Increasing Revenue Collection of $2M+ with Automating Missing Documentation Denial Submissions

Current State Process

At Appalachian Regional Healthcare (ARH), a segment of the patient financial services team is dedicated to manually resubmitting denied insurance claims every month. Some denials are complex, requiring human input and reasoning, while others are simple, but can be very time consuming. 

For example, CO-250 and -252 are simpler denial reasons that require additional documentation to support the insurance claim. ARH has had a long-standing relationship with Tennessee-based advisory and business consulting firm, LBMC, who designed the idea to automate missing documentation denial submissions for a single payer and enlisted their technology implementation partner, EnterBridge, to develop the automation.  

Current State Process

To process CO-250 and -252 denials, all that is required is to search the patient’s medical chart, download any documentation within a date range associated with the denial, and fax it to the payer. While simple to execute, the systems have long loading times and are cumbersome to manage. The team described it as almost “fighting against their applications,” instead of the existing tech making their lives easier. The long loading times could add up to 10 minutes of processing time per transaction.   

Some stats to consider for the manual processing of missing documentation denials: 

• The longest denial resubmission took 1 hour 37 minutes. 

• The average processing time per denial is 20 minutes. 

With a disproportionate amount of time spent processing missing documentation denials, the backlog on other denial types builds up. This leaves millions of dollars in unclaimed revenue on the table, which ultimately affects patient outcomes and quality of care.  

With limited staff to process these denials and lack of a hiring budget, the financial team turned to automation to unlock revenue potential.  

Automated Process

The process was fully automated from end to end. Once a day, the automation is kicked off and begins by logging into Meditech and the Communication Director fax portal. In Meditech, the bot navigates to the 'Denial Management' list, finds each Wellcare CO-250 or CO-252 denial on the work list, and opens the EMR Chart Viewer to access the 'Provider Notes' in the relevant patient profile.  

The bot finds all relevant documentation that matches the dates of service listed in the denial and based on a list of provided criteria, determines if it should be included in a fax to the payer. If determined it should be included, the bot is programmed to download the document using the organization’s fax printer to send it through the fax portal. Once all relevant documentation has been added, the fax packet is automatically sent to the payer. The bot then adds a standard note to the Meditech patient account and closes the denial. 

Benefits

When calculating the return on investment of an automation project, there are multiple components to consider. For ARH, automating the CO-250 and -252 denial resubmission process offers significant advantages such as labor savings and increased revenue collection.  

Just as importantly, the project provides benefits that are harder to quantify – including enhanced employee satisfaction, a jumpstart on a digital transformation journey, and more time for staff to innovate and strategize. This comprehensive approach not only improves operational efficiency, but also fosters a more motivated and forward-thinking workforce. 

Here’s a summary of the overall benefits of the project: 

• Labor Savings: The annual population of CO-250 and CO-252 denials is approximately 3,500, and each denial takes 20 minutes, on average, to process. That’s over 1,000 manual hours annually to process this singular denial type. 
  
  
• Increased Revenue Collection: When the bot was initially deployed, it processed $1 million worth of denied claims in the first month and $2 million in the second month. The automated workflow allows the team to focus efforts on other backlogged denials and increase revenue collectability with the additional capacity. 
   
• Improved Employee Satisfaction: Processing CO-250 and CO-252 denials is a tedious,  time-consuming task that is spread across a team of 10-11 people. Not only will the automation save time by eliminating a portion of their daily work and reducing switching costs across the whole team, but it will also enable them to spend more time working on more complex and higher value denial types. 
   
• Additional Value: By eliminating tedious work, the team can add strategic value with the time they are saving. They can spend time thinking about other ways to improve the operational efficiency of the revenue cycle. 

EnterBridge and LBMC

Have a process in mind that you want to automate? Book a call with us to scope out the process with one of our expert developers today. 

For further advisory and business consulting expertise, be sure to contact our partner, LBMC, to skyrocket your growth.