Like most hospitals, a big challenge for the Mater is achieving greater efficiencies out of administrative processes that are bogged down in paperwork. The claims processing department in particular, where the hospital submits treatment details to the patient’s medical insurance company, called for a more streamlined and simplified submission process.
SoftCo worked with the Mater Private to deliver 'FormsAccess' a suite of applications that could capture, archive and allow visibility on all claims documentation which has been submitted for processing.
“The FormsAccess solution has transformed what was a slow, labour-intensive process into a highly efficient claims tracking cycle” said Killian McCarthy, SoftCo, “which integrates seamlessly with Vhi’s existing SoftCo Document Management solution”.
The Mater Private shared the same vision and took the opportunity.
The inherent flaws of any paper-based claims process were very apparent to Claims Manager Liz Milburn and the three full-time staff employed on the job. “It was slow and awkward and if something went missing we would have to re-collate the whole claim before we could submit it for processing,” said Millburn.
Over a typical two week period anywhere between 1,000 and 1,500 claims could be submitted to Vhi Healthcare, each containing up to 25 pieces of paper. These comprise of miscellaneous bills from consultants and the different hospital departments that were used during the patient’s treatment.
Once all the paperwork is assembled the claims are submitted to Vhi Healthcare. Until now, this was the only complete record of the claim within the hospital and once it was submitted to Vhi Healthcare it was difficult for the MPH staff to respond to any follow-up queries if there is incorrect paperwork on file or when the hospital is unable to reconcile individual payments against a patient’s records.
Inevitably, there is some human error and also the risk that consultants might carry out a slightly different procedure to the one that was originally planned which may have cost implications. The consultant would amend treatment details but it might not be discovered by the hospital until there is a discrepancy between what it has invoiced and what it has received from Vhi Healthcare.
“If Vhi Healthcare return a claim to us because of data incompleteness or where discrepancies as outlined above occur, one of the team had to sit down, look at what’s gone wrong and write to the consultant or patient to get to the bottom of it,” explained Milburn.
Re-collating the paperwork can take weeks or even months. “It isn’t very good for your credibility to be continually going back to consultants,” said Millburn. It is easier if the documentation associated with the claim is saved on a system but quite often it’s just a handwritten document.”
SoftCo FormsAccess removes the inefficiencies of the MPH’s claims submission and tracking process. Using capture techniques tailored for high volume off-line scanning, the documentation associated with all claims is now turned into ‘soft’ copies that are archived in a secure, compliant SoftCo repository.
Within two days they can be accessed online by the MPH claims department as a Cloud service. A significant history of claims, dating back to March 2008, is now available to the hospital via a user-friendly front-end interface which lets them search and retrieve documents using a variety of criteria. SoftCo have given the MPH a Cloud service with carefully constructed access controls that ensure the staff get precisely what they need in terms of storage and retrieval. With an Cloud approach there is no capital investment or IT costs.
Better still, both Vhi and the MPH are now working from a common source of electronic documents. The ability to share the same data speeds up the claims submission and tracking process for the hospital.
SoftCo FormsAccess has transformed a paper based process in the Mater Private, increasing efficiencies, saving time and improving the claims submission and tracking process. “SoftCo FormsAccess is an extremely useful system that has made an enormous difference to us,” said Millburn. “By giving us visibility of all documentation associated with a claim, it has significantly improved our claim submission and payment reconciliation process and we are delighted with it.”
For SoftCo it is a significant example of what can be achieved in organisations where paper-intensive processes lead to bottlenecks and silos of disconnected information. “By leveraging SoftCo expertise in document capture and retrieval and working with organisations like Vhi Healthcare and the Mater Private, it has massively boosted the efficiency of the claims submission and tracking process, giving them immediate access to all the information they need,” said Killian McCarthy.
“SoftCo FormsAccess is an extremely useful system that has made an enormous difference to us. It gives us visibility on all claims documentation submitted for processing and we are delighted with it,” said Milburn.
Since the Mater Private Hospital first opened its doors to patients in 1986 the Hospital has pioneered major developments in Irish medicine, introducing outstanding technological innovation and services. The Mater Private Hospital has 184 inpatient beds, 24 day therapy beds, 10 day oncology couches, 7 theatres and a 9 bed Intensive Care Units and carries out thousands of investigations and operations each year. It is Ireland's only private hospital that provides an all integrated 24 hour, 365 day intensive care and anaesthetic service delivered by a team of specialists.