Case Study: Data Management

Version 3 Oct 2010

Background The client is an international healthcare organisation and UK largest private hospital group caring for thousands of patients from around the world every day. The company has centralised the patient billing and patient accounts management process in a Central Billing Office (CBO) facility in London. The collection of patient dues, as such, is governed by a series of complex processes. This complexity is further compounded by very high volume of transactions and a wide range of patient categories that include insured, uninsured, inpatient, outpatient, etc. In order to build efficiencies the client bifurcated the collection process, retaining the front end patient management activities (including billing) onshore and outsourced the collection of patient dues to MeritGroup. Challenges Prior to outsourcing, in addition to managing a large number of patients, the CBO management team faced a number of challenges in terms of the collection of patient dues: Meeting very high (and constantly increasing) monthly cash collection targets of 3040m per month Keeping debtor days to a minimum Keeping the billing days (the gap between when a patient leaves the hospital and when they receive their bill) to a minimum. An escalating use of overtime and temporary staff with attendant costs A shortage of physical office space in the existing facilities In addition to the local audit and regulatory norms the CBO had to conform to a host of Sarbannes-Oxley audit procedures as the parent company was US based. The delivery of the services had to be undertaken, via high security infrastructure as well as in accordance to tightly specified processing procedures.

The Process The collection process involves: Recording a series of administrative and insurance details and in many cases checking that insurance cover is sufficient. Invoicing and issuing follow-up letters on patient accounts. Providing inbound help desk services for patient administration queries. Liaising with insurance companies on specific patient accounts. Handling payments via credit card, bank transfers, etc. In order to mitigate the challenges of outsourcing, Merit developed an integrated solution that combined the power of technology and that of an efficient workforce to effectively deliver services. IT Systems: The client already had a comprehensive system security in place, complete with password protection, firewall, use of security keys (key fob), that Merit duplicated in Chennai. Merit implemented a thin client component on each agent PC enabling staff to login to the clients central billing system over the internet. Process Maps: Step by step procedures of all activities were documented in a comprehensive format, along with exceptions. This was useful to client itself in reaffirming its own handling guidelines as well as enabling Merits staff to get started with clear direction. Training: A significant amount of time was spent in training 6 core members in-depth on the process and escalation procedures along with the CBO for an efficient and coherent Client Benefits queries. resolution of From the time the process was outsourced the CBO has exceeded its performance targets on cash collection, debtor days, etc. This success has been unprecedented in the organisation. Initially, the client invested significant time in assisting the Merit team. However, this has yielded rich dividends in terms of increased management time to be channelised into other activities. The CBO now has more time to address complex patient accounts, overseas accounts, and long standing insurer accounts. A. bigger workload is now being accommodated without recourse to new recruits, temps or staff overtime. Also, working with the management of one outsourcer is much easier than recruiting, training and managing changing team members over a long period of time.