SUCCESS
STORIES

Physician Education and Consultancy Deliverables

Background:

The Client is a 150-bed community hospital located in the heart of a large city in North East US that combines state of the art healthcare with compassionate care of patients. The parent hospital has a tradition of excellence spanning 100+ years offering primary and preventive care as well as leading specialty care services to the city. Over the years a large number of their physicians have been listed in consecutive issues of the city magazine's “BEST DOCTORS” special editions. Additionally, they run several residency programs for student physicians as the academic medical center of the city's Medical College.

The hospitals Emergency Department was struggling with falling collections coupled with growing Account Receivables. The medical coding, charge entry, cash posting and A/R management was being handled by a US based billing company for the last 7 years. The CFO and the Emergency Department Director found it extremely challenging to figure out a solution consistently falling top line revenues that continued to grow over the months.

Key Challenges:

• Consistent fall in top line revenues month after month.
• Limited Quality Control cover on medical coding leading to deteriorating accuracy levels.
• Turn around Time increasing for getting the medical charts ready for charge entry, impacting collections.
• Insufficient documentation on medical records by Emergency Room Doctors resulting in down coding of charts and thus lower claims reimbursement from payers.
• Staff augmentation in Billing Office considered as a possible solution but deemed not feasible since it led to higher costs for administering the patients.

The Medusind Approach & Solution:

• Medusind's team identifies and recommends outsourcing of medical coding services to its offshore facility.
• Medusind's CPC & CPC-H certified team with American Academy of Professional Coders (AAPC) takes charge of the processes.
• Focus on operational efficiencies to minimize turn around time for the client.
• 24/7 operations leading to a catching up on the backlog.
• Flexibility with staffing allowing more coders put on this project.
• Implementation of in-house developed quality tools & processes.
• Quality initiatives focused on continuous improvement and reducing error rates drastically.
• Daily reporting to client with value added statistical analysis.
• Physician Education Program identified as a long term solution to problem of insufficient documentation by ER physicians.
• Individual MD physicians provided feedback through onsite presentation and coaching sessions as well as conference call discussions on appropriate documentation standards to ensure accurate reimbursement for services provided.
• Critical Care Billing Review.
• Focused Detailed Analysis on trends of documentation by each MD physician at each month end.

Benefits to Client:

• Enhanced reimbursements with top line revenues hitting record high as per historical records of the Emergency Department in the last 10 years.
• Correct documentation of critical care services.
• Appropriate revenue reimbursement for all procedures and E/M visits done by ER physicians.
• Better results on external / Medicare audits.
• Develop and understood T-templates and Charge masters (CDM) by customizing to the needs of the doctor group.
• Using Acuity CAVEAT! What you should or should not document.
• Excess capacity created at client end by using Medusind team, enabling the client for faster business growth, without adding to cost.
• Shortened Turn around Times for generating 'clean' claims ready for submission.
• Medusind flexible staffing and working hours ensuring marked increase in productivity numbers.
• Raised client satisfaction level.

Testimonials from the Client

I have always been skeptical of documentation education for Emergency Room physicians. Prior consultants have made multiple promises with few results. Often I would see examples of what I call the, "Coder / Physician gap". Coders understood the confusing rules of documentation but rarely understood the way an emergency physician thinks. Physicians understand the practice of medicine but rarely understand the relevance of certain documentation requirements.

This summer we embarked on a project utilizing Medusind to educate our physicians and deliver medical coding services. I must admit I was pleasantly surprised by the strong positive feedback from many of our physicians. Indeed, per diems from other institutions were so impressed they recommended Medusind to their home facilities. And ultimately the final commendation came in the form of increased dollar revenue with improved RVU's/pt by many of the physicians involved in the program. When it comes to Emergency Room Billing, Medusind seems to get it. I'm very comfortable recommending them.

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