Transcript AppRevSolutions Overview

Improving Revenue Cycle Accuracy
Through Analytics
April 2013
Agenda and Goals
• Statement of the problem
• Current process and use
• Practices of the group
• Future analysis
Introduction
Hospitals struggle to ensure the accuracy of the revenue cycle…
Accuracy
• the condition or quality of being true, correct, or exact; freedom
from error or defect; precision or exactness; correctness.
• the extent to which a given measurement agrees with the
standard value for that measurement.
• the degree of correctness of a quantity, expression, etc.
Revenue Cycle Accuracy
• Where do you start?
• Front End
• Scheduling
• Registration
• Middle
• Clean claims
• Complete bills
• End
• Denials
• Correct payments
Middle Accuracy
Hospitals struggle to ensure the accuracy of the
revenue cycle…
• Charge reconciliation
• Edit on charge posting
• Charge audit
• Clearing house edits
Data for use
• Revenue codes
• Bill Type
• HCPCS
• Charges
• ICD-9 (diagnosis and
procedure)
• Quantity
• Patient Type
• Discharge Status
Sample Tests
• Pairing
• What goes together?
• Diagnosis
• What goes with the clinical assessment?
• Ratio
• What is an expected occurrence rate?
• How should the services be related in their occurrence?
Services that go together….
How would you have found this? Most systems would not edit for this.
Service
Occurrence
% Rate
Cystoscopy with stent insertions
(CPT 52332) without device
billed
56
84%
Cystoscopy with stent insertions
(CPT 52332) and device billed
(C2617 or C2625)
11
16%
Services that go together….
How would you have found this?
Service
Insertion tunneled centrally
inserted central venous catheter
w/o port/pump (CPT 36558)
without device billed
Insertion tunneled centrally
inserted central venous catheter
w/o port/pump (CPT 36558) and
device billed (C1750, C1751, or
C1752 catheter)
Occurrence
% Rate
3
15%
17
85%
Specialty Radiology
Have you ever looked at what radiological services are in your ED Evaluation and
Management levels?
Total Client
Count
Total
Benchmark
Client
Total
Benchmark
Distribution
Level 1
92
18,083
1%
1%
Level 2
1,801
11,252
14%
3%
Level 3
6,025
58,500
47%
17%
Level 4
3,247
169,058
26%
49%
Level 5
1,552
102,285
12%
30%
E/M Level
Surgical Procedures
Have you ever looked at what types of procedures are your ED level distribution?
Total Client
Count
Total
Benchmark
Client
Total
Benchmark
Distribution
Level 1
501
1,441
13%
3%
Level 2
1,772
8,692
47%
15%
Level 3
1,208
25,654
32%
45%
Level 4
192
16.714
5%
29%
Level 5
103
47,077
3%
8%
Details, Details, Details
Procedure
Total
Occurrences
# With ED
Level 2
Customer
%
Benchmark
%
10060 I & D
SKIN SIMP
237
56
58%
18%
10061 I&D
COMP
524
135
58%
21%
12002 SIMPLE
REPAIR 2.67.5CM
597
126
37%
16%
29240
STRAPPING
SHOULDER
144
37
41%
15%
Using Diagnosis Codes
Do you look at diagnosis codes to determine if a procedure was not
billed?
685.0
685.1
685.0/685.1
Total
10
4
14
# w/o I&D code
2
2
4
% w/o I&D code
20%
50%
29%
# w/incorrect 10060
0
1
1
% w/incorrect 10060
0%
25%
7%
# w/ incorrect 10061
2
1
3
% w/incorrect 10061
20%
25%
21%
9.13 Rhythm ECG (CPT 93041).
9.13.1 Defined as a recording of the electrical activity of the heart by placing one to three
electrodes on a patient's chest in a predetermined pattern. CPT 93041 describes the
tracing (or technical component) only. Per CPT Coding Guidelines for Cardiology,
CPT code 93041is appropriate when an order for the test is triggered by an event,
the rhythm strip is used to help diagnose the presence or absence of an arrhythmia,
look for commonly
performed services that were not billed at your hospital?
and a report is generated. There must be a specific order for an electrocardiogram or
rhythm strip followed by a separate, signed, written, and retrievable report. It is not
appropriate to use these codes for reviewing the telemetry monitor strips taken from
a monitoring system. The need for an electrocardiogram or rhythm strip should be
Rhythm ECG
CPT
supported
by 93041
documentation in the patient medical record.
Finding Missing Codes
Do you
Total E&M Billed 99281-99285
(Level 1-5), 99291 (Critical Care)
Lee
43,256
Benchmark
733,498
0
2000
Benchmark
Lee
4000
Total CPT 93041 (electrocardiogram)
% Occurrence
0
10,531
0.0%
1.44%
6000
8000
10000
12000
10,531
% Occurrence
Total 93041
0
0.00% 0.20% 0.40% 0.60% 0.80% 1.00% 1.20% 1.40% 1.60%
9.14 Duplex scan of extremity veins (CPT 93970, 93971).
9.14.1 Defined as Duplex scan of extremity veins including responses to compression
and other. Report CPT 93970 for a bilateral study and CPT 93971 for a
unilateral study.
Total E&M Billed 99281-99285
(Level 1-5), 99291 (Critical Care)
Lee
43,256
Benchmark
733,498
Total CPT 93970 or 93971 (duplex scan of
extremity veins)
753
20,084
% Occurrence
1.74%
2.74%
Discussion