SaaS Replaces Traditional CSR-Based Medical Records Processing Saving 50 Percent | Article

7808Physician’s Group provides billing and administrative back-office work for a network of medical providers in four states. These companies don’t deal with big healthcare plan providers that are highly automated. Most of the network’s providers do processing manually. In addition, they specialize in car accident victims not covered by traditional healthcare insurance. Their insurance companies pay patients according to the personal injury protection clause of their auto policy.

But every time Physician’s Group added a clinic, the network had to add new people to handle billing and payment processing. Unfortunately, more people didn’t expedite the process enough and errors were unavoidable. According to Vince Payne, CFO, Physicians’ Group, “Because it’s such a manual process, we needed to do a better job to keep our administrative costs in line and get our patients paid on time.” Using outsourced Optical Character Recognition (OCR) to process the payment forms turned out to be the key element of the solution.

The problems with CSR processing

According to Payne, the Physician’s Group’s customer service representatives (CSR) had to look at a wealth of information that could be anywhere on the form since they were not standardized. Error rates were thus greater with manual processing.

The SaaS provider, the OCR Service, offers outsourced OCR and in this case processed electronic Explanation of Benefits (EOB) forms – remittance that comes with the check to the patient. These are forms insurance companies use when processing payment of an insurance claim. Unfortunately, these forms are also nonstandard, so few companies can automate them well.

Like software as a service (SaaS), OCR Service’s customers rent OCR as a service each month rather than purchase it as an up-front capital expense. Upgrades and maintenance are included in the transaction fee. The Bureau’s application delivery is typically closer to a one-to-many model with a single instance, multi-tenant architecture than to a one-to-one model like application service providers. Customers are able to upgrade much more frequently than when they use installed software as well, so they get the latest functionality promptly. The end result is guaranteed accuracy for the fields extracted within agreed-upon turnaround times.

An overview of the SaaS OCR solution

According to Kevin McQueen, Director of Marketing and Sales, OCR Service, the OCR process works as follows. Physician’s Group receives paper forms and sends them over the Internet to OCR Service

OCR Service starts data extraction in its own workflow using 15 different software applications and components to recognize the characters their customers want lifted from the form. That involves looking at the form, launching the OCR process, and physically looking at the forms again to validate characters. This eliminates false positives – say, misrecognizing a “7” for a “1” when examined side-by-side. In all, OCR Service does triple validation to make sure the lifted information is correct. Then it converts the lifted data into the format needed to load it into the customer’s Practice Management system and transfers it via the Internet.

“We also let the customer interface with our application for better exception management,” McQueen continues. If the OCR Service has a problem with the form being processed that doesn’t follow the business rules set up by two companies, OCR Service lets the customer look at the form while it’s still in the OCR Service’s workflow. There the customer can fix the problem in the form and release it so the Bureau can continue the data extraction process.

According to McQueen, “OCR Service can find any field on any form.” This differs from a traditional in-house OCR solution that requires companies have multiple templates for each possible form that comes in. He explains the software his company uses “always looks at the designated field on a form. If you tell OCR Service you’re looking for the ‘doctors’ field, we’re going to find it wherever it is on the page.” Traditional OCR looks for this information in the same fixed position on the form all the time, he points out.

Related services that SaaS OCR offers

The OCR conversion process is complicated by other factors also. Payne says the OCR Service will ping the insurance company to keep its error code database up to date because they change often. This insulates Physician’s Group from having to check with the insurance companies to see if they changed.

OCR Service lets the customer store the resulting images digitally after they’ve been OCRed so customers don’t have to store their forms in cabinets on their premises as they did before. They don’t have to use an in-house imaging system that requires them to purchase storage, software, and servers.

What’s more, finding the form once it’s stored is easy. McQueen says OCR Service already has form index data from the OCR process. If customers want to find it, they just use that index.

The hard benefits of the SaaS OCR solution

The main benefits of OCR Service’s methods are that they reduce labor on the billing side. Says James Swafford, Lead Software Developer, Physicians Group, “We do not have to do a lot of manual check posting.”

The reports are critical too. Swafford says they put data into the CFO’s hands so he can see the big picture of how the company is doing financially. OCR Service offers specialized reports that tell their customers when payers fall behind, for instance.

Payne cites improved efficiency in getting payments posted into the Practice Management system. He explains that “this gives the company another level to check our cash in-flows and monitor the payment habits of the insurance companies to make sure we’re doing everything we have to do correctly.”

Swafford says EOBs are now integrated into the Practice Management system. The company used to have stacks of them that they had to retrieve manually. Now they can now access them digitally.

Finally, the system has improved the company’s bottom line. Payne says before OCR Service took over, the cost to post a check was 90 cents. That cost has more than halved to about 40 cents a check with the new system.

Lessons from the Outsourcing Center:

  • Billing and administrative back-office work for medical insurance providers can be a tedious and time-consuming manual process, especially for mid-range service providers. Using CSRs to manually do the work often doesn’t lower error rates or process the forms involved quickly enough.
  • Instead, using an SaaS service that provides optical character recognition eliminates manual processes. Outsourced OCR systems process the payment forms, and the expedited process both keeps providers’ administrative costs in line and gets patients paid on time.
  • With outsourced OCR, the supplier lifts the data required by the customer from the paper and gives the customer a digital file to upload into its workflow as efficiently, but more cheaply, as if it used offshore BPO.

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