Claim submissions sailing through in 3 days -- compared to 60 days before
Licking County Health Department
Public Health Medical Billing Improvement Project
• Project was funded by an LGEP grant and
resulted from LeanOhio Boot Camp
•September 2015 - March 2016
• Contact: Joe Ebel · firstname.lastname@example.org
The need for a process to submit insurance claims and invoices within necessary time frames prompted this improvement project. Numerous spreadsheets were maintained by different individuals to track billing without a centralized reporting structure, and there were many extra steps in the process. There was a backlog of claims waiting 3 months or more before submission.
The goals of the project were to: (1) submit claims within 3 days of the day the service was provided, (2) consolidate the billing duties, and (3) reduce the amount of time and steps to submit claims and invoice patients.
The team used several Lean tools, including a current-state process map, root-cause analysis, the 5-why tool, a clean-sheet redesign, a future-state process map, an implementation plan with action registers, and checklists to standardize work.
• The eHR is used as the central tool for the process, eliminating additional processing time in spreadsheets and a legacy software. This improvement was key for redirecting staff time. (implemented)
• The number of functions in the medical billing process was reduced to consolidate billing tasks. This improvement was another key point for redirecting staff time. (implemented)
Steps - Baseline: 57
Steps - Actual: 28
Handoffs - Baseline: 9
Handoffs - Actual: 6
Decision Points - Baseline: 12
Decision Projection- Actual: 5
Delays - Baseline: 21
Delays - Projection: 11
Lead Time - Baseline: 60 days
Lead Time - Actual: 3 days (95% reduction in process time)
Redirected Work Hours - Actual: 1,000
Staff members from multiple divisions of the Licking County Health Department, including Nursing and Administration, now have a better understanding of the role each function plays in the overall medical billing process. This has increased communication, collaboration, and camaraderie, and has led to an overall better experience for clinic clients.