Healthcare system saves cost through optimized revenue capture and compliance

Client background

A healthcare system in the southern region of the U.S. that serves more than 150,000 patients and has nearly 200 hospital beds. 

The business challenge

The healthcare system faced significant challenges in its revenue capture processes, with concerns about potential revenue leaks. The organization aimed to ensure accurate coding, maintain compliant billing practices, and minimize claim denials to optimize revenue capture. Additionally, there was a pressing need to reduce the risk of non-compliance and avoid potential penalties that could result from lapses in these areas. 

Strategy and solution

To address these challenges, Baker Tilly undertook a comprehensive assessment of the healthcare system's existing revenue processes, with a focus on enhancing the Epic platform's capabilities. The strategy centered around several key initiatives: 

1. Comprehensive assessment 

• Conducted an in-depth analysis to identify growth opportunities and potential areas of revenue leakage. 
• Documented current roles, responsibilities, and workflows to establish a baseline for improvement. 
• Developed a strategic growth road map, setting clear growth metrics to guide the optimization process. 

 2. Process optimization

• Standardized charge reconciliation: Established a consistent charge reconciliation process across clinical operations to ensure all charges were accurately captured and reconciled. 
• Charge champion program: Introduced a charge champion program to create accountability and ownership within the revenue capture process, ensuring that key stakeholders were directly responsible for accurate charge entry and reconciliation. 
• Audit and compliance framework: Implemented a robust audit and compliance framework to regularly monitor and enforce compliance with coding and billing regulations, thereby minimizing the risk of claim denials and penalties. 

 3. Enhanced charge life cycle management

• Focused on capturing the entire charge life cycle for each clinical area, from initial charge entry to final billing. 
• Developed a communication portal for charge leads, fostering better coordination and information sharing across departments. 
• Built upon existing leadership structures and leveraged current reports and dashboards to ensure consistent data tracking and trend analysis. 

4. Actionable recommendations

• Evaluated and refined current processes, particularly focusing on changes to CPT/HCPC codes, ensuring that the organization remained up-to-date with coding standards. 
• Established protocols for implementing coding changes and standardized codes and descriptions across the system. 
• Continued documentation of workflows to enhance data consistency and support future process improvements. 
• Managed processes for new clinics, professional services, and equipment, ensuring seamless integration into the revenue cycle. 

By implementing these strategies, the healthcare system realized immediate financial gains through improved revenue capture and reduced claim denials. The organization also established a sustainable framework for continuous improvement, allowing them to independently enhance their systems and workflows over time. The collaborative approach between Baker Tilly and the healthcare system's revenue integrity team was key to addressing pain points and driving tangible value, ultimately leading to a more robust and compliant revenue capture process.