At a Glance

Background and Challenge

Tegria partnered with a 3,300-provider academic health system based in Minnesota to provide a comprehensive revenue integrity assessment. Tegria discovered that an inefficient build, under-optimized workflows, and labor-intensive maintenance efforts contributed to uncollected charges and lost revenue. Encouraged by these
findings, the health system tasked Tegria with driving improvement in their charge integrity practices via an eight-week implementation of a charge reconciliation program across 10 departments. This pilot’s success led to an organization-wide revenue integrity optimization engagement.

Solution

The nine-month initiative targeted four areas for revenue integrity improvement: charge capture, automation, charge reconciliation, and CDM governance.

Tegria’s expert team quickly discovered missing charges for telehealth and EKG charges, undercharging of outpatient facility visit fees, and opportunities to optimize charge automation for emergency department visits. The team also developed new rules to prevent future missing charges, optimized charging workflows, created new ED level-of-service scoring rules, and improved existing outpatient facility charge calculation logic.

To improve charge reconciliation, Tegria worked closely with the client’s revenue integrity team. The rollout of newly developed interactive dashboards and a robust staff education program ensured that charges were accurately accounted for.

Tegria experts also joined forces with the health system’s operational and IT leadership to educate staff on CDM governance best practices. This important effort not only reduced IT service ticket volumes but also accelerated pricing updates and empowered clinical leadership to make data-driven decisions.

Results

The nine-month initiative yielded a projected five-year net revenue gain of $19.4 million with impressive gains expected in the first two years:

• $10.13 million from enhanced charge automation
• $2.33 million from the creation of charge reconciliation dashboards and program expansion
• $1.39 million from improved charge capture workflows
• Savings of $880,000 from refined CDM governance policies, procedures, and training

Call to Action

Does your revenue integrity approach protect against lost revenue? Let’s talk: connect@tegria.com