Kovach Jamison V, Borikar Shrutika
Project Management Program, College of Technology, University of Houston, Houston, Texas (Dr Kovach and Ms Borikar); and Hyve Solutions, Fremont, California (Ms Borikar).
Qual Manag Health Care. 2018 Jul/Sep;27(3):165-171. doi: 10.1097/QMH.0000000000000175.
Health systems typically lose approximately 3% to 5% of net revenues annually due to insurance claim denials. While most denials can be appealed, the administrative burden of sorting through and appealing them can be time consuming and delays the revenue collection process. This article describes how the Lean Six Sigma methodology was used to improve the revenue cycle by reducing insurance claim denials for a leading pediatric hospital in the United States. The use of this approach is demonstrated through a case example focused on reducing denials by improving the hospital's Emergency Center registration process. Multiple pilot tests were performed to ensure the proposed changes sufficiently addressed the problem of missing/incomplete insurance information. Results indicated that the revised registration form reduced missing/incomplete fields by 67%. As a result, the revised form was implemented, which helped greatly reduce insurance claim denials. In addition to providing an example from which other health systems can learn to successfully implement Lean Six Sigma to enhance the performance of their revenue cycle, this work helped the hospital in which this research was performed improve its patient experience by making it easier for patients to complete their Emergency Center registration form.
由于保险理赔被拒，医疗系统通常每年会损失约3%至5%的净收入。虽然大多数拒付可以上诉，但梳理和上诉这些拒付的行政负担可能很耗时，并会延迟收入收取过程。本文介绍了如何使用精益六西格玛方法，通过减少美国一家领先儿科医院的保险理赔拒付来改善收入周期。通过一个案例展示了这种方法的使用，该案例重点是通过改进医院的急诊中心登记流程来减少拒付。进行了多次试点测试，以确保所提议的更改充分解决了缺失/不完整保险信息的问题。结果表明，修订后的登记表将缺失/不完整字段减少了67%。因此，修订后的表格得以实施，这极大地减少了保险理赔拒付。除了提供一个其他医疗系统可以借鉴的例子，以成功实施精益六西格玛来提高其收入周期的绩效外，这项工作还帮助开展这项研究的医院改善了患者体验，因为这使得患者更容易完成急诊中心登记表。
