ERIS Medical Technologies offers comprehensive and automated solutions that quickly and efficiently identify missing and noncompliant charges for health care providers. All of our products are driven by a proprietary rules logic engine that boasts over 375,000 algorithms with code pairing capability and clinical leading practice guidelines. This logic is used to identify problem patient bills either prospectively (before the claim is created) or retrospectively (after the claim has been submitted to the payer).
ERIS’ comprehensive charge-capture solutions have been industry proven and typically improve healthcare provider’s net patient revenue by 1-7% and improve a provider’s revenue cycle operational efficiency by up to 70%.
We provide a superior and quantifiable value proposition with products that deliver immediate financial ROI with relatively no capital expenditure to the customer.
The founders of ERIS Medical Technologies have been involved with helping health care organizations identify missing revenue through operational redesign for nearly 25 years. Our experienced team, with expertise concentrated in the provider revenue cycle arena, understands the importance of revenue cycle emerging trends and recognizes the benefit of comprehensive and efficient charge capture integrity. We have had the privilege of working with world-class health care organizations and understand the struggles that these institutions face in managing their charge capture process and prioritizing charge capture workflow efforts.
Like most businesses, hospitals must be able to catalog, appropriately charge, and reconcile all services provided to its customers. In a hospital’s case, however, the patient is the “customer” and each patient that passes through the doors of a hospital will experience a different encounter. Imagine the monumental task of making sure that each patient is charged comprehensively and compliantly for all services rendered and supplies and pharmaceuticals used. In a hospital, this task is monumental in that it is also further complicated by the fact that each patient may have unique insurance coverage and billing requirements that make the seemingly straightforward, but yet time consuming, act of patient charge capture an intricate and inefficient event which often leads to lost revenue. Patient charge capture in a hospital setting consists of complex and disjointed systems, operational activities, and clinical processes.
Relative to these complexities, the hospital charge capture process is often difficult and subject to a variety of breakdowns. After patient services are rendered, it is commonly the responsibility of clinical staff to precisely document the five Ws: “who”, “what”, “when”, “where”, and “why” of that patient encounter and then accurately translate the complete patient encounter to charges. While it is often clinically clear what patient services have been rendered, specific payer billing requirements and government regulation frequently drive “how” services should be documented in the patient record and subsequently reported on the patient bill (claim) in order to be paid. The ability to satisfy payer documentation and coding requirements necessary to receive appropriate payment is difficult to administer. It is these intricacies related to charge capture and billing processes that create a plethora of opportunities for breakdowns in the revenue cycle which often result in the loss of reimbursement.
This document specifically addresses some of the common contributing factors for lost charges in the middle revenue cycle and how some organizations are mitigating this risk.
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