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Revenue Recovery
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System
setup recovered $800,000. As part of the implementation of a Denials
Management system, this single facility noticed that the data for
managing new admissions was different than the data for the same
accounts in the host Patient Accounting System. Through
investigation we uncovered a system setup problem that was not sending
accounts from the admissions module to the financial module. The
biggest problem is that these accounts were not billed. In looking back
only six month, there were $2 million in claims that had not crossed
properly. This required manual intervention, and with an average 40%
reimbursement rate, recouped $800,000 for the hospital.
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Medicaid
newborns underpaid by $80,000. After implementation of the contract
management system, the reports showed missing reimbursement for Medicaid
newborns. The hospital went back six months and recovered $80,000 from
Medicaid for this issue.
Implementations
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Denial
Management: A five hospital system with a main university teaching
hospital found itself, like many institutions, with a high denial rate.
We met with key stakeholders to identify the issues, develop a plan for
improvement, then implement the software necessary to accomplish the
goals. We included corporate and facility level Directors of Utilization
Review, Patient Financial Services, Health Information Management,
Patient Access, Revenue Recovery, and Case Management. Within six
months, the facility overturned several million dollars in denials. We
continued to be involved in technical support until the facility found
adequate staff for a smooth transition.
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Contract
Management: A multiple facility system came to me when they were
converting from one payor contract management system to another. We
standardized as much as possible in the data for the 14 hospital system
with multiple values for insurance codes, patient identifiers, and
reimbursement rates. After setting up the software rules for the most
complex reimbursement methodologies (Blue Cross among them), we trained
the organization staff on the maintenance of contracts for future rate
changes. We helped staff figure out how to get the data out they needed
to make decisions on underpayments as well as contract negotiations. We
even helped them figure out when interfaces were sending data that
resembled spaghetti. By systematically dissecting the moving parts, we
helped the organization to have a functional system with which to
recover millions in underpayments and to negotiate contracts to avoid
giving away the farm.
Data Mining
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Managed
Care Performance Report: A multiple
facility organization was using old reporting technology that only
allowed printed reports and a lot of manual intervention to get them
archived or shared. They needed a way to allow end users to
run the reports, then email and archive them. We converted the old
reports with the 18 key indicators. We wrote a customized Managed
Care Dashboard for an organization with 23 hospitals. These indicators
allowed comparison for each insurance payor, month by month, for each
facility. End users ran their own reports. Every month. They used this
report for years until converting to yet another system.
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PHIS-NACHRI
file submission: One hospital
spent 80 hours each quarter gathering data for regulatory submission. We
used the contract management database, rich in procedures, charges,
diagnoses, demographic, and insurance information to create the files.
End users ran a few reports and put the output data through a custom
conversion program. This takes less than an hour each quarter now,
saving an incredible 316 hours a year.
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Core
Measure file submission: A four
hospital system gathered JCAHO Core Measure data with its Quality
Management System as part of the original Core Measure Demonstration
Project. The data output was complex and they needed an expert in
reporting out of the relationship database. We wrote the extraction and
conversion into the JCAHO Core Measure submission format. This
hospital was able to also have the data imported into a database they
created for internal analysis. Instead of waiting months to get the
comparative reports back from JCAHO, they had the reports ready within a
month for the process improvement teams. By implementing changes they
improved patient care as measured by improved outcomes month by month,
instead of quarter by quarter. This helped them to meet the
Medicare Market Basket thresholds and to qualify for maximum Medicare
reimbursement.
Data
Recovery
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Lost data
restored: A data center moved resulted in a loss of data. We were
able to compare the data to a source system and restore the data. Since
this six hospital system had three years of data already in the system,
they did not want to start over nor leave the system with inaccurate
data on which to calculate reimbursement and make data-driven decisions.
Within 30 days we had the system restored to functionality.
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Backloaded
a year of data: A single
facility found itself with more than a year of data to restore into
their Contract Management System. A previous upgrade to the Hospital
Information System (HIS) resulted in the interface not working. We
validated the interface data was in the correct format, then worked with
the software vendor to interface the data, two weeks at a time. We
reviewed the interface rejections, fixed underlying issues, and restored
the data. This allowed the hospital to use the database which had data
seven years of data linked to fresh daily data. We saved the data and
created an intact Decision Support database.
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Data
Restoration: A two hospital
system had a new HIS implemented, and the interfaces did not send
accurate data. By the time the bad data was discovered, some of the
backup tapes had been rewritten. We had to recreate two weeks of data,
then interface the data carefully watching for rejections due to the new
HIS and its changed data elements. We were right on target, since we
were brought in a month after the original data failure; it took three
months to get the system back up to daily operations.
Training
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New staff
training: When
the contract coding analyst at a six facility system hired a new person,
we provided 3 days of onsite training followed by 3 times a week 2-hour
sessions to supplement as the new analyst learned the system. Through
individualized training, we were able to accomplish a knowledge transfer
for the new person to be independent within a few months.
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New user
training: When
a hospital lost its main report writer due to retirement, they were
caught short and needed to have that knowledge transferred to the next
generation. We trained the new support staff in management of daily
interfaces, error reports, and data monitoring. We provided tools that
made the daily tasks easier. We spent 4 days training 12 people in the
basics of report writing and using Crystal Reports on their own contract
management database, which they used mostly for decision support.
Most were able to write reports independently at the end of the week.
Technical
Support
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Advanced
Reporting and Contract coding:For a two
hospital system, we picked up and supported the advanced contract coding
and report writing left behind after another consultant retired. Using
older technology, the consultant had developed some very creative
solutions that otherwise would not be manageable with standard tools in
the software. For just a few hours a month, this hospital had peace of
mind and technical support for changes required when payors made changes
to the reimbursement contracts.
- December 31, 2003 system
failure.
It was
a Friday, and very few workers were around. The vendor was closed from
December 31 to Jan 3rd. The crash happened December 30 and though the system
rebooted, the interface failed and the database was corrupted. We assisted
the healthcare corporation to restore the databases for their 19 hospitals
and to catch up the interfaces so that on January 3rd, 2004 they could run
their year end reports. This saved at least three days of time and meant the
reports were ready as expected.
Custom
databases and programming
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Custom
Epilepsy Tracking Database. A pediatric
neurology practice wanted to track its epilepsy program. With no
standard epilepsy data elements, we helped them to define the data they
wanted to track, developed a MS Access database for them to use in data
entry and reporting. This could be the basis for future data management
in epilepsy research and treatment.
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