Health Information Management Auditing and Coding

A national pediatric hospital system leverages our Health Information Management solution to enhance their revenue cycle processes.  

SITUATION 

Our client is one of the top pediatric hospitals in the nation with over 450,000 outpatient visits and more than 16,000 surgeries per year. Their signature services include cardiology, oncology, fetal medicine, neurosurgery, pediatric orthopedics, cardiac surgery, neonatology, and neurology as well as a multitude of additional pediatric services. The revenue cycle department had recently been given added oversight of additional departments and was seeking to improve documentation and provide additional education to staff and providers. They needed the expertise of a strategic partner to help them identify areas of improvement for coding, billing and documentation, in addition to educating their coding staff, revenue cycle team, and providers.  

SOLUTION 

We worked with the key client stakeholders to perform a Current State Assessment. Our engagement team included auditors specialized in pediatrics and identifying general areas of improvement. Our team reviewed records from a variety of process areas including the Emergency Department, Inpatient stays, Outpatient surgeries and clinics within the healthcare system. Our team engaged client leadership to learn about new department responsibilities and future projects so we could focus on the right areas that required improvement including compliance and reimbursement, enhanced workflows and standardized operations. 

Provided future state recommendations that improved coding quality, billing and overall revenue cycle

RESULT 

Our team was successful in assisting our client with improving their coding quality, billing and overall revenue cycle. Our team has continued their effort to develop the client’s internal staff, identify creative ways to provide ongoing education to their providers, and enhance their overall revenue cycle operations.