Author: jaustin

Madison County
Health Department

Team Members:
Jan Shepard Diana Rogers Becky Webb Amy Massey
Sherrie Harwood Pam Gregg
Cindy Kent
Vicki Hensley
(list here)

Quality Improvement
Story Board
Billing Process Improvement Project

Plan
Identify an opportunity and Plan for Improvement

1. Getting Started

MCHD director and finance officer agreed there was a need to improve the process of billing to assure adequate revenue was realized from billable services. Preliminary observations of billing errors resulted in knowledge of deficiencies in revenue. Limited number of staff hours are dedicated to the billing process. In an attempt to correct the deficiencies, a new position was requested and it was up to the team to demonstrate success as a result of this request.
Initial Aim: Develop an enhanced, sufficient patient process that will maximize revenue by November 2012.
Third and Final Aim Statement: Increase revenue from direct billing in Behavioral Health and School Based Health Center 10% by November 2012.

2. Assemble the Team

4. Identify Potential Solutions

Identify and dedicate one staff position to run aging reports, billing denial reports, and billing error reports regularly to investigate and re-bill
Request reports adjustments for all reports that do not run successfully.
Provide access to provider systems to check eligibility prior to patient encounter.
Train providers in CPT Coding and required billing documentation.

5. Develop an Improvement Theory

Initially, it was theorized that if registration knew eligibility and providers document properly, billing would be completed without errors. It was also a theory that if regular aging reports were run, timeliness of correction would prevent bills hanging out past 120 days.

Study
Use Data to Study Results of
the Test

7. Study the Results

Employee in new staff position left in August and a new, experienced billing professional was hired. The processes of eligibility check and denied claims follow-up and resolution are firmly in place and producing results. The systems issues are being considered as we move to a different vendor for Electronic Health Record that will incorporate a billing function. The deficiencies experienced with current State mandated system are actually helping us find a better system. We have seen improvement and have met our third and final goal of realizing revenue increases in two departments and a decline in billing denial.

The team consisted of the following at Madison County Health Department (MCHD).
Jan Shepard, Health Director , Facilitator
Becky Webb, Finance Officer, Team Leader
Vicki Hensley, Processing Asst.
Cindy Kent, Processing Asst.
Diana Rogers, RN Nurse Supervisor
Sherrie Harwood, Billing Expert
Amy Massey, RN Clinic Coordinator
Pam Gregg, Technical Expert

3. Examine the Current Approach

Using a basic flow chart process, we began by examining the entire patient flow process, believing that there were many areas that could effect the billing of patient services. We quickly realized this approach was too broad. We narrowed the process flow work to the actual billing functions.

Do
Test the Theory for Improvement

6. Test the Theory

The new staff position was implemented and an initial aging report was run. The report was extensive and in researching aged accounts staff discovered that the billing system had no way to remove an account when payments posted completed the transaction. This created a barrier to the project. Many of the aged accounts were resolved, but the system could not provide proof. The electronic billing system IT was contacted for systems reporting support. Slowly the reports are being corrected.
Administrative staff were given access and authority to check patient eligibility and this fact alone produced immediate results.

Act
Standardize the Improvement and Establish Future Plans

8. Standardize the Improvement or Develop New Theory

The billing department has developed Standard Operating Procedures that include the process for checking aging accounts, follow up in a timely manner for billing denials, and billing error reports.

9. Establish Future Plans

The next step is to implement Electronic Health Record into both the clinical and practice management areas and to provide Quality Improvement training for all staff to continue QI projects that will enhance the patient flow and revenue cycle processes, as well as other areas of the health department.