Case Studies

Alaska Native Tribal Health Consortium

ANTHC is an Indian Health Service (IHS) hospital located in Anchorage, Alaska. They have leveraged EMUE with Siemen’s SIGNATURE®physician billing system since 2006. After seeing much success with SIGNATURE®, they wanted to use EMUE with MS4.

Automated Adjustments

Before EMUE
Users could request that an adjustment be made to an account by filling out a form that includes the details of the requested adjustment. Once a manager had approved the adjustment, the paper would be given to a payment poster for posting. This process added a lot of overhead.

There were also bulk adjustments that would be performed on a group of accounts. These adjustments were performed using a macro in Rumba, but the process was unforgiving and took a lot of preparation time. There was also a gap in communication as there was no way to notify anyone of outstanding issues.

EMUE Solution
EMUE saved ANTHC a significant amount of time by eliminating the majority of the preparation work and follow-up as well as the data entry portion of the process. Additionally, the EMUE process includes auditing functionality as well as built-in error notification.

  1. Pre-processing: EMUE reduced the 5 hours of file preparation time required for the bulk adjustment process to just 30 minutes on average.
  2. Processing: Reduced 18 hours of manual data entry and macro execution to just 15 minutes per week. In addition to being able to automate data entry, EMUE’s logic allows for decision making and error handling, which greatly improved upon the old process and minimized the amount of manual work required.
  3. Post-processing: EMUE eliminated all manual post-processing time by sending notification e-mails to the appropriate parties that include attachments with the specific details of the process. EMUE also took care of archiving files.
  4. Auditing: Automatic auditing was added to the EMUE script process. A paperless system was set up where users requesting adjustments e-mailed a spreadsheet to their supervisor for review. Approved spreadsheets were dropped into a directory that can only be accessed by that supervisor. EMUE would then pick up the file and process the adjustments. After completion, when the file is archived, EMUE tags the file with the name of the supervisor who approved the adjustment.
  5. Feedback loop: EMUE’s processing added a feedback loop for error correction. Upon completion, EMUE notifies the user who requested the adjustments of any errors or problems with the adjustments that they requested. The user can then research the problems and resubmit the adjustment so that nothing falls through the cracks.

Benefits of EMUE Process:

  • Eliminated close to 20 hours of manual work per week
  • Added auditing to track approvals
  • Process became Paperless
  • Added feedback loop for error correction
  • Increased accuracy by eliminating user error and manual calculation errors

Conclusion
EMUE has helped ANTHC make a process much more efficient as well as more accurate, and more auditable. This has not only saved them over ½ an FTE’s time, but also having the adjustments performed in a more timely fashion have helped improved several financial metrics!

Payment Posting

Click here for a video of the process.

Before EMUE
At ANTHC, all payments were posted manually, and payment posting was incredibly time-consuming. Frequently the hospital was behind on posting due to high volume. There was also potential to introduce human keying or calculation errors.

EMUE Solution
Several EMUE Scripts automatically work to scrub the remit file, post payments, and notify the appropriate persons. Remittances come from three different sources:

  1. The Medicaid remittance comes in a file that EMUE processes and then places in a database for future processing. Next, a second EMUE script queries the database for payemtns from a given check and posts them to MS4.
  2. The Medicare remittance comes from the payer in a PDF file. An EMUE script uses Monarch, a file-scrubbing program, to extract the fields that are needed for posting from the PDF and exports them to Excel. The EMUE script then reads the Excel spreadsheet and posts the payments.
  3. The Blue Cross payment posting process uses the error file that comes from the electronic payment posting process in Siemens SIGNATURE physician billing system. A created EMUE script reads the error log and posts the payemtns to MS4.

For each type of remit, EMUE posts payments and calculates and posts adjustments. Upon completion, EMUE notifies the appropriate follow-up staff including information about any required manual follow-up and review.

One of the payment posters reports, “It used to take me 28 hours to post the Medicaid payments alone. Now they are literally posted in minutes!”

Benefits of EMUE Process
EMUE works within the existing framework to post payments that come from a variety of files and payers. The scripts are scheduled to run automatically, so now they are posted as soon as the remit arrives, which helps payment posting stay up-to-date. Human error is eliminated and 65 hours per week of manual data entry are eliminated.

Insurance Search

Before EMUE:

ANTHC is an Indian Health Services hospital, which means that the majority of patients are not liable for any fees for the services they receive regardless of insurance. Because of this, there is no incentive for them to share their insurance information with the hospital. The reimbursement rates for private insurance are significantly higher than the IHS program, and as a result there is huge potential to collect more cash revenue by billing the private insurance payer instead of IHS. Of course, significant efforts were made to collect information from the patient, but there was no guarantee that the information would be revealed and patients were often reluctant to reveal insurance that they may have. It was far too labor-intensive to manually attempt to find eligibility for each IHS patient for each payer, so that was never an option.

EMUE Solution:
An EMUE process was created to retrieve a patient list for accounts that have an outstanding balance or were written off to IHS and search for new eligibility information at each of the top three payers’ websites. This process would have been far too time-consuming to be done manually, but with EMUE it is completely automatic! The results of the search are stored in a database which not only allows for another EMUE script to automatically adjust some of the charges, but also allows for detailed reporting about the effectiveness of this process. Databound also created a custom web application that allows ANTHC staff to work any accounts that need additional follow-up. For many of these “manual” charges, a user simply needs to provide missing information, and a follow-up EMUE script rebills the charge. Best of all, the patient’s payer information is updated so that future charges are billed correctly the first time!

Benefit of EMUE Process As of 3/25/2011, after only a few months in operation, this EMUE process has helped bill over $3,000,000 and as a result over $1,500,000 has been collected in cash. This is simply the amount of direct revenue provided by this process. It does not include the benefits of having updated new payer information for the patients, which also provides better insurance going forward, which will result in less missed cash in the future. This process will continue to increase reimbursements far into the future. Conclusion
EMUE has shown great flexibility in working not only in MS4, but also against 3rd party payer websites to reliably gather information and to dramatically increase cash collections.

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