RCM “Pro-Claims” Business Process Improvements with Document Automation Solution

Labor costs

Processing time

Billing and claims

Customer: RC McLean

Industry: Healthcare and Insurance

Application: Billing and Claims

RC McLean (RCM), based in Southern California, provides billing and management services to anesthesiologists and other specialists. Over the past 30 years, their services consist of billing, collections, reporting, programming, medical records, contracts, consulting, utilization studies, compliance, third-party credentialing, capitation arrangements and blended unit payouts for their clients. Most of these records and documents require intensive, manual data entry.

The Challenge

RCM processes several thousand claim packets per month for their clients. Mondays are their heaviest volume and they can see up to 800 packets per day. These packets usually have about 3 or 4 pages, so RCM had a Data Entry team of 4 employees that manually keyed in the data. Management recognized this was a costly, inefficient process and wanted to go paperless.

Prior to the start of the project, RCM’s process was to receive claim packets through several different methods such as email, direct mail and FTP transmission and enter it in an enterprise content management tool. For direct mail, an employee would manually sort the documents, key in the data into their billing system. “The number of documents we receive was enormous and created manual, labor-intensive work for our employees,” stated Beth Turnbaugh, Director of Billing Operations at RCM.

A strategic Ephesoft partner recommended the intelligent platform to transform RCM’s inefficient processes and automate their document capture volume, along with reducing of the amount of paper handling.

The Ephesoft team was easy to work with, and they did a great job by improving our technology so our employees can focus on higher-level tasks and less data entry. Processing is much faster using Ephesoft. What used to take us 3 days, now only takes less than half the time.

– Isabel Henson, Quality Control Manager at RCM

The Solution

Ephesoft’s Professional Services team worked closely with RCM to set up a solution to extract, classify, review, validate and export information from their medical packets. RCM utilized the Professional Services team to configure their environment and implement the advanced document capture software. First, they set up a “watch folder” and email account to monitor the incoming documents. The team determined there was nine document types they wanted to capture: Billing Ticket, Anesthesia Report, Patient ID, Insurance Referral, Medical Necessity, Consent Form, Procedure Report, Waiver and Facesheet/Patient Registration with 15 variations.

“The Ephesoft team was easy to work with, and they did a great job by improving our technology so our employees can focus on higher level tasks and less data entry,” said Turnbaugh. Some of RCM’s data entry team was reallocated, saving in labor expenses, especially as the full-time employees converted to part-time employees once the system was running. “Processing is much faster using Ephesoft. What used to take us 3 days, now only takes less than half the time. We only need limited supervision for the review and validation exceptions,” explained Isabel Henson, Quality Control Manager who oversees Ephesoft software at RCM.

“In terms of billing, what’s great about Ephesoft is that it scans and classifies all of our data. We no longer need to walk over to filing cabinets and look up information in the files. This is a huge benefit.”

— Beth Turnbaugh, Director of Billing Operations at RCM

Henson, who monitors the batches in Ephesoft explained, “I use the Batch Maintenance feature quite often because it shows me the status and ratio of where the jobs are. If a batch ‘errors out’ for whatever reason, the tool alerts me to where the error occurred and what stage so I can easily fix the problem.” Overall, the company has reduced costs and increased efficiency, which impacts their bottom line.

Once the batch classes were created, the team set up extraction rules to pull metadata from the Facesheet document type for 23 index fields. A fuzzy database was created to look to a link server. The extracted data was configured to export an XML and associated multipage TIFF to a folder into OnBase. In addition, custom scripts were needed for specific requirements. Essentially, the configuration allowed RCM to scan the documents and automatically extract the data, sort or classify the document types, review any exceptions, validate all the documents and once validated, export them into a repository. From there, RCM could easily search and find all the data captured for the claim forms, without the need to manually search for hard copy files.

Next Steps

RCM thrives on servicing the medical community and being on the forefront of using advanced document capture software on their Windows platform. “We’re excited to see continued performance and growth using Ephesoft,” exclaimed Turnbaugh.