Application of Process Mining to Medical Billing Using L* Life Cycle Model

Medical billing is a long chain of processes that cut across different sectors and institutions, evolving into a multimillion-dollar industry. Despite the emergence of institutional involvement in the practice, the parties involved face many challenges that hinder the successful management of the diverse process. Process mining uses computer-based tools and techniques to analyze business processes and ensure best practices for improving business operations as it has a track record of success in improving business processes and procedures. As research on process driving problem solving continues to grow, there is a need to start applying the tools and techniques to specific domain areas and bridge the gap between research, development and application. We demonstrated how process mining techniques can be applied to medical billing using the L * life cycle model from a structured perspective. We developed a handmade comprehensive medical billing process flow using domain knowledge reference and established some time perspective Key Performance Indicators (KPIs) of the billing process. We then explored the hospital billing event log generated from an enterprise resource planning (ERP) system to see how the “as-is” from the event log deviate from the generally known knowledge-based (handmade) model. Taking each trace of the event log as patient visit, we discover that about 63 % of all the visit were billed and also about 3 % billed got regretted. The event log used in this research does not capture the complete activity flow for a real-world medical billing system. Hence, we were not able to directly compare the process map with the model and give precise operational support