Hoyleton Youth & Family Services Reduced Invalid Claims By 100% With GLSS
Illinois
Social &
Public Sector
Finance
100%
PROJECT SUMMARY
- Business Case:
- Increase time efficiency
- Reduce duplication of work
- Reduce rework due to defects
- Increase worker satisfaction
- Root Cause Analysis:
- CIS has more built-in mistake proofing, preventing errors
- Solutions Implemented:
- Migrate all BH salesforce work to CIS
- Project Result: Greatly reduced invalid claims from 41 to 0
Hoyleton Youth & Family Services is a nonprofit that provides mental and behavioral health services, including counseling, crisis intervention, foster care, therapeutic residential care, and Hispanic community support.
These services, contracted at set frequencies throughout the fiscal year, are reimbursed via grants or billed through insurance, including Medicaid. Organizations like Hoyleton Youth & Family Services face numerous challenges, such as limited funding, staffing shortages, and reimbursement delays due to complex billing and documentation requirements. These reimbursement delays can strain financial resources and cash flow, greatly impacting their ability to provide much-needed services.
Behavioral Health claims are processed in 2 systems: Salesforce and CIS. A sample of nearly 500 claims was collected to confirm that, in fact, about 41% of claims are invalid (Figure 1) and cannot be submitted to the reimburser.
Surprisingly, Salesforce accounted for 53% of these invalid claims, while CIS identified no invalid claims. (Figure 2)Â The root cause analysis revealed that CIS had better error-proofing and integration with the Medicare site, MEDI, which ensured services were billed correctly.
When engaging in a revenue cycle management project, it’s important to consider all the sources of errors while at the same time resisting the urge to apply a multitude of workaround solutions or Band-Aids that donât adequately address the root cause. I’s important to collect as much information as possible to differentiate the symptoms of a process inefficiency from the inefficiency itself.
The innovative instructional design and results-focused approach of GLSS Training & Certification played a pivotal role in this project’s success. By equipping the Hoyleton team with the right knowledge and tools, they were able to accurately diagnose the root causes of billing issues and implement an effective solution. This comprehensive training ensured a seamless transition from problems to solutions, leading to a remarkable 100% reduction in invalid claims.
With GLSS, Hoyleton was not only able to solve their immediate problem but also establish a foundation for future efficiency and success.
This Lean Six Sigma Case Study was completed in collaboration with Illuminative Strategies, Inc., a management consulting firm offering business process optimization, project management, and more to clients throughout the United States & Canada.