GraCom Services provided billing and facilities management services to small medical clinics in Arlington and Irving in the early 90s. They wanted to connect 4 clinics to a central billing and business office. They wanted to use different medical billing programs for different clinics, based on their size, but they wanted to use a single custom program for collections work with insurance companies and patients.
Most interesting business challenge: understanding insurance billing and collection practices. My research involved gaining an understanding the state of the insurance collections art, and incentive based pay systems. We eventually adopted a case management process, where each patient had a case for each malady. The work for the collections staff was non-stop, and they found it impossible to get a sense of progress or accomplishment. We created statistics for the number of cases produced in a month, and then tracked the performance of the collections staff individually and collectively to create a "scoreboard" so that they would have some kind of feedback, and some sense of when a job or job cycle ended. We also designed compensation based on those statistics.
Most interesting technical challenge: converting the data from the two billing programs into the collections program. This turned out to be more difficult than simply mapping data fields from different formats because the organization of the data was different in all three applications. We defined what was atomic and what was summary and produced a solution that was effective: we batched the charge details, the summary patient info, and the payment info from each billing program into the collections program.
Buzzwords: Stage, Medical Billing, MS Access, Data Conversion