OnBase Automated Patient Accounting
Many providers still are trying to deal with a deluge of paper EOB remits. Whether housed in cabinets onsite, at offsite storage or with pick-up and delivery storage services, the bottom line is that retrieval times for remits needed to answer questions from patients and providers, as well as handling denial follow-up and secondary billing, are frustratingly long. The nature of these remits, sometimes hundreds of pages long and with multiple patients on each page, compound the problem as they typically are filed by posting date and organized by batches and/or insurance carrier names, making them difficult to search at the patient-level.
More frustrating is that the promise of HIPAA and electronic remits nets significant savings associated with the time to post, as ERAs post automatically. However, downstream business processes still require significant paper production and interaction along with the rest of the paper EOBs received.
Providers utilize OnBase to capture, store and retrieve EOBs, whether received via paper or in the electronic HIPAA ANSI X.12 835 format. OnBase Document Imaging is used to scan paper EOBs. Users have the flexibility to index at the batch- or patient-level. Electronic remits received in the HIPAA standard ANSI X.12 835 format are captured and stored with the OnBase 835 Processor. EOBs processed through the 835 Processor are parsed into individual patient transaction EOB documents with a single patient transaction on each page, automatically indexed and searchable at a patient-level.
Once in the OnBase system, EOBs are immediately available to authorized individuals throughout the healthcare enterprise via several retrieval mechanisms. The OnBase Application Enabler integrates OnBase with the existing billing system, allowing patient accounting personnel to access EOBs directly from the billing system. Users simply double-click on a designated field or hit a Function Key within the billing system application to retrieve the EOB from OnBase and bring it up onscreen beside the billing application. This alleviates the need for end users to switch between software applications, virtually eliminating any learning curve associated with the use of document management in the patient accounting environment.
OnBase COLD/ERM (computer output to laser disk or enterprise report management) provides additional opportunities for efficiencies in the patient accounting area. COLD/ERM automatically captures and stores electronic data streams from the billing system and other core applications. COLD documents typically are captured and automatically indexed into the system via a scheduled process, requiring no human intervention. Providers use COLD to capture and store HCFAs, UB92, patient billing statements, close reports, aged receivable reports, etc. Patient accounting personnel reviewing an account with a patient on the phone would now have the claim, in addition to the remit, at their fingertips to assist in answering the patient's questions.
Beyond the savings associated with digital storage and retrieval, OnBase provides further efficiencies by managing the processes associated with those documents. OnBase Workflow provides document-centric business process management, automatically routing documents and work according to defined business processes. Secondary billing and denials management are areas where Workflow can increase process efficiency.
Combining the OnBase technologies of COLD, Imaging, the 835 Processor and Workflow, secondary claims generated by the billing application automatically can be processed into OnBase without scanning or indexing and matched to the primary electronic remit/EOB received for that patient. The secondary claim and primary EOB can be merged together as a single document and sent to the printer for secondary filing. This alleviates the need for staff to make a copy of the primary EOB and then "black out" other patients' information on an EOB page where multiple patients are present.
Utilizing denial codes from the remit, OnBase Workflow automatically can route these remits based on the hospital's business rules for each denial code type. For example, a claim denied for missing documentation can be routed to the appropriate department to provide necessary supporting documentation. The claim would then be routed back for resubmission to the carrier with all appropriate documentation attached.
User-defined and point-and-click configurable, OnBase Workflow utilizes a concept of rules and actions. For each rule, there is an associated action or set of actions. For each denial code, there is an action that is taken, such as automatically routing the document back to the originating department.
OnBase Document Management Benefits for Patient Accounting
- Provides faster responses to patient and provider questions with instant access to patient-level EOBs
- Streamlines denial follow-up and secondary billing times
- Reduces costs associated with paper EOB storage
- Enables EOB access directly from billing system - shortening the learning curve and increasing user acceptance
- Handles electronic remittance advice in HIPAA 835 format
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