Clean Claims, More Money - West Florida Medical Center Clinic uses Claims Editor Professional from ADP Context - Product Information

Health Management Technology, May, 2001 by Ronald E. Keener

In the beginning, client-server technology presented learning curve issues for the relatively mature IS staff, especially in a network environment. Dworshak credits a smooth installation to CIO Allen Kercher and his implementation and training team. As the facility directed, ADP Context trained a core group of clinic staff, implemented a training manual and then turned the project over to the clinic's training department which was ready, willing and able.

"They understand the products, they take accountability for training, and they have the tools needed to train efficiently and effectively. Training is the key to success when implementing a new product," which Dworshak estimates to have been a $100,000 investment. Within a week, she says, almost all of the learning curve issues were resolved.

Product at Work

Dworshak says her staff likes CEP because of its front-end functionality at point of service and its ability to upload carrier rules appropriately into the software.

"Knowing Medicare rules and workers compensation rules, having informational sources that are reliable, accurate, and timely--these are critical requirements in the claims reimbursement business. We get books from all of our carriers telling us what the rules are, but we can't expect office staff to keep a full bookshelf and check every time they have a question. ADP Context has built that information into software and has given us confidence that the rules are available and we can rely on the software to help us fix errors before we submit claims," she says.

Implementation began on a centralized basis. Staff keyed centrally for about three months, refining their use of the product, carefully monitoring the process by which claim codes were corrected and meeting the technical challenges of uploading claim charges into the AR system.

After that, says Dworshak, they decentralized data entry back to the physician practices and out to strategic floor locations so staff could key for multiple practices. The decentralization process took six months. They started with heavy charge departments and took special care to fully implement the application in each department before moving forward to another.

"Today," says Dworshak, "we key at the point of service because this allows instant access to the doctor or nurse who provided the diagnosis code. We can immediately review the claim for error and just as immediately fix the error. We're not working with claims that are 90 or 120 days old. Often we are working with claims generated the same day those patients were seen."

Results Results Results

Dworshak says when West Florida Medical first implemented the CEP solution, they achieved a 65 percent to 70 percent reduction in claims denials the first month. The results were so good, she didn't fully trust them. She waited for the second month's results, which were essentially the same. Still cautious, she waited for yet the third month's results--and the consistency held.

The next step for West Florida Medical is to write their own rules into the product, changing the layout of their own practice management system so that they can be carrier-specific on the rules.