Desktop Scanning Accelerates Revenue Cycle

As the healthcare industry slowly transitions from paper-based records to electronic medical records, providers have been faced with a myriad of new document management challenges annually, from back-scanning existing patient records to managing the bulk scanning of millions of consent forms and other paperwork.

Kaiser Permanente Georgia was an early adopter of electronic medical records and utilizes a variety of technologies to manage the mountain of clinical and billing documents the company processes each year. The company recently further streamlined its registration process with a new distributed scanning solution.

Kaiser Permanente serves 260,000 members and operates 15 medical offices in the metropolitan Atlanta area. As a fully integrated healthcare system, Kaiser Permanente provides to its members health insurance coverage (through the Kaiser Foundation Health Plan of Georgia) and medical services through its facilities, labs, and pharmacies (via The Southeast Permanente Medical Group, or TSPMG).

In 2007, the national Kaiser Permanente organization began rolling out a standardized revenue cycle across all of its facilities in order to streamline patient registration, member enrollment, charge capture, billing, and other processes.

One of the more significant changes to the registration process was asking patients for information about secondary insurance. When a member is covered by a secondary policy, the company is able to recoup a certain percentage of their charges from the other carrier (as much as 20% in some cases). In the past, that information wasn't gathered until after services had already been provided. Patients were typically mailed a questionnaire asking if they had any other insurance coverage, a time-consuming and not entirely accurate method. This not only delayed claims processing, but potentially deprived Kaiser Permanente of revenues it was due from other carriers. "In order to file those claims, you have to have the information about the other carrier, validate the coverage, and then coordinate benefits," says Cleve Shirah, revenue cycle manager for Kaiser Permanente Georgia. At the same time, Kaiser Permanente also began offering new coverage products to employer groups, which required new forms to be filled out during registration.

The company needed a way to scan these new forms and secondary insurance cards during registration and then route those images into the patient's electronic medical record. They also needed to collect this data without making the registration process more cumbersome for patients or staff. "We determined from the outset to look for a long-term solution in meeting this business need," says Shirah. "We needed a fast, secure way to collect, document, and store this patient information that would have the least impact on the registration process."

MULTIFUNCTION SCANNER FITS THE BILL
Representatives from multiple departments including members of the revenue cycle team, medical office administration, patient billing, claims administration, and the IT department were involved in the selection and design of the new document capture solution.

Kaiser Permanente has deployed a variety of technologies to streamline the delivery of care and claims processing, including an electronic medical record system (KP HealthConnect). The new scanning solution would need to integrate seamlessly with the existing IT infrastructure and be simple enough to avoid disrupting the workflow of the registration staff.

After considering a number of possible scanning devices, including basic flatbed scanners and photocopiers, the team selected the Kodak Scan Station 100, along with the AutoStore document capture software from Notable Solutions Inc. (NSi). Kodak reseller Image Access Corp. assisted Kaiser Permanente with the design of the solution.

According to Shirah, the company chose the Kodak units because of their ability to perform multiple functions (scanning, faxing, etc.), their cost, and the fact that the units made it easy for staff to send and store the documents.

SCANNERS SIMPLIFY REGISTRATION PROCESS
In conjunction with the new revenue cycle processes, Kaiser Permanente deployed approximately 70 of the Kodak scanners at its 15 facilities over a 12-week period in the spring of 2008. "We initially presented the system to the registration staff at each facility and explained what was coming and why it was necessary," says Shirah. "Once we had the scanners configured, we scheduled training classes at each facility to coincide with the go-live date at each location."

Registration staff use the scanners to capture regulatory forms and secondary insurance cards from patients during registration. Alerted by prompts within the registration system, staff ask patients to sign required forms and then ask them if they are covered by any other medical insurance. Patients who have other medical coverage are asked for their insurance cards, which are scanned into the system.

To make the process as simple as possible for the staff, there are two icons configured on the scanner's touch screen interface — one for ID cards and the other for paper documents. By clicking the correct icon, the system is configured to automatically scan the front and back of each document.

The system sends the scanned images in real time to the company's Vignette Image Capture indexing system. After metadata (such as member's ID number and date of service) are attached to the image as part of the indexing process, the images are routed to the member's electronic member record. Information from the secondary insurance cards and coordination of benefits (COB) forms is used by the patient billing office to validate coverage and file claims.

The new system simplifies information capture, processing, and sharing among departments and has streamlined registration workflow. "We don't know how accurate or valid the information was that we were capturing under the old process," says Shirah. "Weeks might have passed before we received information from the patient, and we couldn't process the claim until we had an answer. By moving this whole process to the front end, we've eliminated that entire waiting period."

DOCUMENT ACCESS SPEEDS BILLING, BOOSTS REVENUE
The business plan for the new scanning system included a four-year return on investment projection, based primarily on the company's ability to capture revenue from its members' secondary insurance carriers and by making the billing cycle faster. "We have made great progress in the collection of other insurance information from patients, which has allowed for a more efficient primary/secondary billing process to recoup revenue," says Shirah. "Implementing a uniform process also allowed for a more consistent patient experience and improved customer service."

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The company has reduced the days-to-bill and days-to-claim cycle by capturing accurate insurance coverage information earlier in the process and improved access to patient records for the billing and claims departments. "We didn't do a good job of capturing that information before, and the information was not easily shared among departments," says Shirah. "Now, the revenue cycle, patient business office, and claims administration department have access to that data for processing."

The system is also fully compliant with both Sarbanes-Oxley and The Health Insurance Portability and Accountability Act (HIPAA) requirements for maintaining the privacy of patient information. The solution has been such a success that Kaiser Permanente facilities in the company's Northwest region are in the process of implementing it, and staff there have looked to their colleagues in Georgia for assistance with the deployment.

Sweeping healthcare reform legislation is poised to emerge from the U.S. Congress at some point this year, and both healthcare providers and insurance companies will potentially face new regulatory requirements that affect the way they manage clinical and billing information. With a flexible and scalable document imaging solution in place, Kaiser Permanente Georgia is well-positioned to meet these new information management challenges.