Claims and Coding Eliminate charge disparity
After Bon Secours aligned its revenue and procurement departments, items marked “non-billable” in the past were found to be billable and worth millions of dollars.
By Jaimie Masson T
he quest for revenue recovery has never been more critical for hospitals. In an environment where every dollar counts, hospitals simply cannot afford mistakes in the revenue cycle management department, and this means particular attention is required in the claims and coding areas. To get it right in claims and coding, organizations need to ensure that their practices and processes are correct, and that they are being correctly implemented across all areas of the organization. In short, they need standards: processes and best practices that are leveraged across the system for the benefi t of the entire enterprise. As a $2.9 billion not-for-profi t Catholic healthcare organization, Bon Secours Health System (Bon Secours) recently discovered, however, that standardization across practices and organizations is hardly something employees (and even some executives) are immediately ready to embrace. Change is hard, and just the term “standardization” can conjure up fears of lost control, changes to long-held practices and even lost jobs. Fortunately, Bon Secours discovered that with great commitment comes great payoff. While it’s been a lengthy process to implement its new enterprise patient ac- counting system, the health system fi rst undertook a major corporate standardization initiative and clinical information build. In just eight months, the system saw far greater benefi ts than the organization ever imagined at the outset, and Bon Secours is ready to share what it has learned and some key advice with others.
Inside Bon Secours
Bon Secours owns, manages or participates in joint ventures in 18 acute-care, fi ve long-term-care, four as- sisted and seven independent/senior housing facilities, primarily on the East Coast. Realizing that the health system was potentially losing revenue from a lack of processes and coordination between facilities, admin- istrators decided to take action to eliminate disparate
12 October 2010
technologies and develop a corporate standard for supply charging. Bon Secours’ ultimate goal was to standardize and leverage its pricing strategy across the health system and effectively eliminate charging disparity. With the help of technology and an intense focus on
refi ning processes, Bon Secours has been able to build and maintain a corporate standard around its charge description master (CDM). This has allowed the health system to streamline processes across the organization, helping to do more with fewer resources, utilize best practices in a system-wide approach, provide a sup- port system for independent leadership styles in the multiple markets and more easily transition its patient accounting practices.
By integrating its charge capture results with its billing work flow in the claims processes, Bon Secours is able to reduce the cost of followup on missing charges, which automatically maximizes the reimbursement owed to the organization.
w Jaimie Masson The process
Although Bon Secours has 14 owned hospitals with a wide variety of services in place, the process of imple- menting a standardized CDM took approximately eight months. John Whitesel, senior fi nancial consultant at Bon Secours, credits the quick turnaround and success- ful implementation in large part to a strong governance structure that was put in place at the beginning of the process.
A 20-person steering committee met every two weeks to consider recommendations from three sub- committees that focused on CDM standardization, pricing and implementations, respectively. The CDM standardization sub-committee met several times a week and was instrumental in communicating with the
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