Client Profile:
An east coast children’s hospital with more than 45,000 emergency department visits per year.
Challenge:
The hospital system had been unable to adequately staff their emergency department with utilization review care managers. Although the system was able to staff during business hours Monday through Friday, their data indicated that the greatest number of their patients were presenting after hours and on weekends. As a result, the system experienced a high denial rate.
Solution:
The hospital system engaged McBee Care Managers to provide coverage on weekends and expand their coverage until 11 p.m. during the week. McBee provided unique expertise geared toward pediatric hospitalization. Our team scheduled educational sessions focused on documentation improvement with the physicians at the facility and worked closely with facility care management staff on the use and application of pediatric care guidelines.
In addition, McBee analyzed claim and payment metrics and implemented a robust reporting system to track and manage denials, identify care management opportunities, and report on documentation improvement.
Results:
Our concurrent, real-time reviews resulted in a $1.7M revenue increase in just one year through appropriate identification of patient status—a 4% increase in net patient revenue for the system.
The pediatric hospital care management department increased their understanding of pediatric care guidelines. The facility was able to provide coverage during times of highest utilization. Physician documentation improved and observation rates approached appropriate levels.
The facility used McBee to expand coverage for continued stay reviews as a result of the success achieved in the emergency department.
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