Process Improvement and Cleanup of Insurance Allocations and Health Plan Information.
Moffitt Cancer Center in Tampa, Florida is dedicated to contributing to the prevention and cure of cancer through service, science, and partnership. One of only 47 National Cancer Institute-designed Comprehensive Cancer Centers, Moffitt is ranked the sixth best cancer hospital in the nation. With more than 5,600 team members, Moffitt’s services include the Southeast’s largest blood and marrow transplant program, outpatient treatment programs that record more than 328,300 visits per year, the Moffitt Research Center, Moffitt Cancer Center at International Plaza, and Moffitt Cancer Center Screening and Prevention.
Automating Costly Manual Tasks
As a large organization, the Moffitt team is always looking for ways to streamline operations and automate costly manual tasks that can be time consuming and tedious. The business office and billing personnel at Moffitt identified several areas that needed improvement and set out to streamline and simplify these processes.
Cleanup of Insurance Allocations and Health Plan Information
A main area of concern was cleanup of insurance allocations and health plan information. Before EMUE, schedulers would schedule appointments in one system then move to another system to allocate insurance, and use another process for financial clearance worklists for unallocated insurance. In addition to this bulky workflow, Moffitt had experienced an explosion of health plans. Often, these plans are very similar in that they are for the same payer and have an identical reimbursement rate, but having a large number of payers increases the chance that registration and authorization staff will select the wrong plan. This problem is multiplied because there are a large number of users in various registration areas selecting different but similar plans for the same date of service. When this happened, it created broken billing periods which required manual verification, cleanup, and consolidation.
Steps Toward Automation
To solve this problem Moffitt took several steps toward improvement. First, they removed the unnecessary payers from the pick list. Originally starting with almost 1300 plans, the team narrowed the plans to only 50. They reviewed the existing plans and terminated or consolidated them using a simple EMUE script to make the adjustments in the Health Plan master file.
Once the plans were condensed, encounters needed to be updated. For example, the initial phase for Aetna and Blue Cross eliminated six Blue Cross health plans and nine Aetna health plans, which resulted in a new plan assignment for approx. 1400 future encounters. To update these encounters, the team broke out the problem into steps. First, they used EMUE to identify the encounters with terminating plans based on whether authorizations were attached. Next, EMUE used these reports to find the encounter, unallocate the terminating plan, check to see if the replacement plan was available in the other policies section, and allocate the replacement if available.
Process Improvement = Money and Time Savings
Automating the cleanup of insurance allocations and health plan information on each encounter was done by EMUE in significantly less time than the manual process was going to take Moffitt’s staff.
Manual errors were eliminated and EMUE was able to perform approximately 700 hours of work, considerably reducing the workload for the team.
After the cleanup Moffitt team members worked to enhance consistency across redundant tasks and focused their EMUE scripting on automating routine tasks.
They also use EMUE to prepare work queues in the early morning hours so the worklists are ready when staff arrives.
What’s Next with EMUE
Insurance assignments and allocation is just one of the many areas that Moffit’s team has streamlined with EMUE. They also use EMUE for automating worklists, processing system data entry, master file maintenance, removing collection holds, triggering Business Rules Development Tool (BRDT) rules, and extracting information from their EHR that is otherwise difficult to obtain manually.
A longtime EMUE user, Jackie Jolly, Lead Systems Analyst at Moffitt Cancer Center said “EMUE has become an integral part of our business. It provides significant time savings for large cleanup projects and ongoing system maintenance. We have also improved efficiency in our business office by using EMUE to drive work queues for our staff each day.”
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