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| Gwinnett Hospital System identifies $16.3 million in net improvement with MedAssets Charge Integrity Solutions |
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Incorrect charges and charge omissions on patient bills is a common mistake that leads to significant lost revenue. Often only retrospective audits identify the significant financial impacts of this “silent” negative impact to the bottom line. With increased margin pressures and shrinking reimbursements, healthcare providers should focus on automation and solid processes to validate all charges have been captured on claims prior to submission.
Gwinnett Hospital System (GHS), a two-hospital system, implemented MedAssets proven suite of revenue cycle management solutions in its goal to automate and optimize charge captures and to date has identified $16.3 million in financial improvement.
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Challenge |
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GHS is a 553-bed not-for-profit healthcare network located in a suburb of metropolitan Atlanta, with net patient revenue of
$567 million.
GHS had a revenue integrity department staffed with two charge audit nurses, two charge analysts, a chargemaster coordinator. Staff, however, lacked an automated solution to help them enhance and streamline the charge capture process and the ability to identify financial value of the revenue integrity department – GHS needed a tool that would show the value in capturing net revenue.
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Solution |
In 2005, GHS selected a variety of MedAssets revenue cycle solutions, including the Charge Capture Audit (CCA) tool to help the revenue integrity department identify missed patient charges prior to claims being submitted. Complementing the benefits of CCA was the deployment of MedAssets solutions and services to address chargemaster management and comparative rate modeling services.
CCA is a web-based solution that provides electronic audits for all inpatient and outpatient bills based on multiple sources with more than 2,000 business-driven rules. The solution is designed to flag charging issues based on clinical practice guidelines and Medicare coding requirements. The system will reflect updated rules as needed and new rules are introduced monthly; meanwhile customers are able to develop their own custom rules.
Michelle Johnson-Bolden, Director of Revenue Integrity, GHS noted how CCA helped facilitate communication and efficiency among various departments involved in the charge capture process.
Within the first fiscal year after the launch of the enhanced version of CCA, GHS captured $1 million in net revenue and reduced reviewed accounts by 50 percent.
“Simply put, accurate charge capture creates cleaner claims and fewer denials,” said Johnson-Bolden. “The technology that CCA offers is much higher and more evolved than some of the other tools out there.”
In March 2010, MedAssets collaborated with GHS to beta test an enhanced version of CCA.
“Operating as the MedAssets beta site for CCA gave us a great advantage,” said Johnson-Bolden. “By the time the tool went live, 75 to 80 percent of our requests were implemented. It’s a great learning tool that allowed our facilities to develop the knowledge base for our staff to understand the rules of charging, overcharging and undercoding.”
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| Results |
GHS’s successful use of MedAssets revenue cycle management solutions has led to $16.3 million in financial improvement since its implementation in 2005. In just seven months alone after the launch of the enhanced version of CCA, GHS captured $1 million in net revenue and reduced reviewed accounts by 50 percent.
“Our revenue integrity team has been able to reduce missed charges, increase compliance and reduce reworking accounts because of improved rules editing with MedAssets charge capture audit,” said Johnson-Bolden. “We were able to see significant results in our productivity and workflow, and because our savings were so substantial, we were able to reallocate that money and hire two more charge nurses to our staff.”
In addition, two key process improvement opportunities were identified and corrected through CCA, resulting in increased accuracy and enhanced revenue. In the radiology department charge accuracy improved from 44 to 100 percent after identifying and correcting incorrect coding for biopsies. In addition, $90,000 in missed charges from the nuclear medicine department were identified over a 10-month period. An underlying system issue was preventing the correct clinical charges from being sent to the patient accounting department, resulting in undercharges. The correction and staff education resulted in a jump in accuracy from 51 to 100 percent.
“After seeing the positive results, our clinical departments began using CCA directly to further increase our efficiency, improve our rules editing and compliance and capture more charges,” added Johnson-Bolden. “Charge Capture Audit enables us to work within one tool, and the entire process has helped our clinical staff move away from performing non-clinical data entry, which allows them to be more productive.” |
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