Before a patient receives treatment
Billers verify patient’s insurance
Before a patient is seen by a doctor, billers need to verify that a patient's insurance plan(s) has active coverage and determine the benefits this coverage provides. Known as Eligibility and Benefits Verification (EV/BV), this work enables the practice to determine what types of care will be covered for the patient and estimate out-of-pocket expenses.
I led my team through the discovery research phase of this project to understand how billers approach and work through EV/BV. Our goal was to develop a new vision for more effective verification of patients' insurance coverage. This project was put on pause due to larger strategy changes.
@ Flatiron Health
Doctor evaluates patient to diagnose and prescribe treatment(s)
Patient goes for imaging
Some diagnoses require imaging (e.g. MRI, sonogram) in order to complete/confirm the doctor's diagnosis. Whether at a hospital or outpatient imaging center, the clinical staff need to manage their patients' appointments and communicate the imaging results back to the doctor.
We built a Radiology Information System (RIS) that imaging offices use to schedule appointments, perform exams, and manage results.
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Billers obtain prior authorization
When a doctor orders a high-cost or high-risk treatment, the practice contacts the patient's insurance company to confirm that the insurance company will reimburse the practice for the cost of treatment. Known as Prior Auth, this process must be completed before treatment can be administered.
We built and maintain a collaborative workflow solution that enables billing teams to receive and track prior authorizations for patients from insurers.
@ Flatiron Health
When a patient receives treatment
Pharmacist prepares medications
Some hospitals and treatment centers have an in-house pharmacy where medications are stored. A pharmacist and their staff manage medication inventories and ensure that medications are ready in time for patients' treatments.
We built a tool to help in-house pharmacies quickly and accurately gather pre-packaged medications, mix IV bags and custom medications, arrange them for pick-up by clinicians, and manage medication and supply inventories.
@ athenahealth
Clinical staff prepares to give treatments
Clinical staff administers medications
Whether a patient is at a hospital or an outpatient treatment center, the clinical staff (usually nurses) administers the right medication(s) to the right patient(s).
We rebuilt our Medication Administration Record (MAR) so that nurses could quickly and accurately retrieve medications for their patients, administer these medications, and document all of their work. Our new MAR resulted in saving 50% of nurses' time and auto-billing for 90% of medications on over $10M of transactions, and driving new sales opportunities.
@ athenahealth
Two clinicians administer “high alert” medications
Hospitals frequently need to give medications to patients that could cause serious problems if something goes wrong (e.g. opioids, insulin). For these "high alert" medications, a second clinician must validate and co-sign the administration.
We rebuilt a feature in the MAR that enables the second clinician to document that “high alert” medications were administered properly.
@ athenahealth
Doctor signs off on treatment and writes visit note
After a patient receives treatment
Billers submit claims to insurers
After a patient is treated, the practice submits medical claims to their insurer(s) to get reimbursed. Insurance companies all have their own rules, requirements, and preferences for the claims that they receive. There's very specific data and documentation that must be submitted, and with high patient volumes it's easy for the practice to accidentally submit claims that don't meet all the requirements. Claim submission issues often result in denials or partial payments.
We built a best-in-class claim scrubbing tool that automates comprehensive reviews of claims, improving billers' efficiency for identifying and resolving errors before submitting to insurance companies, speeding up reimbursement transactions.
I translated customer feedback into product requirements and prototypes used for rapid evaluation. I also developed custom front-end components and logic that enabled faster product launch.
@ Flatiron Health
Billers handle incoming payments
After claim submission takes place, insurers will send payments back to the practice with details about why or why not the entire billed amount is being paid. A core functionality of any practice management system, Payment Posting is the process by which payments and adjustments from insurance companies are documented, and next steps are determined (e.g. appeal, write-off, bill to patient).
We set the vision for rebuilding an existing workflow for allocating incoming bulk payments from insurance companies to their corresponding medical claims. We made iterative improvements to enable faster allocations
We also built a tool for managing patient payments over time for which I developed the front-end experience to reduce time to launch by 4 weeks.
@ Flatiron Health
Billers send medical bill to patient
After a patient's insurer reimburses the practice, there may be a remaining balance that becomes the patient's responsibility. Unfortunately, medical bills can be very confusing and hard to understand, which may lead to patients not wanting to pay; the less they understand what they're paying for, the less likely they are to make a payment.
We designed a coversheet to be given to patients at the time of payment that clearly explains their outstanding balance to them.
@ athenahealth
Billers manage payment issues
Administrative office tracks performance against payment programs
There are many government-run programs that exist to incentivize hospitals and practices to deliver high-quality care to patients. In order to attest to their high-quality care, hospitals and practices must produce their own analytics of treatment data to submit to the government.
We redesigned our Quality Management Reporting (QMR) product to deliver real-time actionable insights that would help practices identify gaps in their care delivery, as well as attest for government payment programs.
@ athenahealth