Background:An $80MM medical service company had discovered a billing problem with a large number of items aged over 180 days that had never been billed to the patient or their insurance company. Samuels Consulting was engaged to survey and analyze the current operations, customer service and billing processing areas to understand the cause(s) of the problem, specify key areas to be addressed in a new billing system and to recommend interim solutions to prevent a re-occurrence prior to implementation of the new system.

Approach

• Agreed upon the project deliverables
• Reviewed all documentation of protocols, workflows, accuracy/timeliness standards and status reporting
• Interviewed managers and leads in each area to understand their roles, responsibilities and deliverables
• Personally observed and interacted with employees performing each product/service workflow step to understand the impact on the billing system. Compared the observed actions against documented protocols and workflows
• Tested/measured key service delivery metrics to determine the current state of billing aging
• Identified 4 key solutions and the expected results to improve accuracy, efficiency and control in the service delivery/billing process (BP)

Understanding the detailed workflow

Direct observation and interaction with employees and managers performing each function provided insight regarding:

What is really happening in the product/service delivery workflow at a detailed level. Contrasting this with the expected protocols and workflows provides the business with data on what needs to change to accurately execute the current service delivery/billing process. Examples of subjects addressed:

• How is work assigned and prioritized?
• How are jobs defined?
• How are decisions made?
• How are backlogs handled?
• How are errors/problems reported and addressed?
• How does the staff communicate/interact with their management and internal/external resources or stakeholders?
• How are customer/client communications managed?
• How are protocol/workflow changes communicated?

Areas of insight

1. Fix the current inventory/billing measurement/reporting system. How did our independently measured metrics compare with prior reporting? Where/how do gaps or misinterpretations of data occur? Implement a controlled process for handling/reporting exception items that do not ‘fit’ the standard workflow and therefore become ‘lost’.
2. Where do hand-offs of inventory items cause billing/customer service issues? Organizational alignment to improve communications and accountability for service delivery and billing.
3. Develop/augment product knowledge and management skill sets required to successfully execute the optimal business process (BP). A key result was the elimination of ‘firefighting’ by implementing problem/exception handling processes to address the issue and utilize the knowledge to minimize future occurrences.
4. Utilize technology to replace manual data gathering/reporting to improve quality/accuracy, efficiency, timeliness and management metrics and staff efficiency.