Verastream Streamlines Host Access for Hospital Billing Specialist
Published: November 27, 2007
by Alex Woodie
Collecting insurance payment information from hospital computer systems was often a tedious and time-consuming process for Medical Reimbursements of America (MRA). When the company could convince the hospital's IT staff to run some reports, things went smoothly. But in many cases, MRA representatives sitting behind terminal emulators had to navigate through hundreds or thousands of screens to gather the necessary information. That began to change 11 months ago, when MRA installed the Verastream Host Integration product from Attachmate, which automated much of this work.
The billing departments of most hospitals are well equipped to deal with standard patient accounts, where only one insurance company is involved. But when there are multiple people at fault and several insurance companies involved--as is often the case in major accidents--the level of complexity quickly escalates beyond what the typical hospital AR team is prepared to deal with, and that's when Medical Reimbursements of America steps in.
Based in Nashville, Tennessee, MRA functions as an extension of hospital Accounts Receivable (AR) departments for patients injured in major accidents, which typically accounts for 5 to 10 percent of the total patient load at major hospitals. The company helps about 250 hospitals around the country by dealing directly with insurance companies and arranging for them to make direct payments to the hospital's AR department. Because full payment can only be received when insurance claims are issued in the right order, its very important that these accounts be handled correctly.
In addition to employing a team of lawyers who know the ins and outs of the health insurance business and a group of billing agents, MRA keeps a team of technical experts on staff to get access to the hospital information system (HIS) and patient account databases run by hospitals. While MRA often sees the same group of products and systems--including HCA, IntraNexus, Meditech, McKesson, and Siemens running across System i, System z, and Unix machines--the fact remains that every implementation of HIS software is unique, and requires a certain degree of customization to access, says Price Barnes, a business analyst who's worked with MRA for six years.
This forces MRA to be flexible in how it obtains its information. "It runs the whole spectrum. Sometimes we're able to get what we want, a data load or an extract. But since we're working only five to 10 percent of hospital AR, we're not going to be the number one priority for the IT staff," he says. "Sometimes we go into a client and they'll say we'll give you a connection to our system, and that's it. We really have to have as many tools as possible at our disposal to try to fully integrate with our clients."
If the hospital's IT staff is too busy to prepare weekly or monthly batch reports for MRA, it forces the company's MRA billing agents to manually access the HIS server, either through a standard terminal emulator running 5250, 3270, or VT (MRA uses Attachmate's Reflection product), or through proprietary client software (such as what is used to access McKesson's Star HIS application). "We try to bring as much standardization as we can, but at the end of the day, it's not our system," Barnes says.
Manually checking for payments can be very time-consuming. "In a fully manual role, the process is, 'I've got 1,000 open accounts, so I'm going to manually check every single account in the client's system and look for recent transactional activity, then print it off and hand it to someone else for processing,'" Barnes says. "It literally can take two days for someone, particularly if it's a slow system."
This manual information gathering was not only slowing down the receipt of payment for hospitals that contract with MRA, it was also slowing down MRA's own billing processes. Barnes recalls very hectic days at months-end, as billing agents scrambled to find nuggets of transactional gold in their clients' HIS systems, enabling MRA to close the account and invoice the hospital to garner its payment.
MRA attempted to standardize the manual process using scripts and software from Boston WorkStation, which makes task automation and scripting tools for healthcare IT environments. Barnes says the product works very well in a desktop environment, but that it didn't offer the level of enterprise functionality MRA needed.
Barnes eventually found a deeper degree of enterprise functionality in Verastream Host Integrator (VHI), a programmatic integration tool originally developed by WRQ and now sold by Attachmate. (The two companies merged in 2005.) With VHI, the company is able to automate the process of an agent sitting behind an emulator, navigating the screens, and obtaining information from hospital patient account databases.
"We're essentially able to treat their system as a database," Barnes says. "And as with any database, you can build procedures, so if I want to look for payments for a specific account, I can build a procedure that has a filter on it, pass it an account number, and it's going to return any data."
Once MRA has modeled a hospital's HIS software using VHI--a process that takes about two days--it's connected to a Windows-based case management system that MRA built in Microsoft .NET. "Basically it allows us to schedule and execute all of these jobs that contain the procedural code that we need," he says. "But the really cool thing about VHI is we model it, it cranks out a DLL for us, and then we just reference that DLL in our code, and it just fires off those procedures. It's really slick."
What sets VHI apart from other tools and techniques Barnes has tried is the level of knowledge VHI develops for host systems, and the intelligence it brings to system navigation. "The beautiful thing about the VHI design tool is you actually map out, or model, the entire system, so every time you encounter a new screen in the system, it prompts you to name it as an entity, and as soon as you save it, it says, 'Here's how you got to this screen. Do you want to save this operation?'" he says. "It almost builds a sitemap for the system, so if you happen to step outside of your 1-2-3 procedural steps, as long as there is a map of how you got from screen A to screen B," it will still be able to navigate the system.
MRA started using VHI in January, and today is using it with about 15 of its larger clients, representing about 30 percent of its total case load. (Because VHI requires a standard emulation interface, it's not able to work with HIS software that use proprietary interfaces, such as MediTech's. It's also not used in cases where MRA is able to arrange a data dump with the hospital's IT staff.)
While MRA hasn't conducted a formal return on investment (ROI) study, Barnes has seen the effect the software has had on the company. For starters, it's able to accomplish in about 10 minutes what it might take a human two days to do. As a result, MRA has not had to hire any additional agents to work with the hospitals where VHI is used, despite a company growth rate in the neighborhood of 30 to 35 percent per year. "If I had to guess, we've saved 1.5 to 2 full-time employees," he says.
It's also brought some sanity back to the hectic month-end process, Barnes says. "This has been able to bring a little bit of calm to the end-of-the-month process, because we're on top of it," he says. "It's really kind of brought a little bit of maturation to the company."
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