Lean Thinking with focus on Medical Billing and Coding Services - OptiSol

Lean Thinking with focus on Medical Billing and Coding Services

Lean thinking is about mindset or the way of thinking of organizations to achieve a totally waste free operation that focuses on customer value. It involves cross functional orientation within organizations to improve efficiencies and achieve waste free operations. However, it is easier told than practiced!

It needs a house of lean tools laid on stronger organizational commitment to improve their level of service to the customers. It is more so challenging on the services industry when compared with the manufacturing since the process maturity levels on the services industry are still evolving. However setting aside the challenges, one would still find surprising similarities between services and manufacturing, that both involves complex interlinked processes managed by personnel to accomplish their tasks to yield end value to customers. Hence it necessitates a need to cognitively approach the success stories on the manufacturing side and apply those best practices with more rigor.

In the context of Medical Billing & Coding Service

To maximize value and reduce waste in the context of medical billing and coding services, the first step is to create a unit with lean thinking. It needs lots of communication from the strategic management team to the line personnel on the objectives of lean. This shall create a sense of belonging and brings down uncertainty around job losses. It needs to carry a strong and meaningful message that services differentiators can be accomplished only with personnel.

At a next level on the process side, the starting point need to be defining the critical to quality parameters for their customers that includes but not limited to,

  • Expected financial accuracies and processing accuracies
  • Turnaround time requirements
  • Rework percentages

It is important that organizations assess themselves on their standings with respects to these parameters so that they will be able to define roadmaps. This includes doing a value stream mapping of theirprocesses that will list the steps involved in accomplishing the end value desired by the customer.Being a federally regulated process, it becomes mandatory that organization assess their process efficiencies to identify and isolate value added processes from non value added processes. Imbalances here shall definitely create friction within the system. It needs classification of processes into,

  • Core repeatable processes
  • Core non repeatable processes
  • Support and repeatable processes
  • Support and non repeatable processes

Define Implementation approach to a successful lean program

It begins with defining a program charter to roll out and institutionalize a lean program. It involves programs to

1. Improve Quality, Eliminate wastes through Training Integrated Quality Assurance Framework

It involves rolling out a training integrated quality framework. This includes combination of statistical tools and methods that results in identifying and isolating defects / wastes from the process. Statistical tools are extensively adopted to perform

  • Pareto analysis-to identify the vital few
  • Define Corrective and Preventive Actions (CAPA)
  • 5 Why Analysis and
  • Time Trend Analysis
  • Time Trend Analysis

This QA framework helps in accomplishing the process within its control limits. However organizations need to appreciate those statistical tools assists only in identifying and isolating the outliers. But to improve quality, there needs to be very active participation from the training function since variations within billing and coding processes are very high.

2. Improve Quality, Eliminate wastes through Technology

Define claims scrubbing mechanisms on top of claims data so that common and more frequent errors can be automatically detected. This shall increase the velocity of the process and also reduce rework. For instance a claim for male insured with a diagnosis code related to gynecology is obviously incorrect and this can be caught upfront in the system instead of allowing it to traversing through different processes within the overall system and finally getting rejected for payment. This saves lot of payment rejection upfront. Hence a good lean program shall leverage the expertise from IT and operations team to define solution. Hence it becomes imperative that the medical billing and coding team to understand the way adjudication systems on the insurance companies work so they can build upfront claim scrubbers and pre edits.

3. Optimize Process overheads

It involves operations unit to do a comprehensive time trend analysis on operations data. This shall include incoming volume data, capacity utilization levels, throughputs, TAT compliance etc. With proper incentive and remuneration program, organizations need to do plan for running the process with optimal utilization levels that shall remove over allocation of personnel to the processes. This approach reduces process overheads. Organizations need to understand overproduction is equally bad as under production.


Lean thinking is not new. However the dynamics of healthcare industry keeps continuously changing and it places a need on the organizations to keep striving for innovations so they perform exceedingly well on customer satisfaction index. Innovations cease to exist if organizations fail to ask one fundamental question on an ongoing basis- Why am I doing it this way and am I doing it right?

Lean thinking facilitates organization to ask these fundamental questions, as it did before!

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