Key Takeaways:

  • 1,000+ Manual Hours Saved: 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.

Increasing Revenue Collection of $2M+ with Automating Missing Documentation Denial Submissions

At Appalachian Regional Healthcare (ARH), a segment of the patient financial services team is dedicated to manually resubmitting denied insurance claims every month. To address this challenge, ARH has embraced automating insurance claim denial resubmissions. Some denials are complex, requiring human input and reasoning, while others are simple, but can be very time-consuming.

For example, CO-250 and -252 are simpler denial reasons that require additional documentation to support the insurance claim submission. ARH has had a long-standing relationship with Tennessee-based advisory and business consulting firm, LBMC, who designed the idea to automate missing documentation denial submissions for a single-payer and enlisted their technology implementation partner, 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, download any documentation within a date range associated with the denial, and fax it to the payer.
  • System Inefficiencies: While simple to execute, the systems have long loading times and are cumbersome to manage.
  • User Experience Challenges: The team described it as almost “fighting against their applications,” instead of the existing tech making their lives easier. The long loading times could add up to 10 minutes of processing time per transaction.
  • Impact on Workflow: This inefficiency in handling patient data significantly hampers the overall workflow.

Some stats to consider for the manual processing of missing documentation denials:

  • The longest denial resubmission took 1 hour 37 minutes.
  • The average processing time per denial is 20 minutes.

With a disproportionate amount of time spent processing missing documentation denials, 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.

Need for Automation

With limited staff to process these denials and a lack of a hiring budget, the financial team turned to automation to unlock revenue potential and improve medical billing efficiency. Additionally, by automating these tasks, ARH can reduce the need for extensive staff training on repetitive processes, allowing the team to focus on more complex and valuable tasks.

Automated Denial Submission Process

The process was fully automated from end to end. Once a day, the automation is kicked off and begins by logging into Meditech and the Communication Director fax portal. In Meditech, the bot navigates to the ‘Denial Management’ list, finds each Wellcare CO-250 or CO-252 denial on the work list, and opens the EMR Chart Viewer to access the ‘Provider Notes’ in the relevant patient profile. By ensuring all relevant documentation is included and sent promptly, the automation helps to reduce claim denials in the future.

The bot finds all relevant documentation that matches the dates of service listed in the denial and based on a list of provided criteria, determines if it should be included in a fax to the payer. If determined it should be included, the bot is programmed to download the document using the organization’s fax printer to send it through the fax portal. Once all relevant documentation has been added, the fax packet is automatically sent to the payer. The bot then adds a standard note to the Meditech patient account and closes the denial.

Benefits of Automation

When calculating the return on investment of an automation project, there are multiple components to consider. For ARH, automating the CO-250 and -252 denial resubmission process offers significant advantages such as labor savings and increased revenue collection. Additionally, this project plays a crucial role in improving revenue cycle efficiency.

Just as importantly, the project provides benefits that are harder to quantify – including enhanced employee satisfaction, a jumpstart on a digital transformation journey, and more time for staff to innovate and strategize. This comprehensive approach not only improves operational efficiency but also fosters a more motivated and forward-thinking workforce.

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

Labor Savings

  • Annual Savings: The annual population of CO-250 and CO-252 denials is approximately 3,500, and each denial takes 20 minutes, on average, to process. That’s over 1,000 manual hours annually to process this singular denial type.
  • Efficient Resource Allocation: By eliminating tedious work, the team can add strategic value with the time they are saving. They can spend time thinking about other ways to improve the operational efficiency of the revenue cycle.

Increased Revenue Collection

  • Initial Results: When the bot was initially deployed, it processed $1 million worth of denied claims in the first month and $2 million in the second month.
  • Enhanced Capacity: The automated workflow allows the team to focus efforts on other backlogged denials and increase revenue collectability with the additional capacity.

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. The automation will save time by eliminating a portion of their daily work and reducing switching costs across the whole team.
  • Strategic Value: Freed from mundane work, the team can innovate and strategize to further improve revenue cycle efficiency, and work on higher value denial types.

EnterBridge and LBMC

ARH’s success in automating missing documentation denial submissions showcases the transformative potential of technology in healthcare finance. By partnering with LBMC and EnterBridge, ARH not only saved labor hours and increased revenue but also paved the way for a more motivated and forward-thinking workforce.

Have a process in mind that you want to automate? Reach out to our team today to scope out the process with one of our expert developers.

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

Content provided by Lane Jackson and EnterBridge.