Pre Billing Consultants, Inc. (PBC) has provided billing, coding, credentialing and collection services to healthcare providers along the East Coast, from hospital emergency departments to urgent care centers, for over 15 years. From its main office in Red Bank, NJ, PBC currently bills over 60,000 patient accounts monthly. Contributing to this consistent growth has been a proactive embrace of technology-driven efficiency, which led PBC to look into implementing enterprise content management (ECM) in 2008.
Before then, IT Director Lewis Paskin recalls PBC’s paper-based processes becoming overly cumbersome as the company grew, while escalating costs were adversely affecting profitability. There were shipping costs to receive charts; clerical costs to collate charts; and labor costs to copy, sort, log and distribute charts for coding, data entry and accounts receivable. “Adding to the paper overload were insurance claims that resulted in inbound Explanation of Benefits [EOB], patient payments, receipts, checks and correspondence—all of which needed to be opened, logged, accounted for and dispensed with daily,” Paskin says. “There were also significant paper costs from producing coding sheets for charts, making multiple copies of EOBs and eventually the long term offsite storage costs, as well as the HIPAA concerns that come with having all this copied and ‘travelling’ paper.”
Paskin led an internal committee to assess PBC’s needs in an enterprise content management (ECM) solution and began to search around four key features:
- Simplicity of user interface.
“We needed to make sure that billing records were easily retrievable, that protected health information was secure and that we could account for all our documents,” Paskin explains. “But we also needed a solution that was cost-effective and scalable. Our immediate goal was to be able to store billing records electronically, but our long term goal was a completely paperless workflow.”
Finding an ECM solution that fit—and would keep on fitting
PBC’s search soon took them to Laserfiche, and specifically to Laserfiche reseller JPI Data Resource. Paskin, for one, was initially skeptical. “When they said Laserfiche could dynamically create folders and structures as well as automatically extract text from documents, I told them I’d be shocked if it could. But it did,” he laughs.
“The Laserfiche product fulfilled our requirements,” Paskin continues, “but it was how it did it—the fact that it was really simple but also very powerful in terms of processing information—that’s how we knew it made sense for us. We have some of the least technical and most technical people working with our information, sometimes in a similar capacity. So, seeing how a staff member could just drop a document in a scanner and how Quick Fields automatically pulls and files all the metadata, or how Workflow would mean our users wouldn’t have to leave their desks, this was functionality we’d see improvements with immediately.”
Working with JPI’s Joseph Gutierrez, Paskin and his PBC team designed a 20-user Laserfiche system including Audit Trail; Workflow and Quick Fields; Bar Code and Zone OCR; Scan Connect and Snapshot for capture; and set up five different scanning stations. Installation, Paskin notes, was completed in less than a day, while user training took less than three days.
Paskin credits the comprehensive capture methods with making the transition to an automated environment a smooth one. “We’ve found that working with whatever file format a hospital is using with minimal modification is our best way to retrieve data,” Paskin says. “We do a lot of scanning directly into Laserfiche from our hospital clients’ facilities, which makes for a wide differential in chart documents. Some hospitals send charts with barcodes, others use file names, some just send text, but through the various Laserfiche applications we ferret out a way to get the data into the system.”
The biggest improvement, he notes, has been in processing paper. “Staff now simply scan those documents, either separated by bar-coded index sheets or by utilizing Zone OCR, into Laserfiche. Quick Fields reads the patient’s name and ID from the bar codes and automatically indexes the scanned files and fills in all the necessary document metadata.”
The effect was as impressive as it was immediate. “We were able to migrate one of our largest volume clients to a completely paperless environment in less than a week. Then we started bringing our other client applications online,” Paskin says.
Scanning volume soon hit 50,000 pages a day. “We scanned over 200,000 documents containing over 2.5 million pages in just under one year,” he adds.
The process(es) of coding and billing, better and more efficiently
The impact on PBC’s business processes was transformative:
- Laserfiche Import Agent constantly monitors the multiple directories PBC has set up to receive files.
- Laserfiche Quick Fields then extracts and sorts data, which triggers Workflow to route files to the respective departments that need to touch the document before it moves forward and is finally archived.
- If any predefined criterion is missing, Workflow automatically reroutes the record to the appropriate department for further follow up.
Previously, PBC’s coders signed out up to three days’ worth of charts and held them at their desks until coding was completed. Charts were then passed in bulk to the insurance review department, then on to data entry for manual entry to initiate billing before eventually being archived in a file room and sent to an offsite storage facility. Now, PBC coders work and code offsite, accessing information over a secure connection to PBC’s terminal servers.
“An entire team of people no longer need to work in the office—everything’s accessed and managed centrally through Laserfiche,” adds Paskin. As the coders finish a chart, it automatically moves through the workflow to the next department, speeding up and evening out the process from inbound chart to billing.
“We have over 10 different client applications that reside in Laserfiche—five of which are hospital-related, and three that are used by our Accounts Receivable (AR) department to look up claim denials, track work batches and store EOBs. We’re using it in more than five distinct departments including coding, claims processing, AR, finance and Human Resources; it’s our document management back-end for all our lines of business,” Paskin says.
This centralized control has improved oversight to monitor productivity as well as to ensure HIPAA compliance. Using Audit Trail, a document ID number can trace the file’s history. “We can see who changed what—and when—for every document,” says Paskin.
Another benefit, Paskin adds, is the ability to use SAP Crystal Reports tools to help monitor PBC’s workflow. “We have about 15–20 reports that go out daily—one of which is referred to as our ‘bucket report.’ When we receive a medical chart, getting it coded and billed quickly is key to cash flow. The bucket reports tell us how many charts are sitting in a user’s folder. Because all this data is in a single, centralized repository, it’s easy to create reports,” says Paskin. “I credit Joe and JPI with understanding our business well enough to show us how we should have our information structured.”
Automating the billing process itself, Paskin notes, “works essentially the same way it does in the Laserfiche brochure that JPI showed us initially. Again, everything’s in a single and straightforward database. We simply wrote Java and Web-related scripts to pull the account number, CPT and diagnosis codes to automate the actual billing process. Of course, there was controlled testing for about two weeks before we went live, but that was it.”
Now, PBC’s business processes are synonymous with Laserfiche—and significantly improved. Paskin points to processing the hundreds of charts sent to PBC on any given day. “That used to take three employees a full day to process manually; now it takes one person about 15 minutes.
“Our original vision was a paperless workflow, and we’ve pretty much achieved that. We have over 800,000 documents representing 10 million pages, and that all happened within the past 2 ½ years,” he adds. “We have redeployed 60% of our FTE’s required to produce a claim, and no longer need a night shift to keep up with the workload. Considering how far we’ve come, it’s pretty amazing.”
For more information, read Laserfiche’s ECM for Third Party Medical Billing brochure.