ARA Floats an Automated Billing Process… And Inhales

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The 65-radiologist Austin Radiological Association is well known for its robust information technology deployment throughout central Texas. Nonetheless, the practice’s billing department, which billed close to a million procedures last year, was awash in the same paper that plagues smaller, less sophisticated practices. Enter Laura Casey, business office director, who partnered with CIO R. Todd Thomas, and a team that included representatives from both departments, to design and write software architecture for an automated billing process that eliminated processing paper.

Using an HL-7 interface engine, a document scanning application that can retrieve text from a document and export that data into a database, and an in-house software engineer, Casey, Thomas, and team devised the new process over a period of a year. And after an initial two-month testing period, the results are very promising. Review of the initial automated charge transactions indicates the practice is within one percentage point of the previous year’s collection rate, claims and patient statements are accurate, and the billing staff has been reduced by 75%.

To fully appreciate the achievement of the new system, it is important to review the former process. “The old process was all about managing our paper radiology reports and patient demographic sheets,” Casey explains. “We would touch each radiology report approximately six times to manually key demographics and charge transactions into the billing system. We organized the paper into batches by date of service and facility. Understanding that an entire hospital’s date of service does not arrive to our facility on the same day, but trickles in over a period of a week or so, we had to organize the paper into batches by date of service and facility and then wait until we thought we had everything for that day. Our next step, to ensure proper 76 and 77 modifier coding, was to alphabetize the batch by patient name.

“The sorted and alphabetized batch was then reviewed by a coder and coded the old-fashioned way; taking the pen to the paper. Once the coder completed a batch it would head back to the same group of people who sorted and alphabetized it. They would log onto a hospital browser, find the demographics appropriate for that exam, and create more paper by printing the face sheet from the browser. Finally the batch would move on to a person who would enter the data into our billing system. From that point the billing system ensured the claim was on its way to the payor.”

“It took 20 people to create charges and update accounts last year,” continues Casey. “Another challenge rested with not knowing what was lost or missing. It was really hard to know what we were missing. We created a missing process, where we compared our billing data quarterly to the hospital’s data to learn which reports had and fallen prey to paper jams, empty toner cartridges, or lost faxes. Our missing process unearthed many lost pieces of paper, and it was effective. However, when we received our new-found missing reports, we had to process the paper through all that the steps I just described.”

Clearly, the manual system was cumbersome, with many potential failure points along the way. “The real pain point for us was getting the charges into the system,” Casey notes. “We knew we’d have to continue coding them manually, and chose not to automate the coding process with coding software, because the larger cost burden resided with all of the people sorting the paper, printing the demographics and then finally performing the data entry.

ARA’s goal was to reduce all of that effort, and to do it in such a way that would be scalable. The practice had served Austin since 1954, and wanted to maintain the same high level of customer service as it grows along with the thriving city. So, the question, according to Casey, was this: “How do we bill more accurately and timely without incrementally adding the most expensive cost to the equation: people?”

When discussions began internally about creating an informatics-based fix, Thomas happened to be looking at an HL-7 interface for another project he was working on. So Thomas assigned one of three staff software developers, and provided him with the HL-7 interface engine and another product called Captiva, an application owned by EMC that is able to scan text the off documents and faxes and export that data into a data base.

“Technically, we had to marry the two pieces of the puzzle,”