The hospital system had been unable to adequately staff their emergency department with utilization review care managers. The hospital system engaged McBee Care Managers to provide coverage on weekends and expand their coverage until 11 p.m. during the week.
Under the Global Budget Revenue model, hospital revenue must fall within 5% of the cap budget or face a CMS penalty. At a large health system in Maryland, revenue fell 7% under the hospital global cap budget in fiscal year 2015.
During the implementation of a new electronic health record (EHR) system, the hospital experienced several leadership losses, including the director of patient accounting, director of patient access, and two managers in patient accounting.
This 1,000 bed urban hospital was consistently denied an average of $1 million per month from third-party payers, mostly for one-day inpatient stays through the ED for which documentation reflected observation level of care.