Problem
A private equity firm, in midst of combining multiple local gastroenterologist practices to create a practice, ran into deepening process operational issues as it continued to bring more offices into its operation. Accurate accounting was increasing in concern due to manual entry of mounting insurance claim payments. With varied practice management applications, the accounting team was burdened with endless entries while lacking a system for sustaining consistent growth of the merged practice enterprise. Additionally, manually entered data was causing a logjam when the enterprise’s month-end books were being closed.
Solution
- Explanation-of-benefit data coupled with insurer payment data were posted daily in EDI format to an Oracle Integration EDI X12 parser.
- Payment distribution amounts for the practice and patient were extracted and posted to practice management systems (PMS) that expose cloud-API endpoints. For practice offices that utilize locally installed PMS’s, a custom REST API was developed to integrate with them.
- OCI MySQL database stores all transactions for historic reference, reporting, and analytics. A simple, easy-to-use user interface with search feature displays transaction records for accounting to review if a transaction needs to be cross-checked.
Impact
- The average claim payments received per day by the practice enterprise was 7,900. It required a team of 7 to manually reconcile. The average time to reconcile a single claim payment was reduced from one minute to 15 seconds.
- The practice’s reconciliation error rate was reduced from 5% to less than 1%.
- Time to close books at month-end decreased to 2 days from 9 days.
Next Step
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