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Coding operations: $1 M monthly incremental cashflow, 40% additional revenue capture

Coding Operations

Client Background and Context

  • Leading provider of healthcare business & operational services serving 600 hospitals, 2,400 physician practices 37 million patients; with annual collection of $41 billion. Client was facing – 
    • Increasing backlog and coverage issues over weekends / holidays
    • Increasing quality issues leading to revenue leakage across IP & OP
    • Ramp up challenges to achieve 5.2 M charts per year
    • Looking for a partner to address these challenges while minimizing existing vendor base

Solution

  • Comprehensive CAC deployed with detailed reports to monitor accuracy & productivity
  • 500+ in-house certified FTE coding talent with decision tree matrix, EM calculator & diagnosis based miss out audits
  • Scalability through HIM training to physician coders & experienced resource hiring from market

Impact delivered – Performance

  • 65%. reduction in DNFB (7+ -> 2.5 days)
  • 70% reduction in missed procedures (10% -> 3%)
  • 75% reduction in EM levelling issues (12% -> 3%)

Impact delivered – Financial

  • $1M incremental cashflow per month
  • 40% additional revenue capture ($0.65 M -> $0.9 M) 

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