Claims Processing at Physicians Medical Group

Physicians Medical Group of Santa Cruz County (PMG) cut its claims processing time by more than half and provided faster access to data, fewer compliance concerns, happier employees and more satisfied customers with an integrated solution from Datacap and Bowe Bell & Howell. 

The Challenge

Worse, since the electronic data provided by the service bureau regularly contained errors, the claims department first had to wait until the paper claims were returned and verify each one manually. Only then could PMG compensate its providers.

Paying healthcare providers quickly and accurately is PMG’s top priority, but with such a labor-intensive process, it often took more than two weeks to settle a claim. That was inconvenient for providers — and costly for PMG. If the company did not reimburse physicians on time, it had to pay interest, so employees frequently worked overtime to meet performance deadlines. When providers were not paid promptly, they sometimes sent duplicate claims, which the claims department had to review again and resend to the scanning bureau.

“There’s a saying in the health care industry that it costs $7 to process a claim,” said Bill Beighe, chief information officer of PMG. “If that’s true, then it was costing us $14 to process it twice.”

To complicate matters, PMG was required under California regulation AB 1455 to acknowledge receipt of claims to its providers within 15 days. But it was an ongoing challenge to comply, given the delays associated with the scanning bureau. What’s more, PMG was audited regularly by the health plans to ensure compliance and to verify that it was providing high-quality service to physicians.

“When an auditor came by and asked for several hundred specific claims, one of our clerks had to locate and pull the paper claims, photocopy them and re-file the originals,” said Beighe, “and it was not unusual for clerks to return claims to places other than where they found them.”

Similarly, when a customer service employee needed to reference a specific document, he would handwrite a note to a clerk, who had to search numerous storage boxes in PMG’s basement. It could take hours, or even days, for customer service representatives to get the documents they needed.

In 2005 the payment delays, compliance challenges, undue expense and stress on employees became too much. PMG decided to take its document imaging in-house. 

The Solution

After carefully considering PMG’s needs and available options, Beighe assembled a desktop imaging system that included Datacap’s Taskmaster for Medical Claims(correct), KnowledgeLake Imaging and Microsoft SharePoint and the Sidekick 1400 scanner bundle from BÖWE BELL + HOWELL Scanners.

Beighe selected Sidekick because it included a powerful, compact, entry-level scanner for color and bi-tonal imaging, VirtualReScan™ (VRS) technology for image enhancement — and a desktop scanning solution that was easy to install, operate and maintain. “Sidekick had an excellent reputation for reliability and trouble-free operation, offered the right scanner bundle at the right price and came highly recommended by other vendors,” he said.

PMG’s IT department installed Sidekick themselves and had it up and running in no time.

PMG now scans about 1,000 pages per day — a quarter of Sidekick’s capacity. A claims department employee scans incoming documents within eight hours of receipt using the scanner, which automatically date-stamps each document. The entire scanning process only takes one worker two to three hours per day.

“The Sidekick is entirely trouble-free and jam-free. We’ve never had to call a service technician because the scanner has provided 100 percent uptime over an entire year of use,” said Beighe. “We purchased an extra Sidekick as a backup, but never had to use it.”

Once the claims are scanned, the claim images are delivered to Datacap Taskmaster for Medical Claims to simultaneously capture index values and automate the claim processing for payment.

Taskmaster delivers the claim images together with the associated index values to Microsoft SharePoint, for easy retrieval by the claims department using the KnowledgeLake document management system. All paper copies can now be immediately shredded to reduce storage costs. For claim payment processing, PMG takes advantage of Taskmaster’s rule capabilities to ensure maximum accuracy for many fields, including ICB9 and CRT4 code validations and ensuring that all fields, such as patient name, are all alpha or numeric as required. After Taskmaster performs data recognition, validation and verification, payment information is automatically delivered to the PMG’s EASYCAP payment system.

The majority of the scanned documents are medical claims, some of which, like the HCFA-1500 and UB-92 forms, are printed in red. Fortunately for the claims department, the Sidekick scanner has an electronic color dropout feature that automatically removes red color from the background on these forms when they’re scanned, leaving only the filled-in data. This further enhances Taskmaster’s accurate recognition.

The Result

Today, when customer service employees need to track down a specific document, they simply search PMG’s secure database for the images, using inputs, such as claim number, patient ID, physician’s name or diagnosis. They access the needed information instantly, even while on the phone with a provider or insurance plan representative. And not only is the claim data entered into the system much sooner, but the claims department has become a less stressful environment — and late nights at the office to meet performance deadlines now are infrequent.

The benefits of reducing paper became even more apparent last year when the company relocated its offices to a new building. With no need to store paper claims and forms, PMG ended up leasing fewer square feet of office space. Eliminating the basement storage area also eased liability concerns about having clerks going up and down the stairs to retrieve documents.

As Beighe is quick to point out, the auditors are pleased with the new system too. “Now when an auditor comes in and asks to see two hundred specific claims, I say, ‘Have a seat and search our database to your heart’s content.’ And the auditor can find the claims instantly on our PC without any clerical assistance,” he said.

The imaging system also enters claims information into PMG Portal, the company’s secure customer Web site. Providers can log on to check the statuses, and view high-quality images of their claims. And whereas physicians used to check PMG Portal only to find claims they sent weeks earlier still unaccounted for, claims now are always posted within three to five days.

With its new solution, including the BÖWE BELL + HOWELL Sidekick scanning bundle and Datacap Taskmaster for Medical Claims, Physicians Medical Group of Santa Cruz County has faster access to data, fewer compliance concerns, happier employees and more satisfied customers.

For more information, contact Datacap.