Stay Compliant With Workflow Automation

by Mitch Taube | 12/16/14

It’s a widely known fact that workflow automation can boost your staff’s productivity, make your company run more efficiently and effectively, and improve your bottom line. But another major benefit to workflow automation — one that’s less frequently talked about — is keeping your business compliant, reducing your risk of costly penalties and fines.

Cumbersome processes leave your company exposed

I recently worked with an insurance company that serves as a typical example of how compliance regulations are often incompatible with manual workflow processes.

The major challenge this company was facing was the need to process pre-approval requests from physicians, and then notify the doctors’ offices of their decision, all within a two-day window. For a company that’s using workflow automation software, this can be done with relative ease; however, when this process is performed manually, a mere two days becomes a very tight timeline.

First, the doctor’s office must fax the pre-approval request forms to the insurance company. The insurance company must then review the documents to make sure they’re complete; this can include having to track down additional information about the patient, leading to further delays. Next, the processor will look up the patient’s benefits in the company’s database, make necessary notes and annotations, and send the documents to an internal physician for review (the case may even need to be presented to a medical review board). Finally, a decision will be made about the patient’s eligibility and insurance limit, about which the doctor’s office must be notified in a timely fashion.

As you can see, the fact that this process is paper based makes it cumbersome and risky. For example, documents can easily get lost in the shuffle as they are passed from person to person with no way to track. Existing support documents can also be difficult to find, causing further complications and delays. And with so many different people involved in the paper-based chain, documents can easily end up spending days on the desk of a processor who happens to be out of the office. With so many opportunities for snags, delays and hold-ups, noncompliance fines are a very real and constant threat for the company in question.

Workflow automation transforms this process

The beauty of workflow automation software in a case like the one described above is that it keeps the entire process tracked and expedited. This ensures the timely completion of processes to meet compliance guidelines.

Requests for approval forms are automatically routed to processors upon receipt and work can be automatically rebalanced based upon each processors workload to ensure expedited processing. Missing information can be added and documentation regarding the patient’s benefits coverage can be added to the electronic file. Once complete, the file is routed electronically to an available physician for review. If the claim is approved it will automatically create an email to inform the patient’s doctor. If the claim requires further deliberation, it will be automatically routed to an internal medical review board and their decision will be automatically emailed to the patient’s doctor. Along the way, emails are automatically sent to each individual alerting them that action has to be taken. The whole process is transparent allowing management to see where in the process each request is and what action has been taken.  

Digital document management software and workflow automation ensures you have quick and easy access to complete documentation in case of an audit. In our health insurance example, the company in question can easily show proof of insurance coverage at the time of a patient’s approval. And the auditing process is quicker, easier and less intrusive–auditors can even be granted secure access to designated documents from a remote location.

With workflow automation, all of the following are placed on auto-pilot:

• Workflow kickoff, which is automatically triggered by receipt of faxed documents
• Load balancing among all of the insurance company’s processors
• Automatic routing from processors to internal physicians to medical review boards and finally to doctors’ offices based upon decisions and actions taken at each step
• Enforced process time for each individual request
• And tracking of documents through multiple departments and processors for maximum accountability and audit preparedness

By automating the process, doctors and processors are ensured to have all of the documents they need in a timely fashion, making the two-day compliance deadline a realistic and achievable goal.

Is your company subject to compliance regulations? If so, workflow automation software is a key step toward consistently meeting those regulations, and avoiding fines and penalties in the process.

Mitch Taube is the principal founder of Digiscribe International, formed in 2001 to provide companies of all sizes with cost-effective document scanning, document management software and workflow automation services. In 2010, he co-founded Digiscribe New England, an affiliated company serving the document management and business process automation needs of companies and organizations in New England. Digiscribe transforms the way companies manage and process their documents with document scanning services, document management software and workflow automation services and software.