562.261.7494
A system of 19 hospitals was plagued by inefficiency and needed a
dramatic evolution to their coding processes.
Client Profile:
A not-for-profit and geographically dispersed health system of 19 hospital campuses and 63,000 total employees.
A physician led health system where 4,500 physicians partner with administrative leaders.
Medical Coding
Case Study Challenge
Campus revenue cycle operations became centralized and mid-revenue cycle staff were responsible for all code assignment tasks without clear roles, responsibilities, and metrics. Revenue cycle management was aligned to campus leadership and across the enterprise.
Outstanding coding dollars and inventory were consistently at high levels, on hold, and impacting cashflow and billing/claims timeliness.
Action
The following actions were taken to correct the challenges this healthcare system faced:
- Established and tracked coding service line metrics to align with RC goals
- Restructured into four coding lines: two hospital and two physician/professional
- Strengthened management competenties and coder technical skill sets
- Provided oversight to a coding vendor staffing model creating a hybrid workforce
- Designed, developed, implemented EPIC charging, coding, and claim generation workflows for hospital and physician billing
- Designed, developed, and implemented seamless workflows between CDI staff and inpatient coders
- Identified denial management opportunities and action plans for revenue optimization
Result
The results of these efforts were profound:
- Implemented a best-in-class inpatient coding operations and clinical documentation integrity collaboration as a factor contributing to U.S. News and World Report rating and ranking for the client
- Decreased the client’s coding (hospital and physician) turnaround time to billing by six days, with no impact to quality
- Sustained the client’s revenue flow during the EHR transition, working down coding inventory within two days
- Implemented new coding workflows for the client, decreasing FTE need by 8%
- Contributed to an eight day reduction in client’s outstanding account receivables
- Reduced open denials account receivables by 23%