Revenue Cycle And Documentation Assurance Management Partnership Produces Measurable Results

A primary focus for SCP was the establishment of the ADT feed as soon as possible, so that patient demographic data could be electronically transmitted between the client’s existing system to SCP’s IMBills system for faster pre-bill processing and coding. SCP implemented a Charge File to Census Log reconciliation process to ensure that we are capturing all viable encounters to bill by provider, by facility, by day. This also prevents duplicative billing in the instances where there may be a transfer to another hospital and uncovers additional services that were not captured but should be billed. As one result, the client’s clean claim rate, the rate of acceptance upon initial submission of an electronic claim, started at 88% when we brought the client into SCP’s RCS workflows and system, and it is now at 99% acceptance rate.

SCP’s pre-billing domains and workflows capture optimal chart elements to expedite full coding prior to dropping a claim. Additionally, the pre-billing domains certify that full demographic information is obtained, and eligibility checks are run to prevent front-end rejections.

SCP’s professional coders code all of the client’s encounters. SCP has developed in-house coding guidelines to warrant compliance to coding industry standards, as well as optimize appropriate coding for the services provided. In addition, Centricity Business, SCP’s revenue cycle billing system, has automated claim scrubbing edits that are built into the system that reviews all coded encounters prior to claim submission to create an optimal claim that will be accepted and paid by the payer on the first submission. Once the claim is submitted, Centricity Business is programmed with optimal workflows that generate collection tasks until the claim goes to a zero balance.

SCP’s documentation assurance team has provided continuous onsite, telephonic, and online provider education on appropriate chart documentation since the onboarding of the client’s providers. This team is continually focused on building better provider relationships around coding and overall documentation. Their support includes recurring meetings between physician leadership, the documentation assurance team, and SCP’s assigned Medical Director to reinforce education and chart completion. An escalation process for deficient charts and a documentation dashboard are also helping to identify opportunities for improvement and targeted education.

Both RCS and the documentation assurance team provide critical performance information via regular reporting packets, such as end-of-month provider report card/acuity trends and overall revenue performance (includes AR; charges; adjustments; payments by month, aging, and days; volumes by DOS and post date; revenue recognition reports to estimate billed charges; credit balances to date; and wRVU reconciliation report by provider by facility.)