Humility of Mary Health Partners

Explanation of Benefit Forms

Humility of Mary Health Partners (HMHP) is a region of Catholic Healthcare Partners, the largest health system in Ohio and the seventh largest not-for-profit health system in the United States.

With facilities throughout Mahoning, Trumbull, and Columbiana Counties, Humility of Mary Health Partners is proud to be the area’s preferred provider for health care services.

The Problem:

When services are provided to patients, claims for the payment of these services are submitted to third party payers (insurance companies, government agencies, 3rd party administrators, etc.). Payments are made to the providers in the form of a check or electronic funds transfer. Accompanying the payment is an itemized report of the claims included in the payment. Typically several patients are paid with a single check. The itemized report is then used by the provider to post the payment to each patient’s account. Often the amount received doesn’t fully satisfy the outstanding balance and then requires them to either submit a secondary claim or bill the patient directly for the difference. The challenge for the health care provider is to create a filing system that allows them to easily retrieve an EOB that lists multiple patients in order to submit a secondary claim or to perform collections for the unpaid balance for a single patient.

Aside from the daily paperwork, HMHP had a backlog of almost 400,000 im- ages that they needed to have imaged in a short amount of time. The staff found that they were spending too much time searching for their documents. The previous process involved doing a “print screen” of the posting, then send- ing a person to a back room for retrieval of the explanation of benefit (EOB). In the back room, there were three temporary staff members that would then look the payments up manually and make a copy of them. They would then attach them to the print screen and send them back to the requester.

The document ended up changing hands three times; from the person making the request, to the person filling the request, and then the person send- ing it back. As can be imagined, the process was much slower, not to mention that if the EOB was filed incorrectly, they were not able to find it.

The Solution:

FileBound provided the perfect solution to HMHP’s process challenges. FileBound allows users to build a process that minimizes the labor required to file and retrieve EOB documents. After the EOB’s have been posted to the accounting system, they are batched according to how that system processed them (typically posting date or batch ID number). These batches are then scanned and indexed by the batch ID or posting date. The scanned batches are run through an OCR (optical character recognition) process that indexes all the words off of the documents. This allows the provider to lookup a payment in the accounting system to get the batch ID informa- tion; they then enter that value into the FileBound system along with a name, amount or claim number and search for the pages within the batch that has this information. Once these pages are found, the system allows you to use a “white-out” process (redaction feature found in annotations) to reprint a version of the form that only shows the information for a single patient as mandated within the HIPAA regulations. This is then used as a backup attachment for secondary claims or in collections.

During the conversion process, GBS completed the backlog in three months. GBS also arranged for daily pickups to ensure that the staff was able to access their files the next day. For the 60 users, plus six at offsite locations, approximately four million images are now available right at their fingertips. Redaction tools have also alleviated many of their HIPAA compliancy concerns.

FileBound Results:

By implementing the FileBound solution, HMHP was able to empty two rooms. One of the rooms is no longer needed and has saved them office space costs and the other room was converted to an equipment room. Additionally, offsite storage space has almost been eliminated.

Above and beyond the FileBound system, HMHP said that the number one asset of having GBS was the out- standing customer service and prompt response to their needs. HMHP saved time in the start up of the project because GBS also coordinated and conducted all of the training, which had been done by management staff for projects like this in the past. HMHP was able to realize a fixed annual savings of approximately $75,000 per year.