Hospitals Case Study
Our extensive experience with working with hospitals and large academic medical centers has given us great insight on the intricacies of these complex organizations and their various types of issues. Our most recent client, a large academic medical center on the west coast, sought us out to commence a multi-faceted engagement within their hospital and clinics having recently gone live on the EPIC system.
HSMN carried out extensive reviews of the following processes:
- Outpatient Data Analysis
- APC Grouper Edit Analysis
- Charge Reconciliation
- Charge Master Verification of Billing Issues
- Key Revenue Cycle Processes, Organization and Function Review
- Selection of Outpatient Records for Review
- Record Review (comparing bill to documentation and to remit)
- Department Manager Interviews and Observations (Clinical and Administrative)
- High Level Systems Analysis
- Financial Impact Analysis of the Current Billing Model
The analyses we conducted uncovered several system idiosyncrasies and process shortages required for a seamless transition and minimal operational interruptions. We clearly identified and quantified many issues that our review of the data revealed. We then shifted focus to investigate the root cause analysis of the issues discovered, by creating work groups and interdisciplinary teams to track the genesis of problems and hone in on the desired outcomes and their individual effects on other faculties enterprise-wide.
A keen understanding of the organization’s culture allowed us to create a unique and comprehensive management plan designed to address each problem identified. Our recommendations spanned from changes in the organizational structure to processes on data and documentation review. We assisted all team leaders and staff in creating team goals and implemented quality checks and performance improvement plans to monitor them. Our thorough financial analyses allowed this client to recoup millions of lost revenue from prior claim submissions while implementing processes we recommended ensuring that all revenue opportunities were captured.