Healthcare: revenue cycle: hospital health system

Challenge:

The health system had experienced a significant decrease in margins as well as deterioration of overall operating and financial performance. The health system recognized the need to improve charge capture across both hospitals through automation and process improvement. We were asked to perform an in-depth charge capture review of pertinent processes and systems to identify areas where lost revenue existed and to implement changes to improve the financial outcome.

Solution:

Mazars assembled a team skilled in revenue cycle, coding, charge capture, pricing and the applicable EHR utilized across the health system.

The team then:

• Reviewed the charge description master (CDM) for accuracy and potential missing services
• Reviewed ancillary systems and their integration with the core financial system for accurate charge capture
• Reviewed the processes centered around charge capture, coding and reconciliation to ensure all charges were captured and reported appropriately when billing
• Performed a full scale chart-to-claim audit to ensure charges for services performed were accurately documented, captured and reimbursed
• Reviewed pricing for opportunity to improve net revenue and align with market rates
• Implemented changes in select clinical departments to ensure improved financial outcomes

The results of the review and net revenue opportunities were reported to leadership. We worked with leadership to prioritize implementation efforts to quickly improve net revenue across the health system and subsequently assisted with implementing changes in charge capture processes across select clinical departments.

Results:

• Identification of approximately $45 million in potential annual gross revenue improvement across the health system through enhanced charge capture
• Significant modifications of technology driving charge capture within the emergency department
• Implementation of changes to ancillary systems to include radiology, laboratory and pharmacy to ensure accurate charge capture
• Development and implementation of system-wide policies and procedures related to charge capture, reconciliation and pricing
• Redesign of charge capture for ECMO services
• Identification of approximately $1.5 million in annual net revenue improvement relative to pricing