Broken Collection Process

Just before New Year’s I got a dunning letter from a Florida collection agency for hospital services dated 10/29/2013. There were three things odd about the letter. (1) We had received no services on that date. (2) We had received no bills from the hospital. (3) The letter was missing our apartment number on the address.

I did not panic. Business Process Analysis has allowed me to solve much more complex problems than this. I would just follow the process flow, instead of raging at the people. I called the hospital billing for an explanation.

The customer service at the hospital could not help me. Once the bill is sent to collections, it is out of their hands (not very friendly policy, I might add). I did discover that they had sent out a bill to the insurance company, but had received no reply. They also sent out five notices, which never arrived in our mailbox. I asked if there were an administrator that could address this issue at the root. No, it has to be handled in Florida.

I called the collection agency. It is really a part of the hospital, but presents itself as a separate company. The agent who worked with me was very helpful. We walked through the workflow together, step-by-step. First, why was a bill created on 10/29? I offered that we had a surgery scheduled for that date. However, the surgeon had rescheduled it for later in 2014. The agent researched the original code, and found that it was for lab work done on that day. No such lab work was performed, as we were not even in town on that day. The agent guessed that the person who initiated this probably was not aware of the changed schedule, and created lab bills in batch to match with her schedule of surgeries.

This is plainly a broken process. Someone has created a short-cut to save time, but invited an error to enter the process. We’ll get back to that.

Next mystery. Why did the insurance not respond. Pam went online, and checked the insurance history. There is nothing for that date of service, nor anything about the amount of the bill. I suspect that they saw a bill for a service that could not be matched up, and dropped the matter at that point.

A second break in the process. The insurance company did not have a procedure to handle rouge claims? Or, they did respond, and the hospital had no process to track such responses? Again, we’ll get back to that.

Next step. Why did I not receive any bills from the hospital? This, I could guess. We just recently moved into this apartment. The mailman was not familiar with us, yet. So, the poorly addressed bills were discarded.

You see where this is going? Each step of this flow has someone doing something that is convenient to them, but breaking the process.

Finally, the hospital pushed the bill to collections. Collections sent me the letter. The letter still had the bad address. However, the postman now knows who we are, so the dunning letter arrived.

Resolution of my problem: we are to send a letter documenting all of the goof-ups, and ask that the bill be corrected. Done and done.

However, this does nothing to solve the process problem. I need to ask the hospital to change their handling of lab bills for surgery to focus on accuracy, rather than bulk convenience. I need to ask the insurance company to explain and possibly modify their handling of unmatched claims. I need to ask the postman to organize orphaned letters instead of piling them on top of the mailbox area.

This is a multiple agency process – probably one of the most common business process problems, and one of the most difficult to fix. But, it should be fun trying.