The data is highlighting the top reasons for revenue leakage. Based on the above statistics, almost 92% of the error rate is due to clinical, documentation, and coding-related issues. It is an eye-opener for most hospitals and physician organizations needing to focus their attention on clinical and coding parts of the RCM process to improve their compliance and reimbursement.
Vee Technologies’ consulting teams provide a unique approach and solutions by helping hospitals and physician organizations develop overall coding and documentation compliance, thereby identifying opportunities to improve their outcome.
An East coast-based hospital was under tremendous financial pressure because of constant revenue leakage and increasing overheads. The physician group, with more than 300 doctors onboard, were taking care of patients and doing their coding. While physicians are good at treating patients, most struggle or have a limited understanding of coding. Physicians tend to pick codes based on their experience and assessment of the patient’s situation that they may or may not have captured in the documentation. It can potentially open up a compliance issue or lost revenue.
The client had seven or eight coders who were primarily responsible for clearing coding-related edits to release the claims. The external audit conducted by the client showed poor quality results.
However, the audit company provided no data or intelligence that would help the client identify the root cause of the problem. Vee Technologies provided a multi-step approach, keeping in mind the client’s budgetary limitations and focusing on improving the effectiveness of the process.