Many providers still depend on paper to process claims. They have systems and procedures that work well and a staff that is comfortable using them. When they finally make the decision to adopt an automated claims management system, they're surprised by how fast and accurately they can move claims forward. We were.

PROBLEM

Patient First is a primary and urgent care provider with 19 medical centers in Virginia and Maryland. Our centers are open 365 days a year on a walk-in, no appointment basis. Although our patient management system was automated, we had used a manual record-keeping process for billing since the company was founded in 1981.

By 1999, we were processing more than 1,000 claims a day. The system had been adapted to the changing needs of a growing business, but these needs were taxing the system.

We had difficulty processing hundreds of thousands of claims each year by paper; it took staff about 10 minutes to pull one file and process a claim, which, of course, diverted their time from assisting patients. Also, we faced a challenge tracking claims because information in the reports was vague or errors were buried in the reports.

SOLUTION

In 1999, we determined it was time for a change. We initiated an extensive review of automated billing systems available, looking at the following criteria:

* Prompt and clear error identification with corrective actions highlighted.

* Up-front control where claims are initially entered.

* A claims management system that interfaces with Patient First's current automated practice management system (PMS).

* A system geared to the specific requirements of major payers, but which can also address the needs of the less frequently-filed commercial carriers.

* A supplier that trains staff to use the system efficiently and is available for on-going support.

* A system that requires minimal or no hardware or software upgrades.

* Following installation, a system that can be up and running in 30 days, showing results soon afterward. We selected Payerpath based on their ability to meet all of the above requirements. In addition, our director of patient accounts had had prior experience with the Payerpath product and their management team, and believed we would be satisfied.

The implementation process took several months. Working closely with our PMS staff, we were able to move ahead with the new system once Payerpath established a customized interface for uploading claims.

The Payerpath system had been developed on the premise that incorporating a local focus was paramount. As such, the company had developed edits for major government and commercial carriers serving Virginia.

It took a day's training for our staff to learn the Payerpath claims management system. By the end of that day, we could access the system via. the Internet, upload claims from our PMS and correct claims online. Within a month, the system was completely up and running.

RESULTS

Within eight weeks of installation, we achieved exciting results. Our claims turnaround time was reduced more than 50 percent for almost 80 percent of our claims; claims turnaround time was reduced more than 75 percent for another 10 percent of the claims.

The initial payer response time for filed claims was cut in half. Our staff also felt a dramatic improvement in the way their time was used. The time they spent dedicated to actual claims processing dropped nearly 75 percent. The total time they spent "fixing" errors and working on rejections was reduced to a few hours. The electronic claims status reports issued through the Payerpath system also helped staff verify proof-of-filing claims, which dramatically affected their time utilization.

We had once considered ourselves remarkably efficient in handling hundreds of thousands of claims annually through a manual record-keeping process. However, the introduction of an automated claims management system made us work better, smarter and faster.

For more Information from Payerpath, Circle 191

SOURCE

Kevin Dumville
Patient First
Richmond, VA
kdumville@patientfirst.com

PRODUCT/COMPANY

Payerpath
Payerpath.com
www.payerpath.com