical issues affecting the revenue cycle are now standardized.