Medical Center

Problem:

Labor, Delivery, Recovery, Post (LDRP) – 2mm in incorrect billing / coding, loss revenues, MSA 70 personnel 50% – 95% to standard

Issue; 70 enterprise wide LDRP nurses and staff at 7 regional hospitals were using incorrect billing codes during the patient LDRP procedures within the Medical Center. This was resulting in a $4,000,000 loss of revenue. Goal was to eliminate the billing code errors and capture accurate information to receive proper revenue for services.

Solution

Approach was to conduct an enterprise wide Measurement System Analysis (MSA) to capture baseline metrics to establish coding errors and reasons for discrepancies. After MSA close coding gaps by re-training nurses and staff to apply proper billing codes throughout the LDRP Process.

Results

Original MSA results concluded that 50% of nurses and staff were applying correct codes as patients moved through the LDRP process thus resulting in loss of revenue.  After re-training staff to proper standards and assessing again, 95% of staff were properly applying LDRP billing codes and regaining $4,000,000 annual revenue income.

 

CTC Detail Specific Measurables Data Point How to Verify Accuracy
Correct Reg Type SN1 SN1 days from STAR Patient Days SN1 Midnight Log
Babies born in house # Monthly babies LDR Stats
SN2 SN2 days from STAR Patient Days SN2 Midnight Log
Babies born OOH or transferred back # Monthly OOH or transfers back Midnight Log
Intermediate care Babies requiring intermediate care # intermediate care days from nsy log Nursery Stats
# intermediate care days from STAR Nursery Stats

 

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