Columbus Prescription
When a patient needs oxygen, a hospital bed, wheelchair or other home healthcare equipment, a home medical equipment provider can’t withhold these items until the insurance claim has been approved. Unlike prescriptions for medicines, durable medical goods and respiratory care require a great deal of supporting documentation from the prescribing doctor in order for insurance to process the claim. Delays or errors in completing this documentation affect the revenue cycle by slowing payment, incurring adjustments following audits or missing timely filing limits.
Columbus Prescription (Columbus, OH), a family-owned chain of retail pharmacies and home medical equipment stores, faced these revenue recognition challenges. In addition, having patient charts and other documents at different locations made it difficult to provide the highest level of service to central Ohio patients and the referral sources Columbus Prescription had built up over its 30-year history. Plans to increase efficiency by centralizing billing and consolidating call center operations weren’t practical with physical documents in diverse locations.
To address these issues, Columbus Prescription sought an enterprise content management (ECM) solution to provide the document imaging, management and workflow functionality to eliminate paper-based manual processes and make documents securely available from any location. After analyzing numerous alternatives, Columbus Prescription selected an OnBase solution implemented by Imaging Solutions Group (ISG), an OnBase Authorized Solution Provider. Developed by Hyland Software, OnBase is a fully integrated ECM suite that includes core capabilities in document imaging and management, business process automation, records management and COLD/ERM.
“We looked at a number of industry-specific solutions, but we shied away from those because they were specialized line-of-business applications limited to medical records,” recalls Peter Anderson, information technology manager at Columbus Prescription. “While our initial implementation has focused on medical records and revenue cycle management, our goal was to partner with a vendor who could provide systems for the whole enterprise. While we were investigating our options, we learned about OnBase and ISG through a referral from one of their customers in the Cleveland area.”
Another differentiator was the OnBase Application Enabler, according to Anderson. This point-and-click configurable integration utility seamlessly links relevant documents to Columbus Prescription’s line-of business applications, Mestamed from CareCentric and QS/1 from J.M. Smith Corp. “The majority of our users retrieve OnBase documents when they double click on an application screen,” says Anderson. “The documents they need are presented to them based on where they are in the application. Most users don’t ever have a need to run a search through the OnBase interface.” By acting as an extension of the familiar application, OnBase Application Enabler virtually eliminates the need for end user training and makes it unnecessary for users to navigate between applications.
OnBase is used by more than 90% of employees in both pharmacy operations and home health/durable medical equipment businesses. In both cases electronic images of the prescription are presented to technicians via workflow queues and data from the images can be keyed into QS/1 (for pharmacy) or Mestamed (for home healthcare). The data is also used as keywords to link the document to the patient record and as search terms.
Because pharmacy prescriptions are authorized in real time, the actual processing is complete when a pharmacist has reviewed the order and the medicine is dispensed. Medical equipment, however, is much more complex. In most cases, these prescriptions are faxed to Columbus Prescription by doctors, nurses or discharge planners. Regardless of the number to which they are faxed, the FAXmaker fax server from GFI Software sends the documents to a centralized location as document images.
OnBase regularly polls this directory to import the documents into the OnBase Workflow. Currently, there is a single initial customer service queue, but ongoing enhancements could include using the org chart functionality in OnBase Workflow to facilitate automatic assignment and load balancing. The prescription/order is entered into Mestamed, and a customer service representative (CSR) calls the patient to collect demographic and insurance information. The CSR also qualifies the patient and lets him/her know about any potential problems or charges and schedules the delivery. A bar-coded work order is printed at the warehouse to accompany the delivery. Whether the customer calls or the call comes from a referral source such as the discharge clerk at the hospital, the CSR can provide immediate assistance, making Columbus Prescription an attractive option.
As preparations are being made to deliver the necessary medical equipment, the process for collecting reimbursement documentation begins. Most insurance carriers require specific information (in addition to the prescription) be collected prior to submitting a claim. This is often a certificate of medical necessity (CMN) or a detailed written order. Much of that information must come from the prescribing physician who must provide additional medical details that the insurance company requires. A custom Web-based application determines the paperwork that must be submitted based on the carrier, and the packet is faxed to the doctor for completion.
As these items are returned from the physicians via fax, they enter another workflow from which employees review them to make sure they are correct and complete. Once all documentation has been collected, the claim is transmitted electronically or, in a very few remaining cases, mailed to the insurance carrier. The better visibility into the status of incoming documentation has been invaluable to the Documentation Department, which Anderson estimates spends 75% of its time following up on document requests to doctors.
