beyond possible
Technosoft Case Study Nov 2012
A revenue cycle
management company
for emergency services
reduces costs, in...
Today this relationship has expanded to encompass 15 processes
and sub-processes which account for nearly 70% of their ...
04 Nov 2012
To ensure proper oversight and communication, Technosoft
developed a dashboard reporting solution. This includ...
© Copyright 2012, Technosoft. All rights reserved. No part of this document may be reproduced,
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Transaction processing-operational-efficiency-for-emergency-services

  1. 1. beyond possible Technosoft Case Study Nov 2012 A revenue cycle management company for emergency services reduces costs, increases flexibility and accelerates cash flows. Technosoft supports 15 processes and sub-processes - nearly 70% of operations. A transformative relationship.
  2. 2. 02 Today this relationship has expanded to encompass 15 processes and sub-processes which account for nearly 70% of their back- office operations. Given below is the involvement of Technosoft throughout the claim lifecycle The claim preparation (derived from PCR/Patient Care Record and the rate card) is done by our client’s team due to compliance requirements. Technosoft then takes over the subsequent processes starting from preparing the hardcopy of the claim (print queue), tracking its dispatch to the payers through to follow-up on the Accounts Receivables. Some of the processes Technosoft is responsible for include • Reimbursement: The insurance company pays the claim through a check along with an EOB (Explanation of Benefits). The team scans them and indexes them on the document management system and posts this payment to the patient bill (known as payment posting). We are also responsible for the refund process in the event both the primary and secondary insurers payout for the same claim. The sub- processes are l Check indexing l Payment processing and posting l Print queue l Refund l Pre-billing l SOF • Denied claim: In this instance the payer denies a claim. Our client scan the denial form which our team then access, capture the reason for denial and assign a denial code to the claim in the billing system (this often involves converting the client Our client provides revenue cycle management for emergency services across nine states. situation & impact As it prepared for rapid growth, our client was facing margin pressures on account of increasing price competition and rising operational costs. This in turn was having an impact on their ability to scale leading to growth challenges. They wanted a partner that would not only provide cost savings in the short term but also help to develop the operational efficiencies and personnel flexibility needed to increase competitiveness and enable growth. In short, they were seeking a transformative relationship. proposed solution Technosoft proposed a multiphase approach that would deliver immediate returns but also prepare for scalability and continuous growth. The solution would focus on providing offsite personnel to deliver services at guaranteed levels of productivity, accuracy, turnaround time at lower than as-is costs, a commitment to apply management techniques to further improve workflow, and applying our technology expertise to automate processes. the technosoft solution Technosoft’s engagement with the client started in July 2005, as an extension of our client’s existing operation. After a successful pilot period, the engagement scaled to 15 FTEs (Full Time Equivalent) across two functions (payment posting & denials coding) within 6 months. By mid 2009, we were providing services across 7 functions with 77 FTEs. As each function was included, we applied our Continuous Improvement Framework (T-CIF) resulting in productivity gains and process refinement. In addition to working with the client on the existing functions, there was a joint collaboration to identify additional functions for migration. Since 2005, 15 processes and sub-processes, team size of 130, 70% of core and non-core operations handled by Technosoft, over 120,000 claims per month, with cost savings that have been proven to improve year over year. project factfile Ambulance Companies Payers OurClient Technosoft Settle PCR CollectPrepare Bill Pay Nov 2012 industry standard codes into client specific ones). This also goes to the denial processing team, a separate team that is responsible for sending and following up on these with the patient if they are responsible for the payment. The sub- processes are l Denial coding l Denial processing • No status: This team works in the US time zone and is responsible for finding out the status of the claims that have not been paid out nor have been denied. They call the insurance companies representatives or the Interactive Voice Response (IVR) system, provide the claim details and obtain the status. In the event the insurance company claims that a payout has been made, the AR (Accounts Receivable) team attempts to resolve the issue In addition, we are responsible for a few supporting processes • In some instances the patient’s insurance information is missing from the claim or not captured in the first place and the team steps in by sending the claim information in a batch mode to insurance companies and/or providers • Support for electronic billing via clearing house: For claims sent electronically via a clearing house, rejection can happen at the insurer’s end due to incorrect format. In such cases the team studies the rejection reasons and if the error is due to a format mismatch fixes the same. On the other hand if the patient information is incorrect, then the correct details are updated and the claim is resent • Rejection process • Legal Continuous Improvement leads to Continuous Cost Savings A joint process improvement task force was formed with our consultants analyzing