Case Study: Pulling together a revenue integrity team from your current staff

A unique organizational model has been developed to handle chargemaster and other revenue integrity workflow at Mary Rutan Hospital in Bellefontaine, Ohio; after sourcing its charge functions from throughout the organization, the hospital has created a centralized team, housed under the title of charge integrity.

“We were able to absorb work without necessarily having to move full-time employees as well,” says David Kelly, MHSA, CHFP, director of revenue cycle at Mary Rutan Hospital. “We had a nurse, a unit clerk, doing a lot of charge corrections. We assessed that workload and said I think we can absorb this into our charge analysts, that way we’ve got four people that can build expertise.”

Auditors came over to charge integrity from the hospital’s case management department, a charge analyst transferred over from ambulatory and physician office billing, while the rest swapped functions within the health information management department.

“Prior to May of 2016, we had a lot of charge functions happening in a decentralized approach throughout the organization,” Kelly says. “There would be a unit clerk, or somebody in IT, or somebody wherever around the organization that would have one day a week—a part of their job—that was charging, whether it was charge auditing or charge capture.”

It wasn’t a quick transition. It took about 12 months to pull team members together, assess who needed training, move around resources, and build a centralized team. Today, there are four charge analysts performing charge capture and charge correction and two charge auditors responsible for performing a full line audit of every surgery and inpatient case. As a whole, the team is around 15 months old. Only one more analyst needs training for the staff to be up to speed, Kelly says.

After training, the next project is improving charge capture, which is set to kick off in this month. As director of revenue cycle, the role of project management falls to Kelly, who has been performing research analysis for the past year to determine how others are tackling the process of automating charge capture.

“I would probably say about 70%–80% is automated, but it’s that 20% that’s the problem,” Kelly says. “We struggle with anesthesia charges in the OR and in procedural areas, as they have essentially paper-based documentation for charge capture. We’re looking for ways to improve that.” Third and fourth quarter goals have been set for the project on late charge containment.

Kelly has been successful in previous charge integrity projects, including insourcing charge capture from a bolt-on Software as a Service (SaaS) Vendor, a model of licensing software through a subscription. The SaaS was used to help with clinic charges, including level charges and evaluation and management codes.

“As we matured our knowledge of MEDITECH, which is EMR, we didn’t believe that the bolt-on was adding value. We believed that we could build MEDITECH to do the same thing,” Kelly says. “So we undertook an effort to basically build out MEDITECH last year over the course of a year, stage by stage, clinic by clinic, and roll that back in from that vendor.”

The result was a significant cost saving. Because the vendor charged a transaction fee, the cost of working with the vendor was around $200,000 annually, according to Kelly. That being said, the new vendor project wasn’t approached with the goal of revenue maximization.

“We believe it was revenue neutral for us based on our pre- and post-analytics, so cost savings but not necessarily added revenue,” says Kelly. “But I believe we increased our defensibility when we looked at it from a compliance standpoint.”

The original vendor looked at facility charges from a physician medical decision rather than a nursing perspective, according to Kelly. Changing methodologies proved beneficial for the facility.

When it comes to new projects, Kelly finds the greatest challenge is what he calls “we’ve always done it that way syndrome.” Being flexible to making changes helps ensure hospitals are staying up to date with emerging technology, such as the automation of charge capture or handling reimbursement. Physicians are often both the biggest opportunity and challenge due to their importance in the process, he adds.

Because physicians are often data driven, this can create a push on implementing a new change as fast as possible. It is more beneficial to take your time to implement the change correctly, he says.

Kelly advises pushing through changes slowly to prevent change fatigue. This requires a level of patience which can be difficult to maintain, he adds.

“I think that despite the pace of change in our industry, to get meaningful change you have to approach most projects with a heightened level of patience, because everybody’s looking to change right now, and that just creates change fatigue. And if you just push it, you wear people out,” Kelly says.

Note: This case study is from the National Association of Healthcare and Revenue Integrity. For more revenue integrity updates, subscribe to our newsletter, Revenue Integrity Insider.