EXECUTIVE SUMMARY:
One of the nation’s leading healthcare systems, comprising six academic and community hospitals, four suburban healthcare and surgery centers, over 40 patient care locations, a home care group, and an international division, faced significant challenges with inpatient (IP) and outpatient (OP) coding. As a globally recognized academic and research institution, the health system handles over 300,000 inpatient discharges and over 2 million outpatient visits annually, generating over $10 billion in annual revenue.
CHALLENGE
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Inconsistent coding accuracy rates for inpatient and outpatient services, averaging around 90%, below industry standard.
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Over 30% of weekly charges were not billed within the same week, leading to a growing backlog in IP and OP coding.
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The average time between discharge and billing was around seven days for IP coding and five days for OP coding.
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Missing, incomplete, or inaccurate documentation resulted in missed or incorrect charge capture, affecting DRG value and causing revenue loss.
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The ongoing transition from four different legacy systems to EPIC introduced additional complications.
SOLUTIONS
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A team of inpatient and outpatient coding specialists with EPIC experience was deployed in phases across all EPIC-enabled hospitals.
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A dedicated team of Clinical Documentation Improvement (CDI) specialists and optimized physician query templates were introduced to enhance documentation and ensure accurate service capture.
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A parallel coding team was assigned to non-EPIC hospitals, aligning their transition with the EPIC implementation timeline.
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A revenue integrity team was deployed to ensure coding accuracy and comprehensive service capture by conducting thorough concurrent and retrospective audits and enhancing physician documentation.
RESULTS
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Inpatient and outpatient coding accuracy consistently exceeded 95% in all external audits.
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Weekly unbilled charges dropped to under 10% for OP and IP coding.
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The unbilled amount for outpatient services decreased to below $3 million, down from over $6 million before partnering with Access Healthcare.
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No inpatient claims remained in the EPIC work queue for over two days, significantly improving from the previous seven-day delay.
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Missed revenue capture was reduced to less than $5 million per month, down from over $14 million before engaging with Access Healthcare.