Our client, a prestigious academic medical system renowned for its excellence in patient care, faced a revenue cycle challenge due to growth. The system serves more than 2 million outpatient visits and manages approximately 300,000 inpatient discharges annually and is comprised of six acute care facilities, four suburban hospitals, and numerous outpatient locations.
The healthcare system’s rapid growth introduced several barriers to efficient inpatient and outpatient coding, which adversely affected both financial performance and operational efficiency.
One significant challenge was inconsistent coding accuracy, which averaged 90 percent—well below the industry standard—leading to errors and revenue leakage. Additionally, the system faced a mounting backlog, with more than 30 percent of weekly charges not billed within the same week, exacerbating delays in revenue capture.
Prolonged discharge-to-billing timeframes further compounded these issues, averaging seven days for inpatient coding and five days for outpatient coding. Documentation gaps, including missing, incomplete, or inaccurate records, contributed to incorrect charge capture, improper DRG assignments, and revenue loss. Moreover, the ongoing transition from four disparate legacy systems to EPIC created significant complications, amplifying the complexity of coding workflows and straining resources.
Customized approach
To address the challenges, the Access Healthcare team partnered with the system to assess operational gaps and develop a comprehensive solution and implementation plan focused on medical coding, documentation improvement, and revenue integrity. With the mutually agreed plan in place, Access Healthcare executed a multi-faceted approach.
First, expert coding teams with deep EPIC experience were phased into all EPIC-enabled hospitals to ensure seamless inpatient and outpatient coding. Clinical Documentation Improvement (CDI) specialists collaborated closely with the system, using optimized physician query templates to enhance documentation quality and guarantee accurate service capture.
For hospitals still operating on non-EPIC legacy systems, Access Healthcare provided targeted support, ensuring alignment with the EPIC implementation timeline while minimizing disruption. To further reinforce revenue integrity, concurrent and retrospective audits were conducted to maintain coding accuracy. Additionally, comprehensive service capture processes strengthened physician documentation and optimized financial outcomes.
Transformative results
The collaboration between Access Healthcare and the academic medical system delivered transformative results:
Increased coding accuracy: Significantly surpassed 95 percent accuracy rate, which greatly reduced errors and revenue leakage.
Reduced unbilled charges: Weekly unbilled charges dropped to under 10 percent for inpatient and outpatient coding.
Decreased unbilled amounts: The unbilled amount for outpatient services decreased to below $3 million, down from more than $6 million before partnering with Access Healthcare.
Faster billing: Inpatient claims in the EPIC work queue were cleared within two days, down from the previous seven days.
Optimized revenue capture: Missed revenue capture dropped to less than $5 million per month, down from more than $14 million a month before the Access Healthcare engagement.
Streamlined EPIC transition: The strategic support provided during the EPIC implementation enabled a seamless transition, standardizing coding practices across all facilities.
By addressing key operational challenges and implementing sustainable improvements, Access Healthcare empowered the healthcare system to achieve financial stability, operational excellence, and improved patient outcomes. This partnership exemplifies how innovative solutions and dedicated expertise can drive measurable success in even the most complex healthcare environments.