The point system needs to be interpreted and implied in a consistent manner. Therefore, if your billing is being done internally or if an outside vendor is performing your billing, both of those entities regardless of whom it is, needs to interpret your internal guidelines for the point system in a consistent manner.

10 Common Mistakes Index

Deaconess Hospital
Evansville, Indiana

www.deaconess.com

Profile

Deaconess Hospital is a system of five hospitals, located in Southwestern Indiana, serving residents of Southern Indiana, Southeastern Illinois, and Western Kentucky. One of the largest hospitals in the region, Deaconess’ 500+ bed hospital employs more than 4200 people. Each year, on average, Deaconess Hospital treats 18,000 inpatients, 350,000 outpatients, 7500 surgical patients, and 65,000 emergency patients.

Its services include a 24-hour emergency center, radiology, corporate wellness, family medicine clinic, heart services, cancer services, orthopedics, women’s hospital, pediatrics, hospice care, neuro services, and several support groups programs. It is a component of the larger Deaconess Health System, which is dedicated to providing comprehensive, compassionate, and quality care.

Situation

Prior to engaging BDA’s services, Deaconess performed an in-house analysis and identified the following challenges:

• Practices were growing in patient volume
• Overhead and operational expenses were increasing
• Coding remained the same
• Collections did not increase due to patient volume
• It experienced increased insurance denials

BDA Performs a Preliminary Analysis

Deaconess’s management decided to complete a preliminary analysis with Bill Dunbar and Associates, to determine what opportunities may exist for both organizations. BDA requested the following reports from Deaconess for its analysis team to review:

1. The Chargemaster
2. The Chargeticket/Superbill
3. The Fee Profile

In addition to these reports, BDA reviewed a % breakdown of Deaconess’s A/R in 30 day increments, from current to 120+. After receiving the required information, BDA prepared a Preliminary Analysis Results Report for Deaconess Hospital in just two weeks. It presented its findings to Deaconess’s management team in a face-to-face presentation, which included a written report that detailed all of its findings. Based on the results from the Prelim Results Report, Deaconess engaged BDA’s services for a three year agreement.

Initial Challenges in Implementing the BDA Process

• Time (how much time was needed to implement)
  • Initial Management Meetings
  • Training For All Staff
  • Quarterly Meetings
  • Annual Update Meetings
• Documentation (what was going to change)
  • Revision / Update of current documentation templates.
  • Education of Evaluation and Management Guidelines.
• Compliance
  • Alignment of Compliance Officer with BDA Training Program
• Implementation
  • Management support of BDA Program
  • Management meetings with BDA Team

BDA staff held joint meetings with Deaconess staff in order to address all of the identified initiatives that were revealed in the Prelim Report. Deaconess wisely decided to include a large percentage of its staff in the process right from the beginning, to be sure that everyone was involved. This included the following:

• Participation Groups (determining who needed to participate)
  • Management
  • Provider(s)
  • Front Office Staff
  • Back Office Staff
  • Billing Staff
  • Coding Staff
  • Accounts Receivable Staff

Once all of the identified initiatives were communicated to all levels of the Deaconess staff, BDA presented its proposed implementation process, which included the following:

• Evaluation/Management Levels of Service consultation
• Ongoing training of Practitioners and support staff
• Development of portable training tools, templates, and EMR template development specific to provider’s needs
  • Superbill/Chargeticket review and recommendations
• Addition of omitted codes
• Removal of deleted/outdated codes
• Training of Practitioners/support staff regarding revisions and updates
• Chargemaster Review
  • Review, by line item, all descriptors (cross referenced with new Superbill/Chargeticket)
  • Review and recommendation of fees (Geozipcode specific) for usual and customary states, or comparison against State fee schedules
• Appeals Program
  • Automated appeals software: generates over 50 appeals letter templates, maintains data base of appeals with report capabilities, and includes an implementation manual
• Assessment of Current Documentation and Coding Issues through CMS-1500 and random Chart Reviews
• Targeted consultation with Practitioners and Support Staff following CMS-1500 and Chart Reviews
• Reference Binders and Training Manuals
• Coding Hotline: via Fax, E-Mail or phone
• Annual review of the Superbill/Chargeticket and Chargemaster
• Client specific Action Plans and Timelines

Short Term Benefits

• Deaconess became a part of the BDA Team
• Aligned incentive to improve net revenue per visit through appropriate coding and documentation

As a result of using BDA’s targeted approach to improving revenue capture, Deaconess realized some immediate short term benefits in its documentation, coding, and billing processes. In addition, its physicians were made aware of how the new initiatives could have a positive impact on their individual performance through the BDA one-on-one physician coaching.

Long Term Benefits

• Continued appropriate documentation
• Continued appropriate capture of coding
• Accounts receivable collections increased due to appropriate documentation and coding
• A challenge / appeal process was implemented
• Relationship with insurance carriers improved
• Overall processes in practices improved

Historical Data / Results

This chart shows both the financial and net percentage increases that occurred during the engagement.

Net Revenue Per Visit Analysis

Summary

As a result of embracing and implementing the BDA program, Deaconess experienced double digit % revenue growth, without a significant increase to its existing patient load.

If you would like additional information regarding this case study, please contact Terri Scales, BDA Regional Director of Client Services, and National Director of Business Development. She can be reached by calling 812-853-9609, or you may contact her online.