How Caduceus Inc. Processes Refunds with Laserfiche
Laserfiche Solution Contributed By: Rich Maier, VP Information Systems, Caduceus Inc.
Caduceus is a medical service organization based in the New York City metropolitan area which provides revenue cycle, patient scheduling and credentialing services for hospitals and multi-practitioner practices. Here is how Laserfiche Workflow makes the process of issuing refunds for overpayment of co-pay or changes to enrollment fast and easy.
The legacy process
The refunds request process was previously managed out of a database that tracked only the start and completion date of a refund—with few steps in between. The log was not integrated into the IDX medical billing system and was subject to errors. A paper file was created for each refund, containing a copy of:
- The filled out coversheet
- All associated invoices to insurance companies
- The related explanations of benefits (EOBs) from insurance companies
- Proof of payment
Compiling the refund request documentation took approximately one hour, and the package spent five days in the preparation stage as it went from desk to desk for the different pieces of documentation. Sometimes the account status changed (for example additional research could be required) during the preparation stage, making the paper documentation obsolete.
Once the documentation package was complete, either the hardcopy or scanned documents were sent to the client for approval and issuance of the refund check. The client then sent a copy of the issued check back to Caduceus for inclusion in the documentation package. Finally, the package was scanned into Laserfiche for archival.
Each of the steps above required manual status updates in the tracking database.
The new process
The new process is fully paperless and electronic. The Laserfiche folder structure is the key to the system and corresponds to the various steps of the process. As the refund request moves through the process, Laserfiche Workflow files it automatically in the appropriate folder for that step.
Each folder corresponds to the following step:
- 10 Draft: Laserfiche Workflow creates an empty folder and assigns metadata from IDX
- 20 In Progress: Documentation is added and multiple invoices are combined
- 40 Internally Approved: Laserfiche Workflow generates and populates a coversheet and the folder is ready for release to the client
- 70 With Client: The client processes the refund request to cut the check
- 75 Check Processed: The client emails a copy of the check back to Caduceus
- 80 Refund Completed: The check is added to the folder and Laserfiche Workflow moves the refund request folder to an archival location in the repository
Additional status folders are used for soliciting special help with the request or for denying/deleting the refund. Provisions are also made for creating a refund request manually without an active invoice in the medical billing system.
Here is what a finalized refund request coversheet looks like:
The Laserfiche metadata is sourced largely from IDX and is supplemented with additional information (such as status and comments) gathered during the refund request process.
Behind the scenes
Two workflows are key to keeping Laserfiche in synch with IDX. The workflows are scheduled in Laserfiche to run on a regular cycle.
- The first workflow adds new refund request folders to Laserfiche based on new activity in the medical billing application.
- The second workflow takes each refund request folder from Laserfiche, updates the current refund amount and deletes the folder if it is reduced to zero dollars.
Benefits of Laserfiche
Implementing Laserfiche at Caduceus has resulted in the following benefits:
- Throughput has improved by 300%, as Caduceus can now process three refunds in the time it took to process one
- Status changes are automatically reflected in Laserfiche, which is always current
- This process is paperless by sourcing supporting documentation electronically from the Laserfiche archives and the medical billing system — reducing paper, printing and storage costs.
- The coversheet is now a fillable PDF form that is automatically filled out by Laserfiche Workflow and filed in the client’s folder—saving time and reducing data entry errors
- Managers can monitor the overall process for time spent in each stage for statistical reporting making bottlenecks easier to spot
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