Uncovering a Half-Million Dollar Billing Error

MS Case Study

OVERVIEW

RevID’s advanced clinical activity routing and charge reconciliation process identified a misclassification of a billable procedure, correcting a systemic EHR charge build issue worth over half a million dollars. This ensured accurate reimbursement for all services rendered, highlighting the critical role of Streamline’s automated solutions in revenue cycle management.

MS Client Profile

CHALLENGES

  • Ineffective Manual Processes: The existing process was largely manual, leading to inefficiencies and errors.
  • Lack of Awareness: Unaware of discrepancies in charge builds resulted in gaps during reconciliation.
  • Revenue Loss: Missing charges caused significant revenue losses across multiple departments.

GOALS

  • Implement Charge Reconciliation Program: Establish a proprietary approach to ensure all services are accurately charged, billed to minimize missed charges and underbilling.
  • Pre-bill Issue Resolution: Ensure charge build is accurate, and discrepancies are resolved before billing.
  • Expedite Billing: Reduce late billing instances caused by charge build issues, improving cash flow.
MS Quote

OUTCOMES

  • Enhanced Charge Reconciliation Process: A comprehensive charge routing audit was implemented, ensuring accurate revenue capture and billing integrity across all service lines.
  • Error Identification: Discovered charge build errors, specifically a “No Charge” function was misapplied to a nuclear medicine procedure, preventing automatic charge generation upon completion of clinical activities.
  • Significant Revenue Recovery: This single error resulted in reconciliation of gross revenue totaling $568,345.
MS Revenue Copy 2

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