Through an IT department run from Cork, the organisation is always exploring new ways to leverage technology to deliver twenty-first century healthcare services. Administrative processes around the hospital, patients and healthcare professionals have been targeted for change, where the aim is to replace a paper trail with electronic documents and automated workflow. SoftCo introduced a solution to begin the transformation in the patient claims process.
Claim submissions are a paper-intensive part of the management responsibilities at Bon Secours and a burden on hospital administration. Across the four hospitals, approximately six staff are involved in assembling the information that has to be submitted to health insurers to ensure that the hospital is paid for its services. The group has 80,000 admissions a year and submits around 10,000 claims a month to Vhi, each with between three and twenty documents attached.
Patients sign a claim form when they receive treatment which is included with a stack of additional paperwork that typically includes an invoice generated by the hospital along with invoices from surgeons or other professional carers that were involved. “It’s a significant challenge,” said Ian Brennan, Group Head of IT, Bon Secours Health System. “All the documents have to be gathered, checked and collated, and only when they’re all done can we submit them to the insurer.”
Compounding the problem is the level of detail required. Cost of treatment may be paid at different rates depending, for example, on the type of anaesthetic that was used. When there is a problem, the paperwork has to be prepared again, collated again by the hospital and resubmitted. Only in the case of extremely high-value treatment would an administrator consider photocopying the various documents, and even then it is not guaranteed. The volume of claims is simply too great.
“Because we don’t keep any reference documents onsite, we accept the insurer query and resubmit all the paperwork,” said Brennan. “It’s a labour-intensive process and one that healthcare providers and insurers both want to automate and minimise.”
SoftCo FormsAccess is a proven solution deployed in other hospitals by SoftCo, who have a 20-year track record of delivering business solutions. FormsAccess captures and archives all claims documentation submitted for processing, and makes them accessible over the web with a secure log in. “It is a tried-and-tested solution that has turned a labour-intensive process into a highly efficient claims tracking cycle,” said Declan McGonigle, SoftCo’s Business Development Manager.
The claims documents are delivered to SoftCo on a daily basis where they are scanned and uploaded to a compliant repository, and made available to the Bon Secours claims staff within two days. The easy-to-use on-demand service ensures that both the insurer and the hospital are working from the same document if a query arises. Documents are retrieved using a number of index criteria.
Users are given a name and password to access the repository but Bon Secours had an additional requirement. The group wanted to integrate FormsAccess with its iSOFT Hospital Information System (HIS) which spans financial, administrative and clinical processes. The unique patient identifier had to be consistent and searchable across both systems, otherwise users would have to exit one application to use the other.
SoftCo and C2Soft, a third party used extensively by Bon Secours, built a link between the HIS and FormsAccess that has been so successful that users click on an icon in the patient record and seamlessly access the SoftCo repository without realising they are using a different system.
SoftCo has delivered tangible business benefits to Bon Secours by transforming a slow and painful business process and making rechecking easier. Errors are reduced and problems are quickly resolved. “Now we can go online and immediately check any problem and begin resolving it,” said Brennan.
He praised the integration of FormsAccess with the Bon Secours HIS. “It’s elegant and easy to use and saves us a massive amount of time,” he said. “Problems are easily resolved and our team are delighted with it.”
SoftCo took just two weeks to deploy the end-to-end solution and demonstrated a service ethic that made a strong impression on Brennan. “The SoftCo technical team were excellent. They would take our ideas for a product enhancement onboard and do their best to oblige. With other suppliers a change request can take six months and you need to go through layers of bureaucracy. SoftCo came back to us quickly every time and we had the system up and running in days. It’s a dream to get work turned around so quickly.”
Group Head of IT
Group Head of IT