Integrated Care System with 2 hospitals and 16 clinics with revenue of over $1.7B.
Executive Summary:
- $3.1Million claims recovered
- 8X ROI
- Team trained – Reporting & Data Analytics
Challenge:
HealthBPM assisted this Level 1 Trauma Center in a multi-phase engagement. The organization needed assistance with updating renewal contracts, adding new contracts, and training new & existing staff on Epic Resolute build and procedure 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
- Phase 1: Contract Modeling, Record Viewer, Undercharging Analysis
- Phase 2: Contract Modeling, Outpatient Enhanced Ambulatory Patient Grouper (EAPG), and Inpatient All Patients Refined Diagnostic Related Grouper (APR DRG)
- Trained staff concurrently with build as they worked through Epic Certification, which allows them to maintain contracts internally going forward.
Outcome:
- Proprietary Reporting Workbench reports were used to identify underpayments and mange the attestation process. These reports were exercised once the contract build was completed to help identify opportunities to recover fees not previously received.
- Work queues were built for the new and existing contracts to help team identify and work underpayments as they as soon as the payment posts.
- Integrated care system recovered $3.1Million in underpayment
- Phase 1: $1M recovered from 2 payers alone utilizing the workbench reports and data analysis technique
- Phase 2: Additional $2.1M recovered as a result of additional build
- Knowledge Transfer for staff to use the reports and data analysis techniques to manage the recovery process with the payers on an on-going basis
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