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Hospice and Home Care Org Automates Eligibility Verification
SphereGen Case Study
A Hospice and Home Care Organization (HHC) was looking for ways to streamline their eligibility verification process to save time and increase productivity.
Through Intelligent Automation, SphereGen automated the verification process from WellSky (Kinnser) to Waystar and over 6 insurance carriers. The automation also checks PECOS for physician authorization.
As a result, the HHC organization saves as much as 300 – 500 hours per month and can now process more admission cases with existing staff.
Hospice and Home Care Org Automates Eligibility Verification
SphereGen Case Study
A Hospice and Home Care Organization (HHC) was looking for ways to streamline their eligibility verification process to save time and increase productivity.
Through Intelligent Automation, SphereGen automated the verification process from WellSky (Kinnser) to Waystar and over 6 insurance carriers. The automation also checks PECOS for physician authorization.
As a result, the HHC organization saves as much as 300 – 500 hours per month and can now process more admission cases with existing staff.
O V E R V I E W
Verifying insurance eligibility for Hospice and Home Care (HHC) patients is a labor-intensive process, as multiple insurance carriers may need to be checked for one patient. Our customer, an HHC organization in Puerto Rico, struggled with this workflow as it was highly manual and time consuming for staff, particularly at month end when hundreds of patients need to be processed quickly. Their goal was to streamline their verification process, allowing staff to redirect time and efforts to patient admission.
Challenges
The time to verify insurance eligibility for one patient could result in a 10 – 15 minute transaction per patient, as the process required signing into and checking multiple insurance portals for each patient. When processing 50-60 new patients per day and as many as 900 patients at month end, this workflow was costing 300 – 500 hours/month. The tedious process was adversely affecting productivity in other areas of the business.
SOLUTION
By automating the eligibility checks, our client realizes multiple benefits. The verification is run before the staff begin their day when internet bandwidth on the island is greatest. The process runs quickly and only verification exceptions need to be addressed by staff. The automated verification process saves between 300 – 500 hours a month. With time saved, staff can refocus efforts on patient admission, improving patient experience and overall productivity.
THE DETAILS
RETRIEVE LIST OF PATIENTS
The automation bot signs into WellSky to retrieve a list of patients to verify and imports the list to an excel spread sheet. A bot reads through the Excel list identifying the patient ID and retrieving all insurance carriers which need to be checked for the patient.
CHECK INSURANCE CARRIER
Using the patient ID and any other necessary information (such as date of birth or MRN number), the bot signs into Waystar and the appropriate insurance portal and retrieves the patient.
Using a rules-based control, the bot checks that the patient is eligible for the required service and that the insurance coverage will remain active through the date of the service. If verification is confirmed, a report is printed to a pdf and filed in an appropriate folder. That pdf is uploaded back to WellSky.
VERIFY PHYSICIAN AUTHORIZATION IN PECOS
In addition to checking for eligibility status, the bot also checks PECOS to ensure any associated physicians are authorized for the appropriate insurance carrier. Upon successful verification, the provider’s details are printed and uploaded as a pdf to WellSky (Kinnser).
EXCEPTIONS
Any verifications which cannot be certified are written to a report for manual review. If the bot has trouble signing into an insurance portal, email alerts are sent to the appropriate people to notify them of run time issues.
CONCLUSION
By automating Eligibility Verification, our HHC client was able to streamline their workflow and realize huge time savings. Time saved was used productively to improve patient experience by focusing on admissions and providing services to more patients.
Implementing Intelligent Automation provided the ability to greatly enhance process optimization without instigating major system changes or disruptions.
Staff is happier to be rid of tedious data processing and have more time to focus on work which provides value to the patient and the organization.
View and download this case study here
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