Case Studies

Automating Medical Billing and Payment

MOVEit helps a hospital's IT team automate their medical billing and payment process while gaining total visibility and end-to-end security of the file transfer activities

High Visibility for the Medical Billing Process

This hospital’s medical billing process follows the typical procedure(s) for how hospital claims and payments are processed across the healthcare industry.In return they may receive one or more 835 forms from an external party. Each of these files contains sensitive patient information including PHI, social security numbers, patient demographics, etc., and needs to be protected against the risk of possible data breaches and leaks.

The Challenge

Providing care for an extremely large number of patients, the IT department needs to transfer thousands of files on a daily basis to keep up with the billing process requirements for each procedure that is performed. The hospital must submit at least one 837 form for each patient that is discharged. In return they may receive one or more 835 forms from an external party. Each of these files contains sensitive patient information including PHI, social security numbers, patient demographics, etc., and needs to be protected against the risk of possible data breaches and leaks.

If keeping track and processing the exchange of so many 837 & 835 forms wasn’t challenging enough, the hospital also has incentives in place with the insurance companies which encourages them to submit their 837 claims in a timely manner. Many of the insurance companies they work with provide a 48-hour turnaround time in sending payment from when a clean claim form is submitted, As the billing process has a lot of visibility within the organization, IT was on the hook to make sure this process ran smoothly, efficiently, securely and minimized, if not eliminated, any chance for delays in payment for medical services provided to patients.

The IT department relied on a set of shell scripts, developed and maintained in-house, to support the 837/835 medical billing process. This created several challenges for the IT team:

  • Scripting was time consuming and expensive to create and maintain
  • It was difficult to guarantee that scripted workflows were HIPAA compliant
  • There was no visibility into whether or not a file transfer was successful
  • Maintaining multiple scripts in different scripting languages made it difficult to scale operations
  • Homegrown scripts could introduce the possible risk of data breaches due to unintentional coding mistakes or “human error”

Hospital management gave the IT team an aggressive deadline to implement a better solution.

The Solution

Hospital management gave their IT team an aggressive deadline to implement a new solution. The team turned to MOVEit Automation to automate their medical billing file transfer process. Using MOVEit Automation, they created over 30 different file transfer tasks to support this process and, for some workflows, “daisy-chained” the task so that as one completes, the next task automatically starts. This enables a more efficient methodology because now they only have to schedule the first task to kick off at a certain time. The successive file transfers will automatically kick off at the appropriate time, eliminating scheduling gaps and ensuring the entire process runs as quickly and smoothly as possible.

Using MOVEit Automation simplifies the on-boarding of new file transfer tasks. If they need to send files to another vendor, IT can easily switch out the hosts in an already existing task instead of writing a completely new one from scratch. If the changes required are more extensive, IT can clone and modify an existing task. This saves time and has made the process of working with new vendors quick and seamless.

MOVEit provides IT with greater visibility over their file transfer operations. It issues real-time alerts on file transfer failures, allowing the team to quickly and effectively respond to and resolve any problems that arise.

Another big advantage is that MOVEit provides the IT team with the peace of mind that their files are delivered to the intended recipient without any possibility of the data being altered during transit thanks to MOVEit’s data integrity checks, non-repudiation and guaranteed delivery. The sensitive data is encrypted while at rest and in motion, ensuring that HIPAA data security regulations are always met.

Using MOVEit Automation, it took IT only one week to create and test all their medical billing related tasks. It provided them with a more manageable way to handle their file transfers, improving IT productivity and time to implementation for new tasks. Most importantly, as the hospital continues to build their network of vendors and partners within the healthcare space, they feel confident that their MOVEit managed files transfer solution would provide them with the flexibility to quickly on-board new file transfer tasks while ensuring that 837/835 forms were submitted and processed in a timely fashion.

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