EXECUTIVE SUMMARY
One of the nation’s leading health systems, comprising six academic and community hospitals, four suburban healthcare and surgery centers, over 40 patient care locations, a home care group, and an international division, faced significant challenges with inpatient (IP) and outpatient (OP) coding. As a globally recognized academic and research institution, the health system handles over 300,000 inpatient discharges and over 2 million outpatient visits annually, generating over $10 billion in annual revenue.
“Partnering with Access Healthcare has been transformative for our health system. Their expertise in inpatient and outpatient coding and their knowledge of EPIC helped us consistently achieve coding accuracy above 95%. They reduced our unbilled charges by more than half and eliminated claim delays, significantly improving our revenue and operational efficiency. Thanks to Access Healthcare, we’ve closed major gaps in revenue leakage and streamlined our processes.”
CHALLENGE
Inconsistent coding accuracy rates for inpatient and outpatient services, averaging around 90%, below industry standard.
Over 30% of weekly charges were not billed within the same week, leading to a growing backlog in IP and OP coding.
The average time between discharge and billing was around seven days for IP coding and five days for OP coding.
Missing, incomplete, or inaccurate documentation resulted in missed or incorrect charge capture, affecting DRG value and causing revenue loss.
The ongoing transition from four different legacy systems to EPIC introduced additional complications.
SOLUTIONS
A team of inpatient and outpatient coding specialists with EPIC experience was deployed in phases across all EPIC-enabled hospitals.
A dedicated team of Clinical Documentation Improvement (CDI) specialists and optimized physician query templates were introduced to enhance documentation and ensure accurate service capture.
A parallel coding team was assigned to non-EPIC hospitals, aligning their transition with the EPIC implementation timeline.
A revenue integrity team was deployed to ensure coding accuracy and comprehensive service capture by conducting thorough concurrent and retrospective audits and enhancing physician documentation.
Results
Inpatient and outpatient coding accuracy consistently exceeded 95% in all external audits.
Weekly unbilled charges dropped to under 10% for OP coding and less than 20% for IP coding.
The unbilled amount for outpatient services decreased to below $3 million, down from over $6 million before partnering with Access Healthcare.
No inpatient claims remained in the EPIC work queue for more than two days, significantly improving from the previous seven-day delay.
Missed revenue capture was reduced to less than $5 million per month, down from over $14 million before engaging with Access Healthcare.