Case Histories
MULTI-FACETED ENGAGEMENT
A client with 300+ dialysis clinic sites in 40 states asked
Health Systems Management Network, Inc. to do the following:
- Review the clinical documentation for the billing of some
5,000,000 claims.
- Using Web-based Technology, organize all of the data for
each of 70,000 patients to be claim-ready for submission
to the Fiscal Intermediary
- Create Web-based Data formats to allow our 160 nurse reviewers
to enter their reviews of each claim.
- Create an automated Web-based Medical Necessity Scrubber
for a QA of all claims to be submitted.
- Recommend process changes and education for the on-site
clinic staff based on its operational assessments.
- Prepare work flows for this client’s Central billing office
as well as recommendations for a new billing system.
- Develop a Web-based, front-end Medical Necessity tool
for use at all clinic sites. (No software necessary, just
Web access).
- Develop Web-based training modules on Medical Necessity
for all levels of staff.
Outcomes:
- Client was successful in billing all of its claims and
was able to recoup more net revenue than it had projected.
- Client implemented education and process changes while
introducing a new billing system.
|
 |
