Practice Automations • 2022
Introduction / Problem:
In the complex routines of RCM billing, effectively managing and tracking multiple claims can quickly become overwhelming. AR managers and billing clerks often face the challenge of staying on top of numerous claims while identifying the ones that require immediate attention. As a RCM SaaS we understood that having a dedicated page where users could create new claims and keep track of existing ones, would be one of the main features of the product. And, if we wanted to succeed in this task, we needed to make sure to account for all details. Our goal with PAPM’s software was crystal clear: create a solution that not only enables users to track all claims efficiently but also helps them swiftly determine which claims to prioritize.
To craft a tailored solution for AR managers and billing clerks, we engaged deeply with industry professionals, aiming to define the essential functionality for a comprehensive claims management platform. Our core insight or the main Job To Be Done (JTBD) became: "I need to be able to create and keep track of existing claims, so that I can effectively manage my priorities.”
With that in mind, we also felt the need to conduct a thorough exploration of the complex world of RCM billing. To gain a deep understanding of the entire lifecycle of a claim, we conducted user interviews and observational studies. This journey included exploring each stage a claim goes through, the various statuses it can have, the intricacies of handling denials, and all the minute details that make up the billing cycle.
The complexity of the RCM billing process cannot be overstated. Every claim is subject to a complex set of stages, each with its own set of rules, potential issues, and necessary actions. Denials, a major source of difficulty in the process, have their own specific causes, responses, and solutions. Our team dedicated countless hours to ensure that we had a thorough understanding and deep knowledge of every aspect of this domain. The effort required was substantial, but it was essential to ensure that our solution was both comprehensive and effective.
With a deep understanding of the claim billing cycle, we embarked on the design phase. Our approach was iterative, firmly grounded in the knowledge we had acquired. We initiated the process by sketching preliminary designs and presenting them to subject matter experts for feedback. Their insights proved instrumental in refining our concepts and aligning them closely with real-world requirements.
A recurring theme in the feedback emphasized the significance of prioritization. It became evident that tracking claims alone was insufficient; prompt action based on urgency was essential. This realization led us to develop a solution that filters and displays claims according to their level of urgency, determined by their statuses and cycle stage. This streamlined approach enables AR managers and billing clerks to immediately focus on the most critical claims, enhancing workflow efficiency.
Furthermore, we identified the need for seamless efficiency. Rather than navigating through multiple screens or sections, users should have the ability to perform key actions directly from the claims overview page. To address this, we meticulously mapped out a range of actions, such as submitting, scrubbing, posting payments, and more, ensuring that users have all the necessary tools at their fingertips. This not only enhances usability but also significantly reduces the time spent on claim management.
Meet the “All Claims” page:
Conclusion, Reflections & Learnings
The "Claim Details" page has the potential to become an essential tool for AR managers and billing clerks, providing them with a comprehensive understanding of each claim and empowering them to take necessary actions efficiently. Reflecting on the project, we realized the importance of balancing detailed information with a clean, organized design. The project underscored the value of user feedback in shaping a solution that truly addresses their needs and challenges. It was a testament to the fact that when design is rooted in understanding and empathy, it can significantly enhance user experience and efficiency.