Case Study: Improving ED collections by resolving coding and clinical documentation issues
Customer Situation
Our client, a mid-sized hospital group, faced challenges getting reimbursed for ED visits. Sub-optimal client documentation processes led to delayed payments and reduced reimbursements. Our initial analysis revealed that delayed billing was the root cause. We conducted an exhaustive internal audit of 30 physicians working across two facilities in Washington and Florida.
Challenges
Medical Billing Wholesalers' team of revenue cycle practitioners and managers analyzed the issue and determined that the following challenges were leading to delayed billing and reimbursements:
Inadequate clinical documentation by Emergency Department
Missing HPI (History of Presenting Illness), ROS (Review of Systems), and PE (physical examination) information
Missing ancillary procedure notes
Missing information on the depth or the length of the wound (E.g.) – Laceration repair procedures
Lack of awareness that the details of the person scribing the clinical documentation were required to bill the claim
Delayed responses to the coding-related queries from the physicians led to further delays in filing the claims,
Missing Digital signature by the physicians
Solution
As we transitioned the revenue cycle processes to Medical Billing Wholesalers, we developed a comprehensive revenue cycle transformation plan along with the hospital's revenue cycle leaders and clinicians. Our objective was to bring about a holistic improvement by addressing all the issues with the current state and helping the hospital improve reimbursements grow. Our team of billers and coders executed the following solutions:
Medical Records Audit
Reviewing the Medical Records to check for scanning clarity and checking if the billing team has notified the scanning team of any issues
Keeping the claims on hold if the medical records are not complete and notifying the provider team to update and share the records within 24 hours
Discussed the importance of scanning the detailed document to arrive at the specific procedure and diagnosis codes
Connected and confirmed with the provider group on the commonly missed components and explained to them the importance of documenting the complete procedures, including the History, ROS, PE, and Scribe details
Analyzing physician-wise trends on the missing components were shared daily and weekly.
Physician Education
We conducted physician education programs to demonstrate the coding and billing functionalities of the Patient Accounting System. The awareness of the system's functionalities and requirements helped the providers understand their documentation responsibilities better and highlighted how improved clinician documentation leads to better reimbursements.
We shared insights regarding the issues prevailing in medical records with the providers monthly to avoid recurrence. Standardized turnaround time for clarification resolution was also discussed and set as 24 hours with the Providers.
Holding claims with inadequate documentation
Holding the claims for specific scenarios for provider clarifications before submission to avoid claim denials. For instance, in laceration repair, a lack of information about the length or depth of the laceration could lead to claim denials. In such scenarios, we will query the physician for the correct details or code with the procedure of the least level. Such scenarios were discussed monthly with the client to bring improvements to policies and procedures.
Results
We worked with the clinicians to streamline the clinical documentation processes and address the inadequacies. Consequently, the number of accounts pending for incomplete or missing documentation was reduced from 19% in Mar-22 to less than 1% in Sep-22
Laceration repair-related denials were reduced from 11% in Mar-22 to less than 1% in Sep-22
We successfully brought issues related to medical records and clinical documentation under control
By Jun-22, we eliminated the issue of delayed filing due to the lack of digital signatures by educating the physicians on digital signatures being an essential requirement
We increased the monthly collection from $6,325.00 in May -22 to $80,230.10 in Sep-22
Schedule a consultation
Our focus on resolving denials by identifying and systemically eliminating the root causes, helps our clients improve revenue by a minimum of 20%. To learn about how we can help you reduce denials and improve revenue cycle metrics, please fill the form below, and we will be in touch.
