ERIS Medical Technologies

The Dilemma

• The health care industry is consistently evolving and many organizations are challenged to keep pace
• Constant regulatory changes inhibit providers from establishing an effective revenue cycle
• There is more political and legislative focus on consumer-driven health care and transparent billing practices industry-wide
• The provider industry, in general, is expected to operate on razor-thin margins
• A growing urgency to increase bottom line revenues is forcing providers to stay competitive within the market by leveraging new, emerging technologies
• Clinical specialization and provision of diverse outpatient services has contributed to reliance of many hospitals to support charge capture activities through disparate clinical and billing systems
• A clean claim often requires effective interdepartmental coordination and communication, which is often inefficient and undervalued

Did you know?

• It is estimated that 80-90% of all patient bills contain errors, which are likely to lead to significant missing revenue
• Ineffective charge capture management is to blame for significant missing revenue in the outpatient setting
• The General Accounting Office estimates that fraud in health care ranges from $60 billion to $600 billion per year — or anywhere between 3% and 10% of the $2 trillion health care budget. (Healthcare Finance News October 2009: Fraud costs healthcare industry up to $600M a year)
• The government reportedly recovered nearly $700 million in improper Medicare payments through its RAC pilot program, conducted from 2005-2008.
• It is predicted that Medicare and Medicaid payments will continue to decline, thereby making it critical to capture and bill all appropriate charges.
• A hospital or other health-care provider can have a flawless charge description master but still not master the process of charge capture. It is accurately combining the services and codes for the patient visit that lends to successful administration of the charge description master.

What is your organization doing to mitigate the risk of lost revenue and ensure compliant patient billing?