Medical Billing/Healthcare Case Study

Customer: Automated Medical Systems, Braintree, MA
Product Development
Overview:

Our customer is a medical insurance billing company with several branches in New England. They act on behalf of hospitals and medical clinics to collect payments from insurance payers for services rendered by their clients to patients covered by these insurance companies. They had been using a home-grown solution developed in MUMPS, a legacy language, for 15-20 years, and it was becoming inadequate to meet their needs.

Some limitations with the existing system were:

• Legacy system had a character-based user interface: The training and support were becoming cost prohibitive.
• Maintenance of the code was becoming difficult as many changes were made over the years.
• Scanned claims paperwork necessary for charge entry was not integrated with data entry screens, which were character-based.
• Compliance with HIPAA regulations in modules was pretty much non-existent.
• A web-based system was required for our customer to provide easy access to offsite employees and customers to work with the system.

Our customer wanted a solution that would overcome all the limitations of the current system.

Ivesia Proposed Solution:

Ivesia proposed a HIPAA compliant Medical billing software re-engineered from a legacy database technology to the state of art web-based technology, encompassing all the business functions of a medical billing insurance service provider.

The application was developed using Cache, which has a very high data storage capacity along with a multi dimensional perspective. The presentation layer was developed using Cache Server Pages, which can work very efficiently in conjunction with the Cache database. Further, DHTML and JavaScript were used extensively to create a very intuitive and powerful user interface.

The major functions of the application include:

• Patient registration & claims output
• Posting and analysis of adjudicated claims
• Monthly analysis of client's performance and the revenue results for every client
• Tools for managing the efficient use of resources and to enable staff to know each day what is expected of them
• Data is exchanged with many insurance providers using HIPAA interfaces
• Role based security access

The first phase involved re-engineering of the existing billing system along with achieving HIPAA compliance. The deliverables in this phase included core billing functionality, centralized dictionaries and standard reports. The second phase included data migration along with document imaging and integration of appointment scheduling. The system was planned for live production after the second phase, with additional phases planned for enhancing the application with new functionality such as credentialing.

Ivesia had allocated an analyst team based in US and a development team in India for developing the application. QA team was based in India. Automated testing was identified as necessary for handling regression testing for a project of this scale.

An iterative development model based on the Rational unified process (RUP) for long-term software development was used and prototype based solution is practiced. Based on this, the detailed requirement’s elicitation was done at every stage and a weekly demonstration is given to our customer. At every stage of development a thorough quality inspection has been done to eliminate bugs and the product was seamlessly integrated with all the modules.

Technologies used:

Cache Server Pages (CSP), DHTML, JavaScript, PDF integration, Cache (ORDBMS from Inter systems)