CASE STUDY - Review of administrative function for hospital in USA
Background
This was a modern local hospital, which was dependent on timely insurance payments to fund the work needed to satisfy the communities needs.
The problem was that too often the insurance claims were being rejected and needed to be corrected and resubmitted which was not only time consuming but had a direct impact on the hospital cash flow.
We identified the main reasons for the rejections and by putting a procedure in place we increased dramatically the claims paid on time. An indirect benefit was a reduction in the inpatient days due to more frequent follow-up on a patients condition and moving scheduled checks from Monday to Friday meant less patients kept in for the weekend, and lower costs.
The knock on effect of these new procedures was felt throughout the hospital because following up mistakes in the paperwork were keeping nurses and doctors away from the patients, so once we reduced the mistakes the patient care improved considerably.
Main Areas Supported
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Being American the problems we identified here were of a different nature than in the European context but the factor that did not change was the importance that the medical staff placed on the attention we gave to patient care. The major improvement we made in the hospital's cash flow was to speed up the rate at which the insurance claims were handled. In some cases we cut the payout time by more than a year. We did this by reviewing the whole process and putting in an improved processing that mainly flagged up potential problems immediately and then allowed them to be dealt with in good time.