When dealing with a significant increase in the time it takes for insurance claims to be submitted, which results in the hospital not being paid in a timely manner, the best course of action for a healthcare quality professional is to assemble a work group and facilitate the development of a fishbone diagram12.
A fishbone diagram, also known as a cause-and-effect diagram or Ishikawa diagram, is a visual tool used to systematically identify and present all the possible causes of a particular problem in order to find its root causes1. This approach is particularly useful in this scenario because it allows the team to visualize the many potential factors contributing to the increase in submission time for insurance claims.
Here are the steps that the healthcare quality professional would take:
Assemble a Work Group: Gather a team of individuals who are familiar with the process and can contribute to identifying potential causes of the problem1.
Define the Problem: Clearly articulate the problem of increased time for insurance claims submission. This is typically written at the head or mouth of the fish in the fishbone diagram1.
Identify Major Cause Categories: Common categories include methods, machines (equipment), people (manpower), materials, measurement, and environment. These are drawn as the “bones” of the fish1.
Identify Possible Causes: Brainstorm all the possible causes of the problem that fall into each category. These are written on the smaller “bones” off of the major cause categories1.
Analyze and Prioritize Causes: Discuss and analyze the identified causes, and prioritize them based on their impact on the problem1.
Identify Solutions: For each high-priority cause, develop strategies or changes to address the cause1.
Implement and Monitor Solutions: Implement the identified solutions, monitor their effectiveness, and make adjustments as necessary1.
By following these steps, the healthcare quality professional can systematically address the problem of increased insurance claim submission time, ultimately improving the hospital’s revenue cycle2.
