Technology and some enterprise combine to solve the frontend malaise of the WOUND CARE specialty.
Demography data prepping for one of our clients is complex and involving. It adds additional but critical sub-processes that involve eligibility verification, ensuring availability of authorization and identifying the correct place of service for every visit. When the group sees patients every day, the task can be overwhelming. The chances of errors are high and productivity tends to be low, given the multiple steps.
Considering the moderate reimbursement value for these procedures, the wriggle room for deploying manpower erodes margins and competitiveness.
It was imperative we found a way out.
Quintessence built a Demo Prep Tool to assist the employee in making the correct decisions and automate part of the process.
In Phase 1:
A comprehensive rules and guidelines document was prepared. A process chart was created for each step individually and was replicated in the tool
In Phase 2:
A QBOT was programmed to log in to payer websites, scrape necessary data to complete prepping and generate a report that can be reviewed and uploaded to the Billing system. The process / insurance rules were built into the backend and the employee was not required to remember and follow the complex rules.
The DPT tool and the QBOT together eliminate process error and minimize manual intervention. The employees were now reaching the 98% quality mark and the mandated productivity. The team was also able to meet the tight TAT requirements, without overtime.
Downstream coding processes kicked off earlier than normal and enabled transmission within 24 hours.
DPT also tracks pending claims which eliminate emails, sharing of spreadsheets and inventory drops. We could age the pending claims for immediate and urgent action.
Value in the Partnership What sets us apart is the conceptualization and implementation of such solutions to solve our client’s business problems at no additional costs. The client has since rolled out this model across 27 locations and is using the model to drive more business.
Over the last 10 years of Quintessence (and 20 years in the business) we have delivered services to customers whose requirements cover the full spectrum of business strategies.
We work with customers on Full service on a % of collections model; to others, with discrete processes on a per unit fee. We also helped customers in their strategic pursuit of setting up offshore delivery centers, create and enhance delivery capabilities, and helped soft launch their offshore operations. It all has added to our experience, proficiency in the business and a certain versatility to tackle curve balls.
To find out how Quintessence can impact your business, contact:
Ashok Menon on +1-410-630-4774 today.