Overview
This case study examines the successful partnership between QZ Medx and Sun Hill Medical Center. By implementing QZ Medx’s Swift Insurance Verification Service (SIV), Sun Hill Medical Center improved its billing efficiency, reduced claim rejections, and enhanced patient satisfaction.
Know Our Client
Sun Hill Medical Center is a leading healthcare facility offering a wide range of services and accepting multiple insurance plans, including Regence, Aetna, Cigna, and Kansas City. Each insurance provider has unique eligibility requirements, reimbursement rules, and claim procedures, making billing operations complex and time-consuming. These challenges were affecting the revenue cycle and patient experience at Sun Hill Medical Center.
| Client | Sun Hill Medical Center |
| Insurance Plans Accepted | Regence, Aetna, Cigna, Kansas City, others |
| Services | Comprehensive medical and specialty care |
| Challenges | Eligibility verification, claim errors, cash flow |
Challenges Faced by the Sun Hill Medical Center Billing Team
The team at Sun Hill Medical Center was facing several significant issues related to insurance processing. Here’s an overview:
| Challenge | Impact |
| Insurance Verification Delays | Last-minute verification requests disrupted patient flow and delayed appointments. |
| High Claim Submission Errors | 25% claim denial rate due to inaccuracies, increasing administrative workload. |
| Limited Staff Training | Insufficient training led to knowledge gaps, reducing the ability to handle complex claims. |
| Cash Flow Disruptions | Delayed claim processing led to reduced cash flow, impacting operational expenses. |
Claim Submission Errors (2023)
| Error Type | Percentage of Total Errors |
| Incorrect Eligibility Details | 30% |
| Duplicate Submissions | 20% |
| Incomplete Patient Information | 25% |
| Outdated Insurance Policies | 15% |
| Miscellaneous | 10% |
Key Observation: A 25% claim denial rate was mainly due to incorrect eligibility data, demonstrating a critical need for an effective verification system.
QZ Medx’s Swift Solution: Smart Insurance Verification Service (SIV)
To address Sun Hill Medical Center’s specific challenges, QZ Medx introduced a Swift Insurance Verification Service (SIV) designed to streamline eligibility verification, reduce claim errors, and optimize the billing process.
Key Components of the SIV Service:
| Component | Description |
| Proactive Pre-Visit Checks | Eligibility verification before appointments, reducing last-minute disruptions and improving patient flow. |
| Dedicated Verification Team | A specialized team of experts focused on handling complex eligibility requirements and preventing claim errors. |
| Advanced Technology | Real-time updates with advanced software for immediate access to patient insurance details. |
| Custom Reporting Tools | Analytics tools to identify denial trends, improve processes, and streamline future verifications. |
How Our SIV Service Improved Sun Hill Medical Center’s Operations
1. Proactive Pre-Visit Eligibility Checks
By verifying insurance eligibility before patient appointments, we identified issues such as expired coverage or incorrect plan details in advance. This proactive approach ensured smoother patient flow, reduced last-minute verifications, and minimized disruptions.
2. Dedicated Insurance Verification Team
Our team of experts, knowledgeable in diverse insurance policies, managed every aspect of eligibility verification. This approach greatly reduced errors and improved accuracy, resulting in faster payment processing and a more streamlined experience.
3. Advanced Technology and Real-Time Updates
Using advanced software, Sun Hill’s administrative staff accessed real-time insurance updates, allowing quick issue resolution and reducing time spent on manual verifications. The system simplified eligibility checks, making the entire process more efficient.
4. Custom Reporting and Analytics Tools
Custom reporting tools enabled Sun Hill to analyze trends in verification and claim rejections. This data-driven approach helped the center address common issues proactively, improving overall efficiency.
Achievements and Outcomes
The Swift Insurance Verification Service produced impressive outcomes for Sun Hill Medical Center, demonstrating measurable improvements across several metrics.
Key Outcomes
| Outcome | Results Achieved |
| Claim Rejection Reduction | 40% decrease in eligibility-related claim rejections |
| Time Savings | 20 hours saved per week in eligibility-related tasks |
| Patient Satisfaction Increase | 25% rise in patient satisfaction due to smoother billing |
| Improved Financial Health | Enhanced cash flow and timely payments enabling reinvestment |
Detailed Results of Key Metrics
- Claim Rejection Rate: From 25% to 15% post-SIV implementation.
- Administrative Time Saved: Approximately 1,040 hours saved annually in eligibility verification tasks.
- Increase in Patient Satisfaction Score: From 72% to 97% due to improved billing transparency and fewer surprises.
- Financial Impact: Faster payments reduced cash flow disruptions, allowing more resources to be allocated to patient care and facility improvements.
A Collaborative Partnership for Continued Success
The partnership between QZ Medx and Sun Hill Medical Center has proven successful, resulting in sustained improvements in Sun Hill’s revenue cycle and patient experience. By addressing their specific needs and tailoring solutions, we empowered Sun Hill Medical Center to operate more efficiently and enhance their quality of care.
QZ Medx is Ready for the Future
As healthcare continues to evolve, so do the challenges in medical billing and insurance processing. Therefore, QZ Medx remains dedicated to innovating and providing advanced solutions tailored to the needs of healthcare providers. The success of our SIV Service at Sun Hill Medical Center demonstrates the value of targeted services in transforming billing operations and achieving operational success.