“Because we can’t bill until the equipment has been delivered, the work order that is printed in the warehouse is what really drives the process,” says Anderson. The bar-coded forms are signed by customers upon delivery and scanned when the driver returns using scanners from Böwe Bell & Howell and Panasonic Corp. equipped with Adrenaline® scanner controllers from Kofax Image Products, Inc. Adrenaline supports recognition of information encoded in the bar code, allowing those values to be used as OnBase keywords. Once a file contains the work order and all supporting documentation, it can be confirmed for billing.
The three locations in Dayton, Lancaster and Columbus scan a total of 3,000 to 4,000 documents a day between work orders, paperwork not received by fax and required documents specific to certain items. For example, when delivering medical equipment, employees must complete a checklist, fill out an evaluation of the home environment and provide specific instructions to the customer. To assure that these strict regulations have been met, these signed documents, which are generated from a custom application, are also scanned into the system. Keywords are automatically populated based on information in the document’s bar code. Workflow is also used to manage the internal auditing process. Random samplings of work orders are sent to auditing queues from which they can be reviewed before being confirmed for billing.
In addition to integrating with pharmacy management applications, OnBase also provides functionality that complements existing customer environments. For example, the same instance of OnBase is used to manage COLD reports generated by line-of-business applications, such as remittances; daily billing; daily, monthly or yearly financial reports and other reports that were formerly distributed as greenbars.
These greenbar reports often weren’t stored electronically, so the only records were saved in the printed reports that couldn’t easily be searched. “Pulling them into OnBase using COLD/ERM and making them searchable allows staff to pull up a complete record of a billing process, including what the bill looked like and how information was presented on it. If there is a problem with a claim, the user can search for the claim number to access it immediately and discuss it.”
Columbus Prescription recently completed a pilot project using the OnBase Archival API to use information submitted via intranet forms. Highly customized to integrate with a line-of-business application, these forms include electronic face sheets used to drive workflow for rehab services.
With OnBase, Columbus Prescription has improved its ability to collect revenue, increase service levels and reduce costs. The cycle time for procuring the documentation required to bill insurance carriers has been significantly reduced. Having all documents in a centralized electronic repository not only makes it possible to automate workflow processes, but it also allows the Documentation Department to share work, balance workloads, measure performance, report on throughput and perform other analysis to improve efficiency.
Reducing the cycle time for collecting these documents and immediate availability directly impact Columbus Prescription’s days sales outstanding (DSO). A biller can instantaneously view the complete patient chart as well as the entire transaction. In the past, the same employee would have spent hours in the filing room trying to locate these documents, assuming they weren’t in a stack awaiting filing. Consequently, primary and secondary billing is quicker, denials have been reduced and denials management is much easier.
“We live and die by documentation,” notes Anderson. "If there is a documentation deficiency, not only do we have to adjust the encounter in question; some carriers will take the error rate and extrapolate it to the whole population of similar claims they adjudicated. It is absolutely critical that we are able to audit charts on a timely basis.” In other words, the percentage of reimbursements that fail the audit process can be applied to all similar claims of a given period for that carrier, and that amount of money must be refunded.
The multiple filing rooms spread across Ohio have been replaced by three scan stations and a centralized storage location. In addition, the robust storage configuration provides the ability to replicate disk groups to a hot site which, combined with backups, provides for complete disaster recovery and business continuity.
As with all healthcare organizations, HIPAA forced Columbus Prescription to evaluate and document its personal health information (PHI) controls and auditing. OnBase has simplified this with granular security through document and keyword security. OnBase allows Columbus Prescription to impose the consistent security policies required by HIPAA, Medicare, Medicaid and the State of Ohio.
Known for its rapid deployment and ease of administration, OnBase also makes it easier to provide technical support. “It’s allowed us to create a homogeneous environment,” Anderson says. “Through Active Directory®, we’ve been able to deploy updates to the desktop application through a group policy, which has been a life saver. This makes upgrades totally transparent to the users.
“The acceptance from our users has been great, and we’re really looking at the future,” reports Anderson. “We’re working on a solution for our accounts payable right now and plan to expand OnBase to purchasing and human resources.”
- Reduces days sales outstanding (DSO)
- Improves ability to provide service to patients and referral sources
- Significantly reduced time and complexity of procuring documentation to support billing
- Multiple document filing sites for statewide locations consolidated in a single repository
- Facilitates measuring and reporting to evaluate and improve efficiency
- Supports compliance and disaster recovery initiatives
- CareCentric Inc. Mestamed® billing and operations software for home medical equipment providers
- J.M. Smith Corp. QS/1® pharmacy management software