At H&A, success is more than a concept. We produce tangible, quantifiable results for our clients every day. But you don't have to take our word for it. We invite you to hear how H&A has helped healthcare organizations from coast-to-coast increase revenue, recoup reimbursements, improve compliance, and mitigate financial risk.
A Southern California IPA hired H&A to audit 700 medical records for possible HCC revisions. The purpose of the initial assessment was to evaluate the appropriateness of ICD-9-CM coding and physician documentation practices and to correct claims data to generate appropriate risk-adjusted reimbursement. We performed data analysis, identified probability factors, and provided physician and coding staff education. H&A continues to provide HCC management and on-going, monthly data analysis, auditing, and education.
By identifying a billing and information system glitch, H&A helped one large health system uncover Emergency Department CPT-4 procedures that had been coded properly, but did not transfer to the UB-92. H&A generated and analyzed HIM's soft-coded database reports over a period of 16 months. From there, we linked all CPT codes and accounts, developed and updated the ED charge description master, implemented pre-billing edits, and corrected billing form logic problems.
A healthcare system contracted with H&A to conduct a pro-active RAC revenue risk assessment, audit and strategic plan. Data mining was performed to identify the cases most likely to be targeted by the RAC for DRG and medical necessity issues. H&A analyzed data mining results, performed a focused audit of 250 accounts, and identified RAC risk alongside revenue improvements. Finally, H&A conducted an assessment to determine RAC operational needs and provided performance improvement strategies including staff education.
At a large community hospital, the Interventional Radiology CDM was incomplete, improperly listing just one charge and corresponding CPT-4 code for non-tunneled vascular access device (VAD) insertion. Tunneled VAD insertions are performed routinely at this hospital and billing this CPT code generates an additional $300 in APC payment. H&A generated and analyzed database reports with ICD-9-CM VAD procedure codes, audited the accounts to verify documentation and accurate charge capture. From there, we corrected the CDM and trained capture staff.
At one client hospital, H&A discovered missing facility E/M charges for CHF and Wound Care clinic services. Based on revenue and usage reports, H&A audited specific accounts to verify documentation and charge capture. From there, we determined extrapolation opportunities and forecasted revenue and reimbursement outcomes. Meaningful and compliant CHF clinic E/M criteria were developed and charge assignment staff was trained.
At one client hospital, the Cardiac Cath Lab routinely omitted charges for cardiac catheterization injection supervision and interpretation services. H&A generated and analyzed database reports based on ICD-9-CM procedure codes and analyzed payer mix reports. From there, we forecasted revenue improvements and audited specific accounts. Pre-billing edits were developed to reduce denials and the CDM was corrected.
At one Massachusetts hospital, the cancer center inappropriately charged for “initial” rather than “additional/subsequent” hours of IV hydration and/or therapy services during chemotherapy encounters. In 2006, this client decided that CPT and HCPCS codes that did not generate APC payments would be assigned a $0 charge. As a result of the $0 charge assignment, chemotherapy HCPCS codes did not transfer to the bill when the cancer center properly charged for additional hours of infusion and chemotherapy services. In addition, nursing documentation did not support the duration of chemotherapy services as infusion ‘discontinue time' was not routinely noted. With help from H&A, clinical documentation was improved, charge tickets were updated, in-house billing edits incorporated and training provided to point of service staff.
At a large health system in Texas, the Pediatric Oncology clinic routinely omitted charges for Epoetin injections. H&A generated and analyzed revenue and usage reports, audited accounts, corrected charge tickets and provided training to point of service staff.
At one large health system, charges for prostate brachytherapy services including radioactive seeds and needles did not transfer to the final bill. H&A generated and analyzed revenue and usage reports, audited accounts to verify documentation and charge capture, and extrapolated missed revenue opportunities. A glitch in the billing interface was also discovered and corrected by H&A.
A large, urban teaching hospital hired H&A to identify opportunities in outpatient GI Lab revenue improvement. We assessed the GI Lab CDM, evaluated efficacy of charge protocols, analyzed claim data and conducted drill-down audits of medical records, itemized bills, electronic claims, and remittance advices. From there, H&A identified omitted charges for radiological supervision and interpretation ERCP procedures. Several immediate process and performance improvement opportunities were implemented.
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