DMAIC Project: Reducing Medical Billing Errors

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Baseline (Define)

Problem: A customer complains and receives a credit note for an invoice belonging to another paying party. The paying parties are the customer himself, the customer's employer or the customer's/employer's insurance company.  

The project aims to reduce the number of incorrect payer invoices by at least 35%. The process needs to be improved for customer satisfaction, internal job satisfaction and to reduce the amount of extra clearing work.  

Process performance at the beginning (Measure)

In the period 1.8.-31.10., 2.47% of all invoices sent to customers were issued by the wrong paying party. This was in line with expectations.  

Improvement measures (Analyze & Improve)

The main root cause areas were recording errors made by doctors and nurses and the fact that the sites did not follow the agreed billing data review process. The actual root causes (e.g. induction, work instructions, etc.) that led to human errors were not addressed in the project as they were outside the scope of the project (the project was pulled from the billing process).  

The main improvement measures were:

1. Tackling doctors' errors through weekly management
2. Software robot to fix errors in the database
3. Testing and correction of contract review functionalities in the patient information system
4. Centralising the verification of invoice data for private individuals.

The biggest challenge has been to implement a systematic approach to addressing doctors' errors, as this kind of action has not been done before.

The Lean Six Sigma tools used in the project included One-Way ANOVA, Kruskall-Wallis test, Regression test, Normality test, Graphical analyses, 2-sample T-Test and Standard deviations test.

Results (Control)

The percentage of incorrect payer refunds decreased from 47% to 1.32% of all invoices sent to customers. The results are maintained by monitoring the number of events appearing on the billing error lists weekly and addressing any errors that arise:

1. by immediately identifying and correcting the various technical causes of the most common errors
2. by immediately intervening with the doctors who make the most mistakes and asking them for ideas on how to reduce the number of errors.

This project was a training project that the participant did as part of the Black Belt training and received a Black Belt certificate at the end of the project.
If you are interested in learning how to improve processes using Lean and Six Sigma, and obtain a Black Belt certification at the same time, please visit the training link: Black Belt training.