Charge Integrity Analytics Improves Revenue Recognition, Retaining More Than $6M

MultiCare Health System (MultiCare) recognized it had an opportunity to improve its charge capture processes and reduce losses. The organization sought a solution that was scalable, reduced errors, and increased profitability. MultiCare leveraged its analytics platform and a charge integrity analytics solution to enhance its ability to efficiently manage its charge capture processes, providing access to timely and actionable insights and enabling efficient root cause resolution.

Featured Outcomes:

• $6.1M in net revenue retained, a result of the timely resolution of more than 350 charge capture issues identified by daily audits in the analytics solution.

EFFECTIVE CHARGE INTEGRITY PROCESS KEY TO FINANCIAL SUCCESS

收费捕获是收入周期绩效的一个关键组成部分。不准确的收费捕获会危及收入和法规遵从性。对任何医疗机构来说，高达1%的卫生系统净收费都来自于丢失的收费获取机会。¹An efficient strategy for charge integrity is essential for financially healthy organizations.

TIMELY ROOT CAUSE IDENTIFICATION AND RESOLUTION

MultiCare experienced changing payer reimbursement and billing guidelines as well as significant and extensive growth, which resulted in increased compliance issues, denials, adjustments, and frustration among both patients and clinical department leaders. The organization recognized that its people, processes, technologies, and tools had not kept pace with the changing environment, creating gaps between the needs of the organization and the output of its revenue cycle department. MultiCare assessed the alignment of its revenue cycle performance with its organizational strategy and executive expectations. It recognized the need for a solution that would optimize charge integrity analysis by proactively identifying issues and providing root cause resolution that was scalable with growth, promoted reduced error volumes, and improved net revenue.

PROACTIVE ANALYSIS IMPROVES CHARGE INTEGRITY

MultiCare developed a robust charge integrity audit program to improve revenue cycle performance and increase net revenue. It focused its efforts on improving its people capabilities, processes, and technology.

• People Capability Improvements:MultiCare supported its staff in increasing their analytics acumen, improving the ability to recognize trends, identify high-priority issues and the associated impact, and collaboration with other teams.
• Process Improvements:MultiCare改变了它的流程，以识别和解决根本原因，改变流程以确保员工处理根本问题，而不是单个账户。MultiCare改进了流程，以确保适当选择和利用解决方案来解决系统性问题，有效地实施改进活动，并对结果进行一致的监测。2022卡塔尔世界杯赛程表时间
• Technology Improvements:MultiCare启动了一个新的问题追踪器，标准化了根本原因分析模板，创建了新的监控报告的工具，并开发了执行领导记分卡。

MultiCare leverages the Health Catalyst^®数据操作系统(DOS™)平台和一套健壮的分析应用程序的数据世界杯厄瓜多尔vs塞内加尔波胆预测和分析。该组织选择了实现VitalIntegrity™，这是一种基于web的分析解决方案，通过检测和纠正合规性问题，使组织能够有效地管理医院费用捕获流程，并支持组织改进报销和合规性的总体目标。MultiCare使用分析解决方案作为其前瞻性问题识别和解决过程的一部分，使组织能够认识到由于漏报收费造成的低效率和收入流失，识别由于过高收费造成的合规性问题，并促进对不准确收费的跟踪，直到根本原因。组织进行三种不同类型的审计:日常审计、系统审计和随机审计。

• Daily Audits:Daily audits are automated using the charge integrity analytics solution. The analytics solution receives daily feeds of all coded hospital accounts from MultiCare’s EHR and reviews those accounts and charges against a national database of rules, enabling staff assignment, sorting, filtering, exporting, and reporting. Staff can more efficiently identify and rectify trends and issues rather than focus on individual account resolution.
• Systematic Audits:MultiCare creates an annual schedule at the beginning of the year for systematic audits. Revenue cycle staff complete the systematic audits by clinical area and compare similar units across the organization, enabling comparison of like-type groups. Charge description master (CDM) analysts research and document audit findings, providing the organization the opportunity to resolve issues. For example, a systematic audit might identify a cesarean section charge without an accompanying anesthesia charge. CDM analysts could then review other labor and delivery departments across the health system to determine if there were similarly missed charges.
• Random Audits:日常和系统的审核为部门随机审核的选择提供了依据。MultiCare随机选择并审核与特定部门或服务线路相关的30个账户，进一步了解其他有针对性的改进机会。

MultiCare通过确保在多个组织会议上与利益相关者进行绩效沟通，并定期发布审计结果和报告，从而加快了组织的学习。该组织创建并分发执行记分卡，将内容发布到收入周期和CDM网站，并使用时事通讯与广大受众共享信息。

RESULTS

MultiCare has gained access to timely and actionable insights by leveraging its sophisticated revenue integrity analytics solution, enabling the quick resolution of time-sensitive charging errors that affect optimal reimbursement. The organization’s people, process, and technology changes are delivering the desired results. In just three months, MultiCare has recognized:

• $6.1M in net revenue retained, a result of the timely resolution of more than 350 charge capture issues identified by daily audits in the analytics solution.

The organization also identified $36.6M in additional annualized gross revenue at risk of not obtaining optimal reimbursement or resulting in downstream denials and payer audits. MultiCare can now intervene to retain this revenue.

“MultiCare Health System leveraged Health Catalyst’s DOS platform and VitalIntegrity solution to efficiently identify and resolve charge capture issues, retaining $6.1M in net revenue in just three months, while supporting root cause analyses for ongoing process improvement.”

– Nicole Gorder, MBA, Executive Director of Revenue Integrity & CDM,

WHAT’S NEXT

MultiCare will continue to leverage VitalIntegrity to improve charge capture integrity and further advance revenue cycle performance.

REFERENCES

1. Johnson, H. & Ward, D. (2017). Avoiding the high cost of high-capture leakage.Healthcare Financial Management Association (HFMA).Retrieved fromhttps://www.hfma.org/topics/article/55358.html