A US medical billing, coding and consulting services company improved operational efficiency and revenue

Business Challenges:

  • Enhance revenue generation and be compliant to industry standard guidelines. Significant money was left on the table because of incorrect coding or missing codes.
  • Undercoding, missing of services, incorrect grouping, Code mismatches (like CPT-ICD, CPT-Gender, CPT-Age, ICD-Gender, ICD-Age, CPT-Modifier incompatibility, CPT-Setting/POS) were translating into revenue leakage. The implementation was built around the client’s desire to prevent revenue leakage and ensure optimized reimbursement through an accurate HIPAA compliant coding process.
  • Staff vacations and off time due to ICD 10 training leading to huge backlogs and DNFBs

Vee's Solution:

  • Our team coded the reports of different specialties and settings (inpatient and outpatient).
  • Pre-coding review was done to assess gaps in the medical records and get them completed by the physicians.
  • Codes were assigned, using updated industry standard guidelines and classification systems, to the clinical conditions and services provided to the patients.
  • Electronic algorithms were used to edit the coded output to ensure first time right submission. These algorithms were based on Local and National Coverage Determination Policies, other CMS guidelines like Correct Coding Initiative (CCI) edits, American Medical Association (AMA), American Hospital Association (AHA) and specialty society Guidelines.
  • Industry standard groupers were used to assign the groups.
  • Feedback was provided with rationale and supporting documentation
  • University enabled BPO allowed flexibility with staffing allowing more coders to be assigned in a short span of time on this project.

The solution resolved several challenges and the resultant positive impact included:

  • DNFB days dropped from an earlier average of 13 days to an averaging of less than 4 days. Because of this the hospital garnered a one-time surge of nearly $3 million in cash to their balance sheets. This turned out to earnings of $100,000 annually as interest on this revenue.
  • 18% increase in billed dollar amount for inpatient records
  • 18.04% increase in billed dollar amount on the outpatient records.
  • 68.4% increase in billed value for same day surgery charts.
  • All this is achieved through a a Compliant and Transparent Process