The future of Revenue Hand Held Technology

Transcription

1 HFMA: 16 November 2017 The future of Revenue Hand Held Technology (Automation of Financial Processes) Stuart Pendrich Manager, Finance Technology & Service Improvement

2 2 Introduction Automation of Financial Processes Electronic Forms (eforms) Banking Reconciliation Application Testing Hand Held Technology Smart Phone Application There will be no promotion or recommendation of technologies or systems

3 3 Electronic Forms (eforms) Background Forms need to be completed by patients and medical staff to support claims against insurers. In addition to the manual completion, verification and storing (scanning and filing) of these forms there is a requirement to complete summary details in the billing system. Examples of forms: Current development phase: Patient Admission Election HC21 (National Private Hospital Claim Form) TAC Claim Form Future development phases Health Fund Accident Form TCP Contract Workcover Claim Form 3B Acute Care Certificate Type C Certificate (Day Only & Overnight Stay Certification)

4 4 Electronic Forms (eforms) Automated Solution Outline A tablet based application has been developed that presents the electronic version of the above forms. The functionality will be extended to include the additional forms. The forms use integration to prefill with data from: Demographic, Admission, and Compensable Claim detail. The patient is able to: Complete data items specific to the funding stream, and Sign (on screen). The required data is then passed to the billing system together with rendered PDF documents. With TAC Claims, data is sent to TAC and the Claim Authorisation details are subsequently returned and then forwarded to the billing system.

5 5 Electronic Forms (eforms) Pros & Cons Pros No lost forms Data redundancy is minimised (within Alfred Health and partner agencies) Data is more complete and valid (mandatory compliance imposed) Significant time savings Cons Technology choices

6 6 Banking Reconciliation Background The process of validating payments into the bank with receipts processed into the billing system is a horrendous manual process. It is made more difficult by the volume of transactions from different transaction types (eg Hospital or Service Provider claims) and Payors. All of these have different payment identification logic.

7 7 Banking Reconciliation Automated Solution Outline An application has been developed that uses extracts from the billing system and imported bank statements. The application uses data masks to extract and match data strings from both sources. Where a match is found: the reconciling process is completed. Where a match is not found: a secondary process enables a user to review and manually reconcile detail.

8 8 Banking Reconciliation Pros & Cons Pros Simplified and standardised Bank Reconciliation process Ability to run Bank Reconciliation more frequently (with less staff effort) Significant time savings Cons Development and maintenance of the Payor data masks Billing system issues (ECLIPSE Payor is not the Claim Payor) Still some reconciling that cannot be automated

9 9 Automated Application Testing Background The validation of billing applications is extremely complex with severe consequences if the testing processes are inadequate and/or time constrained. This applies to: Acceptance Testing of new applications, or Regression Testing for application upgrades It is a tedious and frustrating activity. The test results are often confused / masked by data entry errors

10 10 Automated Application Testing Automated Solution Outline There are many different testing automation tools but basically these do the same thing: Enable the scripting of User Test Cases That is, automate the review of inputs and the outputs against defined criteria Enable the application and verification of multiple Data Sets against each User Test case Most significantly: Enable consistent and repeatable testing A User Test Case is documented as: Test Objective Precondition Steps Test Data (initial test run) Expected result Post-condition/notes

11 11 Automated Application Testing Pros & Cons Pros Enforces a testing discipline Removes confusion between data error and defect Repeatable test processes Time a large upfront effort, but testing timeframes reduced Quality the consistency testing outcomes Re-usable test cases (and in some cases test data) Cons Investment in Automated Testing Application (cost and learning curve) Upfront effort Adoption by business SME (almost a systems type approach to documentation)

12 12 Smart Phone (Hand Held) Application Background The validation of billing applications is extremely complex with severe consequences if the testing processes are inadequate and/or time constrained. This applies to: Acceptance Testing of new applications, or Regression Testing for application upgrades It is a tedious and frustrating activity. The test results are often confused / masked by data entry errors

13 13 Smart Phone (Hand Held) Application Automated Solution Outline This application will use custom middleware to push data between the billing system and an application on the end users smart phone. The middleware will use defined data sets for: The standard services billed for in each clinical unit The Service Providers in each clinical unit The Billing, Review and Escalation schedules This data will be mixed with Patient and Admission data to build a billable patient data set that will be pushed to the Smart Phone applications. On completion of the billing details by the Service Provider, the billable services will be pushed into the billing system. Targeted Smart Phone types: IOS Android

14 14 Conclusion Is automation beneficial? Short answer is YES Will hand held be the future of revenue? Hand held will be part of the future of revenue