Invoice Data Capture in Healthcare RCM

Introduction

The RCM major in context based in USA and offers all-inclusive healthcare and medical services. The ​healthcare service provider assists in collecting payments on submitted claims; boost revenue from low paid claims, and consistently follow-up with insurance companies for faster settlements. In addition, it supports institutions with medical billing and coding.

Problem Statement

The RCM was processing about 7,000 invoices/day with a manpower of about 80 people.

They were expecting a growth of about 7x after securing a multi-year deal with a large healthcare player and had to setup systems to process about 50,000 invoices/day in the next 2 quarters.

Challenges

They were suddenly facing the following major challenges -

1. Hiring Workforce - Scaling up the organisation in a short-span was an insurmountable task for the organisation.
2. Training Workforce - Training the organisation to perform the tasks at high accuracy and at large volumes daily would have required time & practice.
3. Managing Workforce - The organisation would have required much larger floor area to accommodate more folks, and would have also had to beef up it's mid tier management to handle the operations of the growing workforce.

The CXOs immediately realised that they workforce management of about 500 people only for coding invoices was practically impossible. The Innovation team in the organisation was tasked with finding a solution to automate the manual business processes involved.

Product

NanoNets worked closely with the Innovation and Product teams to customise the solution to make workflows that could be used conveniently by the current workforce. Image of the moderation UI is below -

\ The tool became the go-to moderation tool for the entire workforce. A phase-wise rollout was carried out to train the existing workforce and scale up the business processes.

The Impact

We helped the client achieve 7x scale, which was unprecedented. The implementation and adoption was super smooth. The organisation became very lean, and the processes became scalable. Due to this new lean model, the company was now saving about 50% of the money that it would have actually spent on its coding workforce alone.