Improving Revenue Cycle Accuracy Through Analytics

1. Improving Revenue Cycle Accuracy Through Analytics April 2013

2. Agenda and Goals • Statement of the problem • Current process and use • Practices of the group • Future analysis

3. Introduction Hospitals struggle to ensure the accuracy of the revenue cycle…

4. Accuracy thecondition or quality of being true, correct, or exact; freedomfrom erroror defect; precision or exactness; correctness. the extent to which a given measurement agrees with the standardvalueforthatmeasurement. thedegree of correctness of a quantity, expression, etc.

5. Revenue Cycle Accuracy • Where do you start? • Front End • Scheduling • Registration • Middle • Clean claims • Complete bills • End • Denials • Correct payments

6. Middle Accuracy Hospitals struggle to ensure the accuracy of the revenue cycle… • Charge reconciliation • Edit on charge posting • Charge audit • Clearing house edits

7. Data for use Revenue codes HCPCS ICD-9 (diagnosis and procedure) Patient Type Discharge Status Bill Type Charges Quantity

8. Sample Tests • Pairing • What goes together? • Diagnosis • What goes with the clinical assessment? • Ratio • What is an expected occurrence rate? • How should the services be related in their occurrence?

9. Services that go together…. How would you have found this? Most systems would not edit for this.

10. Services that go together…. How would you have found this?

11. Specialty Radiology Have you ever looked at what radiological services are in your ED Evaluation and Management levels?

12. Surgical Procedures Have you ever looked at what types of procedures are your ED level distribution?

13. Details, Details, Details

14. Using Diagnosis Codes Do you look at diagnosis codes to determine if a procedure was not billed?

15. Finding Missing Codes Do you look for commonly performed services that were not billed at your hospital? Rhythm ECG CPT 93041

16. Discussion