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Claims & Coding


or missing information. Similarly, CAC tools should that both vendors and coders can use this technology
provide management with a strong capability for to deliver value.
measuring productivity, auditing results, monitoring As the technology of CAC progresses and ICD-10
performance and training coders. gets closer to its 2013 implementation date, the health
5. Build trust. Vendors should deliver solutions that map information-management and technology sectors
to the requirements and work fl ow of the coding staff, should look forward to the revolutionary changes in

while delivering the promised effi ciency, accuracy and coding work fl ow that will surface during the next few

audit value that CAC offers. Coders should be able to years. With the sea change that is expected to occur
trust the technology and utilize it as part of their daily from this transition, CAC use will likely expand in the

work activity. Administrators should be able to trust coming years. HMT
Revenue cycle streamlined
Memorial Hermann is one of the largest not-for- MedAssets’ Charge Capture Audit solution. The system
profi t healthcare systems in Texas, serving the greater performs an automated review of all itemized bills
Houston area through 11 acute-care hospitals, a to identify potential missing charges based on the
large network of affi liated physicians, and numerous services performed.
specialty programs and services. Its system-driven “This provides a more-accurate and complete bill to
centralized model involves the coordination of several the payer,” Powers says, “eliminating the need to rebill
work processes and products, including billing, due to late charges and improving revenue capture
coding, pricing and contracting. and net revenue results. We now use the solution for
“We use a monthly operations review process, all inpatient and outpatient itemized bills.”
designed to identify performance variances and Improving pricing accuracy for supplies and
defi ne preemptive actions,” says Helen Powers, system enhancing overall fi nancial results were among the
executive for revenue operations, decision support goals for Memorial Hermann. Ultimately, it turned to
and Medicare profi tability for Memorial Hermann. MedAssets’ CrossWalk solution, which automatically
“All business operations are reviewed on how well and continuously links supply information with the
they achieve the health system’s overarching goals of chargemaster to ensure charges align with costs and
quality, operational excellence, customer satisfaction a defi ned mark-up strategy. Rolled out in three phases,
and growth. Under this model, the revenue-operations phases one and two involved the linkage of more than
department carefully manages cash fl ow and days in 16,000 supply items to more than 6,000 charges.

accounts receivable.” “This is a massive undertaking, and to be successful,
While Memorial Hermann Healthcare System has you must have a clear vision of what you’re trying to

LIT# doubled in size over the last 15 years, the revenue-
achieve and where you want to be at the end,” says
operations department has managed an increased Powers.

SHOWLINE workload with the same number of personnel through “My objective was to have a defensible chargemaster
the use of automation and “smart” tools. Staff uses that yields the necessary net revenue for the

the MedAssets chargemaster solution to regularly organization,” she adds. “To accomplish this, it’s
maintain the chargemaster for coding compliance important to develop and consistently execute a well-

and best-practice charging information. The team defi ned and structured plan of action.”
also utilizes KnowledgeSource from MedAssets Memorial Hermann also looked for a way to improve
for quarterly and annual code changes, pricing, its billing processes and net revenue performance,
best practices, national including addressing the first-pass percentage
For more information on
benchmarks and to rate of claims, improving process work flow and
MedAssets solutions:
gain regulatory source reducing accounts-receivable days. Six months after
information for coding implementation, Memorial Hermann realized a
Nelson Publishing
decisions, as well as coding intelligence and 17-percent reduction in accounts-receivable days,
2500 Tamiami Tr N
analytics. while its clean-claim percentage increased to 73
percent from virtually zero.
Nokomis, FL 34275
“We fi nd this information is invaluable to the day-to-
day maintenance of the chargemaster and ultimately These improvements have been sustained for more
the reimbursement for 11 acute-care hospitals and than three years. The team expects to improve the
multiple specialty facilities,” Powers says. accuracy of Medicare processing, accelerate Medicare
To ensure that all gaps in potential revenue capture cash fl ow and improve the audit trail and accountability
are addressed, Memorial Hermann implemented for Medicare processing, according to Powers.
HHMT1002 Alife FINAL.indd 26MT1002 Alife FINAL.indd 26 11/25/2010 11:20:39 AM/25/2010 11:20:39 AM
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