1. Internship Abstract
Title: Increasing Revenue Reimbursement from Blue Cross Blue Shield at Robert
Wood Johnson University Hospital Laboratory Outreach
Name: Emily Rose Dominguez
Preceptors: Karen Shepherd, Director of Laboratory Outreach Services
Douglas Katz, Field Service Coordinator of Laboratory Outreach Services
Agency: Robert Wood Johnson University Hospital Laboratory Outreach Services
Purpose: To increase the revenue reimbursement from Blue Cross Blue Shield by analyzing
claims 30-120 days old via Robert Wood Johnson’s LEAN methods.
Significance: Robert Wood Johnson University Hospital Laboratory Outreach Department is able
to break down the monthly account receivables from various insurances through their financial
dashboard. Financial and insurance data pulled from the Laboratory’s billing system from
February 22nd, 2016 showed that Blue Cross Blue Shield had over $382,938.11 in outstanding
claims that have not been paid to the hospital for up to 120 days. This large sum of unpaid
insurance claims from the Laboratory Outreach Department had created a deficit; thus, the
significance of using LEAN methods is to increase revenue reimbursement and determine why
reimbursements had not been paid in a timely manner.
Method/Approach: By using an excel spreadsheet the BCBS insurance claims were analyzed
through the lab’s outside outreach billing company (ARX/Xifin) as well as RWJUH’s registration
and financial database (Optimum), to help examine why the claims were left outstanding. RWJ
LEAN methods allowed the BCBS outstanding claims to be analyzed into reasons/factors that
contribute to the current account receivables outstanding balance. After BCBS data was
compared between the two billing systems, the information was sent over to ARX/Xifin billing to
further analyze why claims were delayed for so long after being billed; which lead to some claims
being rebilled out to BCBS or other insurers.
Outcomes:The LEAN fishbone diagram was used to analyze the root causes of the BCBS
outstanding claims. There were two overall themes that were noted when analyzing account
receivables. First, there had been claims that were already reimbursed by BCBS, but the billing
system did not move the remaining balance into the proper payer bucket. Secondly, claims had
been billed out to the wrong insurance company, due to wrong registration information in
databases. Any incorrect information was updated and corrected in the hospital insurance/billing
system. After some of the root causes have been analyzed and corrected using LEAN methods,
Laboratory Outreach will be reimbursed for any lab services provided to BCBS patients within
the identified time period.
Evaluation: It is projected that at least 10% ($38,293.81) of account receivables will be
converted to cash collections by April 20th, 2016. Actual cash collections were $55,368.72,
which is $17,074.91 more than projected (roughly 15%). It is vital for the Laboratory Outreach
Department and billing system to stay up to date with claims every 30 days. By doing so, it will
insure that claims are reimbursed in a timely manner, because claims older than a year cannot be
rebilled. It is necessary that patient information is evaluated to ensure that it is correct and
updated in the system. Additionally, this project has identified opportunities for improvement for
staff on proper registration practices.