Medical Billing Provider, Associated Billing Services Inc., Streamlines Claims Processing to Meet Growing Business Needs

Case Summary
Associated Billing Services, Inc., located in Phoenix and Tucson employs over 150 personnel to process patient billing and claim responsibilities for Healthcare Industry clients. These clients include hospitals, physician clinics, MRI and other laboratory groups. 

Business was growing with over 250,000 new claims documents received each month. The manual work processes behind the scenes were prone to lengthy processing times and errors. Work was getting backlogged and storage space was diminishing quickly.

The Challenge

ABS was overwhelmed by the volume of paper Medical Claims it was having to process and store. They had rows upon rows of file cabinet storage, and were approaching 250,000 new documents received each month. The company was planning on this volume continuing to grow. 

The processing of all this paper in the incoming mail was a totally manual process —distribution of work consisted of walking from desk to desk. Naturally the process was slow, required more resources than it should have, and created an environment prone to errors. 

ABS also had no way to measure personnel productivity and to identify processing bottlenecks. Company executives understood how the situation affected profitability and called for a solution that would enable them to more easily receive, capture, process, and store Medical Claims and the other documents associated with their business. A resolution to these problems was necessary, and the proper solution, if inserted effectively into ABS operations, would have several beneficial effects on the future of the company.

The ImageSource® Solution
ImageSource worked with ABS to put into operation a set of solutions and new processes using Kofax® Ascent Capture to stream information into an integrated Oracle|Stellent Imaging and Process Management system.

Ascent Capture scanning and document categorization processes are now implemented starting at the mail room level where incoming paper documents are captured with minimal effort, and are pushed through the routing process. About 10,000 documents are handled per day. 

Medical Claims and other related documents are released from Kofax by ILINX into the Oracle|Stellent system, where they are automatically matched and stored. From this point on they are protected from loss, damage, and disasters of any kind. 

Pre-Claim Document information then automatically enters a specifically designed workflow process that guides all activities through the completion of the services ABS provides to its clients. The auditing and performance reporting support provided by the system now allows ABS to observe, manage, and improve all aspects of the process, which constitutes the primary function of their organization, and the generation of revenue and profit.

"The ImageSource solution has drastically improved our ability to process daily work. My employees no longer have to wait for paper to get from one department to the next. I hear them clicking away on their keyboards instead of walking around the office and that sound means we’re saving money!"

– Matt Frick General Manager, ABS

The process itself has been planned, tailored and developed to apply optimal procedures for the work that ABS performs. The procedure creates a Work Package for each Medical Claim. This workflow initialization step attaches links to all the Pre-Claim documents, associated information, and specific processing conditions. It then routes the Package through the analysis and approval steps of the workflow process. Related data that may come into the system later are automatically matched and appended to the Package. 

The workflow process routes Pre-Claim packages to queues for Registration and Indexing, Coding, Encountering, and Supervisor Approval in succession, and routes automatically as each step is completed. 

The first stop is the appropriate Data Entry group which is automatically selected by information parameters and routing rules. Data Entry clerks do their work within the “third party” MIMS Claims Processing application. They can access the Oracle|Stellent IPM system from within the MIMS environment seamlessly, and key new data from the image of the claim which is shown in the Oracle|Stellent Viewing window. At the point of submission, key fields are populated from the MIMS application and associated with the related document images stored in the IPM repository. 

A supervisor can track work, manage and balance individual work queues, and be notified when selected conditions exist. An important factor in the new system is that it will allow for the efficient and supervised processing of those document records in Work Packages routed to exception queues for claims that require exceptional attention. These “Exception” packages are routed to ABS experts in areas of Research, Accounts, Provider Numbers, or Intervention Queues for processing. “Hold and Research” forms are available in the Workflow Packet and are used by system users to provide efficient “exception” routing of documents and to yield high levels of accuracy.

Bottom Line
ABS has reduced the processing time of all work. Personnel now have immediate online access to all accounts and related documents. The company now provides a dramatically faster response time for representative and customer queries. Improvements resulting from shared access to records include more efficient research and quicker account review and conclusion. 

There has been a savings in space and elimination of lost records. By following standard system back up procedures, documents are now secured from damage or total loss in the event of a disaster. 

Claims processing personnel are now more effectively managed as the new reporting and workflow monitoring tools provide supervisors with features that optimize the balance and throughput of work. The number of new users of the system is increasing within the organization and the company is ready for effective management of emerging business.