Community Hospital Captures Millions of Revenue, Avoids Compliance Issues With Harmony Staffing
A California hospital was missing out on millions of dollars in uncaptured revenue while risking audits and penalties for compliance issues. Challenge At a community hospital in California with a high Medicare population, an underperforming and understaffed Inpatient Clinical Documentation Integrity (CDI) team was reviewing less than 50% of Medicare discharges – with some months being as low as 25%. The hospital’s Health Information (HIM) leadership faced a dilemma. The understaffed CDI department lacked the bandwidth to capture the revenue necessary to support budgeting for more CDI staff. At the same time, the area’s high cost of living meant finding…
Are Your Provider Claim Submissions Fraudulent?
Robust Outpatient Clinical Documentation Integrity (OP CDI) programs include establishing policies designed to review select diagnoses that the Office of Inspector General (OIG) has determined to have been historically overpaid. By establishing a policy to review these diagnoses, denials will be minimized, and institutions and providers will be less exposed to potential fines from inaccurate claim submissions. In addition, pre-bill reviews will provide an additional means for provider education targeting suspect providers to cease future inaccurate coding, while at the same time, contribute to the impact as a result of accurate documentation practices. Bombshell Report Leads to Increased Diagnoses Scrutiny…
Rescuing Revenue: How Harmony Transformed a Mississippi Health System’s Financial Outlook
A 700-bed healthcare system in Mississippi faced a dire financial crisis, jeopardizing millions of dollars in revenue due to significant cash flow issues caused by a former offshore coding services vendor. Challenge The health system was at risk of substantial revenue loss and potential non-compliance penalties due to a large backlog of uncoded accounts. The previous offshore coding vendor failed to scale their staffing and lacked the qualified talent to meet the necessary quality and production standards. The client quickly realized they lacked the internal resources to address this problem in time. Without timely coding and billing, they faced reduced…
