Revenue Recovery
- 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 months, it was found that there were $2 million in claims that had not crossed properly. Therefore manual intervention was required. In the end an average 40% reimbursement rate was found and the amount recouped for the hospital was $800,000.
- 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
- 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, and 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 on what was being done. Within six months, the facility overturned several million dollars in denials to paid claims. We continued to be involved in technical support until the facility found adequate staff for a smooth transition.
- Contract Management: A multiple facility system came to us when they were converting from one payor contract management system to another. We standardized a bulk of the data for the 14 hospital system; which needed multiple values for insurance codes, patient identifiers, and reimbursement rates. After setting up the software rules for the most complex reimbursement methodologies (Blue Cross for example), we trained the organization staff on the maintenance of contracts for future rate changes. We helped the staff figure out how to extract the data they needed to make decisions on underpayments and contract negotiations. When we were able to systematically dissecting the moving parts, we helped the organization to have a functional system which allowed them to recover millions in underpayments and to negotiate contracts that was beneficial to the facility and its employees.
Data Mining
- Managed Care Performance Report: A multiple facility organization was using an old reporting technology that only allowed printed reports and a lot of manual intervention to get them archived or shared. Managers felt that they needed a way to allow end users to run the reports, email, and archive them. We were able to convert the old reports with the 18 key indicators. After the conversion we wrote a customized Managed Care Dashboard for the organization which had subsidiaries of 23 hospitals. The indicators allowed for a comparison for each insurance payor, month by month, for each facility to be done. In the end, users were able to run their own reports each month. They used this report for years until converting to another system.
- PHIS-NACHRI file submission: At one point in our adventures we were able to work with hospital that spent 80 hours each quarter gathering data for regulatory submission. We used information from the contract management database, hospital procedures, charges, diagnoses, demographics, and insurance information to create the files. Each of the end users ran a few reports and were able put the output data through a custom conversion program. Now the process of submissions takes the users less than an hour each quarter now, saving the hospital an amazing 316 hours a year.
- Core Measure file submission: A hospital system that include four hospitals gathered JCAHO Core Measure data with its Quality Management System as part of the original Core Measure Demonstration Project. Data output was complex for them and they needed an expert in reporting out of the relationship database. Our part in this process was to write up the extraction and make a conversion into the JCAHO Core Measure submission format. Hospital employees were able to have the data imported into a database that 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
- Lost data restored: A data center moved which resulted in a loss of data. Bloom Road Consulting Group, LLC team was able to compare the data to a source system and restore the data within 30 days. There was a six hospital system had compiled three years of data on the system. The group did not want to start over or leave the system with inaccurate data. The ability to calculate reimbursement and make data-driven decisions would have been effected.
- 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 correctly. We were able to validate the interface data was in the correct format. By working with the software vendor to interface the data, the process was done two weeks at a time. We were able to review the interface rejections, thus fixing underlying issues, and restored the data. This allowed the hospital to use the database which had been storing seven years of data to be linked to the daily data. We saved the data and created an intact Decision Support database.
- 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, interface the data carefully watching for rejections due to the new HIS, and its changed data elements. 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
- New staff training: When the contract coding analyst at a six facility system hired a new person, we provided 3 days of on site 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.
- 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
- 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 health care 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
- 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.