Large metropolitan Level 1 Trauma Center and network of clinics with revenue of $6.4B
Executive Summary:
- $4+ Million in underpaid claims identified
- Team trained – Recovery analysis
- Provided maintenance services
Challenge:
HealthBPM was asked to assist in building Epic reimbursement contracts, underpayment identification and train staff on Epic Resolute build procedure and functionality.
Approach:
- Update existing Epic Resolute Hospital Billing (HB) Contracts with annual updates
- New build of Professional Billing (PB) Contracts
- Training on Epic Functionality not in use (Contract Modeling, Record Viewer, Undercharging Analysis)
- Knowledge transfer to internal staff so they can maintain contracts going forward
Outcome:
- Contracts for the top payers were built and added to the production environment.
- Work queues were built for the new contracts to help identify and work underpayments as they as soon as the payment posts.
- Knowledge Transfer to staff: data analysis techniques to manage the build and recovery process with payers on an on-going basis.
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