Services

276 Transaction

Approach To Transaction Standards

McBee Associates estimates that follow-up efforts can be reduced by 25% to 35% by implementing the 276/277 transaction standards. McBee Associates has developed a process for a provider to take immediate advantage of the transaction standards.

McBee Associates will submit the 276 transactions and interpret the resulting 277 transactions response remotely for a provider. The responses are interpreted into follow-up actions. These actions are categorized into efficient processes that will reduce follow-up time and improve cash flow.

McBee Associates approaches transaction standards in four phases:

• The implementation of a transaction engine to submit and interpret the 276/277 transactions
• Establishment of work rules
• Re-engineering the follow-up process to take advantage of the standards
• Monitoring the results

Transaction Engine

It is estimated that 60% of the effort in account resolution is spent obtaining the status of an account. The remaining 40% is spent on account resolution. The HIPAA 276/277 transaction provides a facility with the opportunity to improve follow-up efficiency by electronically

• Obtaining account status
• Identifying the next follow-up action required
• Categorizing the follow-up actions
• Monitoring productivity

By utilizing the transaction standards, a provider can develop an efficient process to concentrate efforts strictly on account resolution and significantly reduce efforts devoted to obtaining account status. Unfortunately, most health care information systems do not have the ability to utilize the transaction standards.

McBee Associates can implement the transaction engine to interpret the transaction standards and categorize follow-up actions required. The engine is a cost effective method to take advantage of the transaction standards while the provider information system vendor develops these capabilities.

The transaction engine processes status inquiries on all accounts each week. Normally, the results of the inquiries are returned within twenty-four hours. By analyzing the results of the inquiries and comparing the account status to the prior week’s status, the engine will generate a work list for the follow-up function. The work list provides an efficient method for follow-up personnel to resolve accounts. It also simplifies the training of follow-up personnel.

McBee Associates will establish a Virtual Private Network (VPN) with the provider to obtain a download of account information. The information is processed weekly by McBee Associates. The work list and trend analysis are available the following work day on a secure web site. The provider’s financial representatives are able to directly download their work list. Hospital management is able to download reporting that summarizes the response results. All software and processing is maintained on McBee Associates servers.

Establishment of Work rules

The resulting 276 transaction can result in a 277 transaction that will provide up to three statuses on each account. The work action required to move the account to the next stage of the collection process depends on such factors as the account status, age, balance, weeks in the same status, patient type, payer, etc. The possible combinations are in the millions. The work rules categorize the combinations into specific actions that need to be taken by follow-up staff. A work list will be developed based on the facility’s structure for follow-up.

Re-Engineering

Follow-up can be categorized into two functions: obtaining account status, and obtaining account resolution. 60% of the effort in most institutions is utilized in obtaining account status. The 276/277 transaction standards allow a provider to automate the process of obtaining account status. Implementing the 276 transaction will enable a provider to concentrate efforts on account resolution which will significantly improve cash flow.

McBee Associates will work with the provider’s management to establish a process to utilize work lists with current follow-up staff. By concentrating efforts on actions that will move accounts to the next collection stage and eliminating the manual process of obtaining account status, a significant percentage of the follow-up function will be reduced. This will enable the follow-up staff to be directed to other functions. For example, the staff could focus their efforts on outpatient accounts that may not be adequately worked in the current structure.

We anticipate the re-engineering process will take one-two weeks to design, train and implement. McBee Associates will first assess the current follow-up process and document processes in place. We will then redesign the follow-up process to utilize the transaction standards, review the redesign with management and, once approved, implement the process.

Monitor the process

McBee Associates will monitor the follow-up process and provide adjustments to the process on a weekly basis for the first two months and monthly thereafter. Reports will be produced to analyze the issues that arise in the follow-up process. For example, the instances of bad subscriber numbers, invalid HCPCS codes, and MSP issues will be tracked. The provider will be able to identify specific operational deficiencies.

By implementing modifications to correct these issues, the number of accounts that require manual intervention will be reduced and cash flow improved. This proposal does not include implementing the corrective actions. McBee Associates will also monitor the impact on cash flow and productivity.