Stories to Tell
In may prior business working directly with medical providers to recover written off and uncollected underpayments on Virginia workers’ compensation medical claims, I developed a process to determine the accurate amount of an underpayment based on varies factors. In order to address these factors, I always asked a potential account to provide me with written copies of workers compensation network reimbursement agreements.
Often the responses that I received surprised me! The list of reasons included responses such as; what contracts, we don’t have any contracts, we lost them, we don’t know where they are, the last practice manager took them when she left her job, we let the agreement expire and there are in that file cabinet but I have no understanding of what the agreement says.
After hearing these same responses for years, I become convinced there has to be a way to stop this craziness. That is when I started trying to figure out a way to solve this problem. Working with practice administrators in the medical industry, IT professionals and software professionals I began forming different ideas on a software solution, this solution had to be user friendly, address the issue of contracts being difficult to understand and lost contract. In addition, the solution must be secure, accessible, fast and easy to use. While at the same time be affordable.
I spent tremendous amounts of time researching various solutions and found there was a great deal of software developed already available but there were common issues with each software that I found. I could not find a software that addressed my issues of being easy the use, address a specific problem, not require a great deal of clicking, be affordable and easy to access. My initial design was called Medical Contract Management Solutions (MCMS) but it was simply too complicated to use and understand. Starting over again I focused on simple common issues that practice managers told me they had. I kept going back to my original idea of being simple, easy to use and affordable. After a fair number of prototypes, I finally came up with Digi-Docs.
WHY IS DIGI-DOCS NEEDED!
“The story of the lost letter and contract” – While working with a large orthopaedic medical provider to recover underpayments on their claims that went back 5 years from the date of service. I often asked the practice billing manager for a particular network agreement and was told there was not one for this network. We began the process of trying to collect the amounts we thought were owed, had identified over 300 cases totaling close to $800,000.00 in underpayments. Shortly after filing these claims with the insurance company, they produced an agreement justifying their payments. I then went to the CEO of the practice to report what had occurred and was told in fact he had terminated this particular agreement. I asked for a copy of the termination notice sent but it could not be found. The CEO insisted he had sent a letter of termination so I decided to address this with the insurance company and was told they had no such letter. I kept pressing on and through an email exchange from the network manager was told in fact there was a letter of termination and the network simply did not terminate the agreement. I was provided confirmation of when the letter was received, the date of the letter and when termination was to take effect. After receiving this information, my company was able to settle 279 cases in one hour totaling close to $750,000.00 in recovered revenues. My company was paid over $225,000.00 in fees. Happy day for my company! Why is this story important? Because of poor contract management, poor document management, and poor communication between staff this practice was underpaid for years on their work comp claims. It was a great day for my company but it left me with the impression that this situation could have easily been avoided. When thinking about what I wanted the Digi-Docs application to be able to provide, I often thought about this medical practice. This was not the only practice that I worked with in which this same situation occurred.
“Makes my life easy”- I owned a consulting firm that was hired by an out of state medical company to obtain copies of reimbursement contracts for a group of practices that planned to merge together and form a “super group”. The time, expense, effort it took to collect and organize all the information was daunting. We spent a year collecting all the information. By the time we were done with this assignment, we had used several 5-inch three ring binders to house this information. We provided all this paper to our client and realized all the information would be placed on a shelf to sit. I asked the Executive Director what he was going to do with all this information and he said “it is just going to sit here and hopefully never be needed” I asked him if there was a software solution, Digi-Docs, that could house this information, was accessible, easy to use, had the ability to compare documents and he responded “ Makes my life much easier” I went on to explain my idea of converting PDF documents so they could be completely searched and simultaneously compared up to four at a time and the response again was “ Makes my life easy” We made his life easier.
“I have no space left” – Digi-Docs is working with an account in which the practice administrator, a very busy person, needed to house their practice documents such as ownership agreements, lease agreements, licenses, contracts etc. The administrator wanted to get rid of the file cabinets taking up so much space in her office, wanted to be able to access the information and make getting access simple and easy. Through Digi-Docs application we met these needs and the practice administrator is extremely happy. When recently visiting her practice, she relayed a situation to me and how much Digi-Docs has improved her ability to do her job. I was told that in the past if one of her physicians or staff needed information that was either in the file cabinet or stored on her computer, she would tell them she would have the information to them by the end of the day. Now, she simply says hold on and she immediately accesses the information from the Digi-Docs application with just a few key-strokes!