United Diagnostics Achieve HIPAA Compliance, Expand Business Ventures, While Growing Net Income Over 25% with Microsoft CRM Online and MIBAR

United Diagnostics (United) is New York’s largest provider of diagnostic sleep testing and Video EEG service.

When we first met with United, they were operating and managing eight different sleep lab locations throughout Long Island – up from just three locations in the year prior, they were growing quickly, and were in the beginning stages of adding a new line of business – At home Video EEG monitoring.

Business Process

In the healthcare ecosystem, United serves as an intermediary.

They act as both a resources to physicians, providing them with a reputable company for them to send their patients – as well as referral source, providing their patients with a specialty physician to diagnose and treat them.

When United receives a referral from a physician, it is their responsibility to first verify, and if necessary, authorize their insurance; after the insurance has been reviewed by an insurance specialist, the patients record is sent to management for final insurance approval.

Once approved, the patient is then assigned to a client care coordinator (CCC) for scheduling – they are responsible for calling the patient and scheduling them at one of United’s locations; three days prior to the scheduled study date, the CCC must confirm the appointment and a confirming e-mail must also be sent. On the day of the appointment, the technician, in addition to perform the study, must also provide the patient with documentation, obtain a signature and then leave the form for the internal sales representative who manages the relationship with the referring physician.

After the study is completed, a United representative must the ensure that the test results are sent to a specified sleep or EEG physician specialist external to United, who has the expertise to interpret the results of the study. Finally, they must then ensure that they receive back a signed copy of the reading physicians interpretation of the study, that it then gets sent to the original referring physician – and that if any follow up studies are required, that the scheduler coordinates with the patient to arrange an appointment.

Problem

Unfortunately, with their business growth – and increasing sophistication and constant evolution of their business processes – their existing, home-grown Microsoft Access and paper file-based system could no longer keep up.

Management suffered from a lack of process control and had little visibility into the day to day operations of the business or business performance metrics. Chief amongst their problems:

• There was no visibility into which physicians referred them the most business – and without this information, they were not able to prioritize their relationship building.
• There was no visibility, and more importantly, accountability, into the progress of a referral – from initial receipt, to insurance review, management approval, scheduling and post study communications – this resulted in many opportunities “slipping through the cracks” at various points throughout the process, which impacted their reputation, and ultimately their bottom line.
• The nuances and ever-changing rules of insurance made it difficult to systematize their insurance review process – this led to patients being denied for studies they may have been covered for.
• They were constantly overbooking their studies because they didn’t have control or visibility into the capacity of each facility.
• Employee desks were overflowing with pending paper files that could only be stored after the study was completed.
• Furthermore, the complexity of the logic behind the specific rules that dictated which studies could be performed at which facilities, on which days became too difficult to manage – this led to disgruntled patients who were scheduled incorrectly.

Solution

Fortunately, Microsoft CRM Online offered United a Solution to all these problems and more!

It offered a HIPAA compliant platform that was flexible and easy to customize to their specific needs without the need for programming – with just a mouse, they were able to modify existing forms, as well as create brand new record types, fields, views, charts, and dashboards. Microsoft CRM provided them with a platform – a “canvas” if you will – and MIBAR provided them with the insight and creativity to devise a scalable, flexible solution that would provide management with the control and visibility they lacked and enable them to keep track of their key business information and relationships like never before.

Furthermore, using Microsoft CRM’s extremely robust and easy to use Workflow tool, with the guidance of their partner MIBAR, regular business users were able to define the complex business rules that govern every element of their business – from ensuring that Insurance Review assignments get routed to the proper associate, to preventing a study from being scheduled if the current date was outside of the authorization period, to ensuring that patients were followed up with and scheduled properly – and so much more! The ease and flexibility of this platform make it very simple to react to new requirements and implement the business logic required to effectively manage their business.