Client Profile:
A regional Virginia hospital affiliated with a prominent health system.
Challenge:
Due to the constant flux in regulations, the hospital was not successful in capturing appropriate revenue for services rendered and was also not meeting compliance standards. To address these challenges, the need for a comprehensive review of their outpatient charges in relation to payer contracts was required.
The hospital sought to uncover lost revenue through a retrospective claims review, as well as optimize outpatient revenue going forward. They engaged McBee’s Revenue Integrity Services to address discrepancies within the hospital’s charge description master (CDM), billing errors, charge capture, and potential contract issues.
Solution:
McBee implemented an integrated solution to provide a thorough review of payer contracts and processing of the client’s outpatient claims.
Through this holistic approach, McBee captured the revenue for the hospital, in addition to recovering revenue that was not reimbursed. During this process, potential opportunities were recognized and then reviewed by McBee certified coders and consultants to validate the potential opportunities were compliant and supported by the patient’s medical record. After the documents were confirmed and approval was obtained, the claims were adjusted with the additional charges and submitted to the payer for the additional reimbursement.
Based on the findings of the review, process improvements were recommended to the hospital to continually optimize accurate outpatient revenue going forward.
Results:
Through McBee’s custom solution, the hospital recovered over $750,000 in reimbursement in 10-months. In addition, it’s projected they have the potential to generate $700,000 annually as a direct result of process improvements implemented after this review.
McBee assisted this hospital with generating additional reimbursement while also providing assurance that they have the appropriate compliant processes in place to capture revenue.
