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Lean Thinking With Focus on Medical Billing and Coding Services

Lean Thinking With Focus on Medical Billing and Coding Services


Lean thinking is about mindset or the way of thinking of organizations to achieve a waste-free operation that focuses on customer value. It involves cross-functional orientation within organizations to improve efficiencies and achieve waste-free operations. However, it is easier told than practiced!

It needs a house of lean tools laid on stronger organizational commitment to improving their level of service to the customers. It is more so challenging for the services industry when compared with manufacturing since the process maturity levels in the services industry are still evolving. However setting aside the challenges, one would still find surprising similarities between services and manufacturing, that both involve complex interlinked processes managed by personnel to accomplish their tasks to yield end value to customers. Hence it necessitates a need to cognitively approach the success stories on the manufacturing side and apply those best practices with more rigor.

In the context of Medical Billing & Coding Service

To maximize value and reduce waste in the context of medical billing and coding services, the first step is to create a unit with lean thinking. It needs lots of communication from the strategic management team to the line personnel on the objectives of lean. This shall create a sense of belonging and brings down uncertainty around job losses. It needs to carry a strong and meaningful message that services differentiators can be accomplished only with personnel.

At the next level on the process side, the starting point needs to be defining the critical to quality parameters for their customers that include but not limited to,

* Expected financial accuracies and processing accuracies

* Turnaround time requirements

* Rework percentages

Organizations must assess themselves on their standings concerning these parameters so that they will be able to define road maps. This includes doing a value stream mapping of their processes that will list the steps involved in accomplishing the end value desired by the customer. Being a federally regulated process, it becomes mandatory that the organization assesses its process efficiencies to identify and isolate value-added processes from no value-added processes. Imbalances here shall create friction within the system. It needs classification of processes into,

* Core repeatable processes

* Core nonrepeatable processes

* Support and repeatable processes

* Support and nonrepeatable processes

Define Implementation approach to a successful lean program

It begins with defining a program charter to roll out and institutionalize a lean program. It involves programs to 1. Improve Quality, Eliminate wastes through Training Integrated Quality Assurance Framework.

It involves rolling out a training integrated quality framework. This includes a combination of statistical tools and methods that results in identifying and isolating defects/wastes from the process. Statistical tools are extensively adopted to perform

1. Pareto analysis – to identify the vital few

2. Define Corrective and Preventive Actions (CAPA)

3. 5 Why Analysis and

4. Time Trend Analysis

This QA framework helps in accomplishing the process within its control limits. However, organizations need to appreciate those statistical tools to assist only in identifying and isolating the outliers. But to improve quality, there needs to be very active participation from the training function since variations within billing and coding processes are very high.

2. Improve Quality, Eliminate wastes through Technology

Define claims scrubbing mechanisms on top of claims data so that common and more frequent errors can be automatically detected. This shall increase the velocity of the process and also reduce rework. For instance, a claim for male insured with a diagnosis code related to gynecology is incorrect and this can be caught upfront in the system instead of allowing it to traverse through different processes within the overall system and finally getting rejected for payment. This saves a lot of payment rejection upfront. Hence a good lean program shall leverage the expertise from the IT and operations team to define a solution. Hence it becomes imperative that the medical billing and coding team understand the way adjudication systems on the insurance companies work so they can build upfront claim scrubbers and pre edits.

3. Optimize Process Overheads

It involves the operations unit to do a comprehensive time trend analysis on operations data. This shall include incoming volume data, capacity utilization levels, throughput, TAT compliance, etc. With proper incentive and remuneration programs, organizations need to do plan for running the process with optimal utilization levels that shall remove over allocation of personnel to the processes. This approach reduces process overheads. Organizations need to understand overproduction is equally bad as under production.


Lean thinking is not new. However, the dynamics of the Health Care Industry keep continuously changing and it places a need on the organizations to keep striving for innovations so they perform exceedingly well on the customer satisfaction index. Innovations cease to exist if organizations fail to ask one fundamental question on an ongoing basis – Why am I doing it this way and am I doing it right?

Lean thinking facilitates an organization to ask these fundamental questions, as it did before!


Source by Manikandan TVR

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