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. 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 clientβs 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
β’ 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
β’ 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
Technosoftβs engagement with the client started in July 2005, as
an extension of our clientβs 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
03www.technosoftcorp.com
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
β’ 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
β’ In some instances the patientβs 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
β’ Support for electronic billing via clearing house: For claims
sent electronically via a clearing house, rejection can happen
at the insurerβs 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
β’ Rejection process
β’ 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 clientβs 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. 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
β’ Employee productivity averages 25% or greater in the
functions than when we took over
β’ Cost savings of 35% within the first six months
β’ Accuracy improvement from 82% to 98% in less than a year
β’ Gained 5% additional savings through productivity target
revisions within 18 months
β’ System improvements resulting in significant cost savings
β’ Reduction in denials volumes by 7.5% resulting in accelerated
cash flow
β’ Support a greatly increased transaction volume while keeping
headcount steady
β’ 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.
www.technosoftcorp.com 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 clientβs 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 timesβeven 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.