not only the outsourced part of the engagement, but the client’s internal operations as well. A key metric in measuring our impact and efficiency efforts is a metric known as the Technosoft cost per procedure, which provides a measure of workload for the entire client operation. Innovations included re-engineering existing workflows and eliminating or automating steps in several processes, yielding additional savings. For example, Technosoft identified the benefits in moving more payers to an electronic schedule, reporting optimization and standardization for progress monitoring resulting in nearly 40% improved efficiency. The team in place was a critical ingredient to success and initiatives undertaken included incentives based on meeting agreed upon productivity targets while maintaining quality and an investment in a supervisory layer for greater focus by function. Cost Arbitrage Process Improvement Consolidation Transformation Lower wages Scale 24x7 capability Sample process Lower cost Better skills Six Sigma rigor Training Better process Higher productivity COEs Wing-to-wing Best-in-class Least cost Platforms Continued refinement to optimize processes including automation to increase savings Collaboration with client to apply continuous improvements to global operations Phase 4 Phase 3 - (18-24 Months) Phase 2 - (6-12 Months) Phase 1 - (0-6 Months)
  3. 3. 04 Nov 2012 To ensure proper oversight and communication, Technosoft developed a dashboard reporting solution. This includes quality dashboards that are shared with the client and include error trend analysis and provide specific and actionable feedback. The reporting solution delivers function specific as well as aggregate scorecards for easier evaluation and feedback by the client. A system consultant was deployed to analyze system issues that were resulting in system latency and downtime that yielded unexpected cost savings. All these efforts resulted in a reduction of 35% for the average cost per procedure while gaining an additional 5% savings through productivity target revisions and a reduction in denials volume by 7.5%. Further efforts in innovations like E-faxing attorney requests and EMSurance suggestions are resulting in overall savings. outcomes realized • Employee productivity averages 25% or greater in the functions than when we took over • Cost savings of 35% within the first six months • Accuracy improvement from 82% to 98% in less than a year • Gained 5% additional savings through productivity target revisions within 18 months • System improvements resulting in significant cost savings • Reduction in denials volumes by 7.5% resulting in accelerated cash flow • Support a greatly increased transaction volume while keeping headcount steady • A further 30% reduction in cost per procedure during the 4th and 5th years of engagement we can help Our Revenue Cycle Management practice can provide the personnel that your organization needs to reduce denials and improve collections. But our approach goes beyond mere transaction processing. Process Refinement: Apply a Six Sigma based continuous improvement cycle to optimize workflow. People Focus: Training with focus on quality & metric based employee performance monitoring. Technology Optimization & Automation: Our technology experts assist the BPO operations team in creating workflow tools & process automation. 05 Typical BPO engagements rely solely upon labor arbitrage at the agent level and leave it at that. Our philosophy means that we strive for continuous value creation through the development of a true partnership. That means our success is directly tied to the success of our clients business. We begin by deploying our consultants to develop an understanding of the business & operations and to develop strong working relationships. Over time, we collaborate with our client’s team to seek opportunities to optimize their global operations. beyond possible Client Testimonial Our engagement with Technosoft began in 2005 with a small team supporting a single process. It has grown into a highly dependable, true partnership driven by a shared purpose and handling a number of high touch, high impact processes critical to our business. President As we have continued to evolve, Technosoft continues to find opportunities to improve operational efficiencies, drive changes and process innovation while simultaneously reducing costs and turnaround times—even as our business volume has exponentially increased. Our partnership today is based on transparency, trust and empowerment that is accomplished by collaborating in the trenches to find ways to overcome hurdles and succeed together.
  4. 4. © Copyright 2012, Technosoft. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the express written permission from Technosoft. The information contained herein is subject to change without notice. All other trademarks mentioned herein are the property of their respective owners. About Technosoft Technosoft Corporation is an IT and BPO services provider with headquarters in Southfield, MI, USA and delivery centers in India. We provide information technology, business process outsourcing and consulting services to companies in North America, Australia and New Zealand and Asia-Pacific Regions. As a privately owned company we answer to only two constituencies - our customers and our employees. Our customers rely on us to provide services and solutions that leverage our industryand domain expertisecombined withour technologyprowess, delivery focus and quality. Our collaborative culture and work environment helps attract and retain exceptional talent which is a key ingredient of our sustained growth. To see how Technosoft can go ‘Beyond Possible’ for your organizational needs, email us at or visit us at Corporate Headquarters 28411 Northwestern Hwy, Suite 640 Southfield, MI 48034 Tel: (248) 603-2600 Fax: (248) 603-2599