Remember the game show Name that Tune? The host would say “I’ll give you $100 if you can name that tune in less than 30-seconds.” Well, this is kind of like that. Only, instead of a game show host it’s the laboratory billing director saying, “I’ll give you $100 if you can find that document in less than 48-hours.”
If you live in the wonderful world of laboratories this may sound familiar to you because it’s a true story. Frequently, you can expect the insurance auditors to come knocking on your door. It’s a bit like the IRS showing up – we’re sure they’re nice people but we don’t really want to see them at our place of business. It doesn’t typically spell out F.U.N. So the insurance auditors showed up this one cool Fall day, for their bi-annual visit, with 50 “random” claims in their hands and asked the billing director at Universal Standard Medical Laboratories to provide the corresponding requisition and test results for these claims. 45 of the 50 requisitions and test results are matched – without any issue. The remaining five – well here is where the real story begins…
The billing director grabs four of his billing clerks and sends them out to their 10,000 SF warehouse filled floor to ceiling with boxes upon brown boxes of requisitions. He tells them, “I’ll bring you lunch but nobody comes out until you’ve found these requisitions.”
Now, on the upside, there is a date on every box of stored files that corresponds with the date of the service. So now these billing clerks must begin digging through an entire box of records searching for the one (of five!) lost records. Once they search through the entire box of records that match the corresponding day with no success – well the search begins in the day preceding to see if it’s in there. And if no luck – the search continues in the box for the following day the test was done. This gets repeated for each of the missing five claims documentation.
The billing director knows, that if these records are not found he and his firm will be hit with firstly, a fee to reimburse the insurance company for a percentage of ALL the tests done during that time period. Secondly, a penalty fine.
The billing director checks in on his crew digging through boxes of stored files in the warehouse and now says, “I’ll give $100 to whomever finds that requisition.” It’s been 24-hours since the auditor has been there and as time drags on he tells his billing clerks, “I’ll give $200 to whomever finds that missing requisition.” You get the idea.
So, what if today we had a solution for you and your team that would help ensure that you don’t have to send your billing clerks out to that dusty ol’ warehouse on a search-n-rescue mission ever again? What if we told you that we have devised a system that not only keeps your staff from getting full of dust but when you search for those missing documents it would only take seconds to retrieve? For the total project, can you imagine finding 50 requisitions in five minutes and being done with the audit?
You don’t ever have to sweat an audit again!
Freedom Imaging Systems can implement their HL7 Processing Engine so that now, even when an electronic requisition or order has gone missing it can be regenerated into a human readable document from the HL7 file(s) that provides an alternate digital record that can be used for processing the claim. Say it isn’t so?! Oh, it’s so… It’s so easy!
All the data contained within the HL7 file which was created when the patient’s order was initially delivered electronically by the physician; name, DOB, test type, etc. can be mined, sorted, consolidated and finally complete the record based on your specifications. So now, in cases where the hard copy requisition is not archived, laboratories can recapture (regenerate) those lost requisitions, the corresponding revenue stream that obviously went untapped and eliminate any future horror stories like the one above during your audits. You don’t ever have to sweat an audit again. Your laboratory team can be confident that any electronic requisitions or tests that may have gone missing can be regenerated through the use of Freedom’s HL7 Processing Engine.
Now fast forward to the same scenario above. The insurance auditor shows up at your laboratory with 50 claims under their arm. The HL7 Processing engine will have taken care of any client received HL7 files. Since the HL7 Processing Engine automatically creates an HL7 placeholder for your file or electronic requisition in this case, the form is generated automatically – all these files will be in your system. And the form will have a notation saying exactly what HL7 file it came from – in case the auditors have questions regarding authenticity. It’s an unaltered, unsegregated file.
So now your billing director will have to come up with a new game to replace, “$200 to find the lost document” – and I think we can all agree that’s a good thing.
For more information, or to speak with a Freedom HL7 Processing Engine specialist, call 734.327.5600 or email email@example.com